ODDC- Ticket To Work And Work Incentives, Annual Report To The President And Congress, April 2003

ODDC Banner

TITLE:Title: Ticket To Work And Work Incentives, Annual Report To The President And Congress, April 2003, www.ssa.gov/work/panel/whats_new/ssadmin24ahtml.doc (KACW 7/1/03)

Author: Twelve individuals, four appointed by the President, four by the Senate and four by the House of Representatives, sit on the advisory panel. The appointees represent a cross-section of experience and has epertise as recipients, providers, veterans, employers and employees in the fields of employment services, vocational rehabilitation and other disability-related support services.

Background: The Ticket to Work and Work Incentives Improvement Act (TWWII) was enacted on December 17, 1999, with a vote of 99 to 0 in the Senate and by overwhelming majority in the House. The Act increases beneficiaries' choices for rehabilitation and vocational services, removes barriers that require people with disabilities to choose between health care coverage and work, and ensures that more Americans with disabilities have opportunities to work.

Timelines:

In January 2002, the Social Security Administration (SSA) released implementing regulations to govern the Ticket Program.
As of November 30, 2002, more than 13,000 individuals had received services ranging from information and referral to legal representation from the Protection and Advocacy for Beneficiaries of Social Security (PABSS) Programs.
As of January 31, 2003, more than 47,000 beneficiaries had used the Benefits Planning Assistance and Outreach (BPA&O) program for advice on how employment would affect their benefits.
As of February 28, 2003, SSA had mailed out more than 3.5 million tickets to SSI and SSDI beneficiaries in 13 Phase One and 20 Phase Two States. More than 13,000 beneficiaries have deposited their tickets, either with their current State VR agency or a new employment network (EN) providers.
Forty states are currently receiving the Medicaid Infrastructure Grants (MIGs) authorized under the TWWII. Twenty-six states now have operational Medicaid Buy-Ins with almost 35,000 participants.

Implementation Issues: The Panel has learned that SSA is not sufficiently funding or implementing key provisions of the statute in accordance with congressional intent.

SSA has designated existing field staff to be Work Incentives Specialists (WISs) and given work incentive responsibilities in addition to their existing duties, allowing office managers to control the priority of work incentives assignments. SSA plans initially to designate 102 current staff members as WISs; SSA anticipates an increase to more than 600 by 2004 and more than 1,200 in later years.
SSA has conducted initial media events in a few Phase One and Phase Two States and collaborated with Federal agencies, such as DOL, the HHS, and ED, to educate targeted audiences about the program.
SSA is spending very little on training (less than $4 million a year) and only for two new grant programs, even though field staff know very little about the Ticket Program. In comparison, the Rehabilitation Services Administration allocates tens of millions of dollars for training.
Between the program start-up and March 1, 2003, 50 Employment Network Outreach Conferences have been organized and an additional 41 are scheduled for the remainder of 2003. To date, 714 ENs have enrolled in the program, but only 179 (25%) have accepted tickets from consumers.
SSA has long-standing problems with over-paying beneficiaries and the problem will worsen with the TWWII program. SSA prohibits the use of grant funds to represent a beneficiary against SSA on issues related to overpayments, beneficiaries who use Ticket programs to return to work and receive overpayments from SSA that they wish to appeal have no legal representation. In 2002, GAO reported that outstanding SSI debt and newly detected overpayments for the year 2001 totaled $4.7 billion. ENs who return beneficiaries to work will not be paid if the beneficiaries are still receiving cash benefit payments from SSA, even in error becoming a significant long-term disincentive for ENs to participate in the Program.
As of February 28, 2003, fewer than 1,800 (14%) individuals had assigned tickets to an EN other than a state VR agency limiting true choice especially for minorities and those requiring specialized services. SSA plans to examine restructuring the entire EN payment system as part of the Adequacy of Incentives (AOI) study. Congress included the AOI in the TWWII Act to ensure that incentives were built into the payment system for ENs to serve beneficiaries the Act defined as "difficult to serve."
State VR agency are encouraging all potential ENs to contract with them to provide services to ticket holders rather than accepting tickets themselves. State VR agencies are also developing cooperative agreements with ENs that are more coercive than cooperative. Some of these agreements seem to assume that the VR agency is the controller of the ticket and place the EN in a secondary or support role
Many SSI beneficiaries must retain some benefits to live independently in the community, either because they will never earn enough income to be self-supporting or because they use Medicaid funds to acquire personal assistance services. Since ENs are paid outcome payments only when the beneficiary receives zero cash benefits, they risk not receiving payment for the services they provide. Consequently, ENs either will not adequately inform clients about work incentives or will not serve individuals using work incentives at all. ENs should have incentives to work with all beneficiaries who have some earnings potential and be eligible for some level of payment for helping beneficiaries start or return to work if they can reduce their dependence upon SSI.
To meet the definition of disability, applicants of SSI and SSDI benefits must show that they are unable to "engage in substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a period of more than 12 months...." A number of recent developments support the ability of many people to enter the workforce or return to work: passage of the ADA, increased funding for state VR programs, a shift from a manufacturing to a service economy, advances in assistive technology, changes in public attitudes about people with disabilities, and passage of work incentives and the TWWII. Applicants for SSI or SSDI must prove that they are unable to work because of their disability. Then they receive a ticket and other information encouraging them to return to work. These conflicting messages leave beneficiaries confused; at worst, beneficiaries become reluctant to pursue employment and risk losing benefits.
States are reporting significant increases in Medicaid costs due to rising pharmaceutical prices and increases in Medicaid enrollment because of job loss. Although CMS has not reported cutbacks in states that have adopted a Medicaid Buy-In Program so far, states might cut or curtail expansion of Medicaid services or halt plans to adopt TWWII.

Emerging Issues:

DOL One-Stop Programs and state systems are not prepared to serve SSI/SSDI beneficiaries and have little knowledge or understanding of TWWII programs and initiatives.
Proposed changes in the Medicaid program may give states flexibility to implement their programs and community support programs, decreasing the use of nursing homes and institutions. States may cut back Medicaid Buy-In programs, return-to-work programs, and other services they perceive as optional.
Large numbers of beneficiaries are assigning their tickets to VR agencies, which do not have the funds to meet the additional up-front service costs, placing a significant strain on VR dollars and causing waiting lists in some cases.

Panel Recommendations:

A WIS should be the single point of contact for beneficiaries seeking work incentive information and the position should be permanent with its primary duty being work incentives and employment support. Congress provides the financial resources and direct SSA to establish a dedicated corps of trained, accessible, and responsive work incentives specialists.
Coordinate an immediate, national public information effort to explain the array of programs and work incentives authorized under the Act and related legislation to the general public, providers, and employers. The Office of Policy should develop a policy and practice for incorporating the input and experiences of consumers, their families, and/or their representatives as it develops new research designs, including the Adequacy of Incentives Study.
Congress directs SSA to provide information on the size and nature of the backlog of work incentives requests, including work CDRs, earnings postings, overpayments, and other employment-related post-entitlement work, to the public.
Congress directs SSA to work closely with other Federal and State systems to develop and implement a national training plan for current and potential ENs, as well as the public, and earmark appropriate levels of funding for both internal and external level training programs, especially on TWWII.
Congress directs SSA to remove the restrictions on protection and advocacy grant funds in its forthcoming regulations, particularly as the restrictions relate to assisting beneficiaries with overpayments.
Congress conducts a review and comparison of the TWWII and other relevant portions of the Social Security Act and the Rehabilitation Act during the upcoming reauthorization of the Rehabilitation Act.
Congress authorizes benefits reduction that results in other than zero benefits not only as a successful employment outcome but also as a reasonable way of accruing additional savings to the Trust Fund.
Sixteen and seventeen year-olds should be allowed to participate in the Ticket Program.
Congress continues its current level of funding for Medicaid programs.
SSA should provide ongoing interim reporting on the participation of members of the four-targeted groups in the Ticket to Work and Self-Sufficiency Program.
In regards to supplementary research, SSA should: review existing research on the four groups or related groups, including behavioral demonstrations and field experiments; conduct new research on these groups using state data or other Federal data; conduct new research related to ENs and consider best practices of successful programs relating to employment of those with significant disabilities.
SSA should conduct or commission qualitative research, including interviews and focus groups as appropriate, to assess the adequacy of current incentives to large and small providers, including community rehabilitation programs. This data should include attention to national demographics such as rural and urban settings, minority representation, and socioeconomic conditions across the country.

Letters: During the period covered by this report, the Panel issued several advisory letters regarding SSA's plans for "establishing a corps of trained, accessible, and responsive work incentives specialists within the Social Security Administration," as required by TWWII. The Panel, the public, and the SSA field staff supported the employment support representative (ESR) model. SSA decided not to implement the ESR model, but rather a different one involving work incentives specialists. The Panel expressed its concern regarding its lack of involvement in the decision making process regarding these positions in an advisory letter. The Panel also wrote several letters to the President and Congress during this reporting period in support of the reauthorization of the Work Opportunity Tax Credit (WOTC) and extending the WOTC to employers that hire people with disabilities who have received vocational services through an EN authorized by the Ticket to Work and Work Incentives Improvement Act.

Return to the top of the page.