ID: A photo of a newlywed couple. The bride sits in the arms of a groom in a wheelchair, which has a big bouquet of flowers on the back.

Getting married shouldn't be a matter of life and death.

But for many disabled people, it is.

You shouldn't have to choose between marrying your significant other or staying alive.

But for many disabled people, they do.

It's an embarrassing and unpublicized fact that, in a nation that seemingly champions marriage equality regardless of race, gender, sexuality, or religion, there are still legal, systemic barriers preventing up to 23% of the population's right to marry.

In honor of Disability Pride Month, I'll explain how this is (still) possible and what can be done about it. I myself am not very savvy when it comes to adult-ish things like insurance, Social Security, and income accounting. So, I'll break it down from the basics so that nobody can claim ignorance.

What is Medicaid?

To paraphrase medicaidplanningassistance.org, Medicaid is a national insurance provider that provides health coverage to millions of Americans. Medicaid is handled by state governments, but follows national requirements. Some states may have variations or additions to policies, but they're all based on the same guidelines. The program is funded jointly by state and the federal governments. 

(As a refresher, income is the money a person earns monthly/yearly from their job, funds, or allowances. Assets are items like stocks, savings, jewelry, a home, or a business that can be sold, traded, or invested for money.)

It is a needs-based program, meaning people can only qualify if they fall below a certain level of income; typically, around the poverty line. What the specific amount is varies slightly by state and year, to account for inflation.

While Medicaid is mostly known for helping elderly people, the other main applicants they provide for include:

• children

• pregnant women

• low-income adults

• people with disabilities

The disabled population in particular has a special relationship with healthcare. They need it:

• To Live (at all)

• To Live Well

• To Live Long

• To take care of others

Forced Poverty

As previously stated, people can only qualify for medical coverage with Medicaid if their income falls under a certain threshold: the poverty line.

According to medicaidplanningassistence.org,

Nearly any income that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in TX, the Veteran’s Aid & Attendance and Housebound Allowances, which are above and beyond the Basic VA Pension, do not count.

In Texas, the most recently calculated poverty line for an individual is $14,880 and $29,950-30k for a family of four denizens. This might seem like more than enough for an individual. But for many disabled people, it dries up fast thanks to monthly therapies, treatments, medications, assistive devices, hired caretakers, transportation, and typical necessities. "If insurance or the government ... see fit to help ease some of the burden of what it costs to be disabled, then those programs should be appreciated, supported, and expanded," writes Allie Williams, an advocate from SpinalMuscularAtrophy.net. "Disability should not cost so much."

How can these thresholds be legal? Well, the U.S. Supreme Court has maintained that the Marriage Penalty does not violate the Fifth Amendment, which prohibits the government from depriving citizens of property without due process of law (Disability Rights North Carolina).

I personally know people by name who are perfectly capable of having jobs, but they cannot receive payment for them, lest they lose some or all of their benefits. This includes minimum wage jobs, freelancing, and even selling art on Etsy. What's more is that, if someone is able to keep a minimum wage job, for example, they can still lose their benefits because their income adds up to the threshold over time. Keeping the threshold at the poverty line keeps many capable, hardworking individuals out of the work force, in poorer living conditions, and dependent on the government in cyclical inequity.

Can't Get Married

When people marry, their income and assets combine, thus throwing many people in need of Medicaid over the threshold and taking away their insurance benefits. Applicants can lose their Supplemental Security Income (SSI) and Medicaid if they marry a person with an equal or greater level of income/assets. And, if two applicants marry, both face a 25% reduction in benefits, a cap on their assets, or the loss of eligibility for any benefits at all (DREDF). Hence, the name "Marriage Penalty."

Shane and Hannah Burcaw, an interabled couple and lifestyle vloggers, frequently share about their experiences with insurance difficulties and medical surprises. In one video, they list what they wish they had known before getting married:

SHANE: "I wish we had known more about income restrictions as it relates to their ability to get hired caregivers."

HANNAH: "We talked about this in the past how, when you get married, your spouse's income and your income get added together, and for a lot of people, that disqualifies them from getting subsidized healthcare or caregivers' income because of a disability. So, to qualify for those things, you need to be below the poverty line, essentially."

Here, the Burcaws relate the specific problem with professional, Medicaid-afforded caretakers for Shane's daily needs, which many other disabled people need as well. However, caretakers are among the first benefits to be revoked.

Figure 1: A bar graph illustrating how the combined incomes/assets surpass the threshold for married couples. At 500 is Person 1, disabled. At 1,000 is Person 2, nondisabled. Their combined income is 1,500. The threshold for married couples is around 1,400. The threshold for individuals is 900.

As the above, generalized graph illustrates, even if a couple's combined incomes only throws them over the threshold even just a couple hundred dollars, they can still be cut off. In some states, common-law marriages can also be used as an excuse to kick couples off the government's payroll.

Additionally, medicaidplanningassistence.org claims:

The non-applicant spouse, however, may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse to prevent spousal impoverishment. In 2025, the MMNA in TX is $3,948 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred to them from their applicant spouse, bringing their income up to this level. A non-applicant spouse who already has an income of $3,948 / month or more is not entitled to a MMNA / Spousal Income Allowance.

This policy stipulates that the nondisabled spouse can qualify to receive a monthly allowance of their own (MMNA). However, if the spouse's monthly income is greater than $3,948, then they may lose their allowance. Ironically, this policy strives to inhibit poverty on the part of the nondisabled spouse, but not the disabled applicant. And, just as ironically, you can lose it if your monthly income surpasses poverty. 

$3,948 per month comes out to about $47,376 per year, which is below the federal poverty line for a household of seven denizens. This might seem okay, but factoring in the sheer hundreds and thousands of dollars disabled people regularly spend on medical care, transportation, and other typical necessities, it gets used up quickly. Also, $47k is far below the Texas median household income of $67k, which is already below the national median of $74k.

Can't Get Divorced

Sadly, the Marriage Penalty doesn't end here. Not only are people unable to get married, but divorced too.

In order to learn more details about the Marriage Penalty, one must dig past the polite fronts of official websites to the Q&As. As one provider explains:

Assets, on the other hand, are considered jointly owned. That said, there is a community spouse resource allowance that allows a non-Medicaid spouse to retain a larger portion of the couple’s assets. At the time of this writing (2020), most states allow a non-applicant spouse to keep up to $128,640, while the applicant spouse can retain $2,000 in assets.

According to this policy, the non-Medicaid spouse retains control over the majority of assets that may chiefly or originally belong to the Medicaid spouse. Thus, while the Marriage Penalty makes it near-impossible for some to get married, it also makes it near-impossible to get a divorce. “(W)hen you think about it," says disability advocate Imani Barbarin, "that also makes the disability community ripe for abuse, financial abuse, spousal abuse. Because if somebody has your assets in their name, you have nowhere to go.”

Why Should This Matter to Me?

These Marriage Penalty is based on five ableist assumptions:

1. The disabled person’s spouse is not also disabled.

2. That spouse is the main breadwinner of the family.

3. That spouse’s job has sufficient medical insurance.

4. That spouse’s job is high-paying enough to afford medical care out-of-pocket.

5. That spouse is able to be the main/fulltime caretaker.

These policies are not neutral calculations that happen to be inconvenient, but are intentionally systemic. The thresholds are consistently revised year by year to account for inflation, which means that there are people who interact with these policies from an authoritative standpoint to keep them updated, but unchanged. As Gabriella Garbero, an attorney and wheelchair user says, “I think that the government sees us as an expense and not as people worthy of fundamental rights.”

Imagine becoming disabled due to an accident or illness and, on top of the hundred things you need to adapt to and thousands of dollars of medical expenses, you face the possibility that you and your partner may never get to fulfill the married life you planned together. 

The disabled community is one of the few demographics that pervade race, religion, nationality, and cultures all over the world, due to the simple reality that, if you live long enough, you will become disabled in one way or another. Also, anything can happen at any time to disable you, thrusting you into an underserved community.

When you care for a community that you're not a part of, they will, in turn, care for you when your time comes to join.

What Can Be Done?

Sign and make petitions!

• Disability Petitions (Link)

• Protect Section 504 - change.org (Link)

• Protect Section 504 - Resistbot (Link)

Lobby for new bills and policies!

• S.2767 - SSI Savings Penalty Elimination Act (Link)

• Find Your Representative (Link)

• Find and Contact Elected Officials (Link)

Support task forces!

• Self-Advocacy Association of New York (SANYS) (Link)

• Disability Rights Texas (Link)

• Disability Rights and Education Fund (DREDF) (Link)

Support your local community!

• The BEE Community (Link)

• Camp Beloved & Beyond (Link)

• Belong Kitchen (Link)

Follow and learn from community members!

YouTube:

• "Why Don't We Care About Disabled People?" (Link) 

• Rolling Through Life with TALISHA (Link)

• Squirmy and Grubs (Link)

• Zach Anner (Link)

• Molly Burke (Link)

• Gabriella Garbero

  • VICE News (Link)

  • Matter of Fact (Link)

Podcasts:

• From the Throne (Link)

• Living My Best Disabled Life (Link)

• Access All: Disability News and Mental Health (Link)

• Four Bad Eyes (Link)

Books:

• Being Heumann: An Unrepentant Memoir of a Disability Rights Activist by Judith Heuman (Link)

• On the Spectrum: Autism, Faith, and the Gifts of Neurodiversity (2021) by Daniel Bowman Jr. (Link)

• lemon (2023) by Isabella J. Mansfield (Link)

• I'll Pray for You: And Other Outrageous Things Said to Disabled People (2023) by Hannah Setzer (Link) 

• The Pretty One: On Life, Pop Culture, Disability, and Other Reasons to Fall in Love With Me (2019) by Keah Brown (Link)

• Disfigured: On Fairy Tales, Disability, and Making Space (2020) by Amanda Leduc (Link)

• Interabled: True Stories About Love and Disability from Squirmy & Grubs and Other Interabled Couples (2025) by Shane and Hannah Burcaw (Link)

• If at Birth You Don't Succeed: My Adventures with Disaster and Destiny (2017) by Zach Anner (Link)