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Iowans with disabilities say House bill doesn't go far enough to ensure they can work, get married

iowa capitol
Natalie Krebs
A House bill would raise the household income and asset limits for employed people with disabilities to get Medicaid coverage.

More Iowans with disabilities who work could qualify for government-funded health coverage through Medicaid under a bill in the Iowa House of Representatives. But those who have been pushing for changes say it wouldn’t go far enough to ensure disabled Iowans can continue to receive services if they get a job promotion or get married.

The House Appropriations Committee advanced a bill last week that raises the household income limit for employed people with disabilities to get Medicaid from 250% of the federal poverty level to 300%. It also would raise the cap on assets they can have and still qualify for Medicaid.

At a recent subcommittee hearing on the bill, Ben Grauer of Iowa City said he became one of nearly 400,000 Iowans who are disabled after a spinal cord injury made him a permanent wheelchair user.

He said he earned a master’s degree, found a job, got engaged, and is looking for a house in which to start a family.

“Yet all of my successes are threatened by the inability to work and save while maintaining Medicaid benefits,” Grauer said.

People with disabilities who rely on Medicaid have been asking lawmakers to make income limits as generous as possible and ensure that only the income of the person who needs Medicaid is considered, rather than the income of their entire household.

Grauer said the bill being advanced doesn’t go far enough to ensure that people with disabilities can grow their careers and their families, and save for homeownership.

“We’re getting married in November, and we should only be stressed about what kind of cake we want, not whether one of us will need to ask for a pay cut or get divorced simply because I need to keep access to my health benefits,” he said.

Grauer said Medicaid covers services like personal care attendants, adaptive equipment and community living supports that are not covered by private insurance.

Current state and federal regulations let employed people with disabilities have a maximum of $12,000 of available resources for an individual and $13,000 for a couple to maintain Medicaid coverage. The bill would leave $12,000 as the asset cap for an individual, but a couple could have up to $24,000.

Rep. Josh Turek, D-Council Bluffs, proposed a separate bill that would put the income limit at 450% of the federal poverty level, and would only apply to the person who needs Medicaid. His bill also would have removed the asset limits, except for people who have a home valued at more than $400,000 and certain vehicles.

Supporters said current law discourages employment for disabled Iowans, and Turek’s bill would incentivize working, potentially expanding the labor pool by as many as 150,000 people.

Leslie Carpenter with Iowa Mental Health Advocacy said she supports the bill that advanced in the House, though she would have preferred legislation that went further in raising or removing income limits.

“Some of the people that we’ve encountered are people who are thinking about getting married to someone who lives with severe mental illness,” she said. “And one of the biggest questions they have is, what happens if we get married? Will they lose their insurance? Will they lose their disability?”

The bill advanced with bipartisan support.

Rep. Timi Brown-Powers, D-Waterloo, said she has a friend who had to be divorced and turn down a job promotion to keep her support services through Medicaid. She said the bill is a step forward to address the problem, but she wants the Legislature to do more in future sessions.

“We missed the mark in some of the areas,” Brown-Powers said. “This is still going to put folks in jeopardy getting married. I think that if we could take a bolder step I would’ve loved that. I think the return in the workforce would’ve been worth it.”

According to the Legislative Services Agency, the change to income limits would cost the state about $145,000 in the next fiscal year, $1.5 million the following year, and $2.5 million in the third year of implementation.

Rep. Ann Meyer, R-Fort Dodge, agreed that the bill is a first step.

“It is not everything everyone wanted, she said. “But again, it’s a good first step. And I know that we can continue, as long as I’m here, working towards a bigger goal.”

Katarina Sostaric is IPR's State Government Reporter