Most Vulnerable at Risk for Losing Benefits
Federally funded assistance programs--Medicaid, Supplemental Security Income Program (SSI), Temporary Assistance for Needy Families (TANF), and Supplemental Nutrition Assistance Program (SNAP)--have never reflected the real-life needs, or the often-precarious financial circumstances, faced by low-income recipients.
Eligibility requirements are stringent. Voluminous documentation is needed. Changes, even minor, in household income can reduce payments or eliminate one’s eligibility.
In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act signed by President Bill Clinton ended welfare as an entitlement program; required recipients to work after two years of benefits; and imposed a five‑year lifetime limit on federally funded benefits.
On July 4, 2025, President Trumps’ “One Big Beautiful Bill Act” ushered in dramatic cuts to Medicaid, SNAP, and other low-income support programs, passed costs and burdens onto states and recipients, added additional eligibility requirements, and placed millions of recipients at risk for losing access to basic healthcare, food aid, and cash assistance.
Federal assistance program policies are shaped by several concepts, including legislators’ beliefs about who is “deserving” of help, societal attitudes that often link poverty to personal failure, competing fiscal priorities, and the broader ideological view that government support should be limited.
Recipients, unfortunately, generally lack the political influence needed to resist funding cuts or the imposition of restrictive policies.
Recent Rulings
Health care advocates are concerned that recent rulings from Medicaid (administered by the Centers for Medicare & Medicaid Services) and another from SSI will negatively impact beneficiaries.
The Medicaid rule takes effect January 1, 2027, and requires states to determine who is “medically frail” and unable to work, volunteer or attend school.
SSI’s rule (RIN: 0960-AI94), under review by the White House Office of Management and Budget, will affect disabled adults living with their families.
Prove You’re Too Sick to Work
Beginning next year, Medicaid recipients who are currently exempt from the 80‑hour‑per‑month work requirement will be required to provide proof that they are medically unable to work, volunteer, or attend school. Beneficiaries may self‑attest to their condition through 2027. Starting in 2028, however, self‑attestation will be allowed only once; after that, individuals must submit medical documentation every six months to maintain their exemption and keep their coverage.
At issue is who will determine whether chronically ill or disabled recipients are able to work.
The Trump administration requires states to determine which “serious or complex medical conditions” could exempt someone from work requirements. Even so, merely having a condition does not remove the work requirement.
Jennifer Hoque, at the American Cancer Society Cancer Action Network told Politico, “States … have some ways to tell whether someone has a diagnosis … (such as) code lists and lists of diagnosis codes and claims data to try to identify people automatically who would have this exemption … But adding an element of ‘unable to work’ — nobody knows where that data will come from.”
According to the article, “… state officials, clinics and patient advocates (worry) that it will ultimately fall to individual doctors to evaluate each Medicaid enrollee seeking a medical exemption from the work rules and determine whether they are physically able to work.”
While doctors can evaluate how long a patient will need for recovery from a short-term disability-- an accident or a procedure--it is more difficult to figure out whether they can work— especially without knowing what kind of jobs are available to a particular patient.
Sarah Maresh, program director for health care access at the nonprofit Nebraska Appleseed added, “Our providers are strapped for time and buried in paperwork. But we’d be even more worried about a state caseworker making that determination when they’ve never even met the person.”
Critics of the ruling fear that chronically ill people, “whose ability to work often fluctuates, will fall through the cracks and become uninsured at a time when they most need care.”
Disabled Adults Face Cuts in Aid
In April 2026, ProPublica reported on a new SSI ruling under review that “… would slash benefits or end support for as many as 400,000 (SSI) recipients with Down syndrome, dementia and other disabilities whose parents or relatives receive SNAP benefits.”
For example, Shy’tyra Burton, 22, was diagnosed at age four with “… a litany of developmental and intellectual disabilities that left her with an IQ below 70.”
She lives with her father who makes around $2000 a month as a sanitation worker.
Under SSI’s proposed changes, Burton’s $994 benefit, which allows her to contribute to the household, purchase food, and pay her phone bill, could be cut by one-third based on “the value of (her) bedroom.”
Any income and assets her family may have will be calculated and recalculated as often as every month and deducted from (her) SSI check.”
The National Lawyers Guild (NLG) stated, “SSI rules would reduce or eliminate benefits for disabled people who live with family members, including parents and adult children. These changes would disproportionately impact disabled adults with high support needs, as well as older people forced by economic conditions to rely on shared housing arrangements.”
ProPublica explained, “Burton will likely have to make an appointment and report in person at a Social Security field office any time her father’s hours or wages change even slightly; any time she and he switch up how they split utility bills; and any time an adult sibling spends even a few nights at the house and helps her with living expenses. If she doesn’t, she could later receive bills accusing her of having been overpaid by Social Security.”
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