Opinion: A smarter, fairer way to fund Medicaid for people like me
In 2004, I broke my neck and became a quadriplegic. I was 24 years old and completely paralyzed below my shoulders. Without Medicaid, I wouldn't have survived those early years — let alone gone on to earn a law degree. But I also wouldn't have stayed poor as long as I did.
That's the problem with how Medicaid currently works for people with disabilities. To keep Medicaid, you often have to stay below poverty-level income and asset thresholds. Want to work? You risk losing your coverage. Want to save for a car? Not so fast.
We need a Medicaid model that guarantees coverage for vulnerable populations and recognizes both the dignity of independence and the value of work. Here's my proposal: shift the primary responsibility for funding Medicaid to the states, while the federal government reimburses the states for Medicaid spending on:
• Children in low-income families
• Low-income elderly adults
• People with disabilities ages 16-64 who are either progressing students (full reimbursement) or working (reimbursement up to the amount of their taxable income)
The states would be required to provide Medicaid coverage for all people with disabilities regardless of income, assets, and work or student status, but both the states and federal government could require people with significant income to obtain private supplemental insurance — relieving states of some Medicaid costs.
This plan does three essential things. First, it aligns financial incentives. Under current rules, the states have little reason to invest in helping disabled adults live meaningful lives, including pursuing education or working. Under this model, the more someone earns or pursues valuable education, the more their state receives in federal reimbursements. Helping disabled adults enter and remain in the workforce becomes not just morally right but also financially sound.
Second, this plan unleashes human potential. According to the U.S. Bureau of Labor Statistics, the 2024 labor force participation rate for people with disabilities ages 16-64 was a tragically low 40%, compared to 78% for those without disabilities. The unemployment rate among people with disabilities was 8%, more than double the less than 4% rate of those without disabilities. These disparities aren't simply the result of individual limitations — they reflect a system that undermines work for people with disabilities, trapping them in poverty and limiting their potential. My plan removes that disincentive.
Third, this plan brings fiscal discipline to Medicaid. In 2024, total Medicaid spending was over $900 billion, with about two-thirds covered by the federal government and one-third by the states, according to the National Association of State Budget Officers. We can target those funds better. According to the Kaiser Family Foundation's 2021 data, adults with disabilities ages 18-64 account for about one-third of Medicaid spending. My proposal would incentivize states to use Medicaid to help people with disabilities to pursue education, employment and independence, while encouraging state-led innovation to deliver those services more efficiently.
States are better equipped to tailor care programs. They are 'laboratories of democracy.' With clearer authority and direct financial incentives rewarding their success, states will be free to pursue innovative care models: consumer-directed services, telehealth, supported employment or customized in-home care, whatever works best for the people of their state.
Critically, this approach also elevates education as a path out of dependency. If a student with disabilities is making 'substantial academic progress' — a term that could be precisely defined in federal regulation — their state would qualify for full reimbursement of their Medicaid costs. This rewards long-term investment in human potential and acknowledges the added effort it takes to pursue education while managing a serious disability.
For someone like me, this is more than policy — it's personal. Medicaid made my education possible. But the rules also penalized me for every financial step forward. That's not just inefficient — it's inhumane.
We can do better. We can fund Medicaid in a way that values work, education and independence — while targeting federal dollars more precisely and empowering states to find better ways of delivering care. Let's stop trapping people with disabilities in poverty and start treating them as full participants in our economy.
Let's build a Medicaid system that sees us not as burdens, but as investments.
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