Maggie Sanchez: You Can't Weaken Medicaid Without Weakening Everything It Touches

Maggie Sanchez is a Medicaid beneficiary, a mother of a child with disabilities, and a caregiver for a loved one living with severe mental illness. When she talks about what proposed federal Medicaid cuts would mean, she is not speaking theoretically.

Maggie also contracted COVID-19 during the pandemic and has not fully recovered. She has been managing the effects of long COVID ever since, sharing she is not her old self anymore. Medicaid has covered the care she needs to manage her condition while she continues to show up for her family every day.

Her loved one with severe mental illness has needed crisis intervention on multiple occasions, including for suicidal ideation. Each time, Medicaid made it possible for him to get care. Most recently, he was able to access a specialized facility that accepts Medicaid and limited private insurance. Without that coverage, that option would not have existed.

“Medicaid has literally saved his life,” Maggie said. “Many times.”

She is alarmed by proposed work requirements in federal legislation and what they would mean for him. Her loved one has tried, over and over, to work. He volunteers. He pushes through severe anxiety. But the barriers that accompany severe mental illness are real, and they are not always visible. “He may not look physically disabled,” Maggie said, “but he does need the support. He does need Medicaid to survive.”

The language around work requirements, she says, does not account for people like him. “What is the definition of able-bodied?” she asked. “That’s not clear in the bill.” She finds the framing ableist and disconnected from the reality of what it means to live with a serious mental health condition.

Maggie pushes back on the assumption underlying work requirements: that Medicaid recipients are not contributing. Many are already working, she says, often for low wages. Many others are caregivers for children or family members with disabilities, a responsibility that makes full-time employment nearly impossible, especially without access to affordable childcare. “So, you’re going to do both?” she asked, describing the impossible position caregivers would face.

Work requirements, she notes, have already been tested in other states. The result was not greater employment. It was people who were eligible for Medicaid losing coverage because of administrative hurdles they could not clear.

Maggie also has a child with disabilities whose care and support services depend heavily on Medicaid, including OPWDD waiver services for individuals with developmental disabilities. She describes the process of securing that eligibility as a second job, one that is unpaid, relentless and ongoing. “You have to do it in order to get just the minimum for your kid,” she said.

Even without explicit language targeting OPWDD services in proposed federal legislation, Maggie understands that cuts to Medicaid will cascade. “Just because you don’t directly have language in the bill that states that something’s going to be taken away doesn’t mean that it’s not going to affect those people,” she said. Medicaid, she explains, is deeply intertwined with hospital networks, jobs, and even private insurance premiums. When it weakens, everything connected to it weakens too.

Maggie lives in Queens, NY, and relies on safety-net hospitals like Elmhurst Hospital and the New York City Health and Hospitals network. She worries that reduced federal Medicaid funding will diminish what those institutions can provide to her community, which includes many Black and brown residents, immigrants, people with disabilities, and low-income families. “Do you know how many lives depend on those safety-net hospitals?” she asks, adding, “It’s going to affect every single person in the state, every single person in the country.”

Maggie thinks often about the people she knows and the people she does not: those who do not speak English, who lack access to the kind of information and advocacy networks she has built through her work with Medicaid Matters New York. “What about the people who don’t speak the language, who are not as privileged as me?” she asked.

Her message to the lawmakers who voted for these cuts is direct.

“People will die. And they have no idea the monster that they have unleashed. They have no idea the lives they’re going to destroy.”