Rachel Barkley: Medicaid Reform Falls Short for People with Disabilities

“Speaker Johnson’s ‘One Big Beautiful Bill’ can do more to fix Medicaid for the truly vulnerable — Americans with disabilities,” writes Able Americans Director Rachel Barkley in a commentary published at National Review.

Rachel shares about the “bureaucratic maze” she and her husband experienced when she because a quadriplegic shortly after giving birth to her first child, and how Obamacare’s expansion of Medicaid to encompass more able-bodied adults has watered down Medicaid access for those who need it most. She then offers recommendations on how the Senate can fix Medicaid to get it back to its core mission.

Read Rachel’s entire commentary below.

Medicaid Reform Falls Short for People with Disabilities

The Senate should include reforms to ensure that the program can return to its original purpose of supporting the most vulnerable.

Rachel Barkley

Speaker Johnson’s “One Big Beautiful Bill” can do more to fix Medicaid for the truly vulnerable — Americans with disabilities. I know this firsthand. In 2019, I became a quadriplegic at age 30, just after becoming a new mom. Overnight, I was thrust into a bureaucratic maze that most Americans never see. If my husband and I wanted access to Medicaid through Supplemental Security Insurance (SSI), we had to accept the government’s terms: no working, no savings, and no financial autonomy. The asset limit for Medicaid? Just $2,000 for an individual, $3,000 for a couple. In today’s economy, that’s not assistance — it’s forced poverty for health care.

Thankfully, I had community support and modest savings. Many others do not. Over 700,000 people with disabilities are currently stuck on waiting lists for in-home caregiving services that they desperately need. Meanwhile, Medicaid’s resources are stretched to cover far more than its original mission. The House’s Medicaid reforms are a step in the right direction toward fiscal sanity, but they could further endanger Americans with disabilities who have to depend on the program.

When Congress created Medicaid in 1965, it was a joint federal-state program to help low-income children, pregnant women, elderly adults, and people with disabilities. But the Affordable Care Act dramatically expanded eligibility, allowing states to enroll any adult earning up to 138 percent of the poverty line — with 90 percent of the cost paid by federal taxpayers.

This created two Medicaid populations: the traditional group, which includes individuals with disabilities, and the expansion group, made up largely of able-bodied adults. Here’s the catch: States receive only 57 percent federal reimbursement for the traditional group, but 90 percent for the expansion group. The result? Incentives that are skewed toward enrolling able-bodied adults over those with the greatest needs. Nearly 17 million new adult enrollees were added to Medicaid.

The consequences are real. Provider networks are overstretched, and many doctors limit Medicaid patients due to low reimbursement rates. States use Medicaid as a stopgap for rural hospital deficits, addiction treatment, and other budget challenges — leaving individuals with disabilities sidelined.

It doesn’t have to be this way. The Senate should include Medicaid reforms to ensure that the program can return to its original purpose of supporting the most vulnerable. That starts with winding down the enhanced federal match for the expansion population and redirecting those dollars to improve care for people with disabilities. States that expand their home- and community-based services — as Governor Glenn Youngkin did in Virginia’s budget — should receive a higher traditional match rate.

The Senate should also modernize Medicaid’s outdated disability asset test. Right now, able-bodied enrollees have no asset test, an outrageous imbalance compared with the $2,000 to $3,000 test for people with disabilities. The Senate should raise the limit to $10,000 for individuals and $20,000 for couples and apply the same test to all enrollees. It’s unreasonable to ask someone to give up modest financial stability just to receive basic medical care.

The Senate has the opportunity to fix the Big Beautiful Bill and make Medicaid funding fair and focused on those who truly need it. Saving Medicaid for those who depend on it isn’t a partisan issue; it’s a test of priorities. If Congress is serious about restoring fiscal discipline and strengthening the social safety net, the path forward is clear: protect the most vulnerable by fixing the incentives that distort this vital program.

Rachel K. Barkley is the director of Able Americans, a project of the National Center for Public Policy Research that supports Americans living with intellectual, developmental, and physical disabilities, advocating for innovative solutions that harness the free market, emphasize individual freedom and choice, and remove barriers to progress. This was first published at National Review.