Abstract
Abstract
To understand how policies either exacerbate or reduce employment inequality, this chapter examines state policy drivers of employment disparities between people with and without disabilities across US states, paying particular attention to the roles of Medicaid and Long-Term Services and Supports (LTSS) policies. Merging nationally representative data from the 2008–2019 American Community Survey (n = 19,506,716 adults ages 25–64) with a variety of state-level policy and administrative data, this chapter uses two-way fixed effects linear probability models to analyze how disability-based employment disparities vary across two aspects of state policy contexts: Medicaid generosity and the percentage of Medicaid LTSS expenditures allocated to Home- and Community-Based Services (HCBS) rather than institutional services. Model results indicate that employment disparities between disabled and nondisabled adults are smaller in states with more generous Medicaid programs and a larger percentage of LTSS expenditures allocated to HCBS. Greater allocation of LTSS expenditures to HCBS is the most important of these measures for reducing disability-based employment inequalities. Findings also suggest that state Medicaid and LTSS policies are more salient for the employment outcomes of disabled adults than nondisabled adults. Study results can inform the development of consistent, equitable policies across states that can improve the future of work for the disability community. To support the undoing of structural ableism, state policies must prioritize home and community living for people with disabilities by strengthening HCBS so that the state someone lives in does not determine their employment opportunities or access to resources.