Medicaid Work Requirements and Their Impact on Brain Injury Survivors

The Big Picture

Proposed Medicaid work requirements would require brain injury survivors to recertify their disability every six months to continue to utilize Medicaid.

For many people with brain injury, that proof is out of reach. People with brain injury often struggle to find medical professionals needed to certify and recertify their eligibility, especially those with limited insurance, in rural areas, or facing long specialist wait times. These barriers, combined with the complex symptoms of brain injury—such as fatigue, memory loss, and difficulty managing paperwork—mean that even a small delay or missing form could cause them to lose life-sustaining services. Work requirements don’t promote independence; they create barriers and put vital home and community-based care at risk.

Understanding Brain Injury

Brain injury is not a one-time event; it can sometimes lead to a disability and develop into a chronic condition that can affect thinking, memory, speech, behavior, and mobility. Survivors often look “fine,” but some live with lifelong impairments that limit their ability to work or manage daily activities.

To qualify for Medicaid, individuals must submit medical documentation from a physician to verify their disability. Yet many doctors are not trained to recognize the chronic, invisible, and wide-ranging impacts of brain injury. As a result, people with brain injury risk being misdiagnosed or deemed “not disabled enough” for coverage.

Barriers to Medical Expertise

• Limited Access to Specialists: Many survivors, especially in rural or underserved areas, cannot find neurologists or rehabilitation experts familiar with brain injury.
• Overwhelmed Systems: Long wait times make it difficult to schedule appointments and obtain required forms.
• Knowledge Gaps: Many providers underestimate or misunderstand the long-term effects of brain injury, which can lead to inaccurate or incomplete disability documentation.

Insurance Gaps and the Cost of Certification

To be approved for Medicaid, individuals must first be screened and certified by a qualified medical professional.

But if they lack insurance or have inadequate coverage, they face impossible choices:

• Go without screening, leaving their disability unverified.
• Pay out of pocket for costly neurological or rehabilitative assessments.
• Be denied Medicaid eligibility because they cannot afford the certification process required to qualify.

This cycle punishes those most in need of support — forcing survivors to pay for the proof that they cannot afford care.

Burden of the Six-Month Recertification

Under proposed work requirements, Medicaid recipients would have to recertify their disability every six months to maintain coverage. That means survivors must:

• Secure new medical appointments and updated documentation.
• File paperwork within tight state deadlines.

For individuals with memory loss, fatigue, or executive-function challenges, this process is overwhelming. Missing a single form or deadline could mean sudden termination of benefits — including home- and community-based services that allow survivors to live independently.

Physicians and clinics are already struggling with staffing shortages and long waitlists. Adding more frequent certification requirements will worsen delays and force many survivors into lapses of care. Without Medicaid, they risk losing:

• Personal care attendants
• Rehabilitation therapies
• Access to medications and essential supports

The Bottom Line

Work requirements do not promote independence — they threaten it. For brain injury survivors, these policies create red tape instead of opportunity and push people toward crisis, institutionalization, or homelessness.