The Domino Effect: Changing Lives, Changing Policies
Josh’s Story
Two families. Two states. One problem worth changing.
In Rhode Island and Tennessee, families reached out with the same heartbreaking dilemma: a loved one with a disability wanted to build a career and share a life with the person they love, yet doing either risked losing Medicaid and the long-term services and supports (LTSS) that make independent life possible.
Work and marriage were being treated like punishments.
In Tennessee, a husband broke his back and was already married—and that status, combined with outdated income and asset rules, kept him out of Medicaid and the caregiving he needed. The system effectively forced him to stop working and get divorced just to access care.
In Rhode Island, a dad recognized that his son, recently paralyzed, wished to work and to marry someday, but the current rules made that dream dangerous, threatening both Medicaid and LTSS if they pursued work or marriage.
I shared my Maryland blueprint: how we removed income and asset limits for workers with disabilities so they could keep Medicaid and the caregiving they rely on.
Together, we translated that model into each state’s reality, built simple, values-based talking points for a jobs-and-marriage bill, and anchored lawmakers in a core truth: no one should have to choose between earning a paycheck, committing to their partner, and accessing essential care.
On their first try through the state legislature, both states moved. Rhode Island’s reforms are in full effect. Tennessee’s reforms were signed into law by the Governor and are now awaiting final CMS approval.
The result? Families no longer have to choose between love, work, and care.
What makes this powerful isn’t just the policy win—it’s the ripple effect. One family’s persistence plus one clear blueprint can unlock freedom for thousands of others. And we’re not stopping here.
Josh
This is the start of a movement to transform the next state, and the next, until workers with disabilities can work without limits and marry the person they love without punishment. Let’s keep the dominoes falling.
