Clinton Administration Unveils Disability Policy Initiatives To Commemorate 10th Anniversary Of The ADA
The announcement on SGA was made as part of a series of policy initiatives designed to follow through on the objectives of the ADA to end discrimination, promote independence and increase access to employment, housing and supports for people with disabilities - including individuals with severe mental illnesses. The full text of the press release put out by the White House summarizing these policy initiatives can be found at: http://www.pub.whitehouse.gov/uri-res/I2R?urn:pdi://oma.eop.gov.us/2000/7/25/10.text.1
Among the key features of this package for people with severe mental illnesses and their families are:
1. Indexing of SGA Level and Adjustment to Trial Work Period Limits
By administrative action, the President has directed the Social Security Administration (SSA) to begin adjusting the SGA limit for both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries beginning in 2001. The SGA level represents the income ceiling, above which SSDI and SSI beneficiaries begin to lose eligibility to cash benefits, and in many cases, Medicare and Medicaid coverage. In 1999, this SGA threshold was increased from $500 to $700 - the first increase in nearly a decade. Under the proposal, the current earnings limit of $700 per month would be automatically adjusted yearly, based on increases in the national average wage index.
A second regulatory change affects the trial work period-time in which beneficiaries may earn any amount and still keep full benefits. Currently, the trial work period allows disabled beneficiaries to test their ability to work for at least nine months, and earnings of $200 a month count as a trial month. The change would increase that amount to $530 a month and provide automatic yearly increases (the SGA limit will continue to be applied after beneficiaries complete nine trial work months).
More information on the SGA and trial work period changes, as well as an expansion of earned income exemptions for students receiving SSI benefits, can be found at: http://www.ssa.gov/pressoffice/newsga.htm
More background information on SGA can be found at: http://www.nami.org/update/990419.html
2. National Mental Health Coalition Proposed
The summary of proposals issued by the White House includes a still to be defined "national mental health coalition" intended to "promote community-based services for individuals with mental illnesses and substance abuse disorders." According to the summary, the federal Center for Mental Health Services (CMHS) is to be directed to work with state and local coalitions to assist persons with mental illnesses and substance abuse disorders in accessing necessary services. However, the summary makes no mention of a key NAMI priority in this area, blended funding for integrated treatment for individuals with co-occurring mental illness and addictive disorders. This effort also excludes any directive to the states on how separate federal mental health and substance abuse block grant dollars can be blended to fund integrated treatment. NAMI will continue to press officials at SAMHSA, CMHS's parent agency, to expand this initiative so that it promotes state efforts to invest in integrated treatment programs.
3. Implementation of the Supreme Court's Olmstead decision
The largest single piece of the White House ADA initiative is implementation of the U.S. Supreme Court's 1999 decision in L.C. v. Olmstead and expansion of Medicaid home and community-based waivers for persons with mental retardation and developmental disabilities. These include a new $50 million grant program to the states tied to implementation of the Olmstead decision and its requirement for states to assist individuals transitioning from institutions (including state psychiatric hospitals) into the community. More detailed information on the Olmstead decision can be found at: http://www.hcfa.gov/medicaid/olmstead/olmshome.htm.
While the White House proposal regarding Olmstead and Medicaid home and community-based waivers does not explicitly exclude adults with severe mental illnesses, it is important to note that it is based on legislation now before Congress, the Medicaid Community Attendant Services and Support Act (S 1935) that generally restricts eligibility to individuals with mental retardation and developmental disabilities. In addition, the White House proposal, which requires congressional authorization, relies heavily on the existing model of state Medicaid home and community-based waiver programs that to date have been limited to individuals with mental retardation and developmental disabilities.
4. Housing Proposals
Like the proposal for Olmstead implementation and Medicaid waiver expansion, the Administration's housing proposal is directed primarily to individuals with mental retardation and developmental disabilities. Specifically, the plan calls for a 5-year, $20 million commitment to link HUD Section 8 vouchers with community supports as part of a public-private partnership known as the National Project Office on Self Determination. This initiative is based on the national "Home of Your Own" project that served primarily individuals with mental retardation and developmental disabilities. Moreover, the Administration's proposal would require HUD to divert as many as 400 Section 8 vouchers in the coming year that Congress had previously directed to non-elderly people with disabilities who have lost access to public and assisted housing as a result of "elderly only" tenant selection policies.
In recent years, NAMI has strongly supported efforts in Congress - led by Representative Rodney Frelinghuysen (R-NJ) - to fund a separate allocation of Section 8 tenant-based vouchers to make up for the loss of affordable housing resources that has resulted from public housing authorities and private owners of assisted housing designating units and projects as "elderly only." As a result of stigma and discrimination, adults with severe mental illnesses are especially vulnerable in this process. By contrast, the White House plan draws on an existing Robert Wood Johnson Foundation "self determination" program that thus far has been restricted to serving persons with developmental disabilities leaving institutional care. NAMI is therefore very concerned about a proposal that would divert vouchers away from congressional efforts to make up for the previous and ongoing loss of housing through "elderly only" designation.
Finally, the White House initiative includes proposed employment incentives that expand existing earned income disregards for working people with disabilities receiving housing assistance. As many NAMI members know firsthand, consumers can quickly lose access to housing assistance once their income rises above strict eligibility standards. Earned income disregards - which currently exist in law for public housing - allow tenants moving from public assistance to work and exempt their income from consideration for housing assistance for a specified time period. The White House proposal would extend the availability of earned income disregards for people with disabilities in a number of programs including Section 8 rental assistance, supportive housing for the homeless and the HOME program. Legislation would be developed to extend earned income disregards to the Section 811 program and other HUD programs.
NAMI strongly supports use of earned income disregards as an effective protection for people seeking to transition from SSI or SSDI to employment. At the same time, NAMI is concerned that use of income disregards not become so widespread in programs such as Section 811, Shelter Plus Care and supportive housing that individuals with the most severe mental illnesses who are not working lose access to these affordable housing resources. In many communities, there are waiting lists for adults with severe mental illnesses transitioning from institutions, homelessness or living with aging parents. Since these affordable housing resources are so limited, NAMI wants to ensure that housing authorities and non-profit sponsors are not allowed to favor higher functioning working people with disabilities over individuals with more severe disabilities who are not working.
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