Land of opportunity...but not for all
Moving is a hassle for everyone. But the usual headaches and heartaches of relocating to a new place — finding a new home, packing and unpacking, and getting settled into a new community — are usually offset by the opportunities of the move.
For Americans with disabilities, however, there is an additional hassle — one that need not be added to a moving checklist, or risk canceling the move entirely.
America is a land of seemingly limitless options. Our Founders sought to create and safeguard a right to life, liberty, and the pursuit of happiness. Seizing great employment and educational opportunities is part of that pursuit of happiness, and it may include a relocation from one state to another.
While many ambitious Americans chase their opportunity without cause for concern, adults with a disability or families with children who are medically fragile often risk missing out on such opportunities because eligibility for Medicaid — government health care assistance for the needy — varies by state.
The difference in eligibility rules can make an interstate move for any reason almost impossible for those dependent on Medicaid.
When a Medicaid recipient moves to a new state, applications for new coverage cannot be made until he has established residency in that new state. Yet his existing coverage terminates as soon as he leaves his old state for the new one. While there is a provision for three months of retroactive coverage, the process to make the switch can often take longer.
There is also a difference between applying for coverage and actually being added to a new state's Medicaid rolls. Coverage is not instantaneous, regardless of prior eligibility. Vulnerable individuals can be left without needed medical coverage, creating dangerous situations that can be life-threatening.
Part of the problem is one of the things that is the most valuable to our federalist system of government.
The Tenth Amendment ensures that states can exercise the powers not already given to the federal government (or deemed illegal). These powers include overseeing health, education, and welfare concerns. Medicaid falls into that category, along with other benefits like SNAP food aid, TANF financial assistance, and unemployment coverage.
Federalism is a beautiful thing because it allows for this sort of local control. In this instance, each state can determine who is Medicaid-eligible along with what it means to be a resident of that state. But these disparities in eligibility requirements can unfortunately lead to people who need coverage being left vulnerable for up to a year.
Extended lack of coverage can be caused by a recipient's inability to navigate the system. Enrollment is daunting since everything is not in one place and each state operates differently. A whole cottage industry has developed in which Medicaid professionals guide applicants through the process. This can be pricey. And that's ironic, since part of the qualification for Medicaid eligibility is a lack of monetary resources.
Over 10 million people of all ages qualify for Medicaid because of a disability. Some need Medicaid coverage because their disability-related medical needs are not met through other coverage. Others simply do not have the financial resources to afford insurance through any other pathway.
Portability problems can cause a wide array of missed opportunities. For example, my friend's daughter, who was born with a significant disability, could not go to the university of her dreams because it meant changing states and thus losing her Medicaid. Another friend, who was born with a neurological disability, lost out on a dream job because Medicaid in the state where she would have to move won't cover the gap in what she needs to be able to live independently.
Compounding the aggravation is that this problem facing law-abiding Americans does not hinder those breaking our nation's laws.
Not only can an illegal alien cross the border into the United States and receive emergency Medicaid coverage on demand in the state where he arrives, but he can do so in any state where he relocates. Why can't poor and disabled Americans enjoy the same freedom?
States have reciprocity for the licensing of teachers and real estate agents and other professions. States have marriage reciprocity. Can't states also have Medicaid reciprocity? To protect federalism, it need not be an absolute. Start with six-month portability to make the move easier.
A concerted effort must also be made to help people become self-advocates in the enrollment process. As it is, existing frameworks and training can be difficult to find.
Governors can begin the reform process on their own through executive action. Over time, they can work together to create interstate compacts that will ease Medicaid transitions.
People with disabilities and their families should not have to forgo opportunities because they will lose this important coverage if they relocate to a new state.
Part of the role of Able Americans, the program I represent for the National Center for Public Policy Research, is to drive that discussion and help create free market solutions based on commonsense economic principles while still protecting vulnerable Americans so they can live the fullest possible version of the American dream.
Senior Advisor, Able American's Project
National Center for Public Policy Research