Almost four years ago, I took a job as a Program Analyst with a city department that provides services to people with intellectual disabilities. The services are funded through Medicaid. Medicaid has a combination of State and Federal funding, with a little local money thrown in.
The part of the job I like the best is enrolling people in the services for the first time. It could be a young person who will use the services to look for a job and be supported to keep it, or it could be a person who receives services at home during the day so that the family member(s) they live with can go out to work. But my favorite scenario is taking a person out of a restrictive environment and setting them up with services in the community. These are folks who usually move into group homes. Individuals in this last group are usually leaving a hospital, nursing home or some other institution to move to the community.
In order to get enrolled into Medicaid Home and Community Based Services, an individual must be low income (less than $18,075 per year one person household). Individuals work with a supports coordination agency to fill out the application and must provide proof of income. Medicaid enforces a five-year look back, which is designed to establish that an individual has not transferred resources in order to be eligible. The average monthly amount our folks have is usually around $974 (SSI). When the supports coordination agency is done with the application, it comes to me. I review it, and make sure that it is complete and accurate. We also certify that the individual is disabled and in need of an institutional level of care that can be met in the community.
I have two reasons for including this information. One is to show that the process of being authorized is sometimes technical, and the other is to show that the lifestyle of being on a low income is hardly luxurious. People leaving institutions have no resources, and usually apply for social security only when they are settled in their new home. Once the application is approved, the process of certifying eligibility is repeated each year. It is not easy to get and keep eligibility. The cynic in me says that the process is hard in order to stop some from doing it.
I could go on about all the technicalities of MA eligibility and maintaining it, but that’s not why I am writing this piece. In terms of my career in human services, this job is one of the most satisfying I have ever had. I am an individual with a significant disability myself. I was fortunate to be born to a family who kept me at home and did not institutionalize me. That was the trend at the time I was born. I like to think that my disability makes me unusual in this field. The folks at the county assistance office who receive these applications get passionate emails from me. They don’t know me. They probably think I am over the top. I push and push for the person to be authorized because I want my people to be free in the community. I am passionate about ensuring that disabled people live in the community. I will chase them to the ends of the Earth if I have to.
The staunch advocates in the disability community work on all the systems stuff. I do my advocacy one individual at a time. I can’t help it. There but for the Grace of God go I.