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Both the grants and the demonstrations help advance the goals of the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), a law passed by Congress to encourage people with disabilities to work without fear of losing their Medicare, Medicaid or similar health benefits.

The Demonstration to Maintain Independence and Employment is a new approach for the Health Care Financing Administration (HCFA), which administers the Medicare and Medicaid programs. The demonstration will allow states to provide health care services and supports to working individuals that they need to manage the progression of their diseases. The program will help people remain competitively employed by preventing or delaying the deterioration or a relapse of their condition. Qualified enrollees will be those with conditions where individuals usually experience progressive deterioration or periodic setbacks in their health and their ability to work.

"By helping employed individuals better manage their own chronic health conditions while they are working, we hope to prolong a healthy, productive work life," said HHS Secretary Donna E. Shalala. "We think it makes great sense to assist these workers to stay healthy and employed as long as possible for the benefit of the person and society. I am proud of this administration's long record of assisting people with disabilities to support themselves and live independently."

Two states, Rhode Island and Mississippi, will be the first recipients of TWWIIA grants for the Demonstration to Maintain Independence and Employment. All states are eligible to apply for the grants, a program Congress authorized for six years at a spending level of $250 million over the six years.

Rhode Island will receive approximately $2 million over six years. The state plans to provide a package of services equivalent to those provided under Medicaid to individuals who have been diagnosed with Multiple Sclerosis but are not yet too disabled to work. The state will also include

key services such as case management, personal assistance services, pharmaceutical copayments and other employment supports. Qualified individuals will be those working at least 40 hours each month. Rhode Island officials expect that many people enrolled in the demonstration will have employer-sponsored coverage. They will use the added services to "wrap around" that coverage to make it more effective in preventing deterioration of the person's condition.

Mississippi will use its $27.5 million grant award with additional state funds to cover 500 persons with a diagnosis of HIV/AIDS, who work or who PLAN to return to work. The state's program will mirror the full Medicaid benefits and services. The project will be implemented in nine counties in the Mississippi Delta where there is a relatively high rate of HIV/AIDS and limited health care resources for people with this condition.

"Our goal with these grants is to see if getting health care to people earlier than traditional Medicaid rules allow will actually lower long-term costs and increase a person's work life and the quality of that life," said Michael Hash, HCFA's acting administrator.

The second grant program announced today would assist 24 states and the District of Columbia in improving their ability to help people with disabilities hold down a job and maintain their health coverage. Congress approved the Medicaid Infrastructure Grants Program for 11 years with $150 million appropriated for the first five years of the program. States will share about $17 million for the first year.

The Medicaid Infrastructure Grants will help states build the systems they need to allow individuals with a disability to purchase health coverage through Medicaid. People with a disability often cite the fear of losing health coverage as one of the major barriers to a possible return to work. "Seventeen states have taken the lead to enact legislation that enables people with a disability to purchase health coverage through Medicaid at affordable rates," said Hash. "We want to help any state that wishes to improve its economy and its workforce by enlisting the talents of people who have a disability."

Grant monies will help enhance systems that provide personal assistance and supports. Such assistance can include help with bathing, dressing and other activities at home or on the job. States can also use the funds to assist employers to gain better access to this underused pool of workers, conduct outreach to people with a disability, train staff in new employment possibilities, and improve transportation or other supports upon which people with a disability rely.

States receiving this first round of awards include: Alabama, Alaska, Connecticut, District of Columbia, Georgia, Idaho, Illinois, Iowa, Kansas, Maine, Massachusetts, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, Utah, Vermont, Washington, West Virginia, and Wisconsin.

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