National Alliance on Mental Illness
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1999 Law Addressing Disincentives To Work Falling Short of Expectations

On December 17, 1999 former President Bill Clinton signed into law the Ticket To Work and Work Incentives Improvement Act (TWWIIA) and declared a new era of federal policy in which people with disabilities would no longer have to choose between a job and health care coverage. Surrounded by leaders of both political parties President Clinton hailed the new law as bringing an end to inflexible eligibility rules for Social Security and health care coverage that penalize beneficiaries who attempt to enter the workforce. Both Republicans and Democrats hailed TWWIIA as landmark legislation that would finally begin to erode the high unemployment rates experienced by people with severe disabilities – including adults with severe mental illnesses.

Three and a half years later, the vision of the TWWIIA law remains largely unfulfilled as a result of gaps in the law, slow implementation at the federal level and budget cuts at the state level. This slow pace has been frustrating for NAMI advocates who pushed hard for TWWIIA’s passage and had high hopes for ending programmatic rules that leave consumers better off staying at home on benefits that taking a job or severely penalized for engaging in even part-time work. This frustration is compounded by the fact that so many consumers can work and want to work, but stay trapped in poverty because of inflexible rules governing cash and health benefits.

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