Opinion: If Colorado's Medicaid work and cost-sharing program works so well, why would we oppose the federal proposal?

Let's be clear: At the Colorado Cross-Disability Coalition, we're not against working. And we're not against paying into the system. In fact, we've championed a Medicaid program in Colorado, the Working Adults with Disabilities Buy-In program, that requires both.

And we love it.

This program allows Coloradans with disabilities to earn money, get out of poverty and keep their assets while paying a monthly premium between $25 and $200, depending on their income. Since it launched over a decade ago, more than 25,000 of us have found a path to work through this program. It changed our lives.

It changed mine. I spent two decades in poverty. I always worked, but didn't always get paid because I couldn't risk losing Medicaid. This program gave me the opportunity to earn income, pay into the system, and finally have a life that wasn't defined by scarcity. I pay my monthly premium with pride.

Medicaid is the only health coverage that works for many people with disabilities. Private insurance often doesn't cover long-term services, personal care attendants or in-home support. For many of us, Medicaid isn't optional; it's essential to function, to survive and to contribute.

And Working Adults with Disabilities, or WAwD, doesn't require us to give that up just because we start earning a paycheck. However, what's being proposed in Congress won't help get people out of poverty.

How do we know? Because we've helped build and refine the WAwD program with the state over the past 10 years. Colorado worked with us, not against us. Our state understands that people with disabilities want to work, want to contribute and that we should be able to do so without being forced back into poverty just to qualify for health care.

The federal plan is being crafted without that understanding. It is being developed without the input of people who live with disability, and it lacks the nuance and flexibility that made Colorado's approach successful.

The differences are stark — and they matter.

Colorado's WAwD program is voluntary. If someone can't work, they stay on traditional Medicaid. They aren't punished or pushed out. Under the federal proposal, work requirements would be mandatory, regardless of individual ability or circumstances.

We don't require a minimum number of work hours. Why? Because life isn't that simple. What happens when someone's hours are cut? What about Uber drivers who don't get rides in a snowstorm? What about the person with a fluctuating illness who can only work 10 hours one month and 40 the next month?

Premiums are simple, fair and manageable. Our premiums are based on income and capped at less than 5%. We get a 60-day grace period. We can pay online. And the premium only changes with a major change in income.

And remember, this is voluntary. No one should skip care because they can't afford a copay. If we lose our job, our premium goes away, and we go back to regular Medicaid. Nobody falls through the cracks.

Colorado's Medicaid eligibility system runs through 64 counties. It was too much for the counties to manage on top of everything else, so the state had to set up a separate eligibility unit just for WAwD.

Even then, it's not smooth. But it works because it's small, focused and handled with care. Scaling a system like this nationally, without investing in the infrastructure or the people to run it, would be a disaster. This isn't something you figure out in a week or even a month.

Colorado funds its 50% share of WAwD through our hospital provider tax. If that option is taken away in the federal proposal, the entire program collapses. Twenty-five thousand of us go back into poverty. We lose everything we've worked for. Even if they allow us to keep the provider tax we have, not allowing us to grow will force people who want to work and need Medicaid to remain in poverty if we cannot expand this financing mechanism.

And that doesn't just hurt us. This model could help many more people, including nondisabled people who earn too much for Medicaid but can't afford private insurance. But if we can't maintain the funding or grow the program, those people lose out too.

We've spent more than a decade working side-by-side with our state to create a Medicaid model that encourages work and allows people with disabilities to move out of poverty. It is not perfect. It is not easy. But it's possible — and powerful — when it's done right.

The federal proposal? It's not that.

We believe in work. We believe in paying our share. But what's being proposed won't help people succeed. It will push them out, trip them up and cost more in the long run.

If Congress truly wants to support work and reduce poverty, it'll talk to the people who have lived through it and built the systems that work.

We're here. We're ready. We just ask that you listen.

Julie Reiskin, of Denver, is co-executive director of the Colorado Cross-Disability Coalition and is a client of the Medicaid Buy In for Working Adults with Disabilities.

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