Research

Lowering costs and expanding affordable insurance coverage is critical to achieving health equity for  LGBT+ Americans. Barriers to quality and consistent care such as poverty and discrimination make it difficult for LGBT+ individuals to access health care and afford prescription medications. While the Biden Administration has prioritized improving LGBT+ care, Republicans in state legislatures continue to undermine LGBT+ rights by fighting access to gender affirming care, banning LGBT+ representation in schools, and other measures to discriminate against LGBT+ youth. Improving access to care and protecting LGBT+ individuals from health care discrimination are essential for improving the health and well being of LGBT+ Americans nationwide.

The Biden Administration Has Prioritized Improving LGBT+ Care

Expanding Health Coverage For Millions Of Americans. Premium subsidies made available by the American Rescue Plan helped nearly 210,000 LGBT+ enrollees have access to zero-premium plan. Nationwide, 20 percent of Black LGBT+ individuals are uninsured, compared to 15 percent of Black heterosexual and cisgender individuals and 9 percent of white counterparts. Thanks to the American Rescue Plan, nearly 3 million uninsured adults received premium tax credits and a record 14.5 million consumers signed up for health care on the marketplace.

Reversing Trump Policy Allowing Sexual Orientation Discrimination. In May 2021, Department of Health and Human Services Secretary Xavier Becerra announced that sexual orientation would be restored as a protected class under the Affordable Care Act. This protects sexual orientation and gender identity from health care discrimination, ensuring that LGBT+ inidividuals aren’t denied coverage or charged more for care. This reversal has been especially important with transgender rights being attacked by state-level Republicans. 

Protecting Transgender Youth. The Biden Administration is focusing on providing mental health support, creating a more welcoming environment in public schools, and acknowledging the positive impacts of gender affirming care. In honor of Transgender Visibility Day in March 2022, the Justice Department issuing a letter to all state attorneys genera reinforcing federal transgender youth protections against discrimination and obtaining gender affirming care l. The Department of State also enacted gender affirming markers on passports by adding “X” to be selected instead of the binary “F” or “M.” 

Republican Have Intensified Attacks On LGBT+ Care

Gov. DeSantis’ “Don’t Say Gay” Bill. Early this year, Gov. DeSantis signed the Parental Rights In Education bill, otherwise dubbed as the “Don’t Say Gay” bill. This bill prohibits teachers or school personnel from classroom discussion on sexual orientation or gender identity for kindergarten through third grade. In the face of opposition, Gov. DeSantis has said that teaching children about LGBT+ rights is “inappropriate” and is “not something that’s appropriate for any place, but especially not in Florida.” 

Gov. Abbott’s Transgender Child Abuse Order. Gov. Abbott ordered Texas child welfare investigators to launch child abuse investigations into reports of transgender children receiving gender-affirming care. He went one step further in calling for members of the general public and “licensed professionals” to report parents of transgender youth to be investigated. Gov. Abbott’s order was following an opinion by Texas Attorney General Ken Paxton stating that allowing minors to receive transition care such as puberty blockers, hormone therapy and surgery is child abuse under state law. 

Republican Anti-LGBT+ Bills Sweep The Nation. As of late March 2022, 166 anti-LGBT+ bills are pending in state legislatures. Roughly 75 of these new bills restrict classroom discussions or books featuring LGBT+ issues or representation from public schools; nearly 50 bills attempt to ban transgender youth from playing sports that align with their gender identity; and at least 29 bills seek to ban gender affirming medical care. These bills have become especially prevalent as the GOP seeks to energize its base before the 2022 midterm elections. 

Improving Health Care Access Is Essential for LGBT+ Americans

LGBT+ Americans Suffer From High Prescription Drug Prices

Protecting LGBT+ Americans From Outrageous Price Increases. 21.6 percent of the LGBT+ community lives in poverty and nearly half of transgender people have postponed or skipped care due to cost. A 2018 study by the UCLA Williams Institute School of Law found that 15 percent of gay men and women delayed or went without medication in the past year. LGBT+ individuals have an increased risk of diabetes due to inequities in quality of health care. 

Closing The Medicaid Coverage Gap Would Help Low Income LGBT Americans Gain Coverage

Closing The Coverage Gap Improves Outcomes For LGBT+ Individuals. According to a Center for American Progress survey, in 2019, the LGBT+ uninsured rate was 20 percent in holdout states, compared to 8 percent in states that adopted Medicaid expansion. 29 percent of LGBT+ individuals faced difficulty seeking medical care when sick or injured due to cost. LGBT+ Americans are twice as likely to be without health insurance. 

Medicaid Drastically Reduces Disparities. Closing the Medicaid coverage gap is the single most important policy to expand coverage and reduce racial inequities in the American health care system. A 2021 study found that more Black LGBT+ adults had Medicaid as their primary insurance compared to their heterosexual and cisgender counterparts. 

Expanding Home And Community-Based Services Would Help Older LGBT Americans

Millions of LGBT+ Americans To Grow Old At Home. Federally provided home and community-based services funds helped more than 100,000 individuals return to their homes and communities from nursing facilities between 2008 and 2019. Allowing LGBT+ seniors to grow old at home helps alleviate the concern older LGBT+ adults have about being neglected, abused, or face discrimination in nursing home or assisted living facilities.

Throughout Medicaid Awareness Month, Protect Our Care has released fact sheets and hosted nationwide events with elected officials, storytellers, and health care advocates to highlight Medicaid’s critical role in America, discuss what needs to be done to expand and strengthen the program, and raise awareness of the consequences of Republican threats. This week, Protect Our Care is examining the role Medicaid plays in reducing disparities and improving health care outcomes for some of our nation’s most vulnerable populations, including communities of color, people living with disabilities, seniors and older adults, women, rural Americans, and children.

Medicaid is a lifeline for children and families in America. As a result of the Affordable Care Act and President Biden’s American Rescue Plan, which expanded the Medicaid program, millions of young Americans gained coverage and critical protections. Currently, roughly 39.6 million children in the United States are enrolled in Medicaid or the Children’s Health Insurance Program, including 48 percent of children with special health needs and 83 percent of poor children. 

A Closer Look at Medicaid For Children & Families

April is Medicaid Awareness Month. For decades, Medicaid and the Children’s Health Insurance Program (CHIP) have been crucial sources of coverage for America’s children. The Medicaid program remains widely popular as it has served as a lifeline for children and families during the coronavirus pandemic. As millions of families have lost their jobs and health care, Medicaid and the ACA have given them a place to turn to for comprehensive, affordable coverage. Unsurprisingly, by November 2021, total Medicaid and CHIP enrollment grew to an all-time high of 85.8 million Americans.  

By signing the American Rescue Plan into law, President Biden created historic legislation that includes the most significant health care expansion in a decade. The American Rescue Plan provided additional financial incentives for the 12 states that had not yet implemented Medicaid expansion. Since the signage of the ARP, two previous holdout states, Missouri and Oklahoma, have adopted Medicaid, expanding coverage to nearly 500,000 Americans. These measures will have profound impacts on children and their families for years to come. 

Without legislation or extension of the Public Health Emergency, 6.7 million children will lose Medicaid/CHIP coverage or go without coverage for a period of time. Due to the expansion in coverage from the COVID-19 pandemic, nearly half of the nation’s children are now covered by Medicaid/CHIP. 

By The Numbers

• More Than 37 Million Children Are Enrolled In Medicaid And CHIP. Roughly 39.6 million children in the United States are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Nearly 2 in 5, or 37.5% of children in America have health insurance through Medicaid.
  • Medicaid covers 48 percent of children with special health needs and 83 percent of poor children. 
  • Medicaid covers roughly 7.7 million, or 48.8 percent of young children, ages three and below.

• Nearly 4 Million People Would Gain Coverage If Remaining States Expanded Medicaid. Estimates from the Kaiser Family Foundation found that roughly 4 million people, including children, would enroll in Medicaid and the Children’s Health Insurance Program (CHIP) if the remaining states implemented expansion. 

• The Children’s Uninsured Rate In Medicaid Holdout States Is Double The Rate In Expansion States. According to the Georgetown Center for Children and Families, in 2019, the child uninsured rate was 8.1 percent in holdout states, compared to 4.1 percent in states that adopted expansion.

• Almost Half Of Births Are Covered By Medicaid. According to the Kaiser Family Foundation, 42 percent of births are covered by Medicaid. Thanks to the American Rescue Plan, states have the option to extend coverage to new mothers for one year postpartum, which will improve maternal health outcomes. 

• 17 Percent Of Parents Have Health Insurance Through Medicaid. 17 percent of parents have health insurance through Medicaid. When parents are covered, their children are more likely to have access to health care. 

• In 2010, Medicaid Kept 2.6 Million Americans Out Of Poverty. Even before the Affordable Care Act’s expansion of Medicaid, the program kept 2.6 million people out of poverty, “making it the third largest anti-poverty program in the country,” according to the Georgetown University Center for Children and Families. 

Medicaid Coverage Has Long-Term Benefits For Children 

Research Shows Medicaid Prevents Children From Dying Young And Saves Federal Dollars. A 2020 study found that children who received health insurance through Medicaid were less likely to die young, be employed in their adult life, and less likely to develop a disability as an adult. Medicaid for children also saves the government an estimated $200 billion when compared to the average cost of the program at $92 billion.

Medicaid Helps Children Stay Healthy, Leads To Long-Term Benefits For Children When They Grow Up. Medicaid eligibility during childhood lowers the high school dropout rate, raises college enrollment, and increases four-year college attainment. Medicaid for children also has a positive impact on employment opportunities later in life. For each additional year of Medicaid eligibility as a child, adults by age 28 had higher earnings and made $533 additional cumulative tax payments due to their higher incomes.

Thanks To Medicaid, Students Have Access To The Resources They Need To Focus In School. Medicaid’s Early Periodic Screening Diagnostic and Treatment benefit gives children under 21 years old access to comprehensive and preventative health services, such as yearly physicals, hearing, vision, and dental screenings, and physical, mental, and developmental disability treatments. The benefit also helps students gain access to medical supplies, such as hearing aids, glasses, and assistive technology, to help them succeed in school. 

One Study Found Medicaid To Have A Larger Impact On Child Poverty Than All Other Tested Benefits Combined. Medicaid reduces child poverty by an estimated 5.3 percentage points. This has a larger effect on reducing childhood poverty than all non-health means tested benefits combined.

Medicaid Helps Keep Families Out Of Debt. Out-of-pocket spending on health care pushed over 10.5 million Americans into poverty in 2016. Since the expansion, the program has covered the medical expenses of millions more poor and near-poor adults than it did previously, helping prevent households from becoming poor because of medical spending.

The ACA’s Medicaid Expansion Helps Children Gain Access To Care

After the Affordable Care Act expanded access to Medicaid, the children’s uninsured rate fell to an all-time low. Research confirms expanding access to Medicaid for parents has had ripple effects for their children. At the same time, states that continue to reject expansion are limiting children’s health care access: 

When Parents Have Medicaid, Their Children Are More Likely To Have Regular Care. The children of parents enrolled in Medicaid are 29 percent more likely to receive a well-child visit. This relationship is even stronger among families enrolled in Medicaid with household incomes at the federal poverty line as they are 45 percent more likely to receive a well-child visit. 

Medicaid Expansion Led To Gains In Coverage For Children As Well As Parents. Parents enrolled in Medicaid are more likely to access the support they need to be a healthy and effective parent. When parents gain coverage they are more likely to enroll the whole family, so the family will be protected from the economic strains of medical debt and lay the groundwork for optimal child development.

The Children’s Uninsured Rate In States That Have Rejected Expansion Is Twice The Rate In States That Expanded The Program — And That Gap Is Growing. The rate of uninsured children in states that have not expanded their Medicaid coverage grew at nearly three times the rate than that of states that have expanded Medicaid coverage. Texas and Florida, two non-expansion states, were responsible for 41 percent of coverage losses for children in a three-year period.

Throughout Medicaid Awareness Month, Protect Our Care has released fact sheets and hosted nationwide events with elected officials, storytellers, and health care advocates to highlight Medicaid’s critical role in America, discuss what needs to be done to expand and strengthen the program, and raise awareness of the consequences of Republican threats. This week, Protect Our Care is examining the role Medicaid plays in reducing disparities and improving health care outcomes for some of our nation’s most vulnerable populations, including communities of color, people living with disabilities, rural Americans, women, children, and seniors and older adults.

Medicaid is vital for ensuring access to quality, affordable care, especially for women of color who experience higher rates of poverty and remain less likely to have access to quality care. But thanks to the Affordable Care Act and President Biden’s American Rescue Plan,  31 million women across the nation have been able access care and coverage under Medicaid. 

A Closer Look at Medicaid For Women

April is Medicaid Awareness Month and Medicaid is an essential pillar in providing coverage for women. Generations of inequality have resulted in women experiencing high coverage costs, poor health outcomes, and health inequities. As a result, Medicaid coverage remains a critical source of coverage, especially for women of color who experience higher rates of poverty than white women and remain less likely to have access to quality care. For pregnant women, affordable health coverage is essential more than ever as the United States continues to experience the highest rates of maternal mortality among wealthy nations. 

Research confirms that Medicaid expansion saves lives and drastically reduces health disparities. States that expanded their Medicaid programs saw millions of women gain coverage. In 2019, eight states with women’s uninsured rates above the national average had not adopted Medicaid expansion. By rejecting expansion, these states are worsening the maternal health crisis and limiting health care access for the women who need it most. Despite Medicaid expansion’s proven role in reducing disparities in health care access and improving outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated four million uninsured adults are locked out of coverage in the 12 holdout states, with 2.2 million trapped in the Medicaid coverage gap. As of 2021, approximately one million women are in the coverage gap.

By The Numbers

• Medicaid Covers Over 30 Million Women Nationwide. 31 million adult women rely on Medicaid for coverage. In 2020, Medicaid covered 16 percent of nonelderly women in the United States. Women comprise the majority of adult Medicaid enrollees.
• Medicaid Is A Major Source Of Coverage For Women Of Color. Due to systemic inequality, women of color are disproportionately likely to be covered by Medicaid. Nearly 33 percent of Black Americans, 30 percent of Hispanic or Latino individuals, nearly 15 percent of Asian and Pacific Islanders, and 34 percent of American Indian and Alaska Native individuals are enrolled in Medicaid, compared with 15 percent of white individuals.
• Medicaid Covers Nearly Half Of Women With Disabilities. Medicaid covers more than 44 percent of nonelderly women with mental and physical disabilities. As of 2019, Medicaid was the source of health coverage for one in four American women with mental illness.
• Most Women On Medicaid Are Working. According to Kaiser Family Foundation, the vast majority of women enrolled in Medicaid work, including mothers on Medicaid. In 2019, 93 percent of women enrolled in Medicaid were either working, going to school, at home caring for young children or relatives, or experiencing an illness or disability that does not permit them to work. 
• More Than 4 Million People Would Gain Coverage If Remaining States Expanded Medicaid. Over four million people would gain Medicaid coverage if the remaining states implemented expansion, including 2.2 million trapped in the Medicaid coverage gap. 

Medicaid Is The Largest Payer Of Reproductive Health Care Coverage. Medicaid covers about one in five women of reproductive age, giving them access to reproductive health care services such as birth control, cancer screenings, and maternity care without cost-sharing. Two thirds of women enrolled in Medicaid are of reproductive age, with Medicaid accounting for 75 percent of all public expenditures on family planning services.

• Expanding Access To Care At Every Stage. There is an urgent need for quality, affordable health coverage prior to, during, and after giving birth. While 48 percent of maternal deaths occur during pregnancy and delivery, more than half, 52 percent, occur in the year following the birth of a child. 12 percent of maternal deaths are deemed ‘late’, occurring between six weeks and one year following delivery, demonstrating the immense need for continuous health access and coverage for a minimum of one year following the birth of a child. The Biden administration has established a pathway to coverage, providing states the opportunity to extend postpartum coverage under Medicaid from 60 days to 12 months following birth. Currently, four states have begun offering continuous Medicaid or CHIP coverage for 12 months after pregnancy and an additional 11 states and the District of Columbia are working to expand coverage. 
• More Than Four In 10 Births Are Covered By Medicaid. In 2020, 42 percent of births were financed by Medicaid, with 40 percent or more births covered by the program in 24 states and the District of Columbia. Rates varied across the nation, with 61 percent of births financed by Medicaid in Louisiana, and 22 percent in Utah. In the 12 states that have refused Medicaid expansion, eight had more than 40 percent of births covered by Medicaid. Medicaid covers 65 percent of all births to Black mothers. 
• Expanding Medicaid & Closing The Coverage Gap Is Critical To Improving Maternal Health. Women of color consistently experience higher rates of maternal mortality than white women, with the Center on Budget Policy and Priorities finding this to be the result of a combination of factors, including life-long toxic stress resulting from racism and the impacts of structural racism in the health care system. If post-partum Medicaid coverage was expanded to a full year in every state, more than 720,000 individuals would receive quality coverage. 65 percent of women of reproductive age living in the coverage gap are women of color. 
• Medicaid Expansion Improved Access To Primary Care & Family Planning. Two studies from Michigan showed that Medicaid expansion doubled low-income patients’ access to primary care, and that enrollees experienced improved access to birth control and family planning. 

Medicaid Improves Access To Care For Women. Women with Medicaid are far more likely to receive care than uninsured women. According to the Kaiser Family Foundation, women with Medicaid coverage are less likely than women with private insurance to report delaying or forgoing care due to cost. Women with Medicaid coverage receive preventive care at roughly the same rates as women with private coverage and at a higher rate than women without insurance. 

Medicaid Helps Pay For Long-Term Care, Mostly For Elderly Women. Medicaid pays for roughly half of the nation’s long-term services and supports. In 2020, women accounted for 61 percent of the 12.3 million dual-eligibles, or people who rely on both Medicare and Medicaid for coverage. Most dual-eligibles are elderly, and many need Medicaid coverage for their long-term care needs. Medicaid covers nearly 40 percent of Latina and Black women over 65 who are also covered by Medicare.

Medicaid Creates Jobs In The Health Industry, Which Is Overwhelmingly Female. Kaiser Family Foundation estimates that there are 15.5 million frontline health care workers — 77 percent of which are women — establishing Medicaid as a major job creator for women. 

Throughout Medicaid Awareness Month, Protect Our Care has released fact sheets and hosted nationwide events with elected officials, storytellers, and health care advocates to highlight Medicaid’s critical role in America, discuss what needs to be done to expand and strengthen the program, and raise awareness of the consequences of Republican threats. This week, Protect Our Care is examining the role Medicaid plays in reducing disparities and improving health care outcomes for some of our nation’s most vulnerable populations, including communities of color, people living with disabilities, rural Americans, women, children, and seniors and older adults.

Medicaid provides crucial support for seniors and older Americans. Thanks to the Affordable Care Act and President Biden’s American Rescue Plan, over 8.5 million adults aged 50 to 64 rely on Medicaid as a source of long-term care or to fill in gaps in Medicare coverage, such as transportation to medical appointments and medical equipment. As seniors age, long-term care services become more essential, serving half of seniors over age 75 and three in four seniors over age 85. Without Medicaid’s supplements to Medicare, millions of seniors and older Americans would not have access to necessary care and treatment. 

A Closer Look at Medicaid For Seniors & Older Adults

April is Medicaid Awareness Month and Medicaid is an essential pillar in providing coverage for seniors and older Americans. Medicaid remains a critical source of coverage as Americans age, with Medicaid serving as a primary funder for long-term care and filling many of the gaps in Medicare coverage, such as transportation to medical appointments and medical equipment. More than 7.2 million American seniors and 8.5 million adults aged 50 to 64 rely on Medicaid coverage. The benefits of Medicaid for America’s aging population often go unnoticed, but are essential to the health and wellbeing of this population. For seniors and older Americans with low incomes, Medicare premiums are paid by Medicaid, as well as deductibles and health care that requires cost-sharing. Without Medicaid’s supplements to Medicare, millions of seniors would be forced to go without needed care. 

States that expanded their Medicaid programs saw millions of seniors and older Americans gain coverage. Between 2014 and 2017, Medicaid expansion saved the lives of 19,200 older adults. At the same time, 15,600 older adults died prematurely as a result of their states’ decision not to expand the program. By rejecting expansion, these states are limiting the care older Americans can receive. Despite Medicaid expansion’s proven role in reducing disparities in health care access and improving outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated four million uninsured adults are locked out of coverage in the 12 holdout states. 

By The Numbers

• Millions of Seniors & Older Americans Rely On Medicaid Coverage. 7.2 million Americans over 65 are enrolled in Medicaid and more than 8.5 million Americans ages 50 to 64 have health coverage through Medicaid – many thanks to the Affordable Care Act’s Medicaid expansion.
• Nearly 1 in 3 Seniors Live Below 200 Percent Of The Federal Poverty Line. For millions of seniors and older Americans on fixed incomes, Medicaid is a critical lifeline.
• Medicaid Funds Over Half Of Long-Term Care Nationwide. As seniors age, long-term care services become more essential, serving half of seniors over age 75 and three in four seniors over age 85.
• More Than 4 Million People Would Gain Coverage If Remaining States Expanded Medicaid. Over four million people would gain Medicaid coverage if the remaining states implemented expansion, including 2.2 million trapped in the Medicaid coverage gap. 
• Medicaid Covers 6 In 10 Nursing Home Residents. The average annual cost of nursing home care is $82,000 — nearly three times most seniors’ annual income. 

• Over 1 In 5 Medicare Beneficiaries Also Have Medicaid Coverage. More than 20 percent of Medicare enrollees are dually eligible. Most dual-eligibles are over age 65, and are more likely to have complex and chronic health needs.

Thousands Of Lives Saved Each Year. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time, 15,600 older adults died prematurely as a result of their states’ decision not to expand the program. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in non-elderly adults by nearly four percent.

Medicaid Expansion Helps Americans Near Retirement Access Health Care. According to the Center for Retirement Research, after the implementation of the Affordable Care Act, the share of older adults without insurance declined as Medicaid enrollment grew, with the number of uninsured older Americans dropping from over 15 percent in 2012, to nine percent in 2016. 

Medicaid Expansion Helps Older Adults Gain Access To Care Immediately. Medicaid expansion helps older adults with disabilities gain quicker access to coverage without waiting for a disability determination, which can take years. 

Medicaid Expansion Reduces Out-Of-Pocket Health Care Spending. According to the Georgetown Center for Children and Families, between 2010 and 2015, the average out-of-pocket spending decreased in states that expanded Medicaid and increased in non-expansion states. Less than half of American adults ages 55 to 64 work and many live on fixed incomes. Some are retired, and for many others, chronic health conditions make it difficult to maintain steady employment.

Seniors And Older Adults Depend On Medicaid For Affordable, Comprehensive Care. As of 2021, there are 3.6 million older adults going without coverage. Older Americans often have more complex health issues, requiring additional medical attention that is often costly, pushing care out of reach. For seniors on Medicare, Medicaid serves to fill many of the gaps in Medicare coverage, such as transportation to medical appointments and medical equipment.

Low-Income Seniors With Medicare Depend On Medicaid For Long-Term Care. It is estimated that one in three seniors will need nursing home care at some point and two in three nursing facility residents utilize Medicaid to receive their care. Medicaid is a critical provider of home and community based care that are essential to keep loved ones at home with their families and neighbors. Without Medicaid, many seniors would not be able to afford these needed services with Medicare alone. 84 percent of individuals in nursing facilities covered by Medicaid in 2019 were dually eligible, with Medicaid covering costs once Medicare benefits have been depleted. 

Medicaid Reduces Poverty For Seniors And Older Americans. Medicaid has long been considered one of the most effective anti-poverty programs in the nation, and its expansion has significantly improved health outcomes for seniors and older adults. In a nation where out-of-pocket health care spending forced more than 10 million Americans into poverty in 2016 alone, Medicaid serves as a lifeline not only for health care, but for economic stability as Americans age. A January 2021 study from Health Affairs found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states.

Throughout Medicaid Awareness Month, Protect Our Care released fact sheets and hosted nationwide events with elected officials, storytellers, and health care advocates to highlight Medicaid’s critical role in America, discuss what needs to be done to expand and strengthen the program, and raise awareness of the consequences of Republican threats. This week, Protect Our Care will examine the role Medicaid plays in reducing disparities and improving health care outcomes for some of our nation’s most vulnerable populations, including communities of color, people living with disabilities, women, rural Americans, seniors and older adults, and children.

Medicaid has been a lifeline for many people with disabilities, as the program helps adults with disabilities gain quicker access to comprehensive care and coverage and increases financial security by reducing out-of-pocket health care costs. Thanks to President Biden’s American Rescue Plan, which strengthened the ACA by providing financial incentives for Medicaid expansion, Medicaid continues to have profound impacts on the lives of Americans with disabilities.

April is Medicaid Awareness Month, and Medicaid is a vital source of care for people with disabilities across the country. According to a 2019 report from the Census Bureau, approximately one in eight, or 41.1 million Americans, have a disability. Research has shown the people with disabilities covered by Medicaid are more likely to receive comprehensive and consistent care than those who are either privately insured or uninsured. The Medicaid program also provides half of all long-term care in the United States, which includes essential home- and community-based services for people with disabilities. Protecting access to Medicaid is essential to ensuring people with disabilities continue to get the care they need. 

Medicaid has served as a critical safety net as millions have lost jobs and their employer-based health insurance during the COVID-19 pandemic. Experts say an overwhelming majority of the people who have lost coverage during the pandemic have been able to get covered under the Affordable Care Act (ACA) or through Medicaid. By November 2021, Medicaid enrollment had grown to an all-time high of nearly 79 million Americans. 

President Biden took bold steps to strengthen the Medicaid program by signing the American Rescue Plan into law. This historic legislation includes the most significant health care expansion in a decade. Importantly, the American Rescue Plan provided additional financial incentives for the 12 states that had not yet implemented Medicaid expansion.Since the signage of the ARP, two previous holdout states, Missouri and Oklahoma, have adopted Medicaid, expanding coverage to nearly 500,000 Americans. These measures will have profound impacts on Americans with disabilities for years to come. If the remaining states expanded Medicaid, an estimated 500,000 people with disabilities could gain coverage. Expanding access to health care is particularly important as millions of Americans have contracted the COVID-19, with some “long haulers” facing the possibility of lifelong disabilities.

Without legislation or extension of the Public Health Emergency, millions will lose Medicaid coverage or go without coverage for a period of time. Due to the expansion in coverage from the COVID-19 pandemic, Medicaid enrollment has increased by more than 14.8 million people since the beginning of the pandemic.

By The Numbers 

• Over 41 Million U.S. Adults Have A Disability. 41 million Americans have a disability in the U.S. Thanks to the ACA, insurance companies can no longer deny them coverage, drop their coverage for no reason, or charge them more because of a pre-existing condition. 
• Nearly 7 Million Nonelderly Adults With Disabilities Depend On Medicaid For Care. Nearly 7 million adults enrolled in Medicaid have a disability. 
• Over 10 Million Medicaid Enrollees Under 65 Have A Disability. More than 10 million people under age 65 enrolled in Medicaid live with at least one disability.
• Nearly 45 Percent Of Adults With Disabilities Have Medicaid Coverage. Medicaid covers 45 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illness.
• 3 in 10 Nonelderly People With Disabilities Rely On Medicaid For Long Term Care. In 2017, 3 in 10 nonelderly people with disabilities relied on Medicaid for long-term care. Nearly 85 percent of this population has incomes below 200% of the FPL.

Republican Efforts To Block Medicaid Expansion Limits Access For People With Disabilities

Twelve years ago, the ACA opened the door for states to expand Medicaid, and the results are piling in: Medicaid expansion works. In addition to providing coverage for 18 million people, expansion has resulted in healthier people, communities, and economies. 

Study after study shows that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes. The program has increased access to lifesaving cancer screenings, improved infant and maternal health, and increased access to substance abuse treatment — and the list goes on. A growing body of evidence shows that expanding Medicaid has saved lives.

People With Disabilities Rely On Medicaid Expansion For Coverage. Of the 8.7 million disabled adults enrolled in Medicaid, only 43 percent qualify for supplemental security income (SSI). More than six in 10 nonelderly Medicaid adults with disabilities do not receive SSI, meaning that they qualify for Medicaid on another basis such as low-income or as parents in non-expansion states.

Medicaid Expansion Helps Adults Gain Access To Care Without Having To Wait On A Disability Determination. Medicaid expansion helps adults with disabilities gain quicker access to coverage without waiting for a disability determination, which can take years. The ACA Medicaid expansion has allowed people who previously weren’t eligible for coverage, and would otherwise be uninsured, gain coverage. Many uninsured individuals with pre-existing conditions who would have not qualified for Social Security Disability Insurance yet, can now be covered under the ACA.

Medicaid Expansion Reduces Out-Of-Pocket Health Care Spending, Which Is Especially Important For People With Disabilities Who Often Have Limited Incomes. According to the Georgetown Center for Children and Families, between 2010 and 2015, the average out-of-pocket spending decreased in states that expanded Medicaid and increased in non-expansion states. A majority, or nearly 85 percent, of adults with disabilities who have Medicaid coverage earn annual incomes of less than 200 percent of the FPL, $12,060 for an individual, making access to affordable health care even more essential. In 2022, CMS adopted rules to lower maximum out-of-pocket costs by $400.

Medicaid Is A Vital Source Of Care For People With Disabilities

Medicaid Helps People With Disabilities Receive Comprehensive, Consistent Care. Compared to people with disabilities who are covered by private insurance, nonelderly Medicaid adults with disabilities are four times as likely to receive nursing or other health care at home, more than 2.5 times as likely to have three or more functional limitations, and more than 1.5 times as likely to have 10 or more health care visits in a year compared to people with disabilities who are privately insured.

Medicaid Covers A Broad Range Of Preventive And Medical Services. Thanks to Medicaid, nonelderly adults with disabilities have access to regular preventative care and treatment for chronic illnesses and conditions. States are now required to provide a minimum amount of services for adults, such as hospital stays, physician, lab, and x-ray services, and nursing home care. States also have the opportunity to provide a broad range of optional services, such as prescription drugs, physical therapy, private duty nursing, personal care, rehabilitative services, and case management.

Adults With Disabilities Are More Likely To Have Medicaid, And Less Likely To Have Private Insurance, Than Those Without Disabilities. Adults with disabilities are three times as likely to be covered by Medicaid and half as likely to have private insurance. This is due to the greater health needs of people with disabilities and that they are less likely to have access to employer-sponsored coverage.

Medicaid Provides Half Of Long-Term Care In U.S. Medicaid provides half the nation’s long-term care. Medicaid providers and consumers have worked to broaden access to care in home and community based settings, where many seniors and people with disabilities would prefer to live. In 2013, the majority of Medicaid spending on long term services and supports (LTSS) was for home and community based services (HCBS) rather than for institutional care.

Medicaid Helps People With Disabilities Who Need Long-Term Care To Stay In Their 80 percent of nonelderly people with disabilities who use Medicaid long-term care are served in the community, with the remaining 20 percent in institutions. Over the past few decades, states have expanded community services to serve more nonelderly adults with disabilities instead of in nursing home facilities. HCBS typically are less expensive than nursing homes and are preferred by many nonelderly adults with disabilities.

Medicaid Increases Financial Security For People With Disabilities

Medicaid Is One Of The Most Effective Anti-Poverty Programs, Particularly For People With Disabilities. Medicaid reduced the health inclusive poverty measure by 3.8 percentage points. This is comparable to the combined effect of all social insurance programs and greater than the effects of non-health means tested benefits and refundable tax credits. The poverty-reducing effects were greatest for adults with disabilities, the elderly children, and racial/ethnic minorities.

Medicaid Expansion Increased Employment For People With Disabilities. Individuals with disabilities living in Medicaid expansion states are more likely to be employed than are those living in non expansion states. They are able to access and maintain Medicaid coverage while earning at levels that previously would have made them ineligible. However, the Supreme Court’s decision to make Medicaid expansion optional created a coverage gap into which some people with disabilities still fall. For people with disabilities in non expansion states, the existing population health disparities may widen.