March 5, 1999

APA applauded a new bill introduced in the U.S. Senate in January for making it easier for the severely mentally ill to return to work. The Work Incentives Improvement Act of 1999, sponsored by Senators Jim Jeffords (R-Vt.) and Ted Kennedy (D-Mass.), would expand Medicaid coverage to employed disabled individuals even when they earn more than the poverty limit.

Jay Cutler, J.D., director of APA's Division of Government Relations, applauded the new legislation. He commented to Psychiatric News, "This bill embodies the concept of good government-lifting the heavy burden of worry about losing health benefits from individuals on Social Security Income [SSI] and Supplemental Security Disability Income [SSDI] who want to and can work."

Cutler was optimistic that the bill would pass with its bipartisan cosponsor list of 50 senators and continued APA grass-roots advocacy.

Moreover, President Bill Clinton endorsed the proposed legislation in his January State of the Union address (see page 15). He has proposed a $2 billion package of health coverage, tax credits, and rehabilitation services for the disabled in his Fiscal 2000 budget that includes $1.2 billion for the Jeffords and Kennedy legislation.

Laurie Flynn, executive director of the National Alliance on Mental Illness (NAMI), commented in a press release, "The legislation will liberate many Americans with disabilities. It will empower them and strengthen self-esteem. Persons with severe mental illnesses require continuity of care to sustain recovery and renewal."

Jeffords testified before the Senate Committee on Finance last month, "Presently individuals with disabilities must choose between working or getting health care. Despite the fact that 72 percent of Americans with disabilities want to work, less than one-half of 1 percent of the 7.5 million individuals on the Social Security Disability rolls leave them."

NAMI estimated that 28 percent of Americans receiving SSI assistance in 1993 (6 million) were disabled by mental disorders other than mental retardation. About 26 percent of Americans receiving SSDI assistance in 1993 (5 million) were disabled by mental illness.

The bill would allow states to expand Medicaid coverage to disabled individuals whose income exceeds 250 percent of poverty level (about $500 a month). This option builds upon a provision in the 1997 Balanced Budget Act that allows states to offer a Medicaid buy-in to disabled individuals with incomes below 250 percent of poverty. The proposed legislation, however, allows states to set asset limits and require cost sharing and sliding-scale premiums.

States could also provide Medicaid coverage for individuals who continue to have a severe medical impairment but lose eligibility for SSI or SSDI because of medical improvement. These individuals currently are ineligible to receive SSI or SSDI benefits.

The proposed legislation would also

• Continue Medicare coverage for SSDI beneficiaries when they return to work.



• Provide grants to states offering Medicaid buy-ins to disabled workers to study the design, establishment, and operation of services and items they need.



• Establish a time-limited demonstration program for states to extend Medicaid coverage to disabled workers to show that without access to health care, they would be eligible for SSI or SSDI.



• Improve access to job training and placement assistance services through a bonus system to providers.

The text of the bill and its legislative status is posted on the THOMAS Web site at thomas.loc.gov; search on the bill number, S.331.-C.L.