People who are desperately poor and disabled file claims with Social Security for Supplemental Security Income. If that claim is approved, they are categorically eligible for Medicaid, but that approval is unlikely to come until at least several months have passed and the wait can easily be far longer than that. How do they get health care in the meantime? Since the Affordable Care Act was passed, in most states, they’ve been able to get Medicaid because of their poverty. The Kaiser Family Foundation has a piece out about what’s in the process of changing on that front. The 2025 reconciliation act requires that as of January 1, 2027 those on Medicaid must meet work requirements. One exception to this work requirement is if the person seeking to get on or stay on Medicaid is “medically frail.” Those familiar with Social Security’s definition of disability know that the term “medically frail” isn’t part of that definition. To the best of my knowledge “medically frail” isn’t part of any definition previously used in any government program in the U.S. The reconciliation act defines “medically frail” to include “five categories of individuals who: are blind or disabled; have a physical, intellectual, or developmental disability that limits their ability to perform one or more activities of daily living (ADL); have a substance use disorder; have a “disabling” mental disorder; or have a “serious or complex” medical condition.” Again, for the most part, this is not Social Security terminology. Other guidance being given the states helps little.
Who in state government will be handling the workload of determining “medical fragility?” Probably the state disability determination services but they’re already overwhelmed with Social Security work. How long will it take them? It could easily be many months especially since the guidance they’ll receive probably won’t be great, especially at the beginning. The Trump Administration doesn’t have an abundance of Medicaid expertise. Many of the career employees who might have this sort of expertise are no longer working for the government. In the Trump Administration the political appointees who are supposed to be managing this may harbor considerable hostility towards poor people. They may be the sorts of people who naively believe that almost anyone can work and that mental illness is “all in your head.”
I don’t like how this may all sort out. There may be a lot of disabled people getting all their treatment at hospital emergency rooms? That’s bad for both patient and hospital. At least the hospitals will want a loose definition of “medical fragility.” They want to get reimbursement for the treatment they render and want to keep people who just need outpatient treatment out of their ERs.
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The State Agencies are not just overwhelmed by Social Security work, since they are paid by the SSA appropriations, I don't believe they could legally handle any work that was not Social Security related. If the States are going to determine "medical fragility" they would have to create an entirely now structure, perhaps by transferring some of the State Agency Adjudicators but they could not be paid by Social Security for their work.
Just another example of a decision that the politicians just didn't think all the way through.
Midterms in November 2026…
Medicaid cuts needed to happen In order for the rich to get their tax breaks. Republicans delayed the vast majority of cuts after the midterms but cuts are already taking place. Wall Street is enjoying another banner year on the backs of millions of poor and disabled individuals who are just trying to survive. It’s important to note that elections have consequences.and putting ones head in the sand doesn’t work these days. Welcome to the Golden Age America since we voted for this clown car …TWICE!
The rich get richer…
Putting Iran aside for a moment, I want to point out, besides Iranian news, just how strong the American economy is — war or not. By the way, the Dow Jones index just hit a new record high of 53,178.
In PA, the sate Medicaid agency has a Medical Review Team that makes decisions on disability-related MA and Emergency Medicaid. It's separate from DDS.
Medically Frail does appear in the ACA (42 U.S.C. § 1396u-7(a)(2)(B)(vi)). The ACA allowed Medicaid Lite in the expansion population (officially called alternative benefits plan), but medically frail expansion beneficiaries were protected from this and were to be put into the regular adult Medicaid plan. The implementing regulations (42 CFR § 440.315(f)) further defined and sub-categorized what Medically Frail is and Congress use this language to define medically frail in HR1. The Trump administrations implementing regulations added the additional requirement that a person be medically frail AND have a condition that significantly impairs the ability to comply with "community engagement". Who is going to determine that? Unknown. Hopefully a person will be able to self attest. Or maybe a form from a medical provider?
When PA first expanded Medicaid, it was going to have alternative benefits plans. To get the medically frail exemption a person had "to raise their hand" to get the full Medicaid package. After Gov. Corbett left office, Gov. Wolf got rid of Medicaid Lite and now all adults get same package.
🎢
The top 1% are justifying the “Big Beautiful Bill” in order for their handouts to continue. Come January 2027, all the corporate welfare will be on the cutting floor. ✂️
So, these new rules require more regulations in every state and bigger bureaucracy? Aren't republicans supposed to be against that?
You are forgetting that big government is a-ok with many right wingers if it’s hassling lefties or throwing up roadblocks between the indigent and even the most meagre anti-poverty benefits.
Many state DDSs also handle the state Medicaid workload , not that they have time for this extra nonsense put in place solely to prevent assistance getting to where it is needed. I’m waiting for the administration to go after MIRS.
I suspect the welfare workers will ask for a Dr letter and approve the status.
The object of this administration is to remove recipients from welfare roles by any means necessary to pay for the tax cuts for the wealthy.
Arizona has removed over 450,000 people from the Supplemental Nutrition Assistance Program (SNAP), effectively cutting the state's enrollment in half over the last year. This drop represents a 47% to 48% decline since July 2025, making Arizona the hardest-hit state in the nation following sweeping federal policy overhauls.
The Republicans thought this through, and this is exactly what they intended. Create obstacles, but leave no method by which the obstacles can be navigated. The whole idea is to gum up the works and make sure as few people as possible qualify. Death of Medicaid Expansion by a million cuts.
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