Livelihoods, or the means to secure the necessities of life, shape how we live as individuals, families and communities, and our sense of well-being. While discussions of livelihoods have influenced academic discussions and government actions in international development over the past 25 years, few have discussed the implications of a livelihoods approach for people with disabilities in the context of global Northern societies. This paper argues that by using a livelihoods approach, we can recognize the multiple and, at times, conflicting ways that people with disabilities sustain themselves and secure the necessities of life. A livelihoods approach recognizes the agency of individuals, including those with disabilities, in the context of their relationships in households, families and communities, while also identifying the systemic barriers, inequalities and opportunities that shape livelihood choices. Using this approach, we argue, will enable a better understanding of how people with disabilities both survive and thrive, the diverse livelihood choices they make and the implications these choices have for policy decisions.