CW: Poverty
Across the country, disabled Americans face the same obstacle. Whenever they try to build a career, save money, or accept a better job, the systems meant to help them threaten to take away the care they need to survive. Iowa’s Medicaid income limits are one example, but this issue is national, structural, and based on outdated views about disability and work.
Erica Carter’s story in Iowa highlights the emotional and financial strain these policies create. She works full-time helping students gain hands-on experience, a job she enjoys and excels at. However, when her income increased, she received a letter stating she no longer qualified for Medicaid. The services she relies on, such as wheelchair repairs, and home health aides, are not luxuries; they are crucial for making her career possible. Losing Medicaid meant losing her ability to live independently.
Keeping her job meant paying tens of thousands of dollars out of pocket. She decided to keep working but at the cost of draining her retirement savings and taking on extra jobs just to stay afloat.
Her situation is not unique. Years earlier, Anna Landre faced the same tough choice on the other side of the country. Landre, who has Spinal Muscular Atrophy, grew up in New Jersey and attended college at Georgetown University in Washington, D.C.
As a sophomore, she was offered a paid internship, an opportunity that could shape a young person’s future. But accepting the $14-an-hour position would have increased her income, causing her to lose the personal care assistance she needed to live and study. The system forced her to choose between career advancement and basic survival. Her story gained national attention because it revealed a truth that disabled people have lived with for decades: the programs meant to support independence often end up punishing it.
These stories resonate across the states. Whether it’s Medicaid income limits in Iowa, strict asset rules in New Jersey, or narrow eligibility guidelines in many other states, disabled workers are repeatedly told they can participate in society—only up to a point. Work too much, earn too much, or save too much, and the safety net disappears. The message is clear: independence is conditional.
Some states have started to change this approach. Minnesota and Tennessee have removed income and asset limits for their Medicaid programs for disabled employees, realizing that penalizing people for earning a paycheck makes little economic or moral sense. But many states, including Iowa, still operate under a model that treats disabled people as if they should be shielded from the workforce instead of being supported within it.
The consequences extend far beyond individual lives. When disabled employees have to decline promotions, turn down internships, or limit their hours, the whole economy suffers. Communities lose skilled professionals, families lose financial stability, and states lose tax revenue. Disabled people learn early that success comes with a cost.
What connects Erica’s story to Anna’s—and to many others—is the shared experience of being forced to choose between opportunity and survival. They do everything society claims to value: pursuing education, building careers, and contributing to their communities. The barriers they face result not from a lack of effort or ability but from policies that have not kept pace with the realities of disabled people’s lives.
The national conversation is gradually shifting. Advocates are pushing for federal reforms that would remove asset limits, raise income thresholds, and modernize Medicaid to ensure that disabled employees are not penalized for participating in the workforce. Until those changes happen, people like Erica and Anna will continue to navigate a system that forces them to make choices no one should have to face.
The question now is whether we are willing to create a system that truly supports disabled Americans in living, working, and thriving—not just surviving. The people affected by these policies have already demonstrated their commitment to their communities and their futures. The next steps depend on the states and, ultimately, the nation.
Sources:
Carino, Jerry. “NJ Forces Disabled Howell Student to Make Brutal Choice: Internship or Health Aide Money.” Asbury Park Press, Gannett, 21 May 2018, http://www.app.com/story/news/local/values/2018/05/21/disabled-howell-student-nj-forces-choice-internship-health-aide/610909002/.
Krebs, Natalie. “Disabled Iowans Say Medicaid Income Caps Limit Their Ability to Work.” Iowa Public Radio, Iowa Public Radio, 12 Mar. 2026, https://www.iowapublicradio.org/health/2026-03-12/disabled-iowans-medicaid-income-restrictions.