New Year, New Barriers: What the 2026 Policy Changes Mean for Disabled People

Every disabled person has the right to the highest attainable standard of health without discrimination. That's not just an aspiration—it's enshrined in the UN Convention on the Rights of Persons with Disabilities. Yet as 2026 begins, federal policy changes are moving the United States sharply in the opposite direction.

The One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, represents the largest cuts to Medicaid in U.S. history. The nonpartisan Congressional Budget Office estimates these cuts will strip healthcare coverage from approximately 10 million people over the next decade—with disabled people, chronically ill people, and multiply-marginalized communities bearing the heaviest burden.

This isn't abstract policy. It's about whether you can afford your medications, keep your home health aide, or access the care that keeps you alive.

Here's what's changing, what it means for our community, and how disabled people are organizing to fight back.

The Medicaid Cuts: What's Actually Happening

The Numbers Are Staggering

The OBBBA slashes approximately $1 trillion from federal Medicaid and CHIP spending through 2034. To put that in perspective: this single law will remove more people from healthcare coverage than any legislation in American history.

The cuts work through multiple mechanisms:

Direct funding reductions mean states will receive far less federal support. When federal dollars shrink, states historically cut "optional" Medicaid benefits first—and home and community-based services (HCBS) are often first on the chopping block. For disabled people who rely on personal care attendants, day programs, or other community supports to live independently, this threatens the very foundation of community living.

New restrictions on state funding limit how states can raise their share of Medicaid costs. Many states use provider taxes on hospitals and nursing homes to fund Medicaid; the OBBBA caps these taxes, further squeezing state budgets. States simply cannot replace the lost federal dollars on their own.

A token HCBS "expansion" that's designed to fail: The law creates a new HCBS waiver category with $50 million in funding for fiscal year 2026. Sounds good until you do the math—that's enough to cover approximately 27 people per state. Meanwhile, hundreds of thousands of disabled people languish on HCBS waiting lists nationwide.

Rural Communities Face a Double Hit

Rural areas—where disability rates are higher and residents disproportionately rely on Medicaid—face devastating consequences. The law includes a $50 billion "relief fund" for rural hospitals over five years. But spread across roughly 2,000 rural hospitals, that works out to about $4.5 million per hospital annually—and the funding disappears entirely after five years.

Compare that to the $12+ billion rural hospitals currently receive from Medicaid each year. More than 300 rural hospitals are already at "immediate risk" of closure. When rural hospitals close, disabled residents—who often have limited transportation options—lose access to care entirely.

Work Requirements: The Bureaucratic Trap

What the Requirements Actually Demand

Starting January 2027, every state must require adults in the Medicaid expansion population to meet "community engagement" rules or lose coverage. This means proving—every month—that you're working at least 80 hours, doing approved volunteer work, in job training, or attending school part-time.

On paper, exemptions exist for pregnant people, SSI recipients, people caring for dependents, and those deemed "medically frail." In practice, exemptions don't protect the people they're supposed to protect.

We've Seen This Movie Before

Arkansas tested Medicaid work requirements from June 2018 to March 2019. The results were catastrophic:

• 18,000 people lost coverage in just seven months—roughly one in four of those subject to the requirement
• No increase in employment—Harvard researchers found the policy had zero effect on work rates
• Most who lost coverage were working or qualified for exemptions but couldn't navigate the reporting system
• People who lost coverage experienced serious consequences: nearly half reported problems paying medical debt, 56% delayed needed care, and 64% delayed taking medications

The problem wasn't that people weren't working. The problem was proving it. Arkansas required monthly online reporting through a portal that many people couldn't access. Many didn't even know the requirement existed until they showed up at a pharmacy and discovered their coverage had been terminated.

Georgia's current "Pathways" program tells a similar story. As of late 2024, the program had cost federal and state taxpayers over $86 million—three-quarters of which went to consultants—while enrolling only about 6,500 people. That's roughly 75% fewer than the state projected for year one.

Who Actually Gets Hurt

The new federal work requirements will hurt:

• Disabled people who don't qualify for SSI/SSDI: An estimated 2.6 million adults with disabilities or serious illnesses don't receive federal disability benefits but still have significant barriers to work. They'll be required to prove 80 hours of monthly "engagement" or lose healthcare.
• People with episodic conditions: If your disability flares unpredictably, maintaining consistent monthly hours—and documenting them—becomes nearly impossible.
• People without reliable internet access: Reporting systems typically require online submission. Rural disabled people and those experiencing poverty face additional barriers.
• Caregivers and parents: While parents of children under 14 are technically exempt, proving that exemption requires navigating bureaucratic processes that trap eligible people.

The CBO estimates 5.3 million people will become uninsured specifically because of work requirements. Most experts believe that estimate is conservative.

The Six-Month Churn

Beyond work requirements, the OBBBA requires states to verify eligibility for Medicaid expansion adults every six months instead of annually. That means twice as many opportunities for paperwork to get lost, for addresses to be outdated, for eligible people to fall through bureaucratic cracks.

This isn't about finding ineligible people. It's about making coverage so difficult to maintain that people give up.

Medicare Changes: Prior Authorization Comes to Traditional Medicare

The WISeR Pilot Program

For the first time, traditional Medicare is introducing prior authorization requirements for certain services. The Wasteful and Inappropriate Service Reduction (WISeR) model launches January 1, 2026, in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.

Seventeen procedures will require pre-approval, including:

• Epidural steroid injections for pain management
• Spinal cord and nerve stimulators
• Certain knee procedures for osteoarthritis
• Various pain-management interventions

Private technology companies will review requests, using AI alongside human clinical review. These companies receive a percentage of the savings from services they prevent—a financial incentive that patient advocates find deeply concerning.

CMS officials insist contractors won't be incentivized to deny claims but rather to "get the determination right." But disabled people who've dealt with Medicare Advantage prior authorization know how these systems actually work: delays, denials, and appeals processes that exhaust people into giving up.

For now, WISeR affects only beneficiaries in six states needing specific procedures. But pilot programs have a way of expanding.

Other Medicare Concerns

The OBBBA also:

• Blocks rules that would have expanded Medicare Savings Programs, keeping strict asset and income limits that prevent low-income disabled Medicare beneficiaries from getting help with premiums and cost-sharing
• Eliminates Medicare eligibility for certain lawfully present immigrants who have paid into the system through payroll taxes
• Triggers potential automatic Medicare cuts of approximately $490 billion from 2027-2034 under PAYGO rules, unless Congress intervenes

The ACA Marketplace: Higher Costs, More Barriers

Enhanced Subsidies Are Gone

The OBBBA allowed enhanced premium tax credits to expire at the end of 2025. These subsidies—originally provided under COVID-era relief—have helped millions afford marketplace coverage. Without them, premiums spike for nearly everyone on the exchanges. An estimated 4+ million people could lose marketplace coverage because they can no longer afford it.

New Enrollment Barriers

The law also:

• Shortened the open enrollment period and eliminated automatic re-enrollment, meaning more people will accidentally end up uninsured if they miss deadlines
• Ended year-round enrollment for very low-income individuals (under 150% of poverty), removing a safety net for people who didn't know about deadlines or experienced qualifying events
• Cut off ACA subsidies for many lawfully present immigrants, including refugees and people with Temporary Protected Status

For disabled people above Medicaid income thresholds who rely on marketplace coverage, these changes mean harder choices between healthcare and other necessities.

One Bright Spot: Lower Drug Prices for Some

Separate from the OBBBA, the Inflation Reduction Act's Medicare drug negotiation program takes effect in 2026. For the first time, Medicare has negotiated prices on 10 high-cost medications:

Approximately 9 million Medicare enrollees use these medications. CMS estimates the negotiated prices will save beneficiaries $1.5 billion in out-of-pocket costs in 2026 alone.

Additional negotiation rounds will follow: 15 more drugs in 2027, and expanding from there. Combined with the $2,000 annual cap on Medicare Part D out-of-pocket costs (which took effect in 2025), this represents meaningful relief for many chronically ill and disabled people.

But here's the cruel irony: affordable medication only helps if you have coverage. And the same political forces celebrating drug price negotiation are stripping millions of people of their insurance.

ABLE Account Expansion: A Win Years in the Making

One genuinely positive change arrives January 1, 2026: the ABLE Age Adjustment Act finally takes effect.

ABLE accounts allow disabled people to save up to $100,000 without losing SSI eligibility—a critical tool for financial independence in a system designed to keep us poor. Previously, only people whose disability began before age 26 could open accounts.

Starting in 2026, eligibility expands to people whose disability began before age 46. This opens ABLE accounts to an estimated 6 million more Americans, including approximately 1 million veterans whose service-connected disabilities occurred after age 26.

This expansion resulted from years of organizing by disability advocates. It's a reminder that policy wins are possible—and that we have to keep fighting for them.

Who's Organizing and How to Get Involved

Disabled people aren't waiting passively for these policies to devastate our communities. Organizing is happening at local, state, and national levels.

National Organizations Fighting Back

ADAPT continues its decades-long fight for community living, organizing direct actions against Medicaid cuts and demanding enforcement of Olmstead. Their motto—"Free Our People"—remains urgent as policies push more disabled people toward institutions.

The Arc is tracking OBBBA implementation state-by-state and supporting families navigating the changing landscape. Their state chapters provide direct advocacy support.

National Council on Independent Living (NCIL) coordinates Independent Living Centers nationwide—critical resources as community-based services face cuts.

Autistic Self Advocacy Network (ASAN) focuses on how these changes specifically impact autistic people and others with developmental disabilities.

Little Lobbyists mobilizes families of medically complex children, putting human faces on policy through direct congressional advocacy.

Center for Public Representation pursues legal strategies to protect Medicaid rights and community integration.

What You Can Do

Know your deadlines: If you're on Medicaid, pay close attention to renewal notices. Respond immediately. Update your address with your state Medicaid office. Don't assume everything is fine.

Document everything: Keep records of your work hours, exemption status, and any communications with state agencies. If you're denied coverage, this documentation supports appeals.

Connect with local advocates: Your state likely has disability rights organizations, legal aid offices, and Independent Living Centers that can help navigate denials and appeals.

Share your story: Policymakers respond to constituent pressure. Contact your representatives. Attend town halls. Write op-eds. The more visible the human impact, the harder it becomes to ignore.

Support disabled-led organizations: The groups fighting these policies are chronically underfunded. Financial support, volunteer time, and signal-boosting all matter.

The Stakes Are Clear

The changes taking effect in 2026 and beyond represent a fundamental assault on disabled people's right to healthcare, community living, and basic security. They're not accidental—they're the predictable result of policy choices that prioritize tax cuts for the wealthy over healthcare for those who need it most.

But our community has faced existential threats before. The 504 Sit-In. The fight for the ADA. The Olmstead decision. ADAPT actions that put wheelchair users in the streets and in jail cells. Every protection we have exists because disabled people organized, disrupted, and demanded.

The policy landscape is grim. The fight continues.

Resources

If You're Facing Coverage Loss

• Healthcare.gov: Open enrollment information and special enrollment periods
• Medicaid.gov: State-by-state Medicaid contact information
• Benefits.gov: Screening tool for federal and state benefit programs
• Your state's Independent Living Center: Find yours at ilru.org/projects/cil-net/cil-center-and-association-directory

For Appeals and Legal Help

• National Health Law Program: healthlaw.org
• Center for Medicare Advocacy: medicareadvocacy.org
• Your state's legal aid organization

Stay Informed

• Kaiser Family Foundation Medicaid tracking: kff.org/medicaid
• Georgetown Center for Children and Families: ccf.georgetown.edu
• Center on Budget and Policy Priorities: cbpp.org

This article centers disabled people's expertise and draws on analysis from disability-led organizations, independent research, and Congressional Budget Office estimates. Last updated January 2026.

Have questions or want to share how these policies are affecting you? Reach out to The Crip Chronicle.