A Disability Policy Primer for Funders

A well-known national service organization set out to create a program designed to help people with disabilities develop community leadership skills. When the organization applied for funding to foundations that listed leadership development among their categories for giving, they were told that the foundations “didn’t do disability.” When they approached funders that focused on community development, they were told that the disability community was not a geographically defined community and therefore was not eligible for that category of funding. After trying unsuccessfully to explain that disability concerns cut across the funding priorities listed in their guidelines, the organization went back to the foundations that had previously funded its more traditional disability services. There the proposal was rejected because it was targeted at leadership development rather than providing medical or social services. The project was never funded.

This story is far from apocryphal. Versions of it are often told by people in disability organizations, and it illustrates the extent to which grantmaking in the disability arena follows an outdated model of disability policy – often referred to as the “medical model” – which views people with disabilities as patients to be treated and/or clients requiring special services that set them apart from the mainstream of society. The paternalism and pity that have historically characterized disability policy and services have also evoked a “special needs” approach that goes hand-in-hand with the medical model.

In the past 30 years, a move away from these older models has energized the field of disability policy. Rather than locating the problem as the disability within the person, the new paradigm shift looks at the nexus between the individual with a disability and the environment. From this perspective, the problem is not a person’s inability or disability, but social, attitudinal, architectural and environmental barriers. In the new disability policy model, “the problem” includes inaccessible buildings with barriers such as narrow doorways, stairs and lack of elevators; employers with negative attitudes who do not provide accommodations and opportunities to people with disabilities to prove they can do the job; and a legal system that has historically sanctioned discrimination against people with disabilities.

Information collected by The Foundation Center in 18-month intervals in its guidebook, Grants for the Physically and Mentally Disabled, consistently shows that over 50 percent of grants for people with disabilities fall into categories like health, medical research and mental health. On the other hand, disability-related grants for education receive just over 10 percent and employment less than 6 percent, while the combined category, “civil rights and social action” does not even receive 1 percent of the total grants for people with disabilities.

A 1995 study, Survey of Disability-Related Philanthropic Activity, conducted by the Center for Social Policy and Practice in the Workplace at The Columbia University School of Social Work, confirms these findings and introduces new data showing that the Americans with Disabilities Act (ADA) has had minimal impact on the internal operations and grantmaking activities of foundations and corporate giving programs. The survey revealed that although people with disabilities are the largest minority group in America, only 12 percent of all foundations and corporate giving programs in the United States had a board member who identifies as having a disability. Although there were approximately 49 million Americans with disabilities in 1995, only 10 percent of all foundations had a staff member who self-identified as having a disability.(1) Even oday, although one in five Americans will be a person with a disability at some time during his or her lifetime, just over 3 percent of foundation funding earmarked for social change went to benefit people with disabilities.

Foundations have been pivotal in providing support for research, cures and medical innovations that have made it possible for millions of people with disabilities to live longer and better than ever before, yet they have been slow – some would say resistant – to respond to the social and political changes that have arisen as a direct result of those achievements. This is explained by a number of factors, including lack of information or misunderstanding about current sociopolitical developments; the proliferation of other issues requiring attention; and, perhaps, a sense of frustration that the millions of charitable dollars poured into medical research and treatment are now seen by some who benefited from those gains as the problem, rather than the solution. Historian Paul Longmore points out that the younger generation of disability activists, in repudiating the medical model, has presented a sweeping critique of its assumptions:

The new disability perspective . . . has argued that by locating the problem in the bodies of individuals with disabilities, the medical model cannot account for, let alone combat . . . bias and discrimination. . . . Indeed, disability-rights advocates have argued that the implementation of the medical model in health-care, social services, education, private charity and public policies has institutionalized prejudice and discrimination. Far from being beneficial, or even neutral, the medical model has been the core of the problem.(2)

Disclaiming the medical model, however, is not the same as rejecting the need for funding for health and medical issues. In fact, health care and health insurance are major concerns for individuals with disabilities – just as they are for any individual whose health care and coverage is threatened in these transitional times of change in health management, managed care and medical costs. The difference is that, when people with disabilities are not seen through the prism of the medical model, health-related issues take their place as just one of many areas of concern in the lives of people with disabilities today.

The paradigm shift in the disability community is surfacing in many ways. “Sixties-style” political activism has taken the form of civil disobedience aimed at such targets as transportation companies, nursing homes, government commissions like the FDR Memorial Commission, and inaccessible buildings – including the Houses of Congress. Another form is the anger of one-time poster-children (now adults) at the public mentality characterized by telethons that perpetuate the “pity and paternalistic” view of people with disabilities. Still another movement is the evolution of accessible design and of what is known as “universal design” in architecture and manufacturing. The principles and practices of “universal design” are considered by some policy thinkers to be an important part of an inclusive society, designed and built so that it is accessible to the broadest range of abilities, ages (including children, disabled and elderly people), ethnicities, income levels and styles of life.(3)

Dr. Paul Longmore offers a complementary analysis of the universal potential of another new policy perspective based on “disability culture,” which he believes is founded in the need for “self-definition.” That is, having repudiated the view of themselves as victims and patients, a growing number of people with disabilities are claiming their right to define their own identities – coining such phrases as “Deaf-Pride” and “Disability Cool,” which turn once-negative terms into “self-affirming slogans.” This self-definition involves formulating values derived from the experiences of disability, and these are often alternative values to those of society at large. For example, some advocates of disability culture replace the necessity for total self-sufficiency with the need for self-determination, value interdependence over complete independence, and prize personal connection and the notion of community over physical autonomy. By adopting such a perspective, says Longmore, the disability movement has not only helped itself but has presented what is a better model of community for all:

Itcan offer a critique of the hyper individualistic majority norms institutionalized in the medical model and at the heart of the contemporary American crisis. That analysis needs to be made not just because majority values are impossible for people with disabilities to match up to, but more important, because they have proved destructive for everyone, disabled and nondisabled alike. They prevent real human connection and corrode authentic human community.(4)

These new perspectives have redefined the field of disability funding for a small segment of the philanthropic community, and they have broadened the horizons of many more funders who are beginning to see the limitations of the old models. Some grantmakers are now supporting leadership training, community development, advocacy, self-determination and other projects fostering economic and social independence. They are addressing people with disabilities as individuals who are not defined as patients or commodities, but as members of society with the potential for productivity and participation in the life of the community. They see people with a broad set of needs that go far beyond health concerns. These grantmakers have taken the position that if the problem is not with the person, but in the environment, some of the solutions must be focused on the physical, legal, social and attitudinal factors affecting that environment. They have listened to people with disabilities and advocates who say that disability cuts across all social classes and that people with disabilities represent the largest minority group whose rights to inclusion in society are equal to others.

In listening, these funders are challenging the tacit assumption that disability organizations must be considered under health or services specifically designed for people with disabilities. They are responding to grant applications from disability organizations by developing a method of evaluation that incorporates, or at least does not reject, the disability community’s own evolving model of itself. This new approach requires either a leap of faith or knowledge of the history and influences – legal, political, social, economic, technological and medical – that have affected the course of the disability movement over the past 25 years. Funding disability issues and projects with increased knowledge and a willingness to embrace new perspectives has the potential to have an impact on all Americans – not just Americans with disabilities.

The remainder of this document describes the disability movement and highlights significant disability legislation to provide a context for evaluating proposals that reflect changes in the traditional models as well as newly emerging models of disability policy.

The Disability Rights Movement and New Disability Policy Paradigm

The origins of the disability community’s radical shift in self-perception can be traced to the late 1940s, when dramatic changes took place in medicine that rapidly increased the numbers of individuals with disabilities in the United States. As a result of the discovery of antibiotics and other medical advances, soldiers who would not previously have survived returned from the battlefields of Europe and the Pacific with disabilities far more severe than those of earlier conflicts. The polio epidemics of the 1940s and 1950s expanded the disability population and focused attention on the fact that disability could happen to anyone, regardless of age, race or circumstance.

Other advances in medicine, social science, technology and education led to increased health, improved methods of functioning and new assistive technologies. All of these have opened up new opportunities for people with sensory, mobility, learning, mental and develop mental disabilities to be more participatory and productive members of their communities. For example, in 1947, a person with Down syndrome had a life expectancy of seven years; today, life expectancy ranges between 45 to 50 years of age. Another example is the increased incidence of disability in America as a result of brain injury. In 1980, 90 percent of people with brain injury died; in 1990, just 10 years later, 90 percent lived. As health and capabilities improved for Americans with disabilities, they began to discover important differences between how they felt about their lives and what society had always expected of them.

The civil rights movement and legislation of the 1960s and early 1970s set the stage for later legislation granting rights to Americans with disabilities, but they also illustrate the slow recognition of the rights of citizens with disabilities.(5) For the most part, the civil rights advances of this time had no immediate legal impact on people with disabilities.(6) An exception was the Architectural Barriers Act of 1968, which required that all new federal construction be made accessible to people with disabilities. This statute was limited in scope and there were no enforcement provisions in the original legislation. It was, however, an expression of the notion that the environment, not just the individual’s disability, can affect his or her ability to function in a given situation.(7)

The 1960’s civil rights movement – and the subsequent anti-war, student and feminist movements – inspired the disability rights movement. Efforts by students with disabilities in Berkeley in the 1960s to gain access to university programs and facilities were pivotal to ultimately achieving wide recognition of the right to maximum-quality higher education for people with disabilities in America. In 1972, the activists who were students in the 1960s founded the Berkeley Center for Independent Living, the first of hundreds of independent living centers throughout the country that now provide resources that guide and support individuals with disabilities to live and work on their own.

The early disability rights activists learned valuable lessons from the other rights movements of the ’60s and early ’70s: they came to see their disabilities in the same political sense as people of color view their race or women their gender. Along with this new consciousness came an appreciation of how the change-strategies of other movements could be adopted. While models of change-oriented advocacy did not guarantee success, they did suggest a method for stirring up latent support among a constituency and among the general public, and for channeling that support in attempts to influence governmental and institutional decision makers.(8)

Many political strategies were adapted from the male-dominated civil rights movements. But the disability rights movement also learned key lessons from the women’s movement: first, that community empowerment is linked to the growth of the sense of self-worth of the individuals that comprise it; second, that interdependence is preferable to independence; and third, that demands for equality and differential treatment are not necessarily incompatible.(9)

The change in self-perception within the disability community spread slowly, but it brought a momentous shift in outlook. Increasingly throughout this period, a growing number of people with disabilities stopped seeing themselves as damaged – afflicted by medical or physical conditions that made them incapable or invalid. Instead, they began to see themselves as people first, with the right to personal autonomy and full inclusion in all aspects of community life.

The passage of the Rehabilitation Act of 1973 provided the disability rights movement and leaders with their first major statutory expression in the form of Section 504, which bridged the gap between disability policy and civil rights law. Drawing on language from Title VI of the Civil Rights Act, Congress prohibited discrimination toward qualified individuals with disabilities by recipients of federal funds. For the first time, people with disabilities were seen as a legitimate minority group, subject to discrimination and requiring civil rights protections.(10) Furthermore, in Section 503, Congress required that many federal contractors create affirmative action plans for the employment and advancement of individuals with disabilities.

Section 504 broke new ground for Americans with disabilities and was subsequently followed by other disability legislation that incorporated a civil rights orientation. The Developmental Disabilities Assistance and Bill of Rights Act stated that people with develop mental disabilities have the right to appropriate services and treatment that maximize their development and take place in the “least restrictive environment.” Additionally, it established a system of “protection and advocacy” services in each state to advocate for people with developmental disabilities and represent their rights.

The Education for All Handicapped Children Act (1975), now renamed the Individuals with Disabilities Education Act (IDEA), granted children with disabilities their constitutional right to “an appropriate education in the least restrictive setting.” This law, which was reauthorized in 1977, stresses the concept of inclusion of students with disabilities in “mainstream” classrooms and educational programs.(11)

In 1977, after four years of delay, the regulations implementing Section 504 were released by the Department of Health, Education and Welfare (HEW). The agency had moved with glacial slowness in the regulations process, particularly because HEW began to recognize the potential impact of 504 to prohibit discrimination and open up federal programs and activities of federal contractors to people with disabilities. Under the administrations of Presidents Nixon and Carter, HEW delayed time and again. Only when the disability community organized with vocal and visible protests and sit-ins did the administration move to release these regulations. It ultimately took the occupation of HEW Secretary Joseph Califano’s office in Washington, D.C., and a 27-day sit-in at the HEW office in San Francisco to force their release.

During the 1970’s, the disability community was experiencing a revolution of rising expectations; but in 1980, Section 504 and the Education of All Handicapped Children Act came under attack. This resulted in new organizational strategies by individuals with disabilities, parents, disability rights advocates and service providers who demonstrated their resistance by using organized lobbying and other means of advocacy and protest to protect the gains achieved during the previous decade. The greatest impact was experienced at state and community levels where independent living centers (ILCs) were established around the country. The ILCs took on leadership roles to advocate for disability rights at local and state levels. During this time, many municipal offices on disability and state disability advocacy offices were formed to help strengthen laws addressing employment, access and education.

A second wave of disability legislation began in the mid 1980’s. In 1986, Congress passed the Air Carriers Access Act, which protects people with disabilities against discrimination by air carriers. The Civil Rights Restoration Act, which extends the antidiscrimination coverage of prior civil rights legislation, was enacted in 1988, a seminal year for disability rights legislation. The Civil Rights Restoration Act amended Section 504 provisions and other legislation to cover not only direct recipients of Federal funds within an institution, university or business but the entire institution, university or business. While this Act was a victory for the larger civil rights community by extending discrimination laws, it was especially significant for the disability rights movement because, for the first time, people with disabilities were accepted as full partners by the civil rights community. With this law, disability policy rose to a new level, one, which served as a building block for the passage of the ADA.

The Fair Housing Amendments Act (FHAA), also enacted in 1988, extended civil rights protections for people with disabilities into a portion of the private sector – housing – which has a major influence on the quality of life of people with disabilities in allowing access to better options for living in the community. The FHAA extended the protections of the Civil Rights Act of 1968 to two new groups: people with disabilities and families with children. The law had a number of disability-specific provisions, including the requirement that “reasonable efforts” be made when needed to secure and enjoy housing. This was the first time that provisions against disability discrimination were included in a “traditional” civil rights law prohibiting race discrimination.(12)

Also in 1988, the first version of the Americans with Disabilities Act (ADA) went before Congress. It had been crafted by the National Council on Disability,(13) which at that time was comprised of Republicans appointed by President Ronald Reagan. The coalition supporting the ADA grew rapidly, and the campaign to support and pass it was historic in its bipartisan nature. Nationally and globally, the passage of the ADA was a decisive moment for all people with disabilities. It is the broadest legal mandate in the world for the rights of people with disabilities, exceeding that of any other nation. President George Bush signed the legislation on July 26, 1990, in one of the largest celebrations ever held on the White House lawn – attended by over 4,000 citizens and members of the disability community and press.

The ADA is doing for individuals with disabilities what the Civil Rights Law of 1964 did for people of color and for women. The ADA holds that it is no longer legal to discriminate against individuals with disabilities in sweeping areas of life covering both the public and private sectors: employment, access to public accommodations, transportation and telecommunications.

Thanks to the architectural and technological advances pursued under the ADA over the past 10 years, as well as the efforts of educators and activists who helped change mainstream attitudes, people with disabilities now enjoy increased access to civic life, public services, health and childcare, entertainment, commercial sites such as stores, banks, and offices, and education. People with disabilities can participate more meaningfully in public life as city and town halls are made accessible to those with mobility impairments and telecommunications devices are provided for effective communication in court proceedings, public meetings, and other events. Because of the ADA, children who have food allergies, as well as children with diabetes or who are HIV-positive, cannot be denied admission to childcare facilities, and childcare providers can be required to administer simple tests in order to accommodate these children.(14)

The ADA has made access to health care more meaningful by requiring hospitals and other healthcare providers to provide the technology necessary to facilitate communication between patient and provider.(15) The ADA also protects people who are HIV-positive from discrimination in the provision of services, and the United States Supreme Court has recognized that HIV-positive status is a disability under the ADA.(16) Another gain was the Supreme Court’s declaration that unnecessary institutionalization violates the ADA, which requires that people with disabilities must be treated in the most integrated setting that is appropriate, including non institutionalized placement in the community when possible.(17) Activists who have fought for increased availability of and access to community-based housing and services welcomed this decision, and it has prompted states to re-evaluate the administration of their institutional and community services.

The ADA has also guaranteed that the pursuit of entertainment and leisure, as well as the necessities of life, are accessible to people with disabilities. Settlements have prompted architectural changes at grocery and department stores and gas stations,(18) the installation of telecommunications devices and accessible seating at theaters and stadiums,(19) and have made travel less burdensome for travelers with disabilities.(20)

Educational opportunities have also expanded since the ADA’s enactment 10 years ago. Educational testing accommodations – such as providing auxiliary aids, more test date options and sign language interpreters – opened the doors to higher education for more people with disabilities.(21) Furthermore, campuses are now more accessible because of architectural modifications and other accommodations.(22)

There are also many examples of voluntary compliance. The removal of barriers in architecture and transportation, in particular, have meant that people with physical disabilities can circulate more freely and easily and be more active in all spheres of society since the enactment of the ADA.

While disability policy has made tremendous gains in empowering people with disabilities toward independence, many challenges for the future exist. For example, there are areas of conflict and mixed messages between the provisions of the ADA and Social Security programs that contain significant “disincentives” for beneficiaries to return to or obtain work. Over 95 percent of federal funds spent on people with disabilities are targeted for supporting dependency. Little is spent on supporting people to pursue and maintain employment. Too often, health insurance is accessible for people with disabilities only if they do not work. Because they fear losing health-care support, many people with disabilities are locked into Social Security and that system’s built-in disincentives, which prevent employment because beneficiaries can loose health-care options if they earn even a meager income. As a result, employment remains a major issue for Americans with disabilities.(23)

Another major challenge for the future for people with disabilities is accommodation with the most appropriate assistive technology. Science and technology are continually evolving and helping to level the playing field for individuals with disabilities; but the cost is often prohibitive for many in the disability community, and they frequently settle for less than adequate technology.

Further, the disability community is faced with a number of potential setbacks at this time. A series of Supreme Court cases in 1999 exempt from the ADA definition of disability persons who can control the effects of their impairment (i.e., through medication, therapy, assistive technology, etc.) when the mitigating measures eliminate the effects of the disability.(24) As a result of these cases, persons with disabilities who use mitigating measures may find themselves unprotected by the ADA. Also, amendments to the ADA have been proposed which seek to dilute the strength of the original legislation but have so far been defeated. The Supreme Court dealt a blow to the ADA by declaring that state workers may not sue for damages if their employers discriminate against them because of disability.(25) The climate at this time sends a signal to the disability community to remain vigilant as forces attempt to curb the advances of the past 10 years.

Polls show that most people with disabilities want to be employed, educated, participating, tax-paying citizens living in the community and contributing to the economic and social fabric of American life. According to Achieving Independence, published by the National Council on Disability, public and private funds should be an investment in those goals. In the long run, says this 1996 report, investments in the productivity and mainstream participation of people with disabilities are essential to achieving a balanced budget, a maximally productive society, and an America that is able to continue to provide economic leadership in an increasingly competitive world marketplace.(26)

Foundations and corporate giving programs have the opportunity to become an integral part of the history of the disability movement as they look at funding innovative projects that test, challenge and support the issues and the empowerment of citizens with disabilities in America.

Footnotes

(1) Sheila H. Akabas, Ph.D., and Lauren Gates, Ph.D., Survey of Disability-Related Philanthropic Activity, The Workplace Center, The Columbia University School of Social Work, 1995. [return to citation 1]

(2) Paul K. Longmore, “The Second Phase: From Disability Rights to Disability Culture,” The Disability Rag & ReSource, September / October 1995, p.6. [return to citation 2]

(3) Katherine Seelman, “The Changes in Demography Requiring Changed in View on Disability,” The Grantmaker Forum on Disability Policy: Forum I Proceedings (1996) pp, 18-19. [return to citation 3]

(4) Longmore, p.9. [return to citation 4]

(5) The legal foundation of contemporary disability rights law is the Civil Rights Act of 1964, the historic legislation on which the ADA and other American civil rights statues are based. Between 1965 and 1968, two other pieces of legislation – the Voting Rights Act and the Civil Rights Act of 1968, known as the Fair Housing Act – were enacted. These, together with the Education Amendments of 1972, prohibited discrimination based on race, religion, national origin, and gender. However, they did not extend protections to people with disabilities. [return to citation 5]

(6) In the early 1970s, two attempts, one by Hubert Humphrey, were made to amend the Civil Rights Act to include people with disabilities. Both attempts failed, however. [return to citation 6]

(7) Richard K. Scotch. From Good Will to Civil Rights, Temple University Press (1984), pp. 30-1, 36. [return to citation 7]

(8) Scotch, pp. 35, 36. [return to citation 8]

(9) Sara Watson, “Holistic Policymaking: ‘Neo-Liberalism’ as Illustrated by the Women’s and Disability Rights Movement,” Policy Studies Journal, Vol 21, No.4, 1993, pp.752-764. [return to citation 9]

(10) Arlene Mayerson, “The History of the ADA: A Movement Perspective,” in Implementing the Americans with Disabilities Act (ed. Lawrence O. Gostin and Henry A. Beyer) Paul H. Brooks Publishing Co., p. 18. [return to citation 10]

(11) The reauthorization strengthens the emphasis on inclusion by requiring state school systems to remove financial incentives for keeping children segregated in “special” classrooms. Vermont’s new system, for example, gives districts just as much money to provide services in a child’s home school as in a segregated setting. [return to citation 11]

(12) Mayerson, p 20. [return to citation 12]

(13) The National Council on Disability (NCD) is an independent federal agency whose purpose is to promote policies, programs, practices and procedures that guarantee equal opportunity and empower individuals with disabilities. NCD plays a major role in developing disability policy in America. [return to citation 13]

(14) U.S. v. La Petite Academy, Inc., DJ 202-79-58, et al., Settlement Agreement; Stuthard v. Kindercare, Civ. No. C2-96-0185 (S.D. Ohio 1996), Consent Decree; U.S. v. Happy Time Day Care Center, Civ. No. 97-C-439-C (W.D. Wisconsin 1997), Consent Decree; U.S. v. Kiddie Ranch, Civ. No. 97-C-440-C (W.D. Wisconsin 1997), Consent Decree; U.S. v. ABC Nursery, Inc., Civ. No. 97-C-441-C (W.D. Wisconsin 1997), Consent Decree. [return to citation 14]

(15) DeVinney v. Maine Medical Center, Civ. No. 97-276-P-C (D.C. Maine 1997), Consent Decree; Connecticut Assoc. of the Deaf v. Middlesex Memorial Hospital, Civ. No. 395-CV-02408 (AHN), (D.C. Connecticut 1995), Consent Decree . [return to citation 15]

(16) Bragdon v. Abbott, 118 S. Ct. 2196 (1998). [return to citation 16]

(17) Olmstead v. L.C., 119 S. Ct. 2176 (1999). [return to citation 17]

(18) Fox, et al. v. Safeway, Civ. No. 94-0878 (NHJ) (D.D.C. 1994), Settlement Agreement; Lieber, et al. v. Macy’s, Civ. No. C96-2955 MHP (N.D. Cal. 1996), Court Order; Lawson v. Chevron, Civ. No. C99-0529CAL (N.D. Cal. 1999), Consent Decree; Greener v. Shell, Civ. No. C-98-2425-CAL (N.D. Cal 1998), Consent Decree. [return to citation 18]

(19) Arnold v. United Artists Theatre Circuit, Inc., Civ. No. C 93 0079 THE (N.D. Cal. 1993), Settlement Agreement. [return to citation 19]

(20) Ingram v. Seredipity Yachts, Civ. No. C-98-3058-CRB (N.D. Cal. 1998) Settlement Agreement (providing for access to persons with mobility disabilities on buses); U.S. v. Avis, DJ 202-37-60, Settlement Agreement (providing for hand controls in rental cars, among other accommodations); Crowder v. Kitagawa, Civ. No. 93-00213DAE (D.C. Hawaii 1993), Settlement Agreement (overturning Hawaii’s mandatory 120-day quarantine of dogs, including service dogs); Chevron, id. (nationwide settlement requiring Chevron to make covered stations accessible to persons with disabilities, including gas pumps, card readers, counters, and providing refueling assistance); Shell, id. (same). [return to citation 20]

(21) U.S. v. Harcourt Brace/BarBri, Civ. No. 94-CV-3295 (N.D. Illinois 1994), Consent Decree; Okin v. The College Entrance Exam. Bd., et al., 94 Civ. 1659 (PKL) (S.D. New York 1994), Settlement Agreement. [return to citation 21]

(22) U.S. v. Duke University, DJ 202-54-20, Settlement Agreement. [return to citation 22]

(23)The Ticket to Work and Work Incentives Improvement Act of 1999 or TWWIIA (Public Law 106-170) provides that social security recipients with disabilities may receive a “ticket to work” from the Social Security Commissioner, allowing them to choose among a rehabilitation provider, employment service, and other supports. It also offers states the option of allowing working people with severe disabilities to “buy-in” to Medicaid and extends the duration of Medicare coverage. This program will expand work opportunities to a large number of people with disabilities without jeopardizing the important health benefits that are available to social security recipients through Medicaid. Ticket to Work is the first step toward removing Social Security’s work disincentives. [return to citation 23]

(24) Sutton v. United Airlines, Inc., 119 S. Ct. 2139 (1999); Murphy v. United Parcel Service, 119 S. Ct. 2133 (1999); Albertsons, Inc. v. Kirkingburg, 119 S. Ct. 2162 (1999). [return to citation 24]

(25) The Board of Trustees of the University of Alabama v. Garrett, 2001 WL 173556 (S.Ct. February 21, 2001). [return to citation 25]

(26) Achieving Independence: The Challenge for the 21st Century, National Council on Disability, July 26, 1996. [return to citation 26]