Only invalids need apply: States seek to exclude 'able-bodied' from Medicaid

Nov 24 2017
Mike Ervin
The Progressive

Now New Hampshire is getting into the act. It’s asking the federal government for permission to require most of the state’s “able-bodied” Medicaid recipients to either work or be in a job training program up to thirty hours a week.

This is a big trend: Arkansas, Indiana, Kentucky, Maine, Arizona, Utah, and Wisconsin are also seeking permission to impose similar eligibility work requirements on people who receive Medicaid.

This is supposed to make people like me—who aren’t “able-bodied”— happy. We’re supposed to be glad that scarce Medicaid resources are being preserved to serve truly needy disabled people, like us. But it has the opposite effect on me. I’d feel happier and more secure if Medicaid coverage was available to all.

As I see it, the more difficult it gets to become and stay eligible for Medicaid, the more that turns disabled people into invalids. Invalids are those stereotypical people in wheelchairs with blankets wrapped around their legs that we see in stock photos. They sit alone in a dark corridor, looking forlornly out the window. That’s all these sad shut-ins do. That’s all they can do. Invalids are miserable.

(Invalid sure is a sneaky little word, isn’t it? The accent is transferred over to the first syllable from the second, as if that changes what the word means.)

Work requirements are another ploy cynical conservatives use to stoke public resentment. Able-bodied people who can work shouldn’t be hogging up Medicaid money that’s intended for invalids, dammit! That’s what we’re all supposed to think.

But what exactly does “able-bodied” mean?

There are many people with the ablest of bodies, who are nonetheless significantly disabled by things like schizophrenia. Will they be disabled enough to deserve Medicaid? Is a physical disability automatically enough to qualify?

Let’s face it: Due to computer technology, almost nobody is too disabled to engage in some kind of marketable activity these days. Does that make a person no longer invalid?

The more these types of restrictions are imposed on Medicaid eligibility, the more disabled people who need Medicaid’s help may have to double down on playing the invalid game. It will be increasingly important to maintain our public image as useless and miserable. And you can bet that the same conservatives who champion these restrictions will continue to bitch about how programs like Medicaid foster a culture of dependency.

But suppose all I needed to get Medicaid was a pulse. I wouldn’t have to worry about living up to the mythical invalid standard. I’d be free to pursue opportunities and openly enjoy life, without worrying about who’s going to pay for expensive stuff like wheelchairs.

So as far as I’m concerned, when it comes to Medicaid, the more the merrier. But we’re moving in the opposite direction.


Mike Ervin is a disability rights activist with Chicago ADAPT, which is an organizational member of ISPC; a writer who bogs as "Smart Ass Cripple" and has published several collections of his columns; and a member of the artistic staff of Victory Gardens Theater in Chicago.

"Suppose all I needed to get Medicaid was a pulse?" Ervin asks. That's a perfect description of what we mean by national improved Medicare for all. It's simpler to improve (1st dollar coverage of all necessary care) Medicare and expand it to all residents of the US than to improve and expand Medicaid. Medicare is already a federal rather than a combined federal/state program (we need uniform coverage and standards across the country; we need to eliminate inequities among states). Medicare's only eligibility requirement is age (and some public retirees have different coverage) in contrast to complex Medicaid requirements, which differ among states, that include besides "ability" such factors as income, gender, age, and dependents. You only have to enroll once in Medicare; Medicaid requires yearly redetermination--a huge waste of resources for both the public and the people subject to this process, as well as being a source of errors. Medicare is generally seen as an earned entitlement rather than charity--we want to extend that to saying that it belongs to all of us simply by our living here (and paying our share of taxes to support it, according to our incomes/wealth). Regular Medicare (but not privatized Medicare Advantage) is portable across states. In short, we expanded and improved Medicare for all, also called single-payer health care.

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