Medicaid work requirements don’t work for New Mexicans with disabilities

By GARY HOUSEPIAN, CEO OF DISABILITY RIGHTS NEW MEXICO
​Couresty of Source NM

Changes to Medicaid as a result of the One Big Beautiful Act could result in disabled New Mexicans losing their health insurance, the CEO of Disability Rights New Mexico writes.

Just when we thought we’d seen everything, Congress has thrown down a breathtaking new gauntlet: a national work requirement for people participating in Medicaid.  Every state will now be required to track the employment status of its Medicaid recipients in order to receive federal funding for the program.

We don’t know exactly how New Mexico will enact this new rule.  The “One Big Beautiful Bill” does not prescribe how to set up such a tracking system, and it certainly doesn’t fund it.  But every U.S. state will need the system in place in extremely short order, most likely by late 2026.

There are a lot of unknowns, but what we do know is this: Work requirements don’t work for people with disabilities.

As CEO of Disability Rights New Mexico, I have seen how every year, we provide free legal services to thousands of people with disabilities across our state. We exist, in part, because the systems designed to support people with disabilities are so often unnavigable.

​Now, Medicaid will erect a new barrier that many people with disabilities won’t be able to scale.  The new legislation requires that Medicaid recipients prove that they work, volunteer or attend school for 80 hours each month as a demonstration of worthiness for coverage.  If people fail to report, their health care is cut off.  There may be some exceptions to the work requirement for folks with medical issues or parenting obligations. But whether or not they are required to work, we are profoundly uneasy about the ability of many people to navigate a reporting system that requires regular check-ins and submission of documentation. Even if someone is entitled to a medical exemption, they don’t necessarily have the ability to provide regular proof of it.  

Consider the following common scenarios:

A young man with an intellectual disability works in a warehouse, where the predictable routine and structure support his ability to succeed on the job. He is enrolled in Turquoise Care, New Mexico’s basic Medicaid plan. Despite working 80 hours each month, his disability makes it impossible for him to regularly report his work hours to the state. Even though he is meeting the requirements, he loses his health coverage simply because he cannot navigate the reporting system.

A woman with traumatic brain injury meets the medical criteria exempting her from work. However, her disability deeply impacts her executive functioning skills to the point where she is incapable of filling out the exemption forms, scheduling a medical appointment to certify her status and regularly submitting the required documentation. Because of impairments caused by her disability, she loses her health care.

These aren’t hypotheticals. These are real examples of the many disability-related obstacles faced by real New Mexicans. And a lot more people are about to be impacted.

According to New Mexico’s Health Care Authority, HCA, New Mexico has 836,000 enrolled in Medicaid, approximately 40% of New Mexico’s population. Approximately 254,000 Medicaid members would be subject to the bill’s new work requirements. Although the details of exemption requirements have not been disclosed, we can expect a significant number of this group could lose coverage, not because they are unwilling to work, but because the policy ignores real world barriers. HCA estimates that nearly 89,000 will lose coverage for vital health care. We expect that number could be significantly higher, particularly in the rural areas where work and volunteer opportunities are limited. Added to that reality is the limitation of transportation of essential transportation services. As if those were not enough barriers to overcome, there is the new six-month redetermination requirements that pose an additional threat to maintaining continuing eligibility, especially for those with disabilities attempting to continue to meet paperwork requirements.  They will be subject to a confusing and punitive federal reporting mandate.  These individuals will need ongoing support to navigate the new rules and how to follow them.  
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We shared these concerns with U.S. Rep. Gabe Vasquez (D-N.M.) at a recent Medicaid roundtable, and he has taken action to try and right the ship on Medicaid. The entire Congressional delegation has been supportive of New Mexicans regarding the consequences of these Medicaid changes. We ask that other state New Mexico lawmakers and state leaders do the same, recognizing the chaos and harm that will be unleashed by this new federal mandate and taking steps to do something about it. We call upon our state’s leaders to develop, fund and support an employment reporting system that is as accessible, inclusive and fair as possible. We cannot allow the Medicaid system to punish the very individuals it was established to support by depriving them of essential health care services.