I have been prompted tonight to share this story, so... professionally, I do public policy. And looking at 2020, my plan was to do comprehensive marriage reform for people with disabilities.
I had a whole plan. I had talked to many of the loudest voices in the field about how to make sure marriage equality worked for everyone. I had a bill idea that I was planning to take to the hill. I was planning a whole media strategy with my organization.
A short thread about the idea of choice and the poisonous ways it's used in policy work.
There is a deep and abiding assumption choice is an absolute good. Politicians rarely say they're going to take away choice. I always think of Obama's promise that people could choose to keep their health care plan after the ACA was passed.
Except, of course, when it comes to low income people. There's no choice about working and receiving SNAP benefits--if you need help paying for food, you've got to try and work.
A short 101 on Medicaid HCBS funding because I know it can be confusing to everyone. Medicaid is health insurance for the lowest income folks, which includes many people with disabilities. HCBS are the home and community based services people with disabilities can receive.
I say "can" receive because HCBS services are optional. Many services are mandatory, or required by the federal Medicaid law. HCBS are not. Often folks have to get on a waiver to access these services and waivers have waiting lists that can last decades.
This is partially because when Medicaid was created back in 1965, the traditional services provided to people with disabilities were institutional services--psychiatric asylums, facilities for people with physical or intellectual or developmental disabilities, etc.
For people new to disability policy, SSI is how we support the lowest income people with disabilities and older adults. It's an incredibly important program, but one that hasn't been updated in decades.
But a mental illness is a disability. These interventions are not only inappropriate for children with intellectual and developmental disabilities, they're also inappropriate for children with mental health disabilities.
And, hot take, also really inappropriate for adults with mental health disabilities. We are outsourcing mental health care to the police.
I will, for what feels like the hundredth time, remind everyone that Florida has chosen not to expand Medicaid. Meaning that people are serious mental illness do not have access to even the basic health care available via Medicaid.