How Medicaid Changes Could Affect People With Disabilities

Takeaways

• People with disabilities living on limited income are among those who may rely on Medicaid benefits for their medical care.
• Some experts are expressing concern that changes to the Medicaid program proposed by the incoming Trump administration could have a negative effect on disabled beneficiaries and other populations.

What Is Medicaid? The Current Landscape

Medicaid is a public assistance program run jointly by states and the federal government. It currently provides health care coverage to more than 72 million people across the country. This program serves a wide range of eligible U.S. populations who are living on limited income, including the following:

• People with disabilities
• Older adults (aged 65 and over)
• Children (and families of these children)
• Pregnant women

To qualify for Medicaid in most states, you generally must have around $2,000 or less in “countable” assets to your name. Married couples seeking to apply together may generally have about $3,000 in combined assets.

Medicaid is crucial for low-income Americans, as it provides essential health care services that many would otherwise be unable to afford. For individuals with disabilities, it offers vital support for medical treatments, therapies, and long-term care, ensuring they can lead healthier lives. Seniors benefit from coverage for nursing home care and prescription medications, which can be extremely costly. Meanwhile, children and pregnant women receive necessary prenatal and pediatric care, promoting healthier outcomes for families.

Without Medicaid, millions would face significant barriers to accessing health care, leading to worse health outcomes and increased financial strain on families and communities.

During the COVID-19 pandemic, Medicaid enrollment hit an all-time high. Although the number of enrollees has declined since the public health emergency officially ended, millions continue to rely on Medicaid services. This includes an ever-growing population of aging adults in the U.S., on which Medicaid already spends about 20 percent of its budget.

For those in the disability community who are enrolled in Medicaid, receiving their medical care at home or in their community can mean the difference between living on their own and maintaining their independence and having to move to an institution. And yet, as of 2024, more than 700,000 of them are on lengthy waiting lists for these home- and community-based services (HCBS).

Medicaid Coverage in the Next Administration

According to a 2024 poll, 86 percent of Medicaid recipients said that the program should “largely continue as it is today.” Among adults overall, more than 70 percent said they agreed with this statement. However, some pundits claim that the incoming Trump administration is considering cuts to the Medicaid program that could be detrimental to people with disabilities and other populations.

They point to changes proposed in the Republican fiscal year 2025 budget plan that include financing Medicaid under a block grant program and imposing work requirements.

Under a block grant program, states would receive a fixed amount of funding to provide Medicaid services “in a flexible manner” to eligible populations. The first Trump administration had invited states to apply for block grant waivers for Medicaid. Some critics have warned that block grants could result in reduced access to care for millions of enrollees. Others suggest that while states implementing a block grant policy would experience less federal oversight on their Medicaid spending, this could also put them at greater financial risk.

Also starting in 2018, the Trump administration allowed states to begin instituting work requirements for certain Medicaid enrollees. Georgia was one state to introduce such a program in 2023. While the Biden administration unsuccessfully sought to stop its launch, a December 2024 New York Times story reported on a group of senators calling for a federal investigation into the program for alleged misspending.

Work With a Special Needs Planning Attorney

If you or a loved one are considering applying for Medicaid benefits or have questions about your coverage, reach out to your state Medicaid agency. These state agencies develop the policies for Medicaid (and the Children's Health Insurance Program, CHIP) within set federal guidelines.

For further guidance, seek out the help of a special needs planning attorney in your area. An experienced special needs planner can provide invaluable assistance to individuals with disabilities navigating the Medicaid program. Professionals who specialize in this area of law can help determine your eligibility for Medicaid and other public benefits as well as guide you through the complex application process.

They also understand the nuances of Medicaid regulations, which often vary widely from state to state. Relying on their expertise, you can ensure that you do not inadvertently disqualify yourself from the program by exceeding its strict income and resource limits.

Beyond assisting with Medicaid, a special needs planner can walk you through how to execute specific estate planning tools that can help protect your assets while still allowing you access to essential public benefits. These tools may include a special needs trust, ABLE account, or other strategies.

Keep in mind that revisiting your estate plan on a periodic basis is important, as laws and personal circumstances may change over time. What worked in the past may no longer be effective. This is especially important if your loved one has a disability, which can dictate different health care or financial needs at different points in time.

By offering personalized advice, an attorney can help you make informed decisions and ensure that your plans comply with ever-changing laws. Regardless of potential changes to the Medicaid program, enhancing the quality of life for your loved ones with disabilities and giving them a stable, fulfilling future will remain your top priority.