As a person with a disability, it is understandable why I might be considered an advocate for people’s rights. Although I am currently the Special Assistant to the Commissioner at the New York State Office of Mental Health responsible for consumer and family affairs, I regularly experience issues that would be related to the psychiatric labels which I have had since age six. After a lifetime of dealing with my own issues as well as listening to those of other peers, I have come to appreciate a quote from Thomas Eddy written in 1815, “Of all the modes maniacs use to maintain themselves, regular employment seems to be the most effective.”
In the 1800’s, at a time when Psychiatric Hospitals were working farms, every patient was engaged in gainful activities making hospitals profitable enough to contribute funding to state budgets. Full employment at a time before psychotropic medications were even invented seems almost implausible, yet it is our history. Employment provides an identity that for many creates a reason to manage symptoms.
In 1988, I was leading a group of people with psychiatric labels in Maryland and was involved with creating one of the first publicly funded job skills training centers run by peers (On Our Own Computer Center). Early advocates, including Jackie Parrish who was then at NIMH in the Community Support Branch, helped support the program design and encouraged the documentation of outcomes. Dr. Lauren Mosher was our first contract manager from government and helped provide a linkage to sound clinical approaches that resulted in homeless individuals with psychiatric labels successfully sustaining employment. This program became a model employment center recognized by the National Institute on Disability and Rehabilitation Research (NIDRR).
By 1994, I was working with Matrix Research in Philadelphia under a NIDRR contract and providing national training on the development of agency-run businesses. This afforded me the opportunity to assist hundreds of others with disabilities to achieve employment goals with their own businesses. Individuals with psychiatric labels, who would be considered unemployable by many, achieved competitive employment or owned their own businesses, and set a standard that every provider should achieve. This experience has become a hallmark of my personal advocacy efforts.
Despite the fact that many work incentives have been available under Social Security rules since 1987, few of these options are actually used in New York. One of the goals of the OMH Office of Consumer Affairs, which I direct, is to ensure that recipients, families and providers are aware of these incentives and begin to take advantage of them. The Medicaid Buy-in Program for Working People with Disabilities (MBI-WPD) is one of these programs. Available since 2003, barely 6,000 New Yorkers currently use this program. The MBI-WPD provides New Yorkers with disabilities who work (full or part-tine), to obtain Medicaid health insurance benefits while earning up to $55,188 per year and / or having assets as much as $13,800. Presently there isn’t even a premium cost for individuals and yet few are taking advantage of this opportunity. Individuals on “spend-down” who are employed will find an advantage to signing up for the “Buy-in,” saving the cost of “spend down” each month and eliminating monthly paperwork requirements.
New York State now has an exciting set of opportunities, as the result of receiving a federal Medicaid Infrastructure Grant (MIG). This grant has provided $5.9 million dollars this year to advance the employment of individuals with a disability, including expanding the use of the Medicaid Buy-in. The major goals to this grant for New Yorkers with disabilities are to: (1) Develop a statewide strategic plan on employment and economic development; (2) Align disability services, workforce and economic development efforts; (3) Improve employment outcomes using evidenced-based and promising employment practices; (4) Identify and address policy, practice and economic barriers to work and self-sufficiency; (5) Increase work incentives utilization; (6) Research and evaluation support related to disability policy and practice; (7) Link employment at livable wages with asset accumulation tools and strategies; (8) Increase healthcare access through the Medicaid Buy-in; (9) Expanded opportunities for education, skills development and empowerment; and (10) Develop and expand customized and entrepreneurial approaches to employment.
The MIG grant will help to educate individuals and providers about some employment supports that are currently under-utilized. Social Security has had three options about which every provider should become aware: 1619(b); PASS Plans; and Employment Networks. The 1619(b) provision makes it possible for individuals on SSI who begin earning too much to be eligible for cash benefits, to maintain Medicaid eligibility up to the state earnings threshold of $43,421. PASS Plans enable individuals applying for or receiving SSI to save money to spend towards an employment goal, enabling them to receive training or even start their own businesses. Employment Networks make it possible for providers to be paid for assisting individuals with a Ticket to Work to acquire and maintain employment.
It is my fervent hope that with these initiatives, we will dramatically enhance the employment opportunities for all New Yorkers with disabilities.
