National Alliance on Mental Illness
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TWWIIA Designed to Address Multiple Barriers

TWWIIA was intended to address many of these disincentives to work and full participation for all SSI and DI beneficiaries – including those with severe mental illnesses. First, the law authorized an additional 4.5 years of Medicare coverage for DI beneficiaries after they return to work. This provision in the law has been fully implemented and now provides more than 8 years of extended Medicare coverage for working former DI beneficiaries. Unfortunately, TWWIIA did not include relief from the "cash cliff" penalty in the DI program that completely eliminates eligibility for all cash benefits once earnings exceed SGA. Nearly four years since the passage of TWWIIA, Social Security is continuing to drag its feet on developing a study to measure the impact of elimination of DI "cash cliff."

For SSI beneficiaries, TWWIIA included two new options for states to establish "buy-in" programs to offer extended Medicaid coverage for recipients who go to work. While 26 states have taken up these new Medicaid "buy-in" options, all but a few have been unable to fully fund these programs as a result of the severe budget crises facing many states. As states have moved to cut funding for their Medicaid programs to address budget deficits, these new "buy-in" options have either been delayed or curtailed.

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