解决孕妇、产后人群和幼儿的健康相关社会需求（HRSN）刻不容缓。医疗补助和妇女、婴儿和儿童特别补充营养计划（WIC）都可以改善怀孕、产后和儿童早期的健康状况，这是家庭快速变化的高风险时期。

北卡罗来纳州最近成为第41个将医疗补助扩大到收入高达联邦贫困水平138%的成年人的州（包括哥伦比亚特区），并在2023-2024年财政预算中颁布了这一举措。这只剩下十个非扩张州继续拒绝为数十万低收入人群提供挽救生命的医疗补助医疗保险以及随之而来的财政保护。

经营自己的州健康保险市场（SBM）的州具有独特的地位，可以帮助不再有资格获得医疗补助的人过渡到市场计划并获得。。。

An estimated 18 million people with disabilities living in the United States are eligible for federal housing assistance, but do not receive it. Due to low wages and lack of accessible housing options, renters with disabilities are often priced out of their local housing markets, or are moderately or severely cost-burdened if they do have housing. The Money Follows the Person (MFP) demonstration, administered by the Centers for Medicare & Medicaid Services (CMS), was established in 2005 to ensure people with disabilities who need long-term services and supports can receive them in the setting of their choice. The MFP Demonstration is intended to enable grantees—including 41 state and territory Medicaid offices—to experiment and evaluate how new ideas help people with disabilities move to, and remain in, their communities. This includes bolstering home- and community-based services and helping people who choose to move out of institutional settings to secure community-based housing.

工作报告要求不会增加就业，但由于繁文缛节和文书工作过多，在将人们排除在保险范围之外方面非常有效。

HSA绝大多数惠及高收入人群，并加剧了种族和民族不平等。

人们获得医疗保健和其他基本支持的机会不应取决于他们是否满足工作报告要求，或者是否成功地通过复杂的系统报告工作时间或申请豁免。

毫无疑问，在医疗补助中增加工作报告要求将导致许多低收入成年人因官僚主义障碍而失去保险，并使人们得不到所需的医疗保健，包括救命药物、慢性病治疗和急性疾病护理。

这种高度技术性的方法旨在削减联邦资金，并将以数百万通过医疗补助获得医疗保健的人为代价，危及覆盖范围，并将成本转嫁给各州和医疗保健提供者。

第1115条的示范通常使用基于收入或年龄的阈值来确定受益人是否受某些政策的约束。本白皮书为各州提供了一个可访问的资源，以支持在其示范评估中实施回归不连续性。