Case Study Sunday: When FMLA Ends
One of the most frightening moments families face during serious illness isn’t the diagnosis itself.
It’s the email that comes weeks or months later.
The one that says leave is ending.
That job protection is over.
That health insurance may change.
That everything suddenly feels urgent.
This case study comes from a familiar situation: a worker undergoing cancer treatment who has exhausted FMLA and short-term disability after multiple surgeries. Doctors confirm they are not yet able to return to work. The employer notifies them that FMLA is expiring and that the company is no longer required to hold the position, while a long-term disability claim is pending.
What’s often missing from conversations like this is clarity — not just about benefits, but about what still applies once FMLA runs out.
Because FMLA is not the end of the story.
FMLA Is a Floor, Not a Finish Line
The Family and Medical Leave Act provides a clear framework: up to 12 weeks of job-protected leave for qualifying employees. When that leave is exhausted, the law’s specific job-protection requirement ends.
What FMLA does not say is that employment must end.
It also does not eliminate other laws that may still apply.
Many people are told — directly or indirectly — that once FMLA expires, there are no remaining options. That’s not accurate.
The ADA May Still Apply After FMLA
For employers of sufficient size, the Americans with Disabilities Act (ADA) continues to matter even after FMLA leave is exhausted.
Cancer and post-surgical recovery often qualify as disabilities under the ADA, particularly when they substantially limit major life activities such as working, lifting, stamina, or mobility.
When the ADA applies, an employee may still request reasonable accommodations, and the employer is generally required to engage in an interactive process to evaluate whether continued employment is possible with adjustments.
This does not mean an accommodation must be approved.
It does mean the conversation should happen.
What Reasonable Accommodations Can Look Like
Accommodations are highly role-specific, especially in physically demanding jobs. Depending on the situation, they may include:
Modified or light-duty work
Reduced or adjusted schedules
Temporary reassignment to a vacant role
Additional unpaid medical leave
Yes — additional leave can sometimes be a reasonable accommodation under the ADA, particularly when there is a clear medical trajectory and a likelihood of future return.
That said, accommodations are not guaranteed. An employer may ultimately determine that no reasonable accommodation exists without undue hardship. This outcome is common in roles with significant physical requirements.
But the distinction matters:
There is a meaningful difference between evaluating accommodations and skipping the process entirely.
When Continued Employment Truly Isn’t Possible
Sometimes, despite everyone’s best efforts, returning to work simply isn’t feasible — at least not yet.
When that happens, the focus often shifts from job protection to stability during recovery.
This can include:
Long-Term Disability (LTD)
Long-term disability benefits are typically not tied to continued employment. A pending or approved LTD claim can provide income support during extended recovery and may later support other benefit pathways if needed.
Health Coverage Transitions
Loss of active employment often triggers health insurance changes, such as:
COBRA continuation coverage
Marketplace plans through the ACA
Employer notices outlining coverage end dates and election timelines
These transitions can feel rushed and overwhelming, especially in the middle of medical treatment.
Why Location Matters More Than People Realize
When people talk about “falling back on Medicaid,” it often sounds like a straightforward option. In reality, Medicaid access depends heavily on where you live.
In many states, adults who lose employer coverage during illness face extremely narrow eligibility pathways — particularly if they do not yet qualify under federal disability standards. In those states, Medicaid is not a safety net so much as a maze.
This case study takes place in Vermont, and that matters.
Medicaid in Vermont: Why This Case Looks Different
Vermont is one of the states where Medicaid can function as a true safety net during serious illness — not because the process is simple, but because the pathways exist.
Vermont expanded Medicaid, which means adults can qualify based on income alone, without first proving permanent disability through Social Security. For someone undergoing cancer treatment who has lost wages or employment, this can create a realistic coverage option during recovery.
In addition, Vermont’s Medicaid programs tend to integrate more smoothly with hospital systems, specialists, and care coordination. Hospital social workers in the state are often deeply familiar with these pathways and play a critical role in helping patients transition coverage without major gaps.
That does not mean enrollment is automatic, fast, or stress-free. But it does mean that in Vermont, Medicaid can often serve as bridge coverage during treatment and recovery — rather than a last-resort option that only becomes available years later.
This distinction matters. In another state, the same family might face months or years without meaningful coverage while waiting for a disability determination. In Vermont, there is often at least a place to land.
SSDI as a Longer-Term Consideration
For recoveries expected to last many months or longer, Social Security Disability Insurance (SSDI) may eventually become part of the conversation.
SSDI is not immediate, and it is not always the right first step. But when work is not possible for a year or more, it can provide longer-term stability and eventual access to Medicare.
Like Medicaid, SSDI is not a reflection of effort or character. It is a system designed — imperfectly — to support people when health prevents sustained work.
This Is Not Failure — It’s Navigation
There’s a quiet grief that comes with leaving work during illness. Many people internalize these transitions as personal failures, when in reality they are responding to systems that were never designed for long, uncertain recoveries.
Needing disability benefits is not a moral failing.
Needing Medicaid is not a lack of effort.
Needing time is not a weakness.
It is simply what recovery sometimes requires.
If You’re Standing at This Crossroad
If FMLA is ending and everything feels unclear, it’s okay to pause.
You don’t need to understand every system at once.
You don’t need to make every decision immediately.
And you don’t need to navigate this alone.
Understanding what still applies — and what comes next — can change the trajectory of a family’s stability during an already difficult season.
And sometimes, that clarity is the most important accommodation of all.
