How the Big Beautiful Bill’s Medicaid work requirements punish people for being poor

They say the new Big Beautiful Bill only imposes Medicaid work requirements on so-called able-bodied adults. But from where I stand, this policy feels less like reform and more like punishment. I’ve lived through it as a disabled person trying to rebuild myself.

I labored my whole life living with disabilities until I was diagnosed with multiple sclerosis and could no longer physically work. Our bodies are our capital. Lose your body, lose your capital. I know what it’s like to be told you’re too poor to afford care, but somehow not poor enough to qualify for help. And now, they want to add another hoop: prove you’re disabled or go find a job, even if the reason you need Medicaid is because you can’t work.

Here’s the catch: You often need Medicaid to prove that you’re disabled.

In 2018, I just barely missed the income limit — $100 too much to qualify for Medicaid. I was on Social Security Disability Insurance (SSDI), attending college part time, and living in a 450-square-foot apartment in Philadelphia. I had Medicare, but the copays were too high. I didn’t get regular care because I couldn’t afford it. I rationed my food to keep the lights on and avoid another medical bill.

I waited nearly two years before I was approved for SSDI. And even after that, I had to prove I was still disabled every year, paying out of pocket for Medicare-required physicals. Do I eat or pay a $160 copay? I was fortunate to have a community of people help me with a safety net that had a few holes, but it was better than most have.

» READ MORE: Federal Medicaid and ACA cuts could leave half a million Pa. residents uninsured

For those still waiting on approval, it’s even worse. They’re told to prove they’re disabled just to keep care while they wait for a decision. But how? With what documentation? From what provider? At what appointment, when they can’t even afford to go?

Most doctors avoid certifying disability because the paperwork is time-consuming. Many people must hire lawyers, who are legally entitled to 25% of any back pay. That means most lawyers won’t take your case until the money has piled up, leaving people in limbo.

Then there are the smaller barriers: no phone, no car, no tech skills. These aren’t exceptions. This is the reality for many low-income people with disabilities.

And while we’re adding new red tape, the systems meant to help us are shrinking. Government job cuts over the past decade have left social services departments stretched thin. The red tape grows, while the hands to cut through it do not.

This bill solves a problem that doesn’t exist — and creates new ones.

This policy won’t just affect people who are “doing nothing.” It will hit people who are already doing everything they can, like those with disabilities who work part time or attend transition programs.

In 2018, Arkansas became the first state to implement Medicaid work requirements. More than 18,000 people lost coverage within months, primarily due to confusion or technical issues, not because they refused to work.

Most Medicaid recipients are already working, in school, or caregiving. According to a Kaiser Family Foundation study, 92% of nondisabled adults on Medicaid are either employed, in school, or unable to work for valid reasons. This bill solves a problem that doesn’t exist and creates new ones. The “able-bodied” adult is defined in vague terms, usually excluding those certified as unfit for work, in school, or caregiving. But in practice, people fall through the cracks, especially those with invisible disabilities or limited access to documentation.

Meanwhile, applying for disability takes time that people don’t have. In 2021, it took an average of 165 days to get an initial decision; so far this year, it’s about 230 days. If your case went to a judge, it could take even longer. Thousands die or go bankrupt waiting.

In Philadelphia, nearly one in three residents is covered by Medicaid — more than 669,000 people in our county alone. Many are in the same limbo I was in: working just enough to be disqualified, but not earning enough to live.

So when I hear lawmakers say this is about “helping people get back to work,” I want to ask: Do you even know what that takes? Do you know what it’s like to navigate these systems without a case manager, a printer, a car, or reliable internet?

If we want to improve people’s lives, then give them dignity. See their humanity. But instead of compassion, we get paperwork. Instead of healing, we get hoops. The hypocrisy writes itself.

Let’s fund care first, not just for the “fully approved,” but for those in-between, waiting, working, and trying.

I was one of the lucky ones. After eight years on SSDI, I managed to rehabilitate myself and come off benefits. It feels like a miracle. I’m an anomaly — not because I worked harder, but because most people stuck in the cycle of poverty never get the chance to leave SSDI. Community support, access to education, and sheer determination helped me recover. But it shouldn’t take a miracle.

Because if we keep punishing people for being poor, we’re not building a safety net. We’re pulling it out from under them.

Joseph Mahoney is a disabled social work graduate student living in Kensington and the coordinator of student supports at Temple University’s leadership and career studies program. He draws on his own experience with disability, poverty, and survival in public systems to advocate for equity in education and healthcare.