The ABA Commission on Disability Rights recently interviewed Karly Ball Isaacson, Ph.D., one of the researchers of the 2025 study, Counting the Costs: A Proposed Conceptual Model of Disabled Students’ College-Going Decisions, to discuss how disability-related financial concerns influenced the college decision-making processes of disabled four-year college students.
1. How does your study extend or challenge existing models of college choice for disabled students, particularly those that frame decision-making as an individual “choice”?
The term “choice” implies that students exercise full autonomy in deciding whether to go to college and where. Yet research clearly demonstrates that college decision-making is shaped by forces that extend well beyond any single person. Building on Iloh’s 2018 work—which challenges the tendency to frame college-going decisions as a single, one-time decision and highlights how ecosystems shape these decisions—our study pushes back on models that flatten those influences into an individual decision. When we rely on the language of “choice,” we risk obscuring the ways families, institutions, policies, and material conditions actively structure—and constrain—what is possible for students.
Our study extends that critique by showing how disability renders these constraints especially concrete and nonnegotiable. For disabled students, the decision is rarely just about fit or preference; it is often a question of feasibility. Proximity to medical providers for students with chronic conditions, dependable and accessible transportation for students with mobility limitations, and the reality that enrollment may need to pause and restart as access needs change are not peripheral considerations. They can determine whether college is possible at all, and which options are realistically on the table.
Drawing from our empirical findings, we developed a conceptual model of disabled students’ college decision-making that keeps these layered factors in view across both the individual and their surrounding environments. Rather than treating college-going as a singular act of individual agency, the model reframes it as a set of interconnected decisions shaped by access needs, available resources, and the people and systems students must navigate.
2. Can you explain how your cyclical model of college decision-making differs from linear models of college choice?
Linear models of college choice tend to depict decision-making as a one-time sequence: students consider options, select a school, and move forward, with agency framed as residing entirely in the individual. That logic is embedded in the word “choice,” which can make it sound as though students are freely picking among comparable options.
Our cyclical model presents a different reality. Many disabled students in our study did not experience college selection as a broad set of possibilities. Faced with high disability-related expenses alongside the costs of college, some “chose” a school primarily because it was the only financially feasible option. Affordability was not one factor among many; it often set the boundaries of what even counted as an option.
The other key difference is that decision-making did not end at enrollment. Participants regularly described needing to reassess whether college remained financially viable when new disability-related expenses arose, symptoms changed, or care needs shifted. This re-evaluation loop is what makes the model cyclical: It captures how students move between planning, enrolling, recalculating, and sometimes renegotiating their path, rather than progressing neatly through a single pipeline.
Within this cycle, institutional resources play a critical role by stabilizing students at moments when unexpected costs threaten persistence. Rather than treating support as something that comes after “choice,” the cyclical model positions institutional practices and funds as integral to decision-making itself, shaping whether students can remain enrolled once real-life costs change.
3. How does Iloh’s temporal framework deepen our understanding of disabled students’ experiences?
Iloh’s temporal framework deepens our understanding of disabled students’ experiences by pushing us to view “college choice” as an ongoing process that unfolds across time, rather than a single moment fully controlled by the student. In our study, that shift matters because disability-related considerations do not begin at the point of application, nor do they end upon enrollment. Instead, students navigate college through the continuing influence of past disability-related expenses while continuously forecasting future costs.
This temporal lens also helps explain why the decision process can feel recursive for disabled students. They are not only comparing institutions, but also revisiting past experiences with medical bills, assistive technology, transportation, and support needs, weighing them against anticipated expenses and uncertainty. Even tasks often framed as administrative—navigating financial aid forms or locating external disability funding—become central to decision-making because they can reshape what feels possible over time.
Although Iloh did not center disability, her move away from the “one-time choice” narrative creates space for our paper to show how disability makes college-going decisions both temporally extended and structurally constrained. The framework helps us name that disabled students’ choices are shaped by how the past carries forward, how the future must be planned for, and how institutions and aid systems can either alleviate or compound that burden across the full timeline of college-going.
4. How did students’ prior experiences with disability-related expenses shape how they planned—or limited—their postsecondary options?
For students with high disability-related expenses and limited financial capacity to absorb them, prior costs narrowed postsecondary options in very direct ways. Several described pursuing the most affordable college they were admitted to—little meaningful “choice” at all. The decision came down to identifying the lowest net price after aid and building a plan around what they could realistically pay. That pattern aligned with our expectations.
What surprised us was how often students described access to medical care as part of—rather than separate from—the financial calculus. Many treated continuity and affordability of health care as a boundary around whether attending college in certain places was even possible. Some felt pressure to remain in-state to continue seeing current mental and/or physical health providers via telehealth, given that licensing rules often limit providers’ ability to serve patients across state lines. Others required specialized care and did not feel confident they could find comparable services—or afford them—if they moved away from home. In this sense, prior disability-related expenses did not simply shape budgets; they shaped geography, timelines, and the range of postsecondary options students felt they could trust.
5. Did you observe differences in how students with different types of disabilities accounted for anticipated expenses in their college planning?
Absolutely. We saw meaningful differences in how students planned for anticipated expenses, and these differences often corresponded with how predictable, ongoing, or changing their disability-related needs were.
Students with degenerative disabilities, in particular, spoke with a heightened awareness that more substantial expenses could lie ahead and that their future capacity to work might be uncertain. For some, that raised difficult questions about whether college would “pay off” financially in the long run. This was a sensitive topic in interviews with a few participants referencing degeneration briefly and signaling they did not want to elaborate, yet it was clear the consideration was shaping their thinking. Others were more comfortable naming it directly, often framing college less as a strictly economic investment and more as intrinsically valuable in terms of learning, growth, and experience.
At the same time, there were common threads across disability types. Many students, regardless of diagnosis, prioritized access to high-quality health insurance when weighing college options. This priority sometimes outweighed income-earning potential in their planning, shaping decisions about where to enroll and what to study, because insurance coverage and health care affordability felt like the most immediate and reliable way to manage anticipated expenses.
6. What challenges did students describe when trying to account for disability-related costs within standard financial aid applications such as the FAFSA?
Students pointed to a few recurring challenges. First, many students did not know about the FAFSA’s special circumstances provision that students can pursue for additional institutional financial aid. That gap matters because if students do not know there is a pathway to request an adjustment, they are left trying to fit disability-related costs into a system that was not designed to capture them.
Second, even when students were aware of the provision, they still encountered real access barriers. The special circumstances process tends to be oriented toward recent, discrete changes in a family’s financial situation. For many of our study participants, disability-related expenses were neither new nor temporary; they were ongoing, cumulative, and shaped by years of out-of-pocket costs that affected what families could save and what expenses students could take on. When institutions asked for documentation, students described how challenging this could be, given that expenses often spanned long periods, involved multiple providers and purchases, and were not easily reconstructed into a neat paper trail.
Finally, financial aid applications offer no meaningful mechanism to account for forward-looking realities of disability-related expenses. Our study participants described a mismatch between how they must plan for college and how financial aid systems calculate need. Several participants were making decisions with reasonably anticipated disability-related expenses in mind—such as the likelihood of future surgeries, ongoing treatment needs, assistive care, or progressive care needs. While no one can predict the future with absolute precision, when a student has a diagnosed disability with a clear trajectory, those anticipated costs are far from speculative. Participants described such planning as central to their college decisions raising a broader question: whether financial aid systems can genuinely support disabled students if they continue to assess need with a static, backward-looking framework that fails to reflect long-term and anticipated disability-related expenses.
7. What role did institutional policies or practices play in shaping students’ perceptions of whether college was financially viable for them?
Our study participants were already enrolled at a four-year institution, which allowed them to speak in detail about both what helped them choose their college and remain enrolled there. For many, institutional financial aid policies were central to the decision to enroll. Several students described generous financial aid packages as the factor that made one institution feel feasible, while others did not.
After enrollment, students talked about how institutional practices affected their ability to stay in school when disability-related expenses emerged or intensified. Access to institutionally designated funds and support resources made the difference between remaining enrolled and having to step away.
At the same time, these accounts reflect the experiences of students who ultimately found a viable path into a four-year college. That perspective is valuable, but it also highlights an important gap. To fully understand how institutional policies and practices shape access, further research is needed with disabled students who decided that college was not financially viable, as well as those who were filtered out earlier in the college selection process.
8. What gaps did students encounter in navigating VR and higher education simultaneously?
We identified a pretty striking gap: many students who likely would have been eligible for vocational rehabilitation (VR) support were not using it to help cover college-related costs. In the survey associated with the larger overarching study, just over 5 percent of participants reported using VR to pay for college. Given that every survey respondent was a disabled student enrolled in a four-year institution, this low utilization rate stood out.
The interviews helped explain why. Many participants simply did not know VR existed at all. Others had heard of VR but did not realize that, in many states, it can support college as a pathway to employment. Even students who were somewhat familiar with VR often did not understand how it worked well enough to pursue it, given the substantial variation in eligibility for postsecondary VR financial support across states.
Study participants also described the practical burden of trying to navigate VR on top of everything else they were already managing. Many explained that coursework and daily tasks required more time and energy because of disability-related access needs, and many were also working at least one job to keep up with costs. In that context, taking on a complex, state-dependent process without a clear sense of how much financial assistance they would actually receive felt unrealistic.
9. How could stronger coordination between institutional disability services offices and VR agencies alter students’ decision-making trajectories?
Stronger coordination between campus disability services (DS) offices and VR agencies could shift students’ trajectories by transforming VR from a vague “maybe” into a concrete, actionable option at the critical moments when students are deciding where they can afford to enroll and whether they can remain enrolled.
I think back to one interview participant, Anastasia (pseudonym). Like many others, she chose her institution largely based on affordability yet was still juggling medical bills alongside the cost of college and struggling to keep up financially. A DS counselor had mentioned a VR program, but because Anastasia lived right across a state border, she assumed she would not be eligible in the state where she attended college. She was unsure how to start the process in her home state. Without clear guidance or follow-up support, the lead went nowhere.
Anastasia’s situation stood out. Had the DS counselor been aware that the eligibility rules in the state where she attended college were not as strict about residency as she believed, the counselor could have removed a major access barrier and connected her to robust VR postsecondary support where she was enrolled. Instead, her experience illustrates a common breakdown: a counselor trying to help, but lacking the specific, state-level information needed to move from general awareness of VR to actual access.
Coordination matters. If DS offices had a simple, reliable way to access up-to-date guidance from VR programs on common student questions, it could meaningfully change how students plan and reduce the guesswork that often leads them to disengage. Key questions include: Does the state VR program fund postsecondary education? What documentation does a student need to qualify? Is residency required, or does the state use an intent-to-stay standard? Are certain disabilities prioritized in that state’s eligibility determinations?
Yet coordination must be a low lift. Both DS counselors and VR counselors often carry heavy caseloads, so the most feasible solution is a streamlined information bridge. VR provides a concise, up-to-date guide on state-specific eligibility and processes, along with a direct referral contact or pathway. DS offices share the guide widely and consistently with students, rather than relying on one-off conversations that too often end with confusion, as Anastasia’s experience illustrates.
10. You argue for incorporating cost into disability definitions used in policymaking. What might this look like in practice at the institutional or federal level?
In practice, incorporating cost into disability definitions or policymaking would mean building a systematic way to recognize that disability-related expenses can materially constrain access, even when income, assets, or diagnosis categories do not fully capture that burden.
Disability is a broad category, and policymakers already rely on imperfect but useful ways of grouping disability to balance tailoring with broad applicability. In special education, for example, disabilities are sometimes framed as “high incidence” versus “low incidence.” In other contexts, they are distinguished by visibility, such as visible versus non-apparent. These categories have limitations but allow systems to design policies at scale.
A cost-informed approach could take a similar form, with concrete options at the institutional and federal levels:
- Financial aid assessments that explicitly account for disability-related expenses. Institutions—and potentially federal aid systems—could treat verified, recurring disability-related costs as standard adjustments in need analysis rather than exceptional requests. This might include expenses for medical care, assistive technology, transportation, personal assistance, and other disability-related needs.
- Structured “cost tier” lens for aid policy. One way to operationalize this is by incorporating a high-cost versus lower-cost framework for certain financial aid decisions not as a label on people, but as an administrative tool for allocating support. The goal is to acknowledge that two students with the same income may have very different financial capacity once disability-related expenses are considered.
- Clearer guidance and documentation pathways. To incorporate cost meaningfully, processes must be predictable and accessible. This requires clear standards for what counts as disability-related expenses, what documentation is acceptable, and how frequently students need to re-verify, all while minimizing paperwork burdens.
None of these solutions are perfect, and they raise real implementation questions, especially for disabilities with fluctuating costs, students whose expenses shift due to insurance or benefits changes, or conditions where expenses spike unpredictably. But these challenges are not reasons to avoid reform. They are precisely the questions that financial aid policymakers at both institutional and federal levels must address if disability-related costs are to be taken seriously in aid planning.
11. What concrete steps can institutions take to allocate resources that directly offset disability-related expenses for students?
Institutions can take several concrete steps to allocate resources that directly offset disability-related expenses, even while acknowledging that campus budgets vary widely. While it is difficult to point to “model” programs that every institution can replicate, even modest allocations signal priorities and can make a difference when disability-related costs arise at the worst possible moment.
Practical strategies include:
- Create a disability-related emergency fund housed in Disability Services (DS) offices. Set aside dedicated dollars that students can access quickly when unexpected disability-related expenses arise, such as medical bills, medication gaps, broken assistive devices, and transportation costs tied to care.
- Build a rapid, low-burden request process. Keep applications short, allow multiple forms of documentation, and make decisions quickly. The goal is to reduce the likelihood that students must miss class, take on extra work hours, or temporarily leave school while waiting for assistance.
- Partner across offices. Disability services, financial aid, student affairs, and basic needs teams can work together so the fund does not operate in isolation, avoiding a long campus “scavenger hunt” for help.
- Provide proactive communication. Include information about the fund in onboarding materials, DS intake processes, and financial aid messaging, so students know the resource exists before a crisis arises.
Khadijah (pseudonym), one of our interview participants, described the stress caused by unexpected disability-related expenses that made her seriously question whether she could afford to stay enrolled. What made the difference was that her institution’s DS office had dedicated funds set aside for such costs. Even a modest, targeted allocation like this can be the difference between a student persisting and a student having to step away when disability-related expenses spike.