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The Future of Disability in America
vide interim medical benefits to certain applicants for SSDI who have no insurance, whose health would likely improve with treatment, and for whom additional medical information would assist the disability adjudication process.
The committee strongly encourages the agency to pursue these demonstration projects and other strategies that would help reduce the features of the program that discourage work and thereby undermine the goals of independence and community participation that are the hallmarks of modern disability policies. Nonetheless, these approaches will affect only a subset of individuals, a subset that is likely to have the best chance of recovery, and will exclude the most vulnerable. In the absence of a complete phase out of the waiting period, the Congress could consider the expanded use of exceptions or other strategies that would target particularly vulnerable groups.
The Congress has created some options for states to provide Medicaid coverage for certain low-income people with disabilities who have qualified for SSDI or SSI but who can work (Lopez-Soto and Sheldon, 2002; Teitelbaum et al., 2005). For example, among other provisions, the Ticket to Work and Work Incentives Improvement Act of 1999 enhances earlier legislation that allows states to continue Medicaid benefits for individuals with disabilities who enter or reenter the workforce and who meet certain income and asset criteria. Eligible individuals may, however, have to pay premiums (“buy in”) or cover other costs (e.g., make copayments for services). The legislation also extends to 8.5 years the period of premium-free Medicare Part A coverage for people receiving SSDI who return to work. As useful as these federal and state programs may be for some people, they lack the reach of federal and state policies that have extended insurance coverage for children. It is important that policy makers continue to develop and evaluate policies that remove or reduce economic and other barriers to work for people with disabilities, including barriers related to eligibility requirements for public insurance.
Notwithstanding the successful expansion of health insurance for children through the SCHIP program, interruptions in coverage are a problem in this program. As discussed earlier in this chapter, studies have identified administrative practices that increase such interruptions, in particular, requirements for active recertification and reenrollment every 6 months. Requiring recertification no more often than every 12 months would reduce administrative barriers to continuing enrollment in SCHIP of children with disabilities or special health care needs.
As noted above, Chapter 9 includes recommendations related to Medicare and Medicaid coverage for assistive technologies and personal care services. In addition, it cites examples of troubling and complicated actions taken by state Medicaid programs that may seriously affect people with disabilities, even when protections for this group supposedly exist.