GIVING HARDWORKING AMERICANS WITH DISABILITIES

A CHANCE AT A MIDDLE CLASS LIFE

Many Americans with disabilities are denied
their fair chance to pursue the American dream.
Despite gains from the landmark civil rights bill,
the Americans with Disabilities Act (ADA) in 1990
and guaranteed healthcare coverage under the
Affordable Care Act (ACA), much economic
progress remains for Americans with disabilities.
Today, many hardworking Americans with
disabilities are essentially punished for earning too
much money by losing access to long-term services
and supports (LTSS).1
Most Americans who require long-term services
and supports (LTSS) have to rely on Medicaid to
meet their support needs.
Many Americans with disabilities rely on LTSS
which allow them to get up and go to work each
day. For many low-income Americans with
significant disabilities, the only option that will pay
for their LTSS is Medicaid. As they earn more or
save, they risk becoming ineligible for Medicaid
and therefore losing access to their LTSS. Private
health insurance does not cover LTSS and can
result in coverage gaps such as durable medical
equipment and prescription drug coverage.

QUICK EMPLOYMENT FACTS

Americans with disabilities are less likely to be
employed, are more likely to hold jobs with lower
wages and earn less than Americans without
disabilities
The unemployment rate for Americans with
disabilities is nearly double the national rate
(14.7% compared to 7.7%)
8 out 10 people with disabilities or 48 million are
out of the workforce
More than half (53%) of working Americans with
disabilities earn under $25,000 annually and
workers with disabilities on average earn $0.75
for every $1 made by workers without
disabilities2
20 percent of people with disabilities are
employed or looking for employment, and make
up 6 percent or 9 million people of the labor force
These statistics underestimate unemployment
and underemployment given that many may be in
and out of the labor force, and those on public
support such as Social Security, Medicaid and
Medicare are not included in these national
surveys
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2

Department of Labor, as of July, 2013

Census Bureau, as of March, 2013

Federal policies should not punish Americans with disabilities for trying to live middle class lives.
Given that Medicaid is the only option for LTSS coverage, these Americans must impoverish themselves
or remain poor in order to get the support they need. Some are forced to apply for Supplemental Security
Income (SSI) as a gateway to Medicaid and LTSS. They end up foregoing increases in pay and other
economic opportunities in order to keep their LTSS through Medicaid.
The federal government must provide access to LTSS and unique disability-related healthcare
coverage so that all Americans with disabilities have a shot at economic security.
With the right tools, Americans with disabilities can live independently in their homes and communities,
increase their earnings, decrease their reliance on a program like Medicaid that is for low-income people,
and contribute to the growth of our economy as taxpayers, consumers and small business owners.
LTSS is generally defined as personal care services (i.e., help transferring from a wheelchair, dressing, going to the bathroom, etc), transportation services,
assistive technology, durable medical equipment and other daily assistance to support an individual living with a functional impairment due to disability or
health condition
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PILOTING A NEW WAY FORWARD:

To allow Americans with disabilities to earn up to their potential and accumulate resources to
live the American Dream,
To remove work disincentives, and
Help workers with disabilities rely on their earnings rather than go on Social Security income
support programs
AAPD PROPOSES NEW FEDERAL PILOT PROGRAM

Establish a pilot program that provides a new way to access LTSS needed by employed individuals with significant
disabilities (meet Social Security definition of disability) without income and asset restrictions to test a new way
forward for accessing LTSS.

Important features of pilot

Removing income and asset restrictions so that individuals can continue to receive LTSS as they earn more.
Have a cost-sharing arrangement based on a sliding scale of income so that as individuals increase their income
they will be responsible for covering more of their LTSS costs.
This program would be designed to wrap-around private health insurance (whether offered by employer or
through the health reform Marketplaces) and modeled on existing work incentive programs such as the
1619(b) program.

PILOT PROGRAM BUILDS ON EXISTING PROGRAMS

This program will build on existing work incentive programs that allow individuals to earn a little more while
on public programs. For instance, work incentive programs allow working people with disabilities to continue
their participation in the Medicaid program while allowing them to increase their earnings up to a set limit
(usually 250% of FPL) and, in some very limited cases, save for emergency expenses or life goals. These work
incentives include, but not limited to, the Medicaid Buy-In (MBI) programs and the 1619(b) program.2
This program will build on the changes of the Affordable Care Act (ACA). The ACA significantly expanded
medical coverage for low-income adults and has allowed many Americans with disabilities access to private
insurance who were previously denied based on pre-existing conditions. However the ACA did not expand
access to LTSS outside of the Medicaid program.

PILOT PROGRAM WILL CREATE A NEW WAY TO ACCESS LTSS SEPARATE FROM MEDICAID

As Medicaid was designed to provide health care to low-income individuals with no other access to insurance
coverage, its structure and eligibility rules make it difficult to impossible for working individuals with significant
disabilities to achieve the things associated with a middle class lifestyle, making it an inappropriate program for
them to rely on as they earn more. Specifically:
Variations in state Medicaid programs (e.g. income and resource limits for MBI participation, income limits
for eligibility, types of waivers and whether slots are available, and the package of services and supports
available) make moving to another state for a better work opportunity difficult, if not impossible.
SSI/Medicaid resource limits (e.g. a person can have no more than $2000 in assets for an individual or
$3000 for a couple to be Medicaid eligible) are often problematic making it difficult to save for emergencies
and retirement, let alone save to purchase a home or start a business. People with significant disabilities
often have extraordinary support needs that make it difficult, if not impossible, to get those needs met
outside of public programs.

For more information, please contact Colin Schwartz, Senior Associate for Policy and Advocacy,
at 202.521.4309 or cschwartz@AAPD.com or go to AAPD.com
MBI programs allow people to work and save and maintain access to Medicaid while paying co-pays based on income. Most states have MBI programs but
income and resource limits vary significantly. 1619(b) programs allow people to maintain Medicaid access while working but do not change resource limits.
Every state participates in 1619(b) but income limits vary significantly.
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