Medicaid Work Requirements Put People With Disabilities at Risk

by Sarah Terzo

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Despite some last-minute changes, the “One Big Beautiful Bill” would make deep cuts to Medicaid, SNAP (food stamps), and housing. The House of Representatives is gearing up for the final vote on it before this weekend.

Republicans intend to enact a work requirement that will take away Medicaid from people who aren’t working.

Speaker Mike Johnson, in defending the bill, attacked people who were receiving Medicaid and not working: 

When you root out those kinds of abuses, you save the resources that are so desperately needed by the people who deserve it and need it most. That’s what we’re doing.

He further stated: 

[Medicaid is] intended for the most vulnerable populations of Americans, which is pregnant women and young single mothers, the disabled, the elderly. They are protected in what we’re doing because we’re preserving the resources for those who need it most.

He claims that disabled people won’t be affected by the work requirements because we’ll be exempt. However, there are problems with this claim. 

In fact, work requirements will hurt disabled people the most. 

Here is one key reason. 

Only those who have been officially approved for disability by the US government are exempt from work requirements, and applying for federal disability is an extremely long, difficult process.

Many people with severe disabilities can’t get approved at all. 

An applicant for Social Security benefits in the US is considered “working,” and therefore disqualified for disability assistance, if they can earn $1,470 a month before taxes. (It’s a little higher for blind people.) 

If SS workers feel a disabled person can earn this much, they will be denied disability. Of course, no one can afford housing, food, medical insurance, and other necessities on less than $1500 a month. But that doesn’t matter. 

If the applicant is under 50, they must be found unable to perform any job, not just the type of job they are qualified for. 

They don’t consider education or training, or what jobs someone is qualified for. Someone with no high school diploma who’s injured working construction will be denied if he can physically do an office job. It wouldn’t matter that he’s not qualified for one and would never be hired. Nor would it matter if he couldn’t afford more education. 

If he lives in a rural area where such jobs are unavailable and can’t afford to relocate, he would similarly be out of luck. 

A person over 50 is in a slightly better situation. Still, work qualifications, experience, and job availability are given little weight. 

Getting approved for disability is extremely difficult.

First, the person applying needs extensive medical records, often years of them. A disabled person who isn’t working, with no income and no health insurance, who can’t afford regular doctor’s visits with specialists and extensive medical tests, will have no chance of getting approved for disability, no matter how serious their condition is.

Therefore, if a person who can’t work due to their disability (but has not yet filed for disability) has their Medicaid taken away, they will never be able to get approved, because they won’t be able to see enough doctors to document how sick/injured they are. They are permanently locked out of disability payments. 

Even in cases where the disabled person has been seeing doctors regularly and has extensive documentation, they may not be able to get approved. 

WITN News told the story of Ashunti Osei-Copling and her struggle to get disability.

She was an insurance agent, a single mother of two, who owned a home and her own business. The article says that she "was at the top of her field, motivating crowds at industry events [and] winning awards."

Then she was diagnosed with stage IV multiple myeloma, a type of cancer.

Her illness was dramatic and unexpected. She says, "You can pretty much imagine going from owning your home and owning your own business to just everything stopping one day immediately."

Her condition became life-threatening, and at one point, she went into hospice. However, she survived and was removed. She endured countless trips to the hospital. 

Debilitating symptoms made her unable to work, yet she couldn’t get approved for disability. She participated in many multiple myeloma chat groups, where cancer patients often discuss their struggle to get government disability assistance. 

Osei-Copling said:

There are people that get denied that have gone through transplants that still have the disease, that are in stage 4 that are on hospice, and they still get denied because they may have missed questions on their paperwork, or they did not submit everything in a timely manner.

During the time someone spends going through the appeal process, even if they have terminal cancer, they’re not classified as disabled, meaning they’re not exempt from work requirements to get social services. They may be bedridden and in hospice, and still not considered disabled.

Thus, under the budget that may soon pass, a person with cancer in hospice may still be required to work to afford treatment. 

T.J. Geist, the Director of Claims for a firm that represents people seeking disability, says:

It's a complex program. It takes a while to gather the information that is needed and to gather information from treating doctors as well…That's a big reason why many people are denied at the initial level.

He compares getting disability to filing taxes and says, "You use a software, or you use a representative to help you with that. Same goes for Social Security Disability."

But there is no software, and many people who are already too disabled to work cannot afford to hire someone. 

Also, consider that the people applying are struggling with serious health problems and medical symptoms and may even be fighting for their lives against a potentially terminal condition. They must navigate this process while being too severely disabled to hold a job.

And if they cannot get a lawyer, they must navigate it alone.

So, most often, disabled people who are denied disability benefits and cannot afford a lawyer must simply give up.

But let’s assume a person has a lawyer, or is somehow not too ill to pursue getting disability. Let’s assume they are eventually going to be approved. There is another problem — extremely long wait times. 

The Trump administration may be in the process of cutting up to 50% of Social Security’s staff, a few at a time. So all the information and statistics below apply before these staffers are cut. As you read, imagine how much longer the wait will be when there are 50% fewer people processing claims.  

According to research from multiple media outlets, it takes a year or more just for an initial decision. 

If someone is initially denied disability benefits, they can appeal, hire a lawyer (if they haven’t already), and get a hearing. 

Again, they must navigate the entire process, somehow afford a lawyer, fill out reams of paperwork, gather their own medical records, and prepare a legal case while dealing with a serious injury or illness.

The median amount of time it took for a claim filed in fiscal year 2010 to reach the end of the appeal process was 561 days. For claims filed in fiscal year 2015, the median wait time was 839 days.

There is often a long wait between denial and the appeal hearing. According to the Social Security Administration, 410,000 Americans, as of late 2020,  were waiting for their hearing.

The wait to find out if a hearing will even be allowed is often over a year. In Richmond, Virginia, the average wait time was 259 days. In Reno, Nevada, it was 515 days. 

This is after already waiting a year or more just to get the initial decision. And, after the hearing is granted, there is another wait for it to be scheduled and actually take place. Then, after the hearing, a wait for the decision.

Of those who filed a claim for disability in fiscal year 2015, 41% were still waiting on appeals at the end of fiscal year 2017, and 10% were still waiting at the end of fiscal year 2018.

During this time, the disabled person cannot work, has no income, and is not classified as disabled. They are therefore subject to work requirements and will lose access to Medicaid. 

From fiscal years 2014 through 2019, roughly 48,000 people waiting for a decision on their appeals filed for bankruptcy.

From 2008 to 2019, 109,725 people died while awaiting a decision on their disability claim. Some died from their medical conditions. Some died from other poverty-related causes, and some died by suicide. 

The annual death rate of applicants awaiting a final disability appeals decision has increased in recent years. In 2023, 30,000 Americans died waiting for their Social Security benefit decision. 

This is the way it has been in recent years. 

We can only imagine what this will be like with 50% fewer SS staff. 

Claire Grandison, a lawyer with Community Legal Services in Philadelphia, where she works on applications for SSI, says: 

We have had clients who have died while they were waiting for hearings…We have had clients with horrible outcomes — evictions, utility shut-offs, and declining health, even before the point that they pass away.

Marilyn Zahm, president of the Association of Administrative Law Judges, told the Washington Post:

I know that people will die waiting…This is the reflection of our priorities as an American people. We have decided it’s better for people to die than to adequately fund this program…Will this get worse? Will the number of people who die double?

Again, before the cuts to staff. 

The Washington Post also interviewed lawyer Hugh Gibson, who takes clients applying for disability:

When potential clients now ask about applying for disability, Gibson tells them that it could be two years minimum before they get a judge’s decision, and that they can’t work while they wait if they want to be approved. 

They usually lose the car first, then the house. Next comes bankruptcy. Stresses accrue, marriages fracture, pains and illnesses mount, and some die right before their hearings, when the wait is worst…

Most who do continue the long appeals process are eventually approved. According to another article in the Washington Post, in 2022, only 38% of applicants for SSI or SSDI were approved after they first applied.

Among those who were denied and decided to appeal, 15%  were approved after the first appeal. On the second appeal, which involves a hearing before an administrative law judge, 50% of the remaining applicants were approved.

The third-level appeal is to the Social Security Appeals Council. After this appeal, a few of the remaining applicants were approved, and 12% were remanded back to the Social Security Administration for further reconsideration.

The last step is an appeal before a federal court. In this last appeal, applicants and their lawyers attempt to show that the Social Security Administration erred in its decision and that its process for making the determination was flawed.

Shockingly, a majority of the time (nearly 60% in fiscal year 2022), federal judges agree. Fifty-eight percent of that year’s cases were remanded back to Social Security, meaning that the judges found fault with the way they were determined.

However, because of the high cost of going through all these appeals, fewer than 20% of those who lose their appeal at Social Security take their claim to federal court.

Even though most of them win when they do. 

According to the Washington Post, “[M]ost [disabled applicants] lack the time or resources to keep fighting.”

One disturbing fact about this process is that even if the federal court rules that the Social Security Office erred in its decision and failed to correctly evaluate the claim of the disabled person, the Social Security Office still doesn't have to find in the claimant's favor. 

They can continue to turn them down, delay, and force them to go to federal court again and again.

Road worker Michael Sheldon was in a terrible accident where he was thrown from a road-paving machine. He tumbled 50 feet down a slope and hit a mound of boulders headfirst. He had eight surgeries to his head, neck, and spinal cord. 

The accident left him with debilitating headaches, chronic pain, and post-traumatic stress disorder.

The accident happened in 2006. As late as March 2023, he was still fighting for benefits.

Even though three federal judges found significant errors in the way Social Security handled his case and ordered them to conduct new hearings and reconsider, they continued to reject him.

After testifying at his fifth federal hearing, Sheldon said, "They've done everything to prolong this to get me to quit."

Ann Atkinson, Sheldon's attorney, stated:

The system has become one of 'how do we deny this claim' rather than 'what is the right answer in this person's case?' And the federal court is agreeing with us: 'You have to do a better job.’

The Washington Post summarizes:

The high rate of rejections for cases handled by administrative law judges and the attorneys who write their decisions is driven by stringent monthly quotas set by Social Security officials and growing pressure to deny more cases, according to current and former officials, audits, and attorneys who represent the disabled. 

The agency's policies have been reshaped to give less deference to the expertise of doctors who, in some cases, have treated claimants for years, and its policies routinely depart from federal appellate court rulings.

Because of the strict quota system, the pressure put on Social Security officials to deny cases, and the common policy of disregarding doctors’ opinions, most people seeking disability benefits continue to be turned down, again and again.

Very few people who are disabled and unable to work have the resources, financial and otherwise, to engage in a legal battle lasting nearly a decade.

Unfortunately, getting disability often rests on how rich a person was before they became disabled, and how much money they can hold on to in the years they must live with no income while waiting for a decision. 

If they have enough savings to support themselves for years and still hire a lawyer, they may be awarded disability.

If not, they won’t. 

Those who cannot get disability assistance (which can often, as we've seen, be because of factors that have nothing to do with how seriously disabled the person actually is) aren't classified as disabled, and are not exempt from work requirements.

If this budget passes, they will be without any medical care. 

There is another major problem with the work requirement exemptions. They hurt disabled people another way — by taking away their caregivers. 

Politicians have proposed exemptions to the work requirements for single mothers with children of pre-school age, but I haven’t seen a single one propose an exception for those taking care of disabled relatives. 

I have a friend who is a full-time caregiver for her adult son with schizophrenia and her husband. I’ll call her Anna. 

Anna’s husband (I’ll call him Dave) had severe degenerative arthritis in his back and, despite very severe chronic pain, was denied pain medication. For years, he coped with the pain as best he could and worked full time. But then, he suffered a massive head injury on the job.  

He was approved for worker’s compensation. 

Anna’s son has the intellectual ability of a child and needs near-constant supervision. Dave has serious cognitive problems. Neither Dave nor their son can manage their medications or remember to take them. Neither can drive or prepare meals. 

Anna also cares for her granddaughter while her daughter works. This spares her daughter and her son-in-law the extremely high costs of childcare, which would be difficult for them. 

Anna would love to go back to work. She says it would be “a dream come true.” She misses having a job and a career. But her disabled relatives need her. 

Under work requirements, Anna will lose Medicaid unless she goes to work and leaves her husband and son to fend for themselves. She would either have to sacrifice having any medical care or leave them helpless. The only option would be to institutionalize them despite the wretched conditions in many nursing homes and mental hospitals. 

If she could even find one that was covered by their insurance — Medicaid, the very program being cut. 

So in addition to taking away health insurance from many people with disabilities, hundreds of thousands of disabled people could lose their caregivers (and this goes for elderly people too). 

It isn’t too late to stop this budget and spare disabled people this nightmare. Go here to send a message to your representatives. Or call them at (202) 224-3121. You will be transferred to your representative.