During the final days of the 1999 session, both houses of Congress passed landmark legislation that promises to be a tremendous benefit to people living with HIV. This legislation, titled the "Work Incentives Improvement Act of 1999" directs the Social Security Administration to develop and implement new guidelines regarding how disability benefits are approved and managed. The goal of this legislation is to support those individuals who wish to either return to work, or who are currently employed, but need access to medical services to maintain their health.
The passage of this act will certainly have an impact on issues such as Georgia's ability to expand Medicaid benefits to HIV+ individuals, and must be monitored closely by our community to ensure that it is implemented as quickly and efficiently as possible. Although the full implementation of this new policy is still months away, and the details on exactly how it will impact the lives of people living with HIV are still not completely known, below is a brief overview of what this legislation hopes to accomplish.
The Act improves health care options for people with disabilities by:
- Removing limits on the Medicaid buy-in option for workers with disabilities.
This act creates two new options for states to offer the Medicaid buy-in, created by President Clinton in the "Balanced Budget Act of 1997." First, it removes the income limit of 250 percent of poverty (about $21,000), allowing states to set upper income, unearned income and resource limits. This is important since it allows people to buy into Medicaid when their jobs pay more than low wages. Second, it allows coverage of people with a disability, such as rheumatoid arthritis, who can work only because of medical treatment. This act also provides $150 million over five years in health care infrastructure grants to states that take these options.
- Creating a new Medicaid buy-in demonstration to help people who are not yet too disabled to work.
This act provides $250 million to states for a demonstration to assess the health and financial benefits of providing Medicaid coverage to people whose condition has not yet deteriorated enough to prevent work but who need health care to prevent that deterioration. For example, a person with muscular dystrophy, Parkinson's disease or diabetes may be able to function and continue to work with appropriate health care, but such health care may only be available once their conditions have become severe enough to qualify them for SSI or SSDI and thus Medicaid or Medicare. This demonstration would provide new information on the cost effectiveness of early health care intervention in keeping people with disabilities from becoming too disabled to work.
- Extending Medicare coverage for people with disabilities who return to work.
Although Medicare does not currently provide prescription drugs which are essential to people with disabilities, this act extends Medicare Part A premium coverage for people on disability insurance who return to work for another four and a half years. This means the difference between a monthly premium of nearly $350 and $45.50. This assistance will be available nationwide, even in states that do not take the Medicaid options.
The Act modernizes the employment services system by:
- Creating a "Ticket to Work and Self-Sufficiency Program."
This new system will enable SSI or SSDI beneficiaries to go to any of a number of public or private providers for vocational rehabilitation. If the beneficiary goes to work and achieves substantial earnings, providers would be paid a portion of the benefits saved.