Patching the Medical Safety Net

It's true that there's now a fairly comprehensive -- but terribly complex and hard-to-grasp -- set of federal and state laws and rules that encourage disabled SSDI and SSI recipients to try returning to work. (Email the author at tomxix@ix.netcom.com for a detailed paper summarizing them and offering case management suggestions and further resources.) But all these bureaucratic protections still fail to solve the greatest fear of disabled persons thinking about trying to work again: "What if I try to work again and someone at Social Security says that I'm no longer disabled enough to stay in the system? What guarantee do I have that I won't lose my medical care?"

Actually, Congress did offer states one way to meet this fear in a little-known provision of Section 202 of the 1999 Ticket to Work and Work Incentives Improvements Act (TWWIIA). That section is best-known for giving matching funds to States that offer Medicaid, at small premiums, to working persons with medically disabling conditions with earnings up to at least 250 percent of poverty (about $46,000 a year for one person in 2004), or even more. And Section 204 says that states can, on a demonstration project basis, give Medicaid to "pre-disabled" workers at risk of full disability, also using those generous income rules. States can even get extra federal money by offering one or more of these options. Yet as of early 2004 only Mississippi and the District of Columbia (for HIV-positive persons); Rhode Island (for multiple sclerosis patients); and Texas (for schizophrenia and bipolar patients) had successfully applied for such funding -- and Mississippi alone has fully implemented the coverage. This leaves about $100 million authorized and available for such patients but unclaimed and unused by the states.

Furthermore, all states that cover the main, basic option under TWIIA can also give Medicaid under the same rules to eligible workers who recover from their disabilities while in the basic Medicaid working disabled program as long as they still have a potentially serious condition (like HIV or chronic mental illness). Again, few states have implemented this important Medicaid coverage option. And here, too, extra federal money is available to help states do this.

To fully guarantee that the medical coverage safety net for those attempting to return to work is stronger and surer, disabled persons and their advocates need to make at least two things happen: First, they must lobby their states to offer coverage for the working fully-disabled. Second, and most important, they must lobby their states to offer coverage under Section 202 for "ex-disabled" persons -- which would guarantee health coverage to anyone leaving SSDI or SSI to try working, even if they're found to be no longer disabled!

And to really put the icing on the cake, disabled persons and their advocates can also press for two more reforms: State Medicaid coverage of working "pre-disabled" persons under Section 204 of TWWIIA; and getting Congress to permanently extend Section 204 past its scheduled "sunset" at the end of Fiscal Year 2006 -- because doing so would accomplish much of what the HIV community hopes to obtain from the Early Treatment for HIV Act (ETHA).

Thomas McCormack is Public Benefits Policy Consultant to the Title II Community AIDS National Network (TIICANN; www.tiicann.org) in Washington, DC.