National Alliance on Mental Illness
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NAMI's Advocacy Goals and Strategies

NAMI strongly supports full implementation of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) – both with respect to federal responsibilities for Social Security’s programs and new state coverage options under the Medicaid program. Among the key provisions in the new are:

  • Extended Medicaid for SSI beneficiaries - The new law adds two new optional eligibility categories for states. They will be able to offer Medicaid coverage to SSI beneficiaries who go to work and allow a Medicaid buy-in for people with disabilities who earn more than 250 percent of the poverty level. (States would have to charge a sliding-scale premium.)

    Because these are new options for states, NAMI and other disability advocacy organizations will have to    work hard to convince state officials to offer these new options. (In the coming weeks, NAMI will be work with affiliates on model state legislation based on this new law.)
  • New Medicaid demonstration for working people - For adults with severe mental illnesses who are not yet on SSDI or SSI , the new law will allow states—at their option—to cover people with a "medically determinable impairment" that would make it necessary for them to get SSI and SSDI if they did not have adequate healthcare coverage. Lawmakers hope to stop growth in the disability rolls by giving people Medicaid coverage before they have to quit their job to meet the program’s strict eligibility requirements for assets and income. The new law also includes a new state "infrastructure" grant to design, establish, and operate supports for working people with disabilities and enhanced federal matching money for states that offer new buy-in programs.
  • Extended Medicare for SSDI beneficiaries - For SSDI beneficiaries, the law provides extended Medicare coverage for 4.5 years after a person enters the workforce and has earnings above the current "substantial gainful activity" (SGA) level, which will be $700 in 2000. This means that SSDI beneficiaries who remain disabled will still receive Medicare coverage if they go to work. The extension would give SSDI beneficiaries as much as eight years of Medicare—4.5 years on top of the existing trial work period and extended period of eligibility. (Currently, beneficiaries who return to work must pay Part A premiums after an extended period of eligibility.)
  • Easier re-entry to cash assistance - The new law calls for an "expedited re-entry" program that will allow people with episodic disabilities (such as severe mental illness) to immediately return to SSI and SSDI cash benefits if a short-term acute break forces them to leave a job. Currently, SSI and SSDI beneficiaries who leave the cash-assistance rolls to go to work must wait as long as two years when a relapse forces them to quit their job.
  • Continuing disability review protections - The new law protects SSDI beneficiaries who have been in the program two years or more against unscheduled continuing disability reviews (CDRs) that would otherwise be triggered by their working. It will also stop the Social Security Administration from using evidence of a medical improvement to do an unscheduled CDR. Regularly scheduled medical CDRs, however, will continue. As it is now, many SSDI beneficiaries with severe mental illnesses fear that any effort to work will trigger a CDR that could cause Social Security to reclaim "overpayment." The CDR protections will take effect in 2002.
  • "Ticket to independence" - Another new program will give consumers a "ticket to independence" voucher so that they can choose their employment and rehabilitation provider and receive supports and services to keep them working for as long as five years. (The use of a "ticket" would stop unscheduled CDRs). Under this ticket system, which will probably to be up and running in 2001, rehabilitation and employment service providers will be paid only for successful outcomes, and "success" will mean keeping people off of SSI and SSDI and on the job. In contrast, the current vocational rehabilitation program concentrates on pre-employment assessments and services that do not work well for consumers with long-term, episodic mental illnesses.
  • Work incentive help - The new program will help consumers understand and use the complicated and often conflicting work incentive programs. It will provide accurate information about the consequences of employment for both cash benefits and healthcare coverage. Beginning next year, $23 million will be available to non-profit organizations to help consumers and to Social Security to place work incentive specialists in local offices.
  • "2 for 1" offset - The new law will require a study to evaluate a sliding-scale cash offset program in which cash benefits would be reduced by $1 for every $2 earned. This study is intended to show that beneficiaries should not abruptly lose all their cash benefits when their earnings rise above the SGA level for more than nine months. NAMI hopes it will be clear that it is only fair to allow beneficiaries to gradually give up cash benefits as their earnings rise.

    For more information about NAMI’s
    activities on this issue, please call Andrew Sperling at 703/516-7222. All media representatives, please call NAMI’s communications staff at 703/516-7963.

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