Bethesda, Maryland, January 12, 2018 — Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced that states may block some low-income adults from getting Medicaid coverage if they’re not working or participating in work-related activities. The Autism Society of America strongly opposes this fundamental change to the Medicaid program.
“Individuals on Medicaid who are able to work want to work. We have to address Medicaid costs in ways other than blaming the recipient,” said Scott Badesch, Autism Society of America President/CEO. “We have to do so in a passionate way that doesn’t have the potential to harm or punish a person because he or she has a disability.”
While many individuals with autism are eligible for Medicaid through the disability pathway, others receive Medicaid through the Affordable Care Act’s 2010 expansion to low-income individuals, Medicaid buy-in programs, or other eligibility categories.
CMS claims that work requirements will only apply to “able-bodied adults” and will not apply to those who are “medically fragile.” Most people with autism are physically able and can and do work. In fact, most Medicaid beneficiaries who can work are already working. According to a Kaiser Family Foundation issue brief, nearly 8 in 10 non-disabled adults with Medicaid coverage live in working families, and most are working themselves. These include many individuals on the autism spectrum who have difficulty finding jobs that provide adequate health benefits or that pay sufficient wages to pay for insurance on the marketplace. Some individuals go in and out of work or work part-time and would have difficulty going to work without health insurance.
Many of those who are not working have disabilities that prevent them from working or are taking care of family members who have disabilities. Many face significant challenges, and requirements that can lead to the loss of health care are not the way to address them.
The new guidance largely tries to justify Medicaid work requirements claiming that people with jobs have better health and higher incomes than people without jobs. We believe that healthy people are likelier to have jobs than those in poor health.
The bottom line is that most people with autism and other disabilities want to work or participate in volunteer and other meaningful community activities. Instead of requiring work to access health care, the Autism Society believes CMS should work to help more states take up optional benefits that promote work such as the Medicaid buy-in program and supported employment options in Medicaid. CMS should also coordinate with the Social Security Administration to improve other work incentives programs that help people with autism and other disabilities keep their health care while working. The Autism Society stands ready to assist the Administration and Congress to promote work incentives that do not jeopardize access to comprehensive health and long-term services and supports.