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House Ways And Means Committee Passes Work Incentives Reform Bill, House Floor Action Next Week Possible

For Immediate Release, 15 Oct 99
Contact: Chris Marshall

After months of delay, action on the Work Incentives Improvement Act (WIIA) is back on track in the House. Yesterday, the House Ways and Means Committee approved a new revised version of the bill (HR 3070) by a vote of 33-1 (only Rep. Lloyd Doggett (D-TX) voted no). The House Rules Committee is expected to take up the bill sometime next week, with action by the full House expected shortly thereafter. NAMI has been pushing hard for reform of the Social Security Administration's disability programs for years. This legislation is the product of more than 2 years work. With only a few weeks remaining in this year's congressional session, it is critically important that the House acts quickly to move this bill forward to a "conference committee" with the Senate so that this historic opportunity is not lost.

WIIA is intended to help people with disabilities, including adults with severe mental illnesses, move into the workforce, and off the SSI and SSDI rolls. The most important provisions in the bill deal with extending health care coverage under the Medicare and Medicaid programs - under the current system, the threat of losing health care coverage remains the most formidable barrier to work for adults with serious brain disorders.


The bill that the House Ways and Means Committee passed yesterday represents a compromise between 2 separate, competing House proposals (HR 1180 and HR 1091). It includes nearly all of the provisions in a similar bill that passed the Senate 99-0 on June 16 and the House Commerce Committee in May 19. Among the important provisions that are similar or identical are:

  • Permanent authorization of the "ticket to independence" program - the new voucher program that will allow consumers to select their employment and vocational program outside of the public vocational rehabilitation monopoly,

  • Extended Medicare coverage for SSDI beneficiaries returning to work - extend coverage for 10 years (6 years on top of current law),

  • New state options to extend Medicaid coverage for SSI beneficiaries returning to work - States would be able to establish new buy-in programs for people who would otherwise be ineligible for Medicaid because of their earnings,

  • Continuing Disability Review (CDR) protections - Social Security would be barred from using work activity alone as a basis for terminating eligibility during a CDR and would stop unscheduled CDRs that now occur when beneficiaries attempt to work (as a result of budget concerns, HR 3070's CDR protections are delayed until 2003),

  • Expedited re-entry to cash benefits -people with disabilities would be allowed to quickly go back on to cash benefits in the event of an acute episode of their impairment that forces them to quit working, and

  • SSDI "2 for 1" demonstration - Social Security would be required to conduct a study of the impact of allowing SSDI beneficiaries to have their cash benefits gradually (rather than abruptly) reduced when they begin earning above the substantial gainful activity level.

At the same time, there are important differences between the Ways and Means Committee passed bill (HR 3070) and the House Commerce (HR 1180) and Senate (S 331) passed bills. Each of these differences result from concerns over the costs associated with the bill. Under complex budget rules that govern the legislative process, changes to federal entitlement programs are required to be "budget neutral" meaning that there must be "offsets" to "pay for" the entire bill (a total in the range of $700 to $800 million over 5 years). Currently, the White House and Congress are engaged in intense negotiations about how and where to find the "offsets" to "pay for" the Medicaid provisions that are in HR 1180 and S 331, but not in HR 3070.

The most important of these Medicaid provisions is the "State Infrastructure Grant" program - an enhanced federal Medicaid match for states that elect to start a Medicaid buy-in program for SSI beneficiaries who want to leave the rolls for work. In S 331 and HR 1180, this program is included as "mandatory" federal spending, meaning that funds would be guaranteed for any state moving forward with a new program. However, the HR 3070 includes the program as a "discretionary" program, with funds subject to future congressional appropriations (meaning that funds may not be available in future years). Without the guarantee that Medicaid matching funds will be available in future years, it is highly unlikely that many states would be willing to undertake new buy-in programs. In addition, a proposed state Medicaid demonstration program for working people with disabilities not yet on the SSI and SSDI rolls is also included as "discretionary," rather than "mandatory."

NAMI is currently pushing Congress and the White House to work together quickly to come up with the "offsetting pay-fors" needed to add the state infrastructure grants program back into the bill and ensure that the final product that reaches the House floor next week has a Medicaid package equal to HR 1180 and S 331. Included below is a letter that NAMI sent today to House Speaker Dennis Hastert (R-IL) and House Rules Committee Chairman David Dreier (R-CA) urging support for, and quick House passage of, the combined "Ticket to Work and Work Incentives Improvement Act" (HR 1180 and HR 3070).


NAMI advocates are urged to contact their House members and urge them to pass work incentives reform legislation this year. Time is running out on the 1999 congressional session. Since 2000 is an election year, it is unlikely that Congress will take on such a complex issue next year. Thus, failure to act on this legislation in the next few weeks could result in the current inequitable system that a) penalizes SSI and SSDI beneficiaries who try to work, and b) forces people with severe mental illnesses to go into (and stay in) poverty remaining in place for another 2-3 years. NAMI continues to place as its top priority in this legislation helping people who are already on the SSI and SSDI rolls, with limited opportunities to go to work under the current unfair system.

NAMI advocates are urged to:

1. Contact their House member and urge him/her to support work incentives reform legislation that fully funds the Medicaid State Infrastructure Grants program as "mandatory" rather than "discretionary" spending. If your member of Congress is already supporting HR 1180 or HR 3070, urge him/her to contact Speaker Hastert and Chairman Dreier and request quick action of work incentives legislation on the House floor, with fully funded Medicaid. All House members can be reached through the Capitol switchboard at 202-224-3121. Email addresses for members of Congress can be obtained by going to the NAMI Web site at and click on "Write to Congress."

2. Contact President Clinton and urge him to come forward as soon as possible with the budget "offsets" needed to finance the Medicaid State Infrastructure Grant program as "mandatory" spending. The White House switchboard and comment line can be reached by calling 202-456-1414 or through the White House website comment page at

October 15, 1999

The Honorable J. Dennis Hastert
U.S. House of Representatives
Washington, DC 20515

The Honorable David Dreier
Chairman, Committee on Rules
U.S. House of Representatives
Washington, DC 20515

Dear Speaker Hastert and Chairman Dreier:

On behalf of the 208,000 members and 1,200 chapters and affiliates of the National Alliance for the Mentally Ill (NAMI), I am writing to offer our support for the Ticket To Work and Work Incentives Improvement Act (HR 3070 and HR 1180). NAMI would like to urge quick action by the full House and conference with the Senate. This bipartisan legislation represents years of bipartisan work by both the Commerce and Ways and Means Committees. It is an important step forward in the process of ending the current barriers to work in the SSI and SSDI programs. As the nation's largest national organization of people with severe mental illnesses and their families, we are encouraged by the large bipartisan coalition in the House that has brought this bill so far. We feel strongly that every effort should be made to pass this bill quickly so that it can be sent to the President for signature before Congress adjourns in a few weeks.

This important legislation is long overdue. For too long, people with severe mental illnesses have been needlessly trapped in a permanent state of poverty and dependence by the current system of cash benefits directly linked to health care eligibility, with limited options for employment and rehabilitation services. NAMI feels strongly that people with severe mental illnesses can and want to work. With access to newer and more effective treatments - and most especially through extended health care coverage that provides access to these new treatments - people with severe mental illnesses who are on the SSI and SSDI rolls can move toward greater independence. NAMI believes that the most profound barrier to employment faced by people with severe mental illnesses living on SSI and SSDI is the threat of losing access to health care coverage. That is why we are pleased that the bill that has cleared both the Commerce and Ways and Means Committees includes important extensions of both Medicare and Medicaid coverage for individuals transitioning off of SSDI and SSI.

NAMI urges you to continue working with the Clinton Administration to find the budget offsets needed to add back all of the Medicaid provisions that are included in both HR 1180 and S 331. We are especially concerned that the Medicaid State Infrastructure Grant program needs to be a part of the final bill as mandatory spending under Title XIX. We therefore want to encourage a bipartisan effort to move forward in finding adequate financing for all of the Medicaid provisions in both HR 1180 (as reported by the House Commerce Committee) and S 331 (as passed by the Senate).

In addition to the critically important health care provisions in HR 1180 and HR 3070, NAMI would also like to take note of important sections that will go a long way toward modernizing Social Security's disability programs. First, NAMI is pleased that the "Ticket To Independence" program is part of this bill as a permanently authorized program. This initiative will help place people with disabilities - not the current public vocational rehabilitation monopoly - in charge of their future. Providing consumers with a portable voucher will allow them to select their own provider and structure supports and services that will follow them into the workforce for up to five years.

Second, NAMI is strongly supportive of provisions in these bills that will provide important new protections for beneficiaries who leave the rolls and must go through continuing disability reviews (CDRs). Third, we strongly endorse the proposal in these bills for a new "expedited re-entry" for people who experience an acute episode of their illness or disability and need to quickly have their cash benefits restored.

Fourth, we applaud inclusion of the "2 for 1" demonstration program to study a new cash offset for SSDI beneficiaries. This is a critically important step forward in proving that flexible "sliding scale" cash assistance can reward people willing to take the risks inherent in going to work. Finally, NAMI supports the new work incentive planning and assistance program as an essential step to helping beneficiaries access accurate, unbiased information about the consequences of work for their future eligibility for benefits. Such a program will help SSI and SSDI beneficiaries make informed decisions about navigating through SSA's complicated disability programs.

Thank you again for your leadership in helping to address the unfairness of the current SSI and SSDI programs that prevent people with mental illnesses from reaching their full potential. NAMI looks forward to working with you and your colleagues on both sides of the aisle to ensure that agreement can be reached in the full House, as well as with the Senate and the Clinton Administration, to ensure that this legislation is passed and signed into law in 1999.


Laurie M. Flynn
Executive Director