Benefits and Cost-Sharing for Working People with Disabilities in Medicaid and the Marketplace

Looking Ahead

Medicaid is likely to remain an important source of coverage for working people with disabilities, and the ACA’s Medicaid expansion and new Marketplace QHPs will provide greater access to affordable coverage for this population across the income spectrum. Given the state flexibilities provided in federal law, there is wide variation in Medicaid benefits and cost-sharing across states. Because of the additional flexibility that states have in designing their new adult ABPs, working people with disabilities who are covered as newly eligible adults may experience some changes in their benefits and cost-sharing if they move between different Medicaid coverage groups due to changes in their income and/or their health status (i.e., medical frailty). Most states have chosen to minimize any differences, but where they exist, newly eligible adults might have broader mental health and substance use treatment coverage and more limited LTSS coverage than other Medicaid adults in their state. Differences in benefits and cost-sharing are likely to be more significant when working people with disabilities move between Medicaid and Marketplace coverage, given the different rules that apply to each program. Understanding how these differences may affect working people with diverse disabilities can help inform future policy-making related to benefits and cost-sharing under the ACA’s new coverage options.