The following is cross-posted from State Health & Value Strategies.
Authors: Emily Zylla and Elizabeth Lukanen, SHADAC
Original posting date June 20, 2025. Find the full post here on the SHVS website.
Medicaid plays a critical role in providing health coverage to millions of people with disabilities across the country. However, our analysis described below shows that more than two-thirds of Medicaid enrollees who self-identify as having a disability are not enrolled through the program’s disability eligibility pathway (Figure 1).
Figure 1. Gap Between Medicaid Enrollees Reporting a Disability and Qualifying Based on a Disability Determination
Note: The ACS identifies individuals as having a disability if they report difficulty in any of six core areas of functioning: hearing, vision, memory or cognitive, mobility, motility, and self-care and independent living.
Sources: SHADAC analysis of the 2023 American Community Survey (ACS) Public Use Microdata Sample (PUMS) file; Medicaid and CHIP Payment and Access Commission (MACPAC) MACStats: Medicaid and CHIP Data Book (2024)
The disconnect between how enrollees experience disability and how it is formally defined within Medicaid is especially relevant as Congress continues to advance the mandatory federal work requirement proposal for the adult expansion population in the federal budget reconciliation bill. Although this proposal includes an exemption for people with disabilities, it relies on the narrow Supplemental Security Income (SSI) definition of disability, which excludes many Medicaid enrollees who self-report having a disability.
While further research and analysis is needed to accurately estimate the prevalence of self-reported disability within the adult Medicaid expansion population, understanding self-reported disability prevalence across the broader Medicaid population can help inform how the work requirement proposal might affect individuals who report having a disability but are not formally recognized as such.
In the full Expert Perspective on State Health & Value Strategies' website, SHADAC Researchers Emily Zylla and Elizabeth Lukanen delve into this topic further, examining Medicaid's disability-eligibility pathway, SSI's definition of disability, the difference between disability pathway enrollment and self-reported disability in Medicaid, and how this all connects to the federal budget reconciliation bill's proposed work requirements. Read the full Expert Perspective here.