Recent Proposals Threaten Basic Needs and Independence for People with Disabilities

WASHINGTON, June 21 -- The Center on Budget & Policy Priorities issued the following news release:

President Trump and some Republican members of Congress are considering cuts that would make it harder for millions of people with disabilities to afford the basics -- food on the table, a roof over their heads, and access to health care. These cuts threaten the basic living standards of people with disabilities -- and would also threaten their ability to live with their families and communities, rather than in costly and isolating institutions. (While this paper focuses on Medicaid, SNAP, and federal rental assistance, the President's budget also cuts Social Security Disability Insurance, Supplemental Security Income, and other programs that assist individuals with disabilities. For example, it eliminates the Low Income Home Energy Assistance Program, which helps many low-income people with disabilities pay their energy costs.(1)) Alongside these disastrous cuts, the Trump Administration and some members of Congress are calling for extremely large tax cuts for the nation's wealthiest people and profitable corporations.(2)

Medicaid Cuts Threaten Health and Independence of People with Disabilities

Medicaid provides health coverage mainly for seniors, people with disabilities, and low-income families.(3) In addition to covering doctor visits, hospital costs, prescriptions, and other medical expenses, it offers supports that allow people to remain independent in their homes and communities, keeping them out of institutions.(4)

People with disabilities account for more than 1 in 5 Medicaid beneficiaries under age 65.(5) Nationwide, nearly 13 million non-elderly Americans with disabilities receive health coverage through Medicaid, including more than 2 million children. Nearly half of non-elderly people with disabilities have their health care covered through Medicaid. (See Appendix Table 1.)

Medicaid is crucial for people with disabilities. It provides comprehensive health benefits and serves as the primary payer for essential long-term services and supports that help people with disabilities stay independent in their homes. Many of these long-term care services are unavailable through private insurance and are too costly for all but the wealthiest people to fund out of pocket, such as personal and attendant care services. Medicaid can also cover wheelchairs, lifts, and case management services. And Medicaid can help people with disabilities find and hold jobs. A number of states provide supportive employment programs through Medicaid that offer services to help people with disabilities join the workforce.(6)

The deep cuts to Medicaid passed by the House in the American Health Care Act, which are under consideration in the Senate and included in the Trump budget,(7) threaten the health and independence of people with disabilities. The House bill would place a fixed cap on per-beneficiary federal Medicaid funding, cutting federal funding to the states by growing amounts over time. This would force many states to make excruciating decisions on whom they cover, the benefits they provide, and how much they pay providers, and likely would jeopardize coverage and care for vulnerable populations that Medicaid covers. People with disabilities who rely on Medicaid-funded services to avoid having to live in a nursing home or other institution would be among those hit hardest. The House bill's cuts would likely prompt many states to roll back their progress in expanding access to care in the community and prevent them from making more progress in the future. That's because unlike most services in Medicaid, which states must cover, most home- and community-based services are optional Medicaid benefits that states can cut when they face funding shortfalls.(8)

Moreover, many of the 11 million people who have gained coverage through the Affordable Care Act's Medicaid expansion struggle with disabilities, chronic illnesses, or other health conditions (such as mental health or substance use disorders) that wouldn't, by themselves, qualify them for Medicaid. Only 36 percent of non-elderly Medicaid beneficiaries with disabilities receive Supplemental Security Income, which allows them to enroll in Medicaid without the expansion. While others may be eligible for Medicaid based on other criteria, many could lose Medicaid coverage under the House bill and wind up uninsured.

Steep Medicaid cuts would make it especially hard for children with special health care needs, including those with disabilities, to get the care they need to stay healthy, remain in their communities, and succeed in life.(9) The cuts also threaten key resources for students with disabilities.(10) In both cases, the funding cuts will leave states seeking ways to reduce benefits provided through Medicaid as well as eligibility, both of which could leave children without the care they need.

As a result, many people with disabilities would have to go without needed services or get care in an institution, and many who have gained coverage under the Medicaid expansion would likely lose it.

SNAP Cuts Would Cause Hunger and Hardship for People with Disabilities

The Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) is the most important federal nutrition program. It helps eligible low-income households purchase food to be prepared at home.(11) The amount households receive depends upon their household size, income, and other circumstances that affect their ability to afford a basic diet; the average SNAP benefit is about $125 per person per month.(12)

People with disabilities account for nearly 1 in 5 SNAP participants under age 65.(13) Nationwide, about 9 million non-elderly Americans with disabilities receive SNAP benefits to help keep food on the table. More than a third of non-elderly people with disabilities receive support from SNAP. (See Appendix Table 2.)

SNAP helps people with disabilities afford the food they need.(14) Disability has emerged as one of the strongest known factors affecting a household's food security. Disability increases the risk of food insecurity -- inadequate access to food -- because it often reduces household income and increases household costs. Disability can reduce household income by limiting the educational attainment and earnings of people with disabilities, narrowing the range of jobs available to them, restricting their hours worked, and reducing the number of hours family caregivers can work given their caregiving responsibilities. Disability can increase household expenses for accessible housing and transportation, personal assistance services, assistive technology, and health care not covered by private insurance, Medicaid, or Medicare. As a result, food insecurity rates are about two to three times higher among households with members with disabilities than households without any disabled adults. (15)

Food insecurity, besides being more likely in households affected by disabilities, may also be more problematic for them. Food insecurity has negative effects on health and diet quality, and these effects may be greater for people with disabilities, research shows.(16) By providing households with income to purchase food, SNAP can reduce food insecurity for low-income people with disabilities.

The deep SNAP cuts proposed by President Trump and under consideration in Congress would harm people with disabilities. President Trump's budget would cut more than $193 billion -- over 25 percent -- from SNAP over the next decade.(17) The biggest cut would shift more than $100 billion of SNAP benefit costs to states, ending SNAP's status as a national program by letting states "manage their costs" by cutting benefits for people who need help paying for groceries.(18)

The budget would also end a state option to raise income limits or ease asset tests, which would disproportionately cut from SNAP people with disabilities who may struggle to afford food because they face high expenses related to their disability. Research shows that assets, particularly liquid assets such as savings, can protect these individuals from food insecurity. (19) Another proposed cut would eliminate the minimum benefit for small households, which also disproportionately benefits people with disabilities. Past House Republican budget plans have also included structural changes and other major cuts to SNAP similar to those included in the President's budget.(20) SNAP cuts of the magnitude of these proposals would inevitably mean more hunger and hardship for people with disabilities.

Housing Cuts Would Increase the Risk of Homelessness and Institutionalization for People with Disabilities

Federal rental assistance programs enable low-income households to rent modest housing at an affordable cost.(21) Three major programs -- Housing Choice Vouchers, Section 8 Project-Based Rental Assistance, and Public Housing -- assist about 90 percent of the households receiving federal rental assistance. Federal rental assistance provides flexible aid to meet the diverse needs of American families, including those with disabilities. An assisted household's rent is typically set at 30 percent of its income, making rent more affordable for those living on very low fixed incomes.

Nationwide, nearly 1.5 million people under age 65 with disabilities live in households that use federal rental assistance to help pay for housing, accounting for 15 percent of all people receiving rental assistance.(22) (See Appendix Table 3.) About 29 percent of households receiving federal rental assistance include a non-elderly adult or a child with a disability.

Federal rental assistance helps people with disabilities meet their basic needs and maintain their independence. Many people with disabilities live on fixed incomes that often fail to keep pace with rising rents. The poorest among them typically rely on Supplemental Security Income (SSI), for example, which offers a maximum monthly benefit of $735 in 2017 -- well below the average "fair market rent" of $861 for a one-bedroom apartment. In order to live independently in the community of their choice, many people with disabilities require housing that has special accessibility features -- such as wheelchair access and single-floor living units -- or ready access to nearby health services. Such services can enable people with disabilities to remain healthy and live independently and integrated in their communities, rather than in expensive nursing homes or other long-term care facilities.

The Trump budget proposes to cut rental assistance programs while raising rents on many assisted families.(23) Cuts to housing assistance would mean about 250,000 low-income households, including roughly 75,000 with disabilities, would lose vouchers that help them pay the rent.(24) The budget would also slash public housing funding by nearly 29 percent compared to 2017, exposing public housing residents -- a fifth of whom are members of households headed by people with disabilities -- to health and safety hazards and the risk of losing their homes. The Trump budget would also cut homeless assistance grants, which are essential to communities' efforts to prevent homelessness, including initiatives to reduce long-term or repeated homelessness among people with mental illness and other disabilities.(25) Steep cuts to rental assistance would increase homelessness and worsen hardship for people with disabilities.(26)

Conclusion

Disability can happen to anyone -- especially with advancing age. Serious illness or injury pushes many people, including families caring for children with disabilities, into poverty, and many more struggle to afford basic needs. The cuts that the President and some members of Congress have proposed would make it much harder for people with disabilities to get by, and would force many out of their homes and communities and into costly institutions -- even as these policymakers propose tax cuts heavily tilted toward high-income families.

See table & graph here: http://www.cbpp.org/research/disability/recent-proposals-threaten-basic-needs-and-independence-for-people-with

Footnotes:

[1] Kathleen Romig, "President's Budget Would Hurt People with Disabilities," CBPP, May 23, 2017, http://www.cbpp.org/blog/presidents-budget-would-hurt-people-with-disabilities; Iris Lav and Michael Leachman, "The Trump Budget's Massive Cuts to State and Local Services and Programs," CBPP, June 13, 2017. http://www.cbpp.org/research/state-budget-and-tax/the-trump-budgets-massive-cuts-to-state-and-local-services-and.

[2] Chye-Ching Huang, "Decoding 'Deficit Neutral' Tax Bill: Low-Income Program Cuts Pay for Tax Cuts for Wealthy," CBPP), June 15, 2017, http://www.cbpp.org/blog/decoding-deficit-neutral-tax-bill-low-income-program-cuts-pay-for-tax-cuts-for-wealthy and Chye-Ching Huang, "Trump Plan: $2.5 Trillion in Program Cuts for Low- and Moderate-Income People; $2.5 Trillion on Two Tax Cuts for Corporations and Wealthy Heirs," CBPP, June 1, 2017, http://www.cbpp.org/blog/trump-plan-25-trillion-in-program-cuts-for-low-and-moderate-income-people-25-trillion-on-two.

[3] "Policy Basics: Introduction to Medicaid," CBPP, August 16, 2016, http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid.

[4] "GOP Health Bill's Medicaid Cuts Threaten Care for People with Disabilities," CBPP, June 2, 2017, http://www.cbpp.org/research/health/gop-health-bills-medicaid-cuts-threaten-care-for-people-with-disabilities.

[5] CBPP analysis using American Community Survey data for 2015. Disability is defined as having difficulty hearing, seeing, performing cognitive tasks, walking or climbing stairs, dressing or bathing, or doing errands on one's own, or receipt of Supplemental Security Income (SSI) benefits.

[6] Hannah Katch, "Medicaid Work Requirement Would Limit Health Care Access Without Significantly Boosting Employment," CBPP, July 13, 2016, http://www.cbpp.org/research/health/medicaid-work-requirement-would-limit-health-care-access-without-significantly.

[7] Edwin Park, "Trump Budget Cuts Medicaid Even More Than House Health Bill, Showing Danger of Per Capita Cap," CBPP, May 23, 2017, http://www.cbpp.org/blog/trump-budget-cuts-medicaid-even-more-than-house-health-bill-showing-danger-of-per-capita-cap.

[8] Judith Solomon and Jessica Schubel, "Medicaid Cuts in House ACA Repeal Bill Would Limit Availability of Home- and Community-Based Services," CBPP, May 18, 2017, http://www.cbpp.org/research/health/medicaid-cuts-in-house-aca-repeal-bill-would-limit-availability-of-home-and.

[9] Jessica Schubel, "House ACA Repeal Bill Puts Children with Disabilities and Special Health Care Needs at Severe Risk," CBPP, June 14, 2017, http://www.cbpp.org/research/health/house-aca-repeal-bill-puts-children-with-disabilities-and-special-health-care-needs.

[10] Jessica Schubel, "Medicaid Helps Schools Help Children," CBPP, April 18, 2017, http://www.cbpp.org/research/health/medicaid-helps-schools-help-children.

[11] "Policy Basics: Introduction to the Supplemental Nutrition Assistance Program (SNAP)," CBPP, March 24, 2016, http://www.cbpp.org/research/policy-basics-introduction-to-the-supplemental-nutrition-assistance-program-snap.

[12] "A Quick Guide to SNAP Eligibility and Benefits," CBPP, September 30, 2016, http://www.cbpp.org/research/a-quick-guide-to-snap-eligibility-and-benefits.

[13] CBPP analysis using American Community Survey data from 2013 to 2015. Disability is defined as having difficulty hearing, seeing, performing cognitive tasks, walking or climbing stairs, dressing or bathing, or doing errands on one's own, or receipt of SSI benefits. Estimates vary depending on the definition of disability and identification of SNAP participants. For example, CBPP analysis using 2015 data from the National Health Interview Survey found about 22 percent of adult SNAP participants under age 60 had disabilities under a similar definition; SNAP administrative data, which uses a much narrower definition based on receipt of disability benefits, found about 13 percent of adult SNAP participants under age 60 were identified as disabled. See Steven Carlson et al., "SNAP Provides Needed Food Assistance to Millions of People with Disabilities," CBPP, June 14, 2017, http://www.cbpp.org/research/food-assistance/snap-provides-needed-food-assistance-to-millions-of-people-with.

[14] Carlson et al.

[15] Alisha Coleman-Jensen and Mark Nord, "Food Insecurity Among Households with Working-Age Adults with Disabilities," Economic Research Service, USDA, January 2013, https://www.ers.usda.gov/publications/pub-details/?pubid=45040.

[16] National Commission on Hunger, "Freedom from Hunger: An Achievable Goal for the United States of America," 2015, https://www.aei.org/wp-content/uploads/2016/01/Hunger_Commission_Final_Report.pdf.

[17] Dottie Rosenbaum et al., "Administration's 2018 Budget Would Severely Weaken and Cut the Supplemental Nutrition Assistance Program," CBPP, May 31, 2017, http://www.cbpp.org/research/food-assistance/administrations-2018-budget-would-severely-weaken-and-cut-the-supplemental.

[18] Michael Leachman et al., "President Trump's Budget Would Shift SNAP Costs to States, Increasing Risk of Hunger and Weakening Response to Recessions," CBPP, June 13, 2017, http://www.cbpp.org/research/state-budget-and-tax/president-trumps-budget-would-shift-snap-costs-to-states-increasing.

[19] Jin Huang, Baorong Guo, and Youngmi Kim, "Food Insecurity and Disability: Do Economic Resources Matter?" Social Science Research, 39(1):2010, 111-24, https://www.researchgate.net/publication/229092352_Food_insecurity_and_disability_Do_economic_resources_mat

[20] Dottie Rosenbaum and Brynne Keith-Jennings, "House 2017 Budget Plan Would Slash SNAP by More Than $150 Billion Over Ten Years," CBPP, March 21, 2016, http://www.cbpp.org/research/food-assistance/house-2017-budget-plan-would-slash-snap-by-more-than-150-billion-over-ten.

[21] "Policy Basics: Federal Rental Assistance," CBPP, May 3, 2017, http://www.cbpp.org/research/housing/policy-basics-federal-rental-assistance.

[22] CBPP analysis of 2016 Department of Housing and Urban Development (HUD) administrative data. HUD considers a person disabled if he or she has one or more of the following: a disability as defined in the Social Security Act; a physical, mental, or emotional impairment that is expected to be of long-continued and indefinite duration, substantially impedes his or her ability to live independently, and is of such a nature that such ability could be improved by more suitable housing conditions; a developmental disability as defined in the Developmental Disabilities Assistance and Bill of Rights Act; or Acquired Immune Deficiency Syndrome (AIDS) or any condition that arises from the etiologic agent for AIDS. Due to data limitations, these figures exclude a small number of people with disabilities. Other CBPP publications define disabled adults on rental assistance programs as persons under 62 with a disability.

[23] Will Fischer, "Trump Housing Changes Would Hike Rents on Struggling Families," CBPP, May 31, 2017, http://www.cbpp.org/blog/trump-housing-changes-would-hike-rents-on-struggling-families.

[24] Douglas Rice, "Trump Budget Cuts 250,000 Housing Vouchers," CBPP, May 26, 2017, http://www.cbpp.org/blog/trump-budget-cuts-250000-housing-vouchers; Will Fischer, "Trump Public Housing Cuts Would Hurt Vulnerable Seniors and Families," CBPP, May 25, 2017, http://www.cbpp.org/blog/trump-public-housing-cuts-would-hurt-vulnerable-seniors-and-families.

[25] Douglas Rice, "Trump Budget Would Increase Homelessness and Hardship in Every State, End Federal Role in Community Development," CBPP, May 23, 2017, http://www.cbpp.org/blog/trump-budget-would-increase-homelessness-and-hardship-in-every-state-end-federal-role-in.

[26] Anna Bailey, "Trump Budget Would Worsen Homelessness," CBPP, June 6, 2017, http://www.cbpp.org/blog/trump-budget-would-worsen-homelessness