HOW TO PROMOTE POOR HEALTH?

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M.S., 54, lost her public assistance benefits for forgetting to make a phone call. A depressive suffering from severe cardiovascular problems, she failed to check in with HS Systems-a company that performs medical screenings evaluating welfare recipients who claim they are too sick to work. She was supposed to make the call after a doctor’s appointment, as part of a city-mandated “wellness plan,” designed to “restore [her] to self-sufficiency,” in the words of a welfare agency directive. When she forgot to call, HSS went into action, terminating her plan and notifying HRA that she’d missed a call. Four days later, the welfare agency closed her case.

Last week, four local legal groups filed a complaint with the Office of Civil Rights of the federal Department of Health and Human Services, alleging that the city’s Human Resources Administration does not take sufficient measures to exempt people with psychiatric disabilities from work requirements, in violation of the Americans with Disabilities Act and other federal rules.

The complaint claims numerous shortcomings in the work of HRA, including a failure to screen clients for psychiatric disabilities that may affect their ability to work. It further alleges that the special programs devised as work alternatives for people with psychiatric disabilities have requirements that participants cannot meet.

But the case also shines a light on how HRA uses the work of HS Systems, the Manhattan-based company that holds an exclusive contract with the city to evaluate welfare recipients for medical problems. If appropriate, it recommends they be provided with special work assignments or exempted from work requirements altogether.

One aspect of the screening process that has proven particularly vexing are “wellness plans”-short-term medical interventions aimed at making individuals facing chronic but manageable illnesses well enough to participate in workfare. For clients who are ordered to follow a wellness plan, compliance is a condition for receiving welfare benefits. “It’s designed for people who have a continuing problem-diabetes, high blood pressure-but which can be managed with medication, diet, exercise,” explained David Neustadt, a spokeperson for HRA. “If you get it under control, you can be functioning.”

But lawyers say that while that goal is worthwhile, in practice the wellness plans have repeatedly resulted in cut-offs in benefits for people with psychiatric disabilities, who represent between one-quarter and one-third of people remaining on the welfare rolls nationally. “We’ve gotten stories of people who didn’t comply with their wellness plan,” said Bill Lienhard with the Urban Justice Center, one of the groups filing the complaint. “But how are you going to get well if your money for food and shelter gets cut off? It doesn’t sound like a wellness plan to me.” Numerous clients, says Lienhard, have had their benefits suspended after failing to report to an automated phone service following each doctor’s appointment. (It remains unclear what happens when a client doesn’t actually follow through on doctors’ orders; in the past, HRA proposed suspending welfare benefits for drug users who failed to comply with drug treatment.)

At the end of their wellness plan schedule, clients are reevaluated by HS Systems for their fitness to work. According to the complaint, however, HS Systems evaluations find people with psychiatric disabilities as “employable with limitations,” even when they have severe problems. “The default is always that people are completely well,” sais Carrie LaCheen of the Welfare Law Center, another organization filing the complaint.

M.S., it turns out, was lucky. Four days after HRA closed her welfare case, the feds found her eligible for SSI-federal assistance for people with chronic disabilities that leave them unable to work.