We aim to enhance community integration by improving communication. Such integration can only occur if individuals with disabilities take an active role in both designing and implementing those policies that directly affect their lives.

Help-Your-Self acts as a liaison between people in the disability community and government and private agencies establishing clear channels of communication that increase the chances for effective legislation.

Having knowledge of both disability issues as well as policy development allows us to provide policymakers a direct link to the needs of the communities they serve. Integration occurs not by just providing programs and services, but by providing effective programs and services.

The staff of Help-Your-Self conducts community forums to inform the public about programs offered by private, public, and government agencies. Our gatherings are educational in format and offer an analysis of past, present, and future programs. We provide constituency advice regarding independent living, community integration, work incentives, and injury prevention issues. Our recommendations always take into consideration the impact upon the community that previous legislation has had.

We contribute to policy planning and analysis and have helped non-profits, theatres, museum, and for-profit organizations increase their physical and program accessibility to individuals with disabilities. We have collaborated and worked with national and local policymakers and advocate agencies such as:

  • AAPD
  • American Paralysis Association
  • D.C. Center for Independent Living
  • D.C. City Council
  • D.C. Long-Term-Care Coalition
  • Disability Focus
  • District of Columbia's Medical Assistance Administration
  • Endependence Center of Northern Virginia
  • Independence Now
  • Independent Living for the Handicapped
  • Mayor’s Committee on Person’s with Disabilities
  • Metropolitan Spinal Cord Injury Association
  • National Clearinghouse on Disability and Exchange
  • National Coalition on Independent Living
  • National Institute of Health
  • National Institute on Disability and Rehabilitation Research
  • National Multiple Sclerosis Society
  • National Muscular Dystrophy Association
  • National Spinal Cord Injury Association
  • National Rehabilitation Hospital
  • Paralyzed Veterans of America
  • University Legal Systems

Advocacy, Medicaid and Work Incentives

Help-Your-Self advocates creating health policies and programs that meet the actual needs, as opposed to the perceived needs, of people with disabilities. Working with the D.C. City Council, the Nursing Board, and the Department of Health, we are helping to replace a medical model of care with a social model of care. We advocate in favor of programs that increase quality of care as defined by individuals with disabilities.

Through these actions we have contributed to the increase of available ‘Home and Community Based Services’, the development and achievement of a D.C. ‘Money Follows the Person’ grant, the implementation of the ‘Real Choice Systems Change’ grant (RCSC) and ‘Medicaid Infrastructure Grant’ (MIG), and have helped set policy for ‘Self-Directed Care’ programs.

We advocate in favor of work incentives and the development of programs that assist people with disabilities in rejoining the workforce. The ability to work and sustain employment is key to an individual’s independence: it provides income, a sense of purpose, identity, self-worth, and a sense of contribution to society. We support and encourage policies that allow individuals to work yet retain their medical coverage: accordingly, we speak formally and informally to audiences throughout the District of Columbia to promote and to educate consumers about a ‘Medicaid Buy-in for Workers with Disabilities’ program and other work incentives.

Why is there a need for the Medicaid Buy-in for Workers with Disabilities program?

In 1990, the Americans with Disabilities Act (ADA) opened doors to support employment of people with disabilities, yet there are barriers within the U.S. Government healthcare system which often deter people with disabilities from seeking employment. Currently, the government guarantees Medicaid health insurance for unemployed people with disabilities, but this insurance is lost when they earn more than a sub-minimum wage, receive partial cash payments, or accumulate assets that render them ineligible to qualify for SSI or SSDI.

Because of this, people with disabilities too often tend to avoid work or any increase in earned income, for fear of losing their Medicaid insurance. Additionally, those who do choose to work are faced with the fact that a great number of employers are unable to provide medical insurance which includes the type of life-sustaining medical supplies and services which they need to remain functional and independent. Access to health insurance is therefore a major obstacle which needs to be overcome.

What is being done?

Help-Your-Self continues to encourage the D.C. Medical Assistance Administration and the D.C. City Council to change the current system, laden with work disincentives, to a system that allows individuals with disabilities to work without fear. We strongly support implementing a Medicaid Buy-in for Workers with Disabilities.

In 1999, the Federal Government enacted the ‘Ticket to Work and Work Incentives Improvement Act’(TWWIA) which D.C. started implementing in June, 2002. This act requires states to design and implement programs that improve client autonomy over service options, provide incentives to seek employment, and provide resources to facilitate training so that individuals may become employable and maintain employment.

The D.C. Government has been working to create an infrastructure to meet these goals. Part of these goals will be achieved by providing: a Resource Center (a clearinghouse of information), planning and Benefit Specialists, counselors, a training center, expanding Medicaid Waiver services to include a ‘Self-Directed Care’ program, training for Personal Care Assistants, training for consumers, and increased housing options.

In order to meet the TWWIA requirement of providing employment incentives, twenty-four states have implemented a Buy-in program and have experienced positive results. The D.C. Medical Assistance Administration could use the MIG grant, awarded by the Center for Medicare and Medicaid Services (CMS), as an opportunity for the District of Columbia to help implement a true work incentive such as a local Medicaid Buy-in for Workers with Disabilities.

What is a Medicaid Buy-in for Workers with Disabilities?

Eligibility for D.C. Medicaid programs is currently limited to individuals with low incomes and few assets. Therefore, people with disabilities who want to work and retain Medicaid coverage are caught in a loop: if they don’t work, they live in poverty, if they work, they risk losing the health insurance that provides what they need to remain in the workforce. For people with disabilities, basic life activities require planning, scheduling and coordinating. In order to work, it is paramount that they receive personal care assistance and assistive products. These type of services are provided by Medicaid. The Medicaid Buy-in for Workers with Disabilities is a program that would provide working Washingtonians with significant disabilities the opportunity to be gainfully employed, purchase full Medicaid services (by paying a low cost premium), while not losing any of their social security benefits.

The D.C. Government is currently running several worthy programs for people with disabilities, provided their income and assets do not exceed SSI or SSDI requirements, such as: a Medicaid State Plan, the Social Security Administration’s Ticket to Work benefits, the Medicaid Spend-Down initiative, job skill training through the Department of Mental Health (DMH) and the Mental Retardation and Developmental Disabilities Administration (MRDDA), and Vocational Rehabilitation through the Rehabilitation Services Administration (RSA) and the Department of Employment Services (DOES). These are indeed work incentive programs, however, if people with disabilities maintain gainful employment, they lose all the benefits provided by these programs.

The Medicaid Buy-in for Workers with Disabilities is a necessary component of a puzzle of services that allows citizens with disabilities to be employed. The inclusion of people with disabilities in the community helps our social and economic system as a whole. A Medicaid Buy-in for Workers with Disabilities would provide essential services that other programs do not offer.