When Congress began crafting a budget reform bill back in February, we shared some informed speculation about how Medicaid spending reductions might affect the limb-loss population. It wasn’t clear at that time how deep the Medicaid cuts might be, or even if there would be cuts at all: Congresspeople from both parties loudly defended Medicaid as an essential service for their constituents, and dozens threatened to scuttle any legislation that undermined the program. Just a few days ago, 16 members of the House majority reiterated that threat in a letter to Congressional leaders: “Protecting Medicaid is essential for the vulnerable constituents we were elected to represent. Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers.”
Well, here we are. The bill squeaked through last week (by two votes in the House and one vote in the Senate), and it will slash Medicaid spending by nearly $1 trillion over the next decade—the largest federal health-care spending reduction in history. More than 15 million people are expected to lose healthcare coverage as a result, according to Congressional Budget Office estimates. The bill also decreases the food stamps (SNAP) program to the tune of almost $200 billion, and it includes costs-saving modifications to the Affordable Care Act (Obamacare).
Amputees and other people with disabilities rely heavily on all of those programs, so they’re likely to bear a large share of the burden. According to detailed analysis by the advocacy organization Disability Belongs, “These changes are expected to significantly affect food security, access to healthcare, and the overall financial well-being of people with disabilities.” We combed through Disability Belongs’ issue brief to better understand how the law might impact federal programs that many amputees depend on. We also listened in on the NAAOP’s monthly webcast to get providers’ perspective. Here are a few top-line findings.
1. Spending Cuts Won’t Take Effect Right Away
The deepest reductions in federal spending won’t occur until after the 2026 midterm elections. That timing helped win the support of legislators who feared a “yes” vote would cost them their Congressional seat. It also buys time for individuals, local/state governments, and community organizations to develop strategies that might cushion the blow of lost funding. Those forward-facing ideas haven’t emerged yet, as advocates have focused their energy on the test of the bill itself. In the months ahead, Amplitude will share concrete, constructive steps you can take to mitigate the potential loss of federal benefits.
2. Maintaining Eligibility Will Become Harder
Supporters of the bill say the spending reductions will merely eliminate waste, while sustaining federal aid for everyone who truly needs federal it. But Disability Belongs paints a different picture, warning that the bill increases paperwork burdens that will cause millions of qualified recipients—including a disproportionate share of people with disabilities—to lose benefits they’re actually eligible for.
Paperwork errors already cause about 10 percent of Medicaid recipients to temporarily fall off the rolls each year, according to the issue brief. These interruptions routinely happen for innocent reasons—people change addresses, change employers, miss a deadline because they’re hospitalized, experience interruptions in internet access, etc etc. Going forward, it will be more difficult to reinstate individuals who mistakenly get dropped for procedural reasons rather than actual ineligibility. “While the intent behind these provisions is to reduce fraud and ensure provider integrity,” concludes Disability Belongs, “they risk unintended harm, particularly for beneficiaries with disabilities.”
In addition, many Medicaid recipients will need to file paperwork recertifying their eligibility twice a year under the new law. (The previous interval was once a year.) The key takeaway for anyone who relies on Medicaid, SNAP, and other benefits is to pay very close attention to eligibility requirements. A single misstep, no matter how trivial, could prove very costly.
3. Work Requirements Will Add to Paperwork Burdens
Over the years, various states have required certain Medicaid recipients to work 80 hours a month (or spend equivalent hours in job training, education, or community service programs). Beginning in 2029, work requirements will become mandatory for all 50 states. Although people with disabilities are exempt from work requirements, the criteria for establishing exemption are complex, and the burden of establishing eligibility falls on recipients—all of which may cause eligible individuals to lose benefits they’re entitled to.
It ought to be simple to claim the disability exemption when you’re missing a limb. But the relevant criteria have to do with income, SSDI status, Medicare’s disability criteria, and other bureaucratic arcana. As a result, says Disability Belongs, people with disabilities shouldn’t assume they’ll automatically be exempted from work requirements. Some people may lose coverage because the government fails to recognize them as exempt. When similar rules were implemented in Arkansas, nearly 20,000 people lost coverage in just five months—at which point the courts intervened and shut down the policy.
“People with disabilities may struggle to navigate the exemption process,” explains the Disability Belongs brief. “Challenges include knowing when to apply, understanding the required paperwork, dealing with errors in state systems, and navigating other administrative hurdles. State systems may not be prepared to identify exempt individuals accurately or in time to prevent termination. Reporting burdens can cause people to lose coverage even when they meet the requirements.”
4. Patients and States Will Have to Bear More Costs
Beginning in 2028, some adult Medicaid recipients will be charged copays on certain types of medical care, including emergency room visits that are deemed “non-emergencies.” Although multiple exemptions and qualifiers are written into the law to protect vulnerable patients (including those with disabilities), this provision creates another tier of confusing paperwork. Various states have estimated that this provision will lower Medicaid spending by tens of billions of dollars, with much of the reduction caused by patients voluntarily foregoing care to avoid the copay.
Other provisions of the bill will shift adminstrative costs—and, in the case of SNAP, direct benefit costs—from the federal government to the states, which lack the resources and budget flexibility to absorb them. “These new federally mandated changes will impact all citizens, not just those served by our safety net coverage programs,” wrote the health department director in one state (Colorado). “The bill is anticipated to result in the large-scale loss of health insurance coverage for Coloradans and an extraordinary cost shift to our state that Colorado’s state budget cannot absorb.” Colorado has begun planning for a range of adverse impacts, including “increased uninsured rates, medical bankruptcies, increased provider uncompensated care, and the cost shifting that will increase commercial health insurance rates paid by Coloradans and employers.”
The amputee community has only begun to mobilize in response to the new provisions passed by Congress. Amplitude will continue to share information about what you can do to protect yourself and other amputees from the adverse effects of the new law.
