Chairman Bilirakis, Congressman Brown, distinguished Subcommittee members, thank you
for inviting me to discuss the strong support of the Clinton Administration for the Work
Incentives Improvement Act of 1999. We would like to thank Chairmen Bilirakis and Bliley,
Congressmen Dingell, Brown, Lazio and Waxman, and Senators Roth, Moynihan, Jeffords and
Kennedy for their leadership in building bipartisan support for this prudent, fair, and
The Health Care Financing Administration is working diligently, in concert with the
President's goals, to improve the lives of
people with disabilities. These individuals deserve to be treated with dignity, to be able
to contribute their talents and skills to society, and to have broad options for obtaining
the care and services they need. Now, more than ever, given innovations in technology and
the historic strength of the economy, people with disabilities can and should be able to
work and pay taxes.
One way we are working to meet these goals is by encouraging States to offer more
Medicaid home and community-based services. This involves allowing funds for care and
services to "follow the person,"instead of dictating that services will be funded
only in specific settings like nursing homes. And, based on results of a University of
California San Francisco study we commissioned, we are changing Medicaid rules to
encourage care in home and community-based settings.
However, some policy changes needed to improve the lives of people with disabilities
require legislation. The Work Incentives Improvement Act is one such piece of needed
We need this legislation so people with disabilities can take fuller advantage of
technology advances that have opened doors to the workplace for them. We must ensure that
people with disabilities can engage in gainful employment without losing public health
care coverage that they often cannot replace in the private sector. We must also give
young people with disabilities the opportunity to go from education to employment without
ever receiving cash assistance in order to gain health care coverage. This bill will do
The President, HCFA and a wide, bipartisan array of Congressional leaders strongly
support this bill. It is included in the President's
fiscal 2000 budget, and is part of a broader Administration agenda for helping disabled
individuals return to the workforce.
Currently three out of four people with disabilities are not working. The unemployment
rate among disabled people is exacerbated by existing law, which can make a person with a
disability who takes a job ineligible for Medicare and Medicaid because of their income or
ability to work. Private sector coverage is often unavailable or unaffordable for disabled
people specifically because of their disability.
The Balanced Budget Act enables States to provide Medicaid coverage to the working
disabled with incomes up to 250 percent of the federal poverty level if they meet the
unearned income eligibility criteria and definition of disability for the Supplemental
Security Income program. We have encouraged States to take advantage of this opportunity,
and have approved Oregon's plan to do so.
Several other States have proposals under consideration, but too few States have taken
advantage of this BBA provision.
The Work Incentives Improvement Act will improve upon the Balanced Budget Act in a
number of ways. It expands State options for providing Medicaid coverage to the working
disabled. It allows States to lift or relax current eligibility limits on assets and
income for this population. States would be able to set limits on assets and income, and
they would be able to charge premiums on a sliding scale. States could also allow the
working disabled to continue to buy Medicaid coverage when they would otherwise lose
eligibility due to medical improvement.
The Work Incentives Improvement Act will provide $150 million over five years in grants
to participating States to help them develop programs and systems that support working
individuals with disabilities, build the capacity to provide home and community-based
services, and conduct outreach campaigns to connect individuals with services. This money
should help States facilitate coverage for optional eligibility groups and increase the
likelihood that they will choose to provide this coverage.
The Act will also provide Medicare Part A coverage (for inpatient hospital and related
acute care needs) to any individual who remains disabled but loses Social Security during
the 10 years following enactment of this bill due to their ability to earn a living. This
will provide important relief for the working disabled in States that do not choose the
And it provides for a $300 million demonstration program over five years that would
allow participating States to provide Medicaid to individuals with health conditions that
have not yet rendered them disabled, but that can be expected to cause the level of
disability required to qualify for disability income. This demonstration would test the
cost effectiveness of providing coverage and consequent care needed to prevent disability
and related costs. And it will provide important data that private insurers can use in
crafting new coverage policies for disabled workers.
The bill also includes a series of non-health provisions that target individuals
receiving Social Security disability benefits, including:
- a "Ticket to Work" public-private partnership program that would allow
beneficiaries to go to either a public or private participating provider for
employment-related services, with payment to providers based on employment outcomes;
- restrictions on employment as the sole basis for continuing disability reviews;
- expedited eligibility determinations for beneficiaries who have left disability rolls to
return to work but then must reduce or stop work due to their impairments; and
- outreach and assistance programs to provide information on work incentives.
The President has proposed to broaden the outreach and assistance grant programs in the
bill to include "one-stop shopping"assistance for people who need help navigating the
bureaucracies involved in returning to work. The proposal would provide grants to ensure
that one-stop centers, established by the Workforce Investment Act of 1998, are focused on
integrating services that are essential for people with disabilities. We hope that you
will consider this broader grant program in this bill or other legislative proposals.
The threat of no health coverage should not be allowed to discourage capable
individuals from returning to work. It is both prudent and fair to extend Medicare and
Medicaid benefits to disabled individuals under the Work Incentives Improvement Act in
order to remove this threat.
ADMINISTRATION SUPPORT FOR THE WORKING DISABLED
As mentioned above, support for the Work Incentives Improvement Act is part of broad
Clinton Administration support for efforts to improve the lives of people with
disabilities and facilitate their employment. President Clinton established the President's Task Force on Employment of Adults with
Disabilities by Executive
order on March 13, 1998. This task force is working to
coordinate national policy to bring adults with disabilities into the workforce at a rate
that is closer to the general population.
The President's fiscal 2000 budget includes a
three-part initiative that will invest more than $2 billion over five years to encourage
employment among disabled individuals. The first part of that initiative is enactment of
the Work Incentives Improvement Act. On January 13, 1999, the President announced his
support for this legislation as part of his larger initiative to improve economic
opportunities for Americans with disabilities.
The President's fiscal 2000 budget's working disabled initiative also includes a
proposed $1,000 annual tax credit for workers with disabilities to help defray the costs
of transportation, adaptive equipment or other job assistance. It also includes a $15
million or 50 percent increase for assistive technology activities authorized under the
Assistive Technology Act of 1998, and expanded access to information and communication
technological advances that help disabled individuals function on the job. Workers with
disabilities also will benefit from the President's
multi-faceted long-term care initiative that includes a number of provisions targeted
toward adults with disabilities.
Also, to further provide States flexibility to offer more home and community-based
services, the Vice President recently unveiled a new proposal to allow States to expand
home and community-based care to individuals with incomes up to 300 percent of the Social
Security Income limit. That is the same income limit for providing care in nursing homes.
This would provide another State option to enable families with long term care needs to
stay in the community. The initiative would cost $110 million over five years, and is paid
for in the Administration's balanced budget.
The Work Incentives Improvement Act is prudent, fair, and necessary to ensure that
disabled individuals can participate fully in the job market without fear of losing health
care coverage. We are proud to be among a wide, bipartisan array of supporters for this
legislation. We look forward to working with you to secure passage of this bill and other
Administration proposals to help bring disabled individuals into the workforce and to
increase the availability of Medicaid services in home and community-based settings. I
thank you for holding this hearing, and I am happy to answer your questions.