“No one should have to choose between a paycheck and their health care. Yet, that is exactly the impossible choice millions of Americans may soon face as the administration moves to implement Medicaid work requirements, one of the key provisions driving the nearly 1 trillion in Medicaid cuts included in H.R. 1 putting care at risk. And now, these rules which take effect this summer are going further than the statute demands, threatening access to support for older adults, family caregivers and people with serious health conditions. People with disabilities face particular risk because of administrative overreach that ties exemptions to the ability to work.
“Congress created the medical frailty exemption in H.R. 1 to protect people based on their health conditions and disability status, not whether they can hold a job. The law explicitly protects people who are blind or disabled, and those with serious or complex medical conditions that affect daily functioning. But, the administration’s rule redefines medical frailty — tying it not to their health condition or disability but to their ability to prove they work 80 hours a month. This interpretation creates a catch-22 for disabled people: work to make ends meet, but risk losing your Medicaid if your hours fall short or stop working to keep your care, and lose your income.
“Any effort to redefine medical frailty this way undermines both the intent of the law and more than 35 years of progress under the Americans with Disabilities Act. The ADA was designed to open doors to employment, not create a system where working, even part-time, can cost you your health care and support. The historic cuts to Medicaid included in HR 1 are already causing pain all over the country, but this rule which determines how work requirements will be enforced – risks compounding the harm by narrowing exemptions beyond what the law requires, overriding state flexibility, and adding bureaucratic hurdles that will fall hardest on the people Medicaid is meant to serve. There is still time to get this right. The Centers for Medicare & Medicaid Services should reject tying medical frailty exemptions to inability to work, preserve the right of people to self-attest their disability or health condition without demanding documentation they may not have, and respect the flexibility states need as they navigate massive federal funding cuts. The public comment period closes July 31st. For the people this program was designed to protect, the stakes are too high to get this wrong.”
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Caring Across Generations is a national organization of family caregivers, care workers, disabled people, and aging adults working to transform the way we care in this country so that care is accessible, affordable and equitable— and our systems of care enable everyone to live, work, and age with dignity.
To achieve our vision, we transform cultural norms and narratives about aging, disability and care; win federal and state-level policies; and build power amongst the people touched by care. For more information, visit caringacross.org.