An Interview with APSE on the Value of Medicaid for Americans with Disabilities

Medicaid serves more than 11 million Americans with disabilities – and in more ways than you’d think. The program provides the health care they need, but it also gives them access to innovative programs that support employment and education.

The Modern Medicaid Alliance sat down for a Q&A with Kelley Land, M.P.A., Southwest Rocky Mountain Regional Delegate to the Association of People Supporting Employment (APSE), to hear more about how APSE partners with Medicaid.

Modern Medicaid Alliance:  Tell us about APSE?

Kelley Land:  [APSE] believes that everyone has the ability to contribute, and their work should be recognized and rewarded with fair pay. [Our work] is meant to deliver meaningful employment, fair wages and career advancement for people with disabilities.

Modern Medicaid Alliance:  Why does APSE support Medicaid? 

KL:  Health and medical services funded through Medicaid are essential to helping individuals with disabilities achieve self-sufficiency and health to be successful employees. Also, the investment of Medicaid dollars into employment-related support helps ensure that individuals with disabilities can maximize their income through work – which fosters greater independence and better health, while at the same decreasing their reliance on public benefits.

Modern Medicaid Alliance:  Sometimes Medicaid is not thought of as a program for people who are working – but in your experience it is serving people who are employed.

KL: The majority of [the people I help through my job] are job seekers and clients who have utilized Medicaid insurance, and that’s given them access to community activities, transportation, volunteering, and the ability to go to work. I’ve worked with thousands of clients who access Medicaid – 60% of individuals on Medicaid are working.

Modern Medicaid Alliance:  Tell us about the unique needs Medicaid helps meet for people with disabilities.

KL:  You can’t put a value on health coverage, especially for those who have chronic health conditions. When we look at the disability arena, some health conditions associated with disabilities result in poor health and expensive healthcare needs. Others do not. Also, all people with disabilities have the same general healthcare needs as all of us, so access to mainstream healthcare services is a necessity.

Modern Medicaid Alliance:  Wouldn’t other kinds of insurance work just as well as Medicaid for people with disabilities?

KL:  Individuals with disabilities frequently have limited access to private insurance. And they need that healthcare access prior to going to work to be able to be healthy and have the supports they need to be able to access those typical work environments. Medicaid covers a full scope of services that often individuals with disabilities need. Finally, many people with disabilities need long-term services and support – Medicaid’s the only source of funding for long- term services.

Modern Medicaid Alliance:  Are there state-level threats to Medicaid coverage for people living with disabilities?

KL:  Any time we rely on federal or state dollars, we need to make sure we are advocating for self-sufficiency. We believe that people with disabilities should be going to work and living that typical life for themselves. That being said, we also believe there have to be supports in place to allow individuals to be able to do that. At the state level, the recent huge news was work requirements, which CMS announced in January.

Modern Medicaid Alliance:  Why is that concerning for people with disabilities?

KL:  CMS said to states, “If you put in a proposal that says people must work to have Medicaid, we will look at those and approve those.” We see potential issues with this, including the definitions being used for disabled individuals, who can be excluded from the work requirement. If the federal definition is used – which defines disabled individuals as those receiving Supplemental Security Income – it may leave many individuals at risk of not receiving the coverage and supports they need. Nearly three-fifths of non-elderly adults with disabilities, 5 million people, do not receive SSI benefits – that’s a large population that could truly be affected by this. Also, with work requirements, some states do not currently consider self-employment as “work,” and that’s really hard for our disability community, many of whom use customized employment.

Kelley is the Project Coordinator, Center on Community Living and Careers at the Indiana Institute on Disability and Community, Indiana University Bloomington and is the Southwest/Rocky Mountain Regional Delegate on the National APSE board.

Kelley Land, M.P.A., Project Coordinator
Center on Community Living and Careers