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APSE can be a strong voice for federal programs and legislation that support Employment First. The most effective voice of all, however, is a motivated constituent who takes the time to contact his/her legislator and weigh in on an issue. 


APSE provides tools--including APSE Action Alerts--to guide you when you contact members of Congress to discuss issues that matter to people with disabilities. We urge you to take advantage of these tools...and let us know how we can help!

Take Action

Updates in the Media

Medicaid Changes Ahead: 

Get Informed, Set Your Strategy, Take Action!

3. As a national organization...

The central principle of APSE's Employment First movement is that work is an important part of a meaningful, healthy, full life. Affordable, appropriate healthcare and employment services make full time jobs a reality for millions of Americans with disabilities. Since 2010, the Affordable Care Act (ACA)-- through its expanded Medicaid coverage--has enabled more people with disabilities to lead productive lives in their communities.


Health care reform is a top priority for both Congress and the Trump Administration. One of the first orders of business for the 115th Congress has been to lay the procedural groundwork to repeal the ACA. The Senate-passed measure allows Republicans on Capitol Hill to use a process known as "budget reconciliation" to roll back major parts of the health care law. The House passed its own version, and President Trump signed an Executive Order on January 20th that will enable federal agencies to take steps that will facilitate the repeal and replacement of the ACA.


Still uncertain, however, are the details of ACA/Medicaid reforms. As Congress and the Administration move forward, APSE will stay involved to advocate for the healthcare provisions that are vital to employment and self-sufficiency for all people with disabilities.


APSE urges members to join our efforts to ensure that those with disabilities have a voice in the ACA replacement bill and any subsequent Medicaid reform packages:

Updates from APSE

1. Get Informed

Major Proposed Reforms

  • REPEAL at least some--if not all--portions of the ACA, including Medicaid expansion. Although Congress has voted more than 60 times in the past to repeal the ACA, those in favor believe they now have the votes to do so. President Trump indicates he will sign such a measure. There currently is no working replacement for the ACA under discussion, although this is likely to change. Such major legislation would take many months to craft, especially if Congress carefully considers the concerns of those who have the most influence on this legislation: insurance carriers, hospital systems, and employers.  
  • CHANGE the way federal Medicaid funding flows to states. Currently, federal funds are allotted to individual Medicaid programs in each state. Proposed reforms include "block grants" or "opportunity grants" where the federal government would pay out a lump sum to each state. The state would then distribute the funding as it sees fit. A second funding alternative under consideration is "per capita caps." This means that the federal government would set a limit on how much it contributes for each Medicaid enrollee. Advocates worry that per capita caps lack the spending flexibility to meet the needs of many people with disabilities.
  • REDUCE the overall amount of federal Medicaid funding. States contend that they would not be able to make up for this funding gap without significant federal support.

2. Set Your Strategy

APSE urges members to monitor how reforms may affect the programs most important to people with disabilities in their area. Here are ACA and Medicaid provisions that have been especially important to the APSE community:  

  • Medicaid expansion - The ACA offers states the option of expanding Medicaid coverage to more low-income citizens. Thirty-one states and the District of Columbia have opted for the expansion.
  • Dependent coverage - The ACA allows young adults to remain under their parents' insurance coverage up to age 26.
  • Long Term Services and Support (LTSS) - Medicaid is the primary payer across the nation for LTSS, including those for children, adults, and seniors with disabling conditions. Medicaid provides coverage in several ways and over a continuum of settings, including community-based LTSS.
  • Community First Choice (CFC) - CFC makes it easier for states to offer home- and community-based services to Medicaid beneficiaries.
  • Home and Community-Based Services (HCBS) - States can provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than in institutions or other isolated settings. HCBS serve people with intellectual or developmental disabilities as well as physical disabilities. Services can include those that support employment goals.
  • Intellectual disabilities/developmental disabilities waiver - This program also provides services to help individuals remain in their homes and communities rather than in intermediate care facilities.

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