Social Security Policy on Drug Addiction and Alcoholism

1. Social Security Policy on Drug Addiction and Alcoholism Co-Occurring Disorders Conference Sept 19, 2006 Mark Dalton, Belltown Community Services Office Administrator Washington State DSHS Seattle

2. Early DA/A History • Drug Addiction and Alcoholism treated as “potentially disabling” in SSI enabling legislation (1972). • Controversy from the beginning. • Sen. Harold Hughes, national champion of addiction treatment and reform, against DA/A allowances. • Confusion over Nature of disability and conditions of allowance – both within SSA and in the medical community. “Material to disability” concept. • SSA problems with SSI “welfare program” administration compounded by DA/A requirements. • Treatment referral requirements largely ignored.

3. “Benign Neglect” • 1984 – only 10 states offered treatment referral and monitoring services (RMA) • RMA services, where available, improved health outcomes, but only 1% went to work • Few non-compliance sanctions imposed by SSA • DA/A remained a very small caseload – in 1989, less than 1% of the SSI population

4. Rapid Escalation in the 90’s • Continuing regulatory ambiguity • Court decisions increasingly favored allowances • State GA cuts and resultant “shifting upwards” to federal SSI program • Disastrous Reagan disability reviews • Federally funded SSI outreach – especially to homeless

6. DA/A Controversy Explodes • Recipient scandals and media outrage • Continuing ambiguity over “disease concept” of addiction • Lack of faith in treatment efficacy • Lack of support by professionals (“enabling” effect of SSI grants) • SSA management seen as ineffective • Funding issues for RMA and treatment services – lack of access

7. 1994 Congressional Response • RMA services mandated in all 50 states, • Available treatment required for all, • Progress in treatment required to retain eligibility, • 36 month lifetime DA/A limit, resulting in: • Rapid expansion of RMA services • 42 states managed by Maximus Corp, with services through sub-contractors in each • Eight states independently contracted

8. 1996 Congressional Response • Continued political pressure to eliminate DA/A • Poor coordination between RMAs and SSA • Continuing lack of treatment and funding • Lack of effective sanctions, lack of SSA staffing, changing political winds result in weak commitment to change at all levels • 1994 reforms effectively DOA • March 1996, Congress eliminated DA/A, no new approvals, and all current recipients to be term’d 1/1/97, if not eligible on another basis.

9. Results of DA/A Termination • Of those who requested review, 49% retained benefits by 12/97 - confirming “tiebreaker” use of DA/A in many cases. • 35.5% of total DA/A caseload retained benefits during that period (many disappeared, or devolved back onto state programs, at least temporarily) • People with addiction issues continue to have difficulty getting approved for SSI – even with other well-documented disabling conditions • Homelessness, addiction and poverty continue to be major national problems, some say a national disgrace.