Where to Turn... Your Guide to Federal Disability Policies and Programs Authors Patrice Drew, Esq. Cathy Ficker Terrill Anne C. Parrette, Esq. Project Coordinator Janna Starr Editors Larry H. Hoffer Lisa Ward Monique Marino Brain Injury Association US Department of Health and Human Services HRSA Health Resources and Services Administration Maternal and Child Health Bureau Disclaimer The Brain Injury Association shall not be held liable for content changes made by unauthorized parties, including but not limited to: alterations of text, images or other information within Where to Turn: Your Guide to Federal Disability Policies and Programs (the Guide.) The Guide contains general information. It is not an authoritative legal document, nor shall it be construed as legal advice. The Guide shall not be relied upon as a legal authority for acting or refusing to act. The information contained in the Guide may change as Federal polices and programs are amended periodically. The Brain Injury Association is not responsible for notifying the Public of these changes. An Overview of the U.S. Government About the U.S. Congress When was the Congress created? The Congress of the United States was created by the Constitution on September 17, 1787. Who makes up the Congress? There are two Houses in Congress. One is the House of Representatives and the other is the Senate. The Senate has 100 members. There are two members from each state. They are elected for six year terms. The House of Representatives has 435 members. The number representing each State is determined by how many people live in that state. Each state has at least one representative. Members are elected for two-year terms. Why are there two Houses? There are two reasons why the Congress has two Houses. The first reason is history. The people who wrote the Constitution were most familiar with the British Parliament, which had two Houses. The second is that a bicameral legislature (two Houses) offered a way of resolving a major conflict in the writing of the Constitution. Delegates to the Constitutional Convention from states with many people wanted a state's representation in the new Congress to be based on population. Delegates from states with fewer people were afraid that the larger states would dominate the Congress if this were done. They wanted each state to have equal representation. A legislature made up of two chambers (or Houses) supports the system of checks and balances that is built into the American form of government. Either House is able to block legislation approved by the other. Therefore, the two Houses often must cooperate with each other and compromise on their differences in writing the nation's laws. How do the House and Senate differ? The two Houses differ in a number of ways. These include size and rules, terms of office, base of representation, requirements of office, and special powers under the Constitution. The House of Representatives is more than four times the size of the Senate. The House of Representatives is led by the Speaker of the House, who is nominated by the majority political party in that chamber. The Vice-President of the United States leads the Senate. Because of its larger size, the House is more formal and has stricter rules than the Senate. For example, a member of the House is recognized to speak during a debate for a limited period of time, often five minutes or less. Senators normally have no such time limits placed on them. It is possible, therefore, as an extreme measure, for a senator or group of senators to use this privilege of unlimited debate to delay or defeat legislation. This delaying tactic is called a filibuster. Members of the House must seek re-election much more frequently than senators and may tend to pay especially close attention to the needs and opinions of their constituents-the people in the districts they represent. The Constitution also requires that one- third of the Senate is elected every two years. As a result, the Senate is more of a continuing body than the House, because two-thirds of the Senate's membership will remain unchanged, regardless of what happens in an election. Who makes Laws? The Congressional lawmaking process is complex. A proposed law, or bill, must pass through a series of steps before it is voted on the House and Senate floors. At any one of these steps, a bill can be delayed, defeated or amended. Most bills that are introduced do not survive this process and do not become law. Except for those concerning money, bills may be introduced in either House. They are referred then to an appropriate committee, where much of the important work of the Congress occurs. What happens to a bill on the floor? If a bill passes the House then it also must pass the Senate. If a bill starts in the Senate, then it needs to go the House. Because a bill rarely will pass both chambers of Congress in the same form, a Conference Committee is selected to work out differences between the Senate and House versions. Both chambers must approve any agreement reached by the Conference Committee. Then the legislation is sent to the President of the United States, who must sign it before it can become law. If the president vetoes (says no) a bill, it requires a two-thirds majority vote of members present in both Houses for passage. What other responsibilities does Congress have? Congress has a number of other responsibilities and powers under the Constitution. It can propose amendments to the Constitution, and it can declare war. The House of Representatives has the power to impeach, or bring charges against, federal officials for misconduct. If no candidate in a presidential election wins a majority in the Electoral College, the House of Representatives elects the president. The Congress also can determine if a president has a disability that makes him or her unable to continue in office. What is the Congressional Record? The work of Congress is published in the Congressional Record. The Daily Digest of the Congressional Record summarizes the proceedings of that day in each House, and before each of their committees and subcommittees. The Digest also presents the legislative program for each day and, at the end of the week, gives the program for the following week. What is the committee system? There are 19 committees in the House and 16 in the Senate. About 10,000 or more bills are introduced by Congress every two years. Each committee has its own special area of interest such as health, taxes or education. Committees only can handle a small number of the bills referred to them. Many bills simply "die" in committee. If a bill is of particular importance, the committee usually will schedule hearings to gather information about the bill and listen to the opinions of those who favor or oppose it. The committee then may proceed to further consideration of the bill and offer amendments to it. Only if the committee votes to approve the bill will it be scheduled for consideration by the chamber's full membership. Standing Committees of the U.S. Congress House Committees Agriculture Appropriations Armed Services Banking and Financial Services Budget Commerce Education and the Workforce Government Reform House Administration International Relations Judiciary Resources Rules Science Small Business Standards of Official Conduct Transportation and Infrastructure Veterans' Affairs Ways and Means Senate Committees Agriculture, Nutrition, and Forestry Appropriations Armed Services Banking, Housing, and Urban Affairs Budget Commerce, Science, and Transportation Energy and Natural Resources Environment and Public Works Finance Foreign Relations Governmental Affairs Judiciary Labor and Human Resources Rules and Administration Small Business Veterans' Affairs Where can I get Congressional Publications? The Congressional Directory, the Senate Manual, and the House Rules and Manual may be obtained from the Superintendent of Documents, Government Printing Office, Washington, DC 20402. U.S. Government Agencies General Accounting Office (GAO) The U.S. General Accounting Office (GAO) is an agency that works for Congress and the American people. Congress asks GAO to study the programs and spending of the federal government. GAO often is called the investigative arm of Congress or the congressional watchdog. GAO is independent and nonpartisan. It studies how the federal government spends taxpayer dollars. GAO advises Congress and the heads of executive agencies (such as Health and Human Services) about ways to make government more effective and responsive. GAO evaluates federal programs, audits federal expenditures and issues legal opinions. When GAO reports its findings to Congress, it recommends actions. Its work leads to laws and acts that improve government operations and save billions of dollars. Congressional Budget Office (CBO) How does CBO help the Congress develop a plan for the Budget? The House and Senate each have a budget committee. The CBO helps prepare the budget plan for Congress each year. A major part of CBO's role in that process is to prepare an annual report that provides economic and budget projections for the next 10 years. That report includes a discussion of some current economic or budget policy issue, such as the effects of the federal deficit on economic growth or recent changes in the budget process. How does CBO help the Congress stay within its budget plan? Once the Congress adopts the annual budget resolution, the budget committees take the lead in enforcing its provisions. To help them, CBO offers their best guess about how much a bill might cost. CBO also prepares a series of reports that advise the Congress and the Administration on two things: whether they spent too much and whether the passage of any new bills has increased how much the government owes or how much they plan to spend. What are the Major Responsibilities of the CBO? Helping the Congress Develop a Plan for the Budget Make projections about the economy Review the president's budget Look at long term budget issues Helping the Congress Stay within Its Budget Plan Look at what a bill will cost Make sure Congress does not overspend Helping the Congress Consider Budget and Economic Policy Issues Review the federal government budget Recommend policy about money and tax laws The Department of Health and Human Services (HHS) What is the Department of Health and Human Services? The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially those who are least able to help themselves. What programs are included within HHS? The department includes more than 300 programs, covering a wide spectrum of activities. Some highlights include: Medical and social science research Preventing outbreak of infectious disease, including immunization services Assuring food and drug safety Medicare (health insurance for elderly and disabled Americans) and Medicaid health insurance for low-income people) Financial assistance for low-income families Child support enforcement Improving infant, child, adolescent and family health Head Start (pre-school education and services) Preventing child abuse and domestic violence Substance abuse treatment and prevention Services for older Americans, including home-delivered meals Comprehensive health services delivery for American Indians and Alaska Natives Does HHS give grants? HHS is the largest grant-making agency in the federal government, providing some 60,000 grants per year. HHS' Medicare program is the nation's largest health insurer, handling more than 900 million claims per year. Where is the main office for HHS? The Department's Headquarters is in the Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, D.C., 20201. Which agencies within HHS provide funding to support TBI activities? Health Resources and Services Administration (HRSA) - HRSA funds a significant program authorized by the Traumatic Brain Injury Act of 1996, the TBI State Grant Program administered by the Maternal and Child Health Bureau. State agencies may apply for grants to build a foundation within the State to determine needs and improve access to services for individuals with TBI and their families. In addition, HRSA funds grants to national organizations such as the Brain Injury Association to develop guides like the one you are reading. HRSA provides access to essential health services for people who are poor, uninsured, or who live in rural and urban neighborhoods where health care is scarce. HRSA-funded health centers provide comprehensive primary and preventive medical care to more than nine million patients each year at more than 3000 sites nationwide. Working in partnership with many state and community organizations, HRSA also supports programs that ensure healthy mothers and children, increase the number and diversity of health care professionals in underserved communities, and provide supportive services for people fighting HIV/AIDS through the Ryan White Care Act. Centers for Disease Control and Prevention (CDC) - CDC is the lead federal agency responsible for protecting the health of the American public through monitoring disease trends, investigating outbreaks, as well as health and injury risks, fostering safe and healthful environments, and implementing illness and injury control and prevention interventions. Established in 1946, as the Communicable Disease Center. Headquarters: Atlanta, GA. National Institutes of Health (NIH) - NIH is the world's premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer's, diabetes, arthritis, heart ailments and AIDS. NIH includes 18 separate health institutes, the National Center for Complementary and Alternative Medicine and the National Library of Medicine. Established in1887, as the Hygienic Laboratory, Staten Island, N.Y. Headquarters: Bethesda, MD. Substance Abuse and Mental Health Services Administration (SAMHSA) - SAMHSA works to improve the quality and availability of substance abuse prevention, addiction treatment and mental health services. It provides funding to the states to support and maintain substance abuse and mental health services through federal block grants. Targeted Capacity Expansion grants provide Mayors as well as town and county officials resources to address emerging drug abuse trends and mental health service needs and related public health problems, including HIV/AIDS, at the earliest possible stages. SAMHSA funds hundreds of programs nationwide to increase the use and improve prevention and treatment methods shown by research to be effective through "Knowledge Development and Application" grants. Established: 1992. (Predecessor agency, the Alcohol, Drug Abuse and Mental Health Administration, was established in 1974.) Headquarters: Rockville, MD. Health Care Financing Administration (HCFA) - HCFA administers the Medicare and Medicaid programs, which provide health care to about one in every four Americans. Medicare provides health insurance for more than 44 million Americans who are over age 65 or who have disabilities. Medicaid, a joint federal-state program, provides health coverage for more than 34 million low-income persons, including nearly 18 million children and nursing home coverage for older Americans with low-income. HCFA also administers the Children's Health Insurance Program (CHIP) through approved state plans that cover more than 2.2 million children. Established: 1977. Headquarters: Baltimore, MD. Administration for Children and Families (ACF) - ACF is responsible for some 60 programs that promote the economic and social well-being of families, children, individuals and communities. ACF administers the state-federal welfare program, Temporary Assistance to Needy Families, providing assistance to an estimated 7.3 million persons, including 6.3 million children in September 1998. ACF administers the national child support enforcement system, collecting some $15.5 billion in FY 1999 in payments from non-custodial parents and administers the Head Start program, serving more than 800,000 pre-school children. ACF provides funds to assist low-income families in paying for child care, and supports state programs to provide for foster care and adoption assistance. ACF funds programs to prevent child abuse and domestic violence. Established in 1991, bringing together several already-existing programs. Headquarters: Washington, D.C. Administration on Aging (AoA) - The Administration on Aging (AoA) is the federal focal point and advocate agency for older persons and their concerns. The AoA administers key federal programs mandated under various titles of the Older Americans Act. These programs help vulnerable older persons remain in their own homes by providing supportive services, including nutrition programs such as home delivered meals (Meals-on-Wheels). Other programs offer opportunities for older Americans to enhance their health and be active contributors to their families, communities, and the Nation. The AoA works closely with its nationwide network of regional offices and State and Area Agencies on Aging to plan, coordinate and develop community-level systems of services that meet the unique needs of individual older persons and their caregivers. The AoA collaborates with federal agencies, national organizations and representatives of business to ensure that, whenever possible, their programs and resources are targeted to older persons and coordinated with those of the network on aging. Headquarters: Washington, D.C. The Department of Housing and Urban Development The Department of Housing and Urban Development (HUD) is the Federal agency responsible for national policy and programs that address America's housing needs, improve and develop the Nation's communities, and enforce fair housing laws. HUD's business is helping create a decent home and suitable living environment for all Americans, and it has given America's cities a strong national voice at the Cabinet level. What is HUD's mission? HUD is the Federal agency that works to help the nation's communities meet their development needs, spur economic growth in distressed neighborhoods, provide housing assistance for the poor, help rehabilitate and develop moderate and low-cost housing, and enforce the nation's fair housing laws. HUD plays a major role in supporting homeownership by underwriting homeownership for lower- and moderate-income families through its mortgage insurance program. What is the Community Development Block Grant program? HUD's Community Development Block Grant (CDBG) program was created in 1974 to help states and communities. CDBG funds may be used for a wide range of activities. Funds must be spent to meet one of three broad national goals: Aid low and moderate income persons; Prevent or eliminate slum or blight conditions; or Meet an urgent need that threatens health or safety At least 70 percent of the funds must be used for activities that benefit people who are poor. States decide how to spend the money through a strategic planning process. Communities and states are accountable to HUD for how funds are spent CDBG funds have been used to renovate housing; construct or improve public facilities, such as water, sewers, streets and neighborhood centers; purchase real property; and assist private businesses in economic development activities. What is "assisted" housing? HUD "assists" low-income households with rental subsidies in the private sector, through Section 8 certificates and vouchers. Individuals looking for help apply through their local public housing agency. Under the voucher program, people have greater freedom of choice to select housing where they want to live within a standard rent range. Under the Section 8 certificate program, rent subsidies are used to pay owners the difference between what tenants can pay and contract rents. Overall, more than three million households received Section 8 rental assistance in FY 1996. Congress gave about $400 million for relocation assistance in the form of Section 8 certificates and vouchers in FY 1996. It also provided $830 million for Section 202 housing grants and subsidies for elderly, and $258 million for grants and subsidies for Section 811 housing for the disabled. The program goes beyond providing certificates and vouchers to individuals; it also renews Section 8 contracts with private owners. This is needed in order to keep enough housing in the country for low-income families. HUD also administers a Housing Counseling Program which was funded with $12 million in FY 1996 to assist tenants and homeowners in property maintenance, financial management and other matters. HUD's HOPE Program is being used to tear down dilapidated public housing developments. How does that work? HUD started a new housing program called HOPE. The HOPE VI (Homeownership and Opportunity for People Everywhere) program is run by the Office of Public and Indian Housing. It gives money to change the nation's most distressed public housing into communities of hope. The program is based on the principles of integration of services and resident contributions. It gives money to: Replace and rehabilitate neighborhood homes; Provide job training and encourage neighboring businesses to hire public housing residents; Offer joint ventures on private multifamily housing financing for Section 8 rentals; Wire selected units for computers and Internet communications; and Develop mixed-income housing with rental and homeownership choices in public housing neighborhoods How do the homeless get help from HUD? HUD gives money to state and local governments and nonprofit organizations to help homeless individuals and families. The funds are used to help the homeless move from the streets, to temporary shelter, to supportive housing (with services, if necessary), and ultimately back to the mainstream of American life. The Assistant Secretary for Community Planning and Development administers most of HUD's homeless assistance programs. HUD's homeless efforts began on a national level with the Stewart B. McKinney Homeless Assistance Act of 1987, which provided the first direct HUD programs to help communities deal with homelessness. More than $4.8 billion has been provided and more than 2 million homeless Americans have been assisted by these programs through FY 1996. Shelter Plus Care - HUD provides grants for rental assistance to homeless persons with chronic disabilities under the Shelter Plus Care program. Eligible recipients are state and local government units, public housing agencies and Indian tribes. To receive the funds each recipient must provide supportive services at least equal in value to the rental assistance. Supportive services would address mental illness, substance abuse and acquired immunodeficiency syndrome (AIDS) and related diseases. Supportive Housing - Supportive Housing grants go to state and local governments, Indian tribes and nonprofit organizations to provide short-term transitional housing and services to deinstitutionalized homeless individuals, families with children, individuals with mental disabilities and others, including people with AIDS. States may receive funds for long-term housing projects for homeless persons with disabilities. HUD provides grants for acquisition, rehabilitation, new construction and annual payments for operating costs and supportive services. HUD also provides technical assistance. Participants must match the acquisition, rehabilitation or new construction costs and provide a percentage of the operating costs. Section 8 Moderate Rehabilitation (SRO) - Public and Indian housing agencies and private nonprofit organizations compete for Section 8 Moderate Rehabilitation grants based on local needs and their ability to provide single-room occupancy (SRO) housing for homeless persons. Emergency Shelter Grants - Emergency Shelter Grants are distributed to states, entitlement cities and counties and territories on a formula basis, and Indian tribes. The funds may be used to renovate, rehabilitate or convert buildings to be used as shelters for homeless persons. The funds also may be used to operate emergency shelters, provide essential services to homeless individuals and prevent homelessness. What is the HOME program? How is it different from other HUD low-income housing programs? The HOME Investment Partnerships Program is administered by the Assistant Secretary for Community Planning and Development. HOME funds are distributed on a formula basis, like the Community Development Block Grant (CDBG) program, and are administered locally through community development departments or housing finance agencies. Participating jurisdictions include states, large cities and urban counties, consortia, Indian tribes and territories. Participating jurisdictions must provide a 25 percent match for housing activities funded by HOME. Are any HUD housing programs available for persons who are not very low income? The Federal Housing Administration (FHA) assists first-time buyers and others who might not be able to meet down payment requirements for conventional loans by providing mortgage insurance to private lenders. It also insures loans for home improvements and buying manufactured (mobile) homes. This is done through the FHA, a branch of HUD which works through local mortgage lending institutions to provide Federal mortgage and loan insurance for homeownership and the construction or improvement of affordable housing. There are approximately 10 mortgage insurance and loan programs administered by the Assistant Secretary for Housing-Federal Housing Commissioner. Interest rates on FHA loans generally are market rates, while down payment requirements are lower than for conventional loans. FHA loans cannot exceed the statutory limit. When buyers become seriously delinquent on their loans, their mortgage companies usually foreclose and file insurance claims with HUD for the amount still owed on the loan. HUD pays the claim and becomes the owner of the property. The HUD Property Disposition staff across the nation and its contractors maintain and market these properties. FHA also assists in providing affordable rental housing by insuring loans to developers and builders who construct or rehabilitate apartments and other multifamily housing developments. FHA had insurance in force estimated at $48.6 billion on 15,935 multifamily developments with 2 million units as of September 30, 1996. Endnotes: www.Congress.gov General Accounting Office www.gao.gov Congressional Budget Office www.cbo.gov U.S. Department of Health and Human Services www.dhhs.gov U.S. Department of Housing and Urban Development www.hud.gov