The Debt Celling Negotiations Put Disabled People at Risk

Millions of Americans who rely on Medicaid for their health insurance have found themselves in a Catch-22 situation. Republicans and Democrats are arguing over a plan to raise the country’s debt ceiling.

Republicans’ plan to connect Medicaid eligibility, the government-funded health insurance program for low-income and disabled adults, to a specific number of hours worked each month appears to have reached a deadlock between Republicans and Democrats.

For Republicans, the plan is part of a decades long push to link federal assistance to work requirements. Democrats say the move would unfairly strip people of their health coverage. In addition, it would push more Americans into poverty.

Under the Republican plan, included in a bill passed by the House last month, Medicaid recipients would have to document 80 hours a month of work, which at the federal minimum wage would amount to a minimum of $580 a month in income.

It would apply to those aged 19 to 55. However, it would not apply to pregnant women, parents with dependent children, or those unable to work due to physical or mental health disabilities.

Enrolling in education or substance abuse programs would also mean someone would be exempt. This primarily targets low-income individuals eligible for Medicaid expansion, a feature of the Affordable Care Act.

Alternatively, people could log hours doing community service or participating in a work training program. If recipients fail to meet the hourly or monthly income criteria for three consecutive months during the year, they will lose their coverage.

Data has shown that work requirements are not successful. In Arkansas in 2028, there were 265,223 Arkansas Works enrollees, more than 62,000 of whom were affected by the new work requirements, according to the state Department of Human Services. By December 2018, more than 18,000 people had lost Medicaid coverage because they did not meet the eligibility requirements.

The Congressional Budget Office, or CBO, predicted last month that the work requirement would apply to about 15 million of the 86 million people receiving Medicaid coverage who would either have to meet the required hours or request an exemption.Among that group, the CBO estimated that 1.5 million would likely become ineligible for federal Medicaid dollars under the Republican plan, lowering the costs of the program by $109 billion over 10 years. 

Kevin McCarthy said in a speech on Wall Street that assistance programs are not supposed to be permanent while outlining his party’s demands in the debt ceiling negotiations.

For people like me, Medicaid provides crucial home and community based services. MassHealth pays my PCAs to help me with activities of daily living such as toileting, showering, and preparing meals. Medicaid is the only insurance that covers home and community-based services; therefore, I can’t lose coverage.

Medicaid also allows me not to live in a long term care facility. This saves Massachusetts thousands of dollars a year. A semi-private room in a long term care facility costs roughly $7,756 a month. A private room costs roughly $8,821 a month. Annually, nursing home care adds up to $93,072 and $105,852.

Communicating new requirements with Medicaid beneficiaries has proven to be particularly difficult in the past, with a significant share of recipients unable to be reached by mail because they are experiencing homelessness or in temporary housing, or because they don’t have regular access to the internet. That could result in people who are eligible for an exemption, like those who have a disability or are caring for a child, losing coverage because they didn’t follow the proper reporting requirement. 

A study of the Arkansas plan found that a third of the people who were subject to the policy had not heard about it. 44% of the target population was unsure whether the requirements applied to them. 

There are additional difficulties due to disabilities or linguistic barriers. Samuel Camacho is a health insurance navigator for the Universal Health Care Action Network of Ohio. Camacho assists Spanish speakers in the Columbus, Ohio, area.

He says the process has become much more difficult because the agency’s local offices in charge of Medicaid have been closed to the public since the start of the pandemic. Because of the closures, people don’t always have access to an interpreter.

Disabled people are frequently sent inaccessible healthcare information. A blind woman says that since 2010, an insurance provider in California has discontinued her coverage every year after sending her documentation for “verification of benefits” that she could not read.

Medicaid provides essential services to millions of people in this country, including therapies, medications, home and community-based services, and medical equipment. Losing Medicaid coverage could mean that people remain uninsured. For some people losing insurance is a matter of life or death.


Goldstein, Amy. “Millions Poised to Lose Medicaid as Pandemic Coverage Protections End.” The Washington Post, WP Company, 1 Apr. 2023,

Galewitz, Phil. “As Pandemic-Era Medicaid Provisions Lapse, Millions Approach a Coverage Cliff.” Kaiser Health News, Kaiser Family Foundation, 2 Feb. 2023,

Godoy, Maria. “Medicaid Renewals Are Starting. Those Who Don’t Reenroll Could Get Kicked Off.” NPR, NPR, 21 Mar. 2023,

Froelich, Jacqueline. “In Arkansas, Thousands of People Have Lost Medicaid Coverage over New Work Rule.” NPR, NPR, 18 Feb. 2019,

Luhby, Tami. “Republicans Use Debt Ceiling Bill to Push Work Requirements for Millions Receiving Medicaid and Food Stamps .” CNN, Warner Bros. Discovery, 26 Apr. 2023,

Pettypiece, Shannon. “The Debt Ceiling Debate Could Put Health Insurance in Jeopardy for Millions.” NBCNews.Com, 18 May 2023,

Scott, Dylan. “The Republican Plan to Sneakily Cut Medicaid, Explained.” Vox, 12 May 2023,

Parker, Tim. “The Median Cost of a Nursing Home.” The Balance, The Balance, 25 Oct. 2021,

Weber, Lauren, and Hannah Recht. “Medical Bills Remain Inaccessible for Many Visually Impaired Americans.” NPR, NPR, 1 Dec. 2022,

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