Asset building: One way the ACA can improve health and employment outcomes for people with disabilities

Working age individuals with disabilities are often forced to live in poverty to maintain Medicaid coverage. The Affordable Care Act may change this dynamic. The objective of this study was to determine the relationship between having assets in excess of usual Medicaid limits and the health and quality of life of Medicaid participants. Using self-reported survey data, we explored health and quality of life measures among a sample of Medicaid Buy-In participants ages 18 to 64. We looked for differences between groups with less than $2,000 in cash assets (the usual Medicaid limit) and with $2,000 or more, the higher asset group. Of the 441 who reported their asset levels, 15% had cash assets greater than $2,000. Participants with higher assets had significantly higher scores on measures of physical and mental health and quality of life. Respondents with intellectual disabilities were most likely to have higher assets (31%); people with physical disabilities were least likely (7%). Male participants were significantly more likely to have higher assets than females (23% vs 9%). Age was negatively correlated with assets, with younger individuals more likely to have higher assets. While many Buy-In programs allow participants to accumulate assets greater than $2,000, assets are still capped for most. Medicaid expansion under ACA does not limit asset levels in determining eligibility. Especially for younger individuals with disabilities and low income, coverage under the expansion might allow greater accumulation of assets and potentially better health and quality of life, while avoiding lifelong dependence on disability programs.