Research on Employment Supports for People with Disabilities: Summary of the Focus Group Findings. Public In-Kind Support


In-kind support consists of goods and services that are provided free of charge. Examples of public in-kind support include food stamps, housing subsidies, and health insurance. In-kind supports function as income, because absent the supports recipients would need to purchase the goods or services on their own.

Medical Assistance: The Medical Assistance Administration (MAA) provides a wide range of medical services based on clients needs and circumstances. The MAA administers the following programs:105

  • Medicaid: Categorically Needy (CN) Coverage. These federally matched Medicaid programs provide the broadest scope of medical coverage. Individuals may be eligible for CN coverage only, or they may be eligible for cash benefits under the SSI or TANF programs. CN includes a full scope of coverage for pregnant women and children.

  • Medicaid: Medically Needy (MN) Coverage. This program is both a federally and state- funded Medicaid program for aged, blind or disabled individuals. Pregnant women, children, and refugees with income and/or resources above CN limits are also eligible. It provides slightly less medical coverage than CN.

In 1998, there were 699,000 individuals enrolled in Medicaid Managed Care. This is 99.9 percent of the individuals enrolled in Medicaid. Total Washington Medicaid spending in 1997 was $3.2 billion.106

  • Children's Medical Program. The CN medical program for children has two categories. Newborns are eligible for CN for 12 months if their month received medical benefits at the time of the child's birth. There are no income or resource limits. For children under 19 years old, this CN program has no resource limits; income limits are based on 200 percent of the Federal Poverty Level (FPL). Children need not live with a parent or guardian to be eligible for this program. They remain eligible for 12 months regardless of changes of circumstances.

  • Pregnant Women Program. The CN medical program for low-income pregnant women has no resource limits. Income limits are based on 185 percent of the Federal Poverty Level (FPL).

  • Spenddown. Through the spenddown process, excess income for MN and excess income and/or resources for MI are assigned to the client's cost of medical care. The client incurs medical expenses equal to the excess amount (spenddown) before medical benefits can be authorized. Spenddown can be thought of like an insurance deductible. The amount of the client's spenddown is computed using a base period consisting of three consecutive calendar months. The client may get medical benefits for all or part of the base period, depending on when spenddown is met.

  • Medical Care Services (MCS). This program is part of general assistance. It is the state-funded medical program, providing limited medical benefits to individuals eligible for the Alcoholism and Drug Addition and Treatment and Support Act (ADATSA) program and General Assistance Unemployable (GA-U). Income resource limits are the same as for CN medical programs.

  • Aged, Blind, or Disabled (ABD). This is a program for individuals with income and resources below federal SSI limits. These individuals may receive both SSI cash benefits and CN medical, or they may receive CN medical only. CN income and resource standards are the same as for SSI cash benefits.

  • Medically Indigent (MI). This state-funded program provides very limited medical coverage for persons, with an emergency medical condition requiring hospital services, who are not eligible for any other medical program. Resource and income limits for the MI program are the same as for MN. Clients with excess income and/or resources above MI limits are not eligible for MI until they spend down the excess income.

Medicare. Medicare is a Health Insurance Program for individuals 65 years old and older; some people with disabilities, under 65 years of age; and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). The Health Care Financing Administration (HCFA) administers Medicare, covering 39 million Americans. Medicare has two parts:

  • Part A subsidizes care in hospitals, skilled nursing facilities, hospice, and some home health care. Beneficiaries with a sufficient earnings history do not pay a premium for Part A.

  • Part B helps pay for doctors, outpatient hospital care, and some other medical services not covered under Part A, including services of physical and occupational therapists, and some health services. Part B helps pay for covered medically necessary doctor services. Consumers are responsible for the monthly Medicare premium of $45.50. The cost of Part B may increase 10 percent for each 12-month period that an individual has Part B but did not take it. Enrollment in Part B is optional; the premium is usually deducted from Social Security, Railroad Retirement, or Civil Service Retirement payment.

The original Medicare plan is available everywhere in the United States. It is the most common plan for receiving Medicare Part A and Part B benefits. An individual may go to any doctor, specialist, or hospital that accepts Medicare. Some people also have access to Medicare Managed Care Plans. Under the Managed Care Plan, an individual is restricted to doctors, specialists and hospitals that are part of the plan. Plans must cover all Medicare Part A and B benefits. Some plans cover extras, like prescription drugs. Private Fee-for-Service Plans is a new health care choice in some regions of the country. An individual may still see any doctor, specialist, or hospital. Plans must cover all Medicare Part A and B benefits. Some plans include extras, such as extra days in the hospital. The plan, not Medicare, determines the cost to the consumer.

Food Stamp Program. The Economic Services Administration (ESA) in the Department of Social and Health Services administers the general eligibility requirements for the federal food assistance program. The federal Food Assistance Program helps low-income individuals and families, people with disabilities, the elderly, and refugees and immigrants obtain a more nutritious diet by supplementing their income with food stamp benefits. During Fiscal Year 1998, ESA provided monthly Food Stamp benefits to 370,234 persons.

Additionally, a household is categorically eligible to receive food benefits when all members are eligible to receive a cash benefit under any of the following cash assistance programs:

  • Temporary Assistance for Needy Families (TANF);
  • State Family Assistance (SFA);
  • Supplemental Security Income (SSI); or
  • General Assistance Cash Programs.

Persons with disabilities may have special eligibility when the individual receives SSI, receives disability payments, receives disability-related medical assistance under Title XIX of the Social Security Act, is a veteran and receives disability payments, or is a spouse of a veteran and has a disability.

Food Assistance Program for Legal Immigrants (FAP). The 1996 Personal Responsibility and Work Opportunity Reconciliation Act, or welfare reform, restricted certain aliens lawfully admitted entry to the United States from receiving food stamp benefits. In response to the federal welfare reform, the Washington State legislature authorized a state funded food assistance program to provide benefits to those aliens who were no longer eligible for federal benefits solely due to new alien requirements. The Food Assistance Program for Legal Immigrants was implemented on September 1, 1997.107

Project Access. Project Access is a one-year pilot program in the Seattle/Tacoma area. It extends telephone service to people with no phones. The program offers free community service voice mail to Department of Social and Health Services (DSHS) clients and free local telephone service in community sites that have volunteered to host Project Access telephones. Project Access is funded from unclaimed refund money resulting from a court settlement. The money was granted to DSHS from the Washington Utilities and Transportation Commission for the project.

Washington Telephone Assistance Program (WTAP). Adults receiving DSHS benefits in a program such as Food Stamps or TANF probably qualify for WTAP benefits too. WTAP offers a monthly discount on basic local telephone service. Currently, WTAP customers pay $4 monthly plus taxes. This is a $12 discount from the typical US West bill. WTAP may pay up to 100 percent of the connection fee for a new telephone service. With a valid Department of Social and Health Services Client ID number, individuals can register for WTAP by contacting their local telephone company.

Services for the Blind.108 The Washington State Department of Services for the Blind (DSB) provides a variety of programs to blind and visually impaired persons of all ages. This includes individuals whose vision is not correctable by ordinary eye care. DSB seeks to promote the economic and social independence of people who are blind or visually impaired through employment, training and other opportunities. Through a VR program, a counselor can assist persons in developing an individualized written rehabilitation plan, to identify the job the person wants and all of the necessary steps achieve it. The program also provides a job training program, assisting individuals in developing skills and a job placement program.

Assistive Technology. This is a program that provides technical assistance and support for employers of blind or visually impaired employees. Assistive technology works cooperatively with the business and the employee to assess the work site and job duties and make recommendations to enable job success. Examples of recommendations include assistive technology devices, job modification or restructuring, skills such as Braille and keyboarding, and other tools. Additionally, assistive technology can train and support the employee in the use of assistive technology devices. DSB also provides information to employers about hiring and retaining individuals with disabilities.