Public Policy

People with disablities or in other margnialized groups routinely rely on local, state, and federal policies for access to things like housing, work, health, and transportation

How does public policy affect an individual?

Occupational participation is shaped by policy

• grocery shopping

• sleeping

• riding a bike

What influenced deinstitutionalization?

• belief that treatment in insitutions were inhumane

• hope that new antipsychotic medication would offer a cure

• desire to save money

• easier to send to outpatient

What is the Community Mental Health Centers Act (1963)?

Provided federal funding for community mental health centers to shift from institutional to community-based care

New services included emergency, partial hospitalization programs, and outpatient

What is transinstitutionalization?

“the movement of people with psychiatric disabilities from large institutional settings to different, smaller institutional settings”

What are policies that impact people with psychiatric disorders?

• Social Security Administration Policies (Social security disability insurance, supplemental security income, medicare, medicaid)

• Non-SSA Entitlements (Food and Nutrition- SNAP and TEFAP, Low-income housing- section 8, shelter plus, support housing)

• Insurance and Service Delivery Policies (mental health parity and addiction equity act, affordable care act)

• Inpatient Community

• Civil Rights (Rehab act of 1973 (section 504), Title 2 of the americans with disabilities act (Olmstead decision), president’s new freedom commission on mental health)

• Policy Impacting OT practice (promoting access to medicare act (and CCBHCs) and occupational therapy in mental health act and occupational therapy in mental health parity act)

What is Social Security Disability Insurance (SSDI)?

Provides a financial safety net for workers who become disabled and are unable to continue working

• application includes a mental residual functional capacity form completed by any service provider and signed by a physician

• drug or alcohol use is NOT included as a diability

• amount awarded is based on social security taxes they have paid

• Qualifications:

  • cannot meet substantial gainful activity (job with income above poverty level)

  • have a disablity that they cannot return to substantial gainful activity

What is Supplemental Security Income (SSI)?

For people who don’t qualify for SSDI or Social Security Retirement Benefits

• Qualifying criteria is same as SSDI (inability to meet substantial gainful activity AND a qualifying disability) with the addition of limited resources such as cash, money in the bank, or other assets

• Current monthly payment for CT

  • individual - $943

  • married couples - $1415

What is medicare part A?

Hospital insurance

• inpatient mental health services

• skilled nursing

• long-term care

• home health

• hospice

• therapy services

What is medicare part B?

Medical insurance

• diagnostic and preventative services

• outpatient mental health services

• partial hospitalization

What is medicare part C?

Medicare Advantage

• all services included in parts A and B

• participant may choose HMO or PPO

What is medicare part D?

Prescription drug insurance

• covers prescription drug costs

What is medicare Medigap?

Supplemental coverage

• helps to cover out of pocket costs and associated Medicare costs (deductibles and co-pays)

What is Medicaid?

National health insurance program funded through both state and federal dollars

compared to medicare, medicaid covers a broader set of services (including community support and general healthcare)

CT Medicaid programs: Husky A, B, C, D

Medicaid Rehabilitation Option (MRO) added in 1980s and provides states an incentive to increase community-based and psychiatric rehabilitation services

What is Supplemental Nutrition Assistance Program (SNAP)?

Original food stamp program, name changed to reflect a focus on meeting nutritional needs through food assistance and education

income eligibility based annually on cost of living (SSA usually means you’ll qualify for SNAP)

current monthly amount for an individual in CT is $291

What is Emergency Food Assistance Program (TEFAP)?

provides food to low-income individuals on an emergency basis at no cost

• state agencies

• food banks

• soup kitchens and food pantries

• low-income individuals

makes use of surplus food purchased by USDA but also funds to purchase food specifically for the program

What is the Section 8 Housing Voucher System?

income-based eligibility

renters with Section 8 vouchers pay about 30% of their income towards rent

• tenant-based vouchers allow the person to use the subsidy at housing of their choice (move with the person)

• property-based vouchers are assigned to a specific unit to be used by whoever is living there (stay with the apartment)

What is Shelter Plus Care?

• provides assistance to homeless individuals with disabilities, including supportive services and rental assistance

• Safe haven shelters provide stable, 24hr residence for homeless individuals to support transition into mental health services and permanent housing

What is the Mental Health Parity and Addiction Equity Act?

Federal law that prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits

What is the Affordable Care Act?

Makes affordable health insurance available to more people

• reducing costs

• improving patient health

• improving quality of care

What is the Rehabilitation Act of 1973?

First bill to ban discrimination on the basis of disability

Section 504:

• banned discrimination on the basis of disability in programs and activities that receive federal funding (where people work, go to school, live, access services)

• most credited for changing the disability landscape

• passing regulations required strong lobbying efforts by people with disabilities, including a 26 day sit in protest

What is the Americans with Disabilities Act of 1990?

Protects people from discrimination on the basis of disability in employment, state and federal government, commercial facilities, telecommunications, and transportation

• Title 2 is the basis for the shift to community-based mental health care

Olmstead Decision

• two women with disabilities who were institutionalized were deteremined to be able to live in the community with supports but were not moved out of the hospital, state argued that commuinty supports were too expensive

• court ruled that unnecessary institutionalization constitues discrimination that cannot be justified by the lack of funding (money follows the person)

What is the President’s New Freedom Commission on Mental Health?

2003 under bush

Unment needs and barriers to mental health care

• fragmentation and gaps in care across the lifespan

• high unemployment and disability for people with serious mental illness

• lack of national priority for mental health and suicide prevention

Goals:

• mental health is essential to overall health

• mental health care is consumer and family driven

• early screening, assessment, and referral to services are common practice

What is Inpatient Commitment in Connecticut?

Patients in inpatient psychiatric care can be either voluntary or involuntary, people who are at serious risk for harming themselves or others who are gravely disabled may be committed to a hospital without their consent

Process:

• someone to petition the court alleging the risk, the court to appoint an attorney for the person, two physicians to evaluate the person, a probate hearing with 10 days, commitment may last until condition is treated and patient is safe for discharge

emergency situation, a certificate for evaluation may be completed at the hospital without hearing, the hearing is then held within 72 hours

What is Protecting Access to Medicare Act of 2014?

Created Certified Community Behavioral Health Clinics (CCBHCs)

• OTPs were involved in determining criteria for CCBHCs

• SAMHSA listed OT as part of suggested staff

• Supported the role of OT in physical and mental health in integrated care systems

What is the Occupational Therapy in Mental Health Act?

Last introduced to congress in 2015, the bill has not advanced

• aim to create opportunity for OTPs to participate in National Health Service Corps, which provides scholarships and loan repayment programs for students who practice in rural and underserved areas

• encourage OTPs to enter mental health field

• would make OTPs “mental health care providers”

What is Occupational Therapy in Mental Health Parity Act?

last introduced to congress in 2023

• goal to expand access to OT for mental and behavioral disorders under medicare and medicaid

  • would address barriers that OTPs face in providing and billing for services in mental health settings

What are policy priorities in 2025?

• Promote lived experience (people with lived experience are driving policy, advance peer support services)

• Advance prevention and early intervention (screening and mental health literacy education)

• Increase access to care and supports (increase insurance coverage and mental health parity, telehealth policy, improve crisis response)

• Ensure equity and reduce disparities (integrated care in primary care and schools and diversifying the workforce)