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Crushing The American Dream: Homebound And Broke


A recent announcement by a federal agency started me thinking about the absurdity of government policies that indicate how the government's left hand does not seem to know what the right hand is doing. In fact, in many cases the two hands are actually working against each other, like in a tug of war. The losers in that battle are members of the disability community, especially those individuals who want to work but must rely on government benefits or programs for their very survival.

On the plus side, the Department of Labor's Office of Disability Employment Policy, the Equal Employment Opportunity Commission, the Department of Education, the Rehabilitation Services Administration, the Department of Justice and the Department of Transportation spend millions of dollars each year to assure that people with disabilities have access to a competitive education, are able to find employment, have their rights protected and can access the entire world they live in. They are joined by several disability-focused boards and commissions in their efforts to level the playing field for those who rely on the programs, services and protections they provide.
On the other hand, some policies at the Centers for Medicare and Medicaid Services (CMS), as well as the Social Security Administration, have the opposite effect. Arbitrary restrictions on income and accumulation of savings serve to keep people unemployed, or underemployed, in order to preserve their access to important services that they would otherwise be unable to afford. The CMS homebound rule, coupled with the agency's restrictions on the purchase of durable medical equipment and mobility devices suitable for use outside the home, serve to restrict the ability of people with disabilities to access the world around them or seek competitive employment.
Policies in place at CMS, the nation's largest medical insurance provider, have worked to assure that people with disabilities who require personal assistance services or the use of wheelchairs for mobility are restricted to their home environment. The result is that thousands of people who have a need for mobility devices have few options for getting out in public, seeking employment, or enjoying many of the benefits shared by their family, friends and neighbors who are not sequestered in their homes.
The arbitrary restrictions on the type of equipment being provided are not confined to the Medicare and Medicaid public insurance programs. Private insurance providers often follow the government agency's lead, as that policy can result in cost reductions to insurers when cheaper mobility devices are provided. It is possible to file appeals to seek a reversal of a CMS decision to downgrade the quality of a mobility device of course. Unfortunately, not everyone has the ability, patience or even the stamina, to follow the arduous process that is necessary to overturn a CMS denial of a claim.
The simple act of leaving the home periodically may result in an agency decision to discontinue eligibility for such vital services as Medicaid homecare, which is an unacceptable risk for someone with a significant disability who requires that care in order to avoid hospitalization or institutionalization. Finding a job and accumulating savings for a future retirement can have the same effect as, in order to remain eligible for Medicaid's health-related insurance program or to receive SSA's Supplemental Security Income, there is a limit of $2,000 for savings or other assets.
The absurdity of the situation came to mind after reading an announcement from the federal Department of Transportation which, in conjunction with the Department of Labor's Office of Disability Employment Policy, recently announced a new program known as the Accessible Transportation Technology Research Initiative to help improve options for people with disabilities to use transportation. Their stated goal is pretty straightforward:

"ATTRI will enhance the capability of travelers to reliably and safely execute independent travel. ATTRI will identify, develop, and deploy new transformative technologies, applications or systems, along with supporting policies and institutional guidance, to address mobility challenges of all travelers, in particular, travelers with disabilities." (per the ATTRI website.)
It would seem that the time and money dedicated to ATTRI might be better spent in reviewing the common link between all modes of travel, which is the mobility device used by the individual. There is no legitimate reason for basic travel between home and employment, or any other destination, to be so difficult or even impossible for people who rely upon mobility devices as their primary means of motivation.  
The inferior quality of some mobility devices that are being purchased by CMS due to the homebound restriction means that every trip on public transportation or a cross-country flight might be the last trip for that device. The competitive bidding process instituted for Medicare and Medicaid that awards the exclusive rights to particular vendors to serve an entire region means that repair or replacement of wheelchairs and scooters can take several months. Because of that, having them damaged while using any mode of transportation is an unacceptable level of risk for anyone with a mobility impairment.
At the same time that the homebound restrictions serve to keep people at home and unemployed, several other federal agencies and the disability community as a whole have been lamenting the fact that the unemployment rate for people with disabilities remains unacceptably high even 25 years after the passage of the law meant to open the doors to employment: the Americans with Disabilities Act.
Many of the systems put in place as a result of the ADA are supposed to make it easier for people to get out of their home: examples are wheelchair lifts on buses, ramps replacing stairs, automatic door openers and accessible businesses. Without a mobility device capable of reaching the nearest public transit stop it doesn't really matter if the next bus has a working wheelchair lift or a favorite restaurant has an accessible restroom.
What can be done to correct the situation? A good first step would be to set aside the homebound restriction and equip people with wheelchairs that are suitable for all aspects of life. While the passage of the ABLE Act was a positive step forward for people who are/were disabled before age 26, there is no reason that it should not be available for the use of people who were disabled later in life and have the same need to accumulate enough funds to maintain their independence as long as they live.
Apparently there is no one taking a high-level view of the conflicting policies and regulations that are a detriment to the disability community and that work against programs in place at other federal agencies. It is long past the time for someone with the ability to change those policies to answer the question: Why?

© 2016 Michael Collins | Like Mike on Facebook
Posted by Michael Collins on Feb 15, 2016 6:45 PM America/New_York