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.
If you have lost your job and you're applying for unemployment, you don't have a choice but to abide by whatever standards your state's system requires.
I've spent the last few months talking to Hill staff about the SSI program and the arcane and cruel rules that govern it and I'm sure some have thought why would anyone put themselves through these rules? And that's because people don't have any other choice.
It is absolutely no choice when the other option is not paying rent. Or not having health care.
You would be surprised how many policy ideas are just about allowing people to choose between two kinds of broken, harmful systems because "they can choose!"
I'm not here for that kind of playing. Especially not when it will, by definition, hurt people of color and with disabilities the most because it won't be a real choice.
We shouldn't be offering people a choice. We should be offering people a functioning, responsive support system that gives them what they need. And we all ask for that, that's what we'll have.
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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.
Okay, there's a fight going on in my mentions, so let's do means testing for disability benefits 101.
First, people with disabilities rely on a f*** ton of benefits usually. This often includes Medicaid, housing supports via Section 8, nutrition assistance via SNAP, various state benefits, and some type of primary income assistance via the Social Security Administration.
Medicaid has asset/resource limits and income tests. The Affordable Care Act eased a lot of these up to the federal poverty level in states that opposed to giving health care to poor people.