For many people, Medicaid might not seem very political. They might think of it as healthcare coverage for low-income Americans. For many disabled people, Medicaid is far more than a government program. It pays for the services that make it possible to live in the community rather than in an institution.
That’s why advocates are concerned as new Medicaid eligibility requirements move closer to implementation. Many fear that eligible people could lose coverage because of paperwork and reporting requirements rather than because they no longer qualify. Those concerns are already beginning to feel real. Nebraska terminated Medicaid coverage for roughly 200 people in August.
The debate over Medicaid is about more than insurance coverage. At its core is a larger question: what happens when systems designed to support disabled people fail to account for the reality of their lives?
David and John Michael Browne, along with their parents, know this all too well. Nebraska recently implemented a new assessment tool called interRAI to evaluate support needs. According to that assessment, David and John Michael no longer required 24-hour care, despite being severely autistic. The problem is that real life rarely fits neatly into an assessment tool. Neither man can safely be left alone.
Still, the determination carried enormous consequences. Their annual Medicaid funding was reduced by more than $200,000, putting critical supports at risk. What appeared to be a routine administrative decision became a source of uncertainty about safety.
Their story illustrates one side of a persistent problem: sometimes disabled people lose support because a system wrongly concludes they need less help than they actually do.
But there is another side to the Medicaid dilemma. Sometimes, disabled people risk losing support not because they need less help, but because they are trying to build a career.
In 2018, Anna Landre was a sophomore at Georgetown University when she was offered a paid internship. For most students, that opportunity would be a stepping stone toward a career. For Landre, it presented an impossible choice. If she accepted the position, she would earn too much money to remain eligible for Medicaid, the very program that funded the home healthcare services she needed to attend college and pursue a career.
She found herself trapped in a contradiction that many disabled people know well. Society encourages disabled people to work and be independent, yet the systems they rely on often make those goals harder to achieve.
Although their circumstances were different, Landre’s story points to the same flaw exposed by David and John Michael’s experiences. One system underestimated what disabled people needed to remain safe. Another failed to recognize that earning a paycheck does not erase the need for disability-related services.
For people like David, John Michael, and Anna, Medicaid is not simply health coverage. It is the foundation that makes participation in everyday life possible. When that foundation becomes unstable, the consequences are felt in the lives of the people who depend on it most.
Sources:
Hixenbaugh, Mike. “A Secretive Computer Algorithm Is Taking Caregiving Money Away from Disabled People.” NBC News, 8 Sept. 2026, https://www.nbcnews.com/news/us-news/nebraska-medicaid-disabled-people-interrai-computer-algorithm-rcna594582.
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/.
Safo, Nova, and Alex Schroeder. “Roughly 200 People in Nebraska Lost Medicaid on Aug. 1.” Marketplace, 14 Aug. 2026, https://www.marketplace.org/story/2026/08/14/americans-have-officially-begun-losing-medicaid-coverage.