Medicaid expansion tied to employment among people with disabilities

(Corrects location of Washington State University Health Policy and Administration program to Spokane, from Pullman, in paragraph 13)

By Madeline Kennedy

Before the Patient Protection and Affordable Care Act (ACA) – also known as Obamacare – was passed in 2010, people with disabilities and low income jobs were often unable to afford their expensive medical care. So many chose unemployment in order to be poor enough to qualify for Medicaid coverage, researchers report in the American Journal of Public Health.

“Policy makers in states that have not expanded Medicaid often suggest that making Medicaid available to more people will increase their dependence on public insurance and discourage them from working to obtain insurance through an employer,” said lead author Jean Hall, a health and disability policy researcher at the University of Kansas Medical Center in Kansas City and the University of Kansas, Lawrence.

“Our results show just the opposite for people with disabilities, who are much more likely to work in states that expanded Medicaid,” Hall told Reuters Health by email.

In 2014, states were given the option to expand Medicaid’s coverage under the ACA, allowing people earning up 138 percent of the poverty rate to receive Medicaid coverage.

In the 19 states that have not expanded Medicaid, the earnings limit for people with disabilities is 85 percent of the poverty rate, or $834 dollars per month, Hall’s team writes.

To examine how Medicaid expansion affects employment rates among people with disabilities, researchers used data from a nationally representative quarterly phone survey conducted 10 times between early 2013 and late 2015.

The analysis included 2,740 participants who answered yes when asked if they had a mental or physical condition or impairment that affects daily activities or requires the use of special equipment such as a wheelchair or communication devices.

Participants were also asked about their work status in each survey round, and researchers compared the employment rates of people with disabilities in states that expanded Medicaid eligibility under the ACA and those that didn’t, before and after the law went into effect.

After the ACA was implemented, people with disabilities living in states with expanded Medicaid were significantly more likely to be employed than those in non-expansion states. In the expansion states, 38 percent of the disabled survey respondents were working compared to 32 percent in the states that didn’t expand coverage.

The proportion of people who said they were not working because of their disability was 40 percent in expansion states and 48 percent in non-expansion states.

In states that didn’t expand Medicaid, employment rates among the disabled fell slightly after the ACA went into effect, but researchers said they didn’t have enough data from the years before the law’s implementation to explain why that happened.

“People with disabilities desperately need health insurance because of chronic health conditions,” Jae Kennedy, chair of the health policy and administration department at Washington State University in Spokane, said by email.

Medicaid expansion requires more funding from states and the federal government, but the result is that newly insured people are able to pay for their care with insurance, said Kennedy, who wasn’t involved in the study.

“Medicaid matters. Expanding it without extra requirements helps people with disabilities remain in or return to work,” Kennedy said.

“Expanding Medicaid empowers people with disabilities to work instead of applying for cash assistance, being dependent on the government, and living in poverty,” Hall said. “Moreover, research has shown that working, even part-time, improves health.”

SOURCE: bit.ly/2h6OMGI The American Journal of Public Health, online December 20, 2016.