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Congress Close To Agreement On The Work Incentives Improvement Act

For Immediate Release, 16 Nov 99
Contact: Chris Marshall

After more than two weeks of difficult negotiations, Congress and Clinton Administration are nearing agreement on legislation designed to address the pervasive disincentives to employment in the SSI and SSDI programs. As readers of the E-News know, NAMI has been pushing hard for Congress to pass the Work Incentives Improvement Act (WIIA, S 331 & HR 1180) for more than two years. The bill that is now in the final stages of negotiations before a House-Senate Conference Committee does not address all of the barriers to employment that exist in the SSI, SSDI, Medicare and Medicaid programs. However, WIIA is the first major attempt by Congress to address the link between federal income support and health care programs and the 75% unemployment rate for non-elderly people with disabilities (the unemployment rate for adults with severe mental illnesses is estimated at 85%).

Even though Congress and the President have agreed on most of the major substantive provisions in the final bill, there is still no resolution on the issue of measures needed to "pay-for" the costs associated with WIIA (most of the future costs are directed to extended Medicare and Medicaid eligibility for SSI and SSDI beneficiaries transitioning off of cash benefits toward work). Congressional budget rules require that all future entitlement spending be "offset" by cuts in other programs so that any change in law is "budget neutral." The dispute over these "offsets" - many of which are unrelated to SSI, SSDI, Medicare and Medicaid - has the potential to prevent Congress from voting on WIIA before final adjournment for the year later this week. Because some of these "offsets" are drawing so much controversy, it is critical that members of Congress and the White House continue to hear the message that WIIA is strongly supported by people with severe mental illnesses and their families.

NAMI is concerned that if Congress fails to act on WIIA in the few days remaining in this year's congressional session, it could be several years before the issue is dealt with again. It is very difficult to move legislation governing Medicare and Social Security through Congress in an election year. In 2001, there is no guarantee that work incentives reform will be on the agenda of a new president and a new Congress. Thus, these last few days of the 1999 congressional session provide a unique, if narrow, window of opportunity to begin the process of making SSI, SSDI, Medicare and Medicaid more fair and less punitive for people with disabilities who can, and want to, work.


NAMI advocates are urged to contact both their members of Congress (House and Senate) and the White House and urge them to pass the Work Incentives Improvement Act before final adjournment for 1999. Controversies over "offsetting pay-fors" should not prevent Congress from finishing this important legislation before going home for the year. All members of Congress can be reached through the Capitol switchboard at 202-224-3121 or through the policy page of the NAMI website at and click on "Write to Congress." President Clinton can be reached by calling the White House comment line at 202-456-1414 or via email at


As NAMI members know from personal experience, the current Social Security disability programs create numerous barriers for persons who, despite having found effective treatment that allows them to function at a higher level, want to work. Not only do SSDI beneficiaries (and persons who are dually eligible for SSI and SSDI) risk losing their cash benefits entirely, they also face the threat of losing health coverage for Medicare and Medicaid. In addition, many SSDI recipients find that Medicare coverage fails to meet all of their health care needs because of the absence of an outpatient prescription drug benefit in the program. WIIA is designed to be the first major step in changing the status quo by extending health coverage and establishing a new flexible, consumer-oriented program called the "Ticket to Independence."

Specifically, the bill includes:

1) Two new optional eligibility categories that would allow states to offer Medicaid coverage to SSI beneficiaries who go to work and allow states to offer a Medicaid buy-in to people with disabilities who earn above 250 percent of the poverty level (states could charge a sliding-scale premium). States would also be allowed to cover individuals who continue to have a severe medically determinable impairment but lose eligibility for SSI or SSDI because of a medical improvement.

2) Extended Medicare coverage (4.5 years) that would permit SSDI beneficiaries, who remain disabled, to continue to receive Medicare coverage if they go to work. This extension would allow SSDI beneficiaries to get as much as 8 years of Medicare; i.e., 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). At this point, the 4.5 year extension is a major disappointment for NAMI. Earlier versions of WIIA contained much longer Medicare extensions, however, cost concerns forced Congress to shorten the period to 4.5 years.

3) A new state incentives "infrastructure" grant to support the design, establishment, and operation of infrastructures to support working individuals with disabilities, including an enhanced federal Medicaid match for states that elect to offer new buy-in programs. If WIIA becomes law, NAMI will undertake a major effort to assist NAMI state affiliates in advocating for states to take up these new Medicaid options.

4) A new "expedited re-entry" program that will allow individuals 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.

5) A protection against unscheduled Continuing Disability Reviews (CDRs) that would otherwise be triggered by work activity on the part of a beneficiary. The bill is also expected to prohibit SSA from using evidence of medical improvement as part of an unscheduled CDR for SSDI beneficiaries and dual eligibles.

6) Creation of a "ticket to independence" voucher that allows all SSI and SSDI beneficiaries to choose the employment and rehabilitation provider of their choice and ensures access to supports and services designed to keep them in the workforce for up to 5 years (use of a "ticket" would stop unscheduled CDRs).

7) A new "Work Incentive Planning Assistance and Outreach" program to help beneficiaries navigate the complicated and often conflicting system of Social Security's work incentive programs.

8) A new requirement for Social Security to conduct a demonstration project to establish a sliding-scale cash offset in the SSDI cash program (cash benefits would be reduced by $1, for every $2 earned, thereby addressing the unfair "cash cliff" in the SSDI program.