The Autistic Self Advocacy Network (ASAN) strongly opposes the Trump Administration’s decision to use work requirements to push individuals out of Medicaid programs. This morning, the Centers for Medicare and Medicaid Services (CMS) announced that states will be allowed to impose work requirements for Medicaid eligibility, a devastating and unlawful decision which will harm thousands of Americans, including autistic people, our families, and the broader disability community.
ASAN, a nationwide 501(c)(3) advocacy organization run by and for autistic people ourselves, is committed to ensuring that all people with disabilities have access to quality, affordable health care. Hundreds of thousands of autistic individuals rely on Medicaid as our primary source of funding for the health care, services, and supports we need to live. Moreover, although many autistic people are eligible for Medicaid as a result of our disability, others rely on the Medicaid expansion, Medicaid buy-in programs for workers with disabilities, or other eligibility categories. In fact, most people with disabilities are not recognized as disabled by Medicaid unless we are receiving Social Security. While CMS claims that work requirements will only apply to “able-bodied adults,” we know from programs such as SNAP that large numbers of people with disabilities have lost benefits due to work requirements, even though our disabilities should have exempted us.
We are outraged that, in the guidance it released today, CMS conflates punitive work requirements with Medicaid-funded employment supports that help people with disabilities reach their own employment goals. Programs such as supported employment and the Medicaid Buy-In provide supports to connect people with disabilities to employment, without threatening their access to critical health care and long-term supports. In no way should these programs be used as a justification for work requirements.
Unlike supported employment, work requirements place high roadblocks in the way of life-saving health coverage for millions of Americans, especially Americans with disabilities. Additional barriers to adequate health coverage will worsen long-term employment outcomes, deepen the cycle of poverty, and waste the government’s limited Medicaid resources on bureaucratic red tape. In fact, work requirements have historically failed to lead to increased employment. Programs such as TANF, which already impose work requirements, have not led to lasting, sustained employment outcomes. Instead, these requirements have merely increased the number of people without employment or supports. Rather than encouraging states to make investments in the services we actually need, work requirements will encourage states to invest in costly bureaucratic systems designed to track people’s activities, monitor job application efforts, and constantly verify and re-verify disability status. People with disabilities, especially cognitive and developmental disabilities, will have significant difficulty navigating these bureaucratic requirements and will “slip through the cracks,” resulting in catastrophic loss of health coverage.
In addition to being cruel and ineffective, work requirements are also unnecessary. The majority of working-age adults on Medicaid are already employed. These adults remain enrolled in Medicaid because their jobs either do not provide adequate–or any–health insurance. The health care coverage working adults receive through Medicaid is essential to maintaining employment, especially for people with disabilities and long-term health conditions. Without access to Medicaid, people with disabilities and other health conditions may find ourselves unable to access the health services – such as insulin, daily medications, and other services – that enable us to live independently and seek employment.
Over the past year, Congress and this Administration have repeatedly attempted to undermine our Medicaid program. Each time, voters have made their voices heard loud and clear, calling on Congress to reject all attacks on Medicaid. We will continue to fight against any effort to undermine Medicaid, be it caps, block grants, or work requirements. ASAN knows that Medicaid saves lives, and we will continue to say, from now until forever — no cuts, no caps, and no compromise.
The Autistic Self Advocacy Network is a 501(c)(3) nonprofit organization run by and for autistic people. ASAN was created to serve as a national grassroots disability rights organization for the autistic community run by and for autistic Americans, advocating for systems change and ensuring that the voices of autistic people are heard in policy debates and the halls of power. Our staff work to educate communities, support self-advocacy in all its forms, and improve public perceptions of autism. ASAN’s members and supporters include autistic adults and youth, cross-disability advocates, and non-autistic family members, professionals, educators, and friends.