Reevaluate This!
Disabled folks dread that perpetually recurring time of the year. It’s when those of us who avail ourselves of certain public support programs have to be reevaluated to make sure we are still eligible. In other words, we must prove we are still crippled.
In my case, reevaluation day takes the form of an annual (more or less) home visit from a social worker from the Illinois Department of Human Services. DHS pays the wages of the members of my pit crew, which is what I call the people I hire to come to my home every day and help me put on my pants, take a shower, et cetera.
During these visits, the DHS social worker asks me if I still have the same disability I had the last time I was reevaluated. I say yes. She asks me if I still need help putting on my pants, taking a shower, et cetera. I say yes again. She asks me to spell the word “world” backward. I say d-l-r-o-w. I’m suspicious of that question. I guess it’s some kind of cognitive test. But how much weight does it carry? What if I choked under pressure and spelled it wrong? Would that make me too incompetent to qualify? Or does spelling it right make me too competent to qualify? I don’t know.
Hey, I know some sort of reevaluation process is necessary. Sometimes, people are temporarily crippled and may no longer qualify. I just think people like me, who are always going to be at least as crippled as we are now, ought to be grandfathered in somehow. It’s like making an older person prove every year that they’re still over sixty-five.
Sometimes computers have been known to determine that people like me have been cured.
Even when, like me, you know you’re a shoo-in to pass any test designed to determine if you are still sufficiently crippled to remain eligible, reevaluation day is nerve-wracking. It’s always possible that something could go wrong. There could be some obscure loophole in the eligibility criteria that a hostile Republican social worker, anxious to please her austerity-obsessed bosses by purging her caseload, could use as an excuse to cut me off.
And even when you’ve successfully survived another reevaluation day, it’s hard to relax because, sometimes, computers have been known to determine that people like me have been cured.
My friend Mike has a monthly ritual. On the third day of every month, he stays awake and waits for his phone to beep at about 3 a.m. That means his bank has texted him to let him know that his monthly Social Security disability payment has been deposited.
But on one recent third day of the month, there was no beep and no deposit.
Mike panicked. He called Social Security the next morning and, he says, after being placed on hold for forty-five minutes, was told, “Your record has been flagged because they want to be sure you’re still disabled.” Mike has osteogenesis imperfecta, which is commonly referred to as brittle bone disease. He’s always had it, and always will have it. After doing the laborious bureaucratic waltz with Social Security and completing a bunch of paperwork, Mike’s payments were restored, retroactively, within about a month, he says.
This is why I’m distressed about this new craze that’s sweeping the nation. It’s called Medicaid work requirements.
On January 11, the Centers for Medicare & Medicaid Services (CMS) sent a letter to all state Medicaid directors announcing a new policy “designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.”
It said CMS, which must approve major changes to Medicaid eligibility, “will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for certain adult Medicaid beneficiaries.”
CMS has always rejected state requests to tie Medicaid eligibility to employment, until the Trump Administration came along. So far, ten states have asked Trump’s CMS for permission to institute some sort of Medicaid work requirement, and Indiana, Kentucky, and Arkansas have been given the green light. All three states exempt disabled Medicaid enrollees from work requirements.
The Arkansas plan, approved on March 5, requires many of those aged nineteen to forty-nine covered by the state’s Medicaid expansion to work or be engaged in educational, job training, or work search activities for at least eighty hours per month to remain eligible. And they will have to prove they are fulfilling this requirement every month.
Twenty-three percent of this population, or about 76,000 people, are disabled, according to the Center on Budget and Policy Priorities. So if CMS approved the Arkansas plan, they must have reviewed it thoroughly to make sure it contained clear and reasonable safeguards to keep disabled people from being burdened by its work requirement. You’d expect nothing less from the Trump Administration, right?
It reinforces the notion that being disabled is the only legitimate excuse for being poor. If you’re not disabled, then the only reason you’re poor is you’re not working hard enough.
Surprise! Either the people at CMS half-heartedly skimmed over the Arkansas plan or they have a mighty funny concept of what constitutes a reasonable safeguard. Because the plan says that anyone who applies for and receives a disability exemption from Medicaid work requirements will have to renew that exemption every two months. This means that they will have to endure reevaluation day six times per year.
What could possibly go wrong? The Arkansas plan also says the exemption application process will be conducted online. There doesn’t appear to be a contingency plan for those without steady access to the Internet.
Those who can’t sufficiently prove they are meeting the work requirement for any three months during a coverage year and fail to qualify for an exemption will be dropped from the Arkansas Medicaid rolls, the plan says, and won’t be allowed to apply for reinstatement until the next coverage year. That could be as long as nine months.
I left a message for the Arkansas Department of Human Services to get its take on this. So far, nobody has called me back.
Trump has replaced Lyndon Johnson’s War on Poverty with his own War on the Poor. Of course, none of the perpetrators call it that. CMS calls it “incentivizing work and community engagement.” That’s so much less affronting. To be opposed to that is to be pro-sloth.
Each new assault comes with a solemn promise that disabled people will be spared. For instance, back in April, Housing and Urban Development Secretary Ben Carson announced something called the Make Affordable Housing Work Act. Currently, residents of government-subsidized housing pay 30 percent of their household income for rent. Carson’s plan would raise that to 35 per cent. But elderly and disabled residents would be exempt from the rent increases.
This phoney empathy for the disabled serves many propaganda purposes. It reinforces the notion that being disabled is the only legitimate excuse for being poor. If you’re not disabled, then the only reason you’re poor is you’re not working hard enough.
It also pits poor people against each other, which makes it harder for them to fight back. Disabled folks and their allies are a lot less likely to revolt against work requirements if they don’t feel immediately threatened by them.
But it’s a false sense of security. An analysis by the Center on Budget and Policy Priorities of state work requirement proposals concluded that, “while state policies include exemptions for people with disabilities and certain caregivers and students, some people with serious barriers to work will not meet the criteria for exemptions or will struggle to overcome the bureaucratic hurdles to document that they qualify.”
I think it’s inevitable that some disabled folks in Arkansas will get sucked up in the undertow of work requirements and lose their indispensable Medicaid coverage as a result. Being disabled isn’t enough. You have to be able to constantly prove that you still are disabled or you can be terminated.
The real goal of these work requirements, of course, is to kick a whole bunch of people off Medicaid. The more the merrier. So the very idea of work requirements should be vigorously opposed by everyone who thinks Medicaid is a good thing, not just by Medicaid recipients who know they’re in the crosshairs.
Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid program. For the first time, CMS thinks that a good way to promote the objectives of the Medicaid program is to leave more people who need it stranded without it. Work requirements speed up the treadmill for everybody relying on Medicaid and force them to exert more and more effort and energy to keep from falling off.
Many will not be able to keep up. Disabled folk will find themselves without Medicaid, even if they can spell “world” backward.
Mike Ervin
Mike Ervin, a writer and disability rights activist in Chicago, writes the blog Smart Ass Cripple at smartasscripple.blogspot.com. His most recent book is Smart Ass Cripple’s Little Chartreuse Book.