by Melanie Brunson
Congress has finally taken action on the Work Incentives Improvement Act of 1999, which contained provisions for the “Ticket to Work and Self-sufficiency” program. Thanks to last-minute lobbying by many in the disability community, the legislation was approved in November by both houses of Congress. The president has said he will sign the bill. The signing ceremony has been scheduled for the week of December 13.
The Work Incentives legislation will implement a number of changes to both SSDI and SSI programs. These changes will be phased in over the next year and a half. Below is a brief summary of the bill’s key provisions.
Expanded Health Insurance Options
SSDI beneficiaries who return to work after October 1, 2000, will be able to keep their premium-free Medicare Part A coverage for an additional four-year period beyond the four years already provided them under current law. This means that they will be able to count on premium-free Medicare Part A coverage for a total of eight years from the time that they go to work.
Also, beginning October 1, 2000, states will be able to offer both SSI and SSDI recipients who would not otherwise be eligible for Medicaid the opportunity to “buy-in” to their Medicaid program.
Although they are not required to do so, states may liberalize limits on resources and income, and may allow employed individuals with medically determinable impairments (as determined by the U.S. Department of Health and Human Services) to buy into Medicaid even though they may no longer be eligible for SSDI or SSI disability benefits because of medical improvement.
For purposes of this particular buy-in, states may require individuals to pay premiums, or other cost-sharing charges, set according to a sliding scale based on income.
There will also be a number of other changes in eligibility rules for SSDI and SSI beneficiaries. Beginning 13 months after enactment of the legislation, individuals whose prior entitlement to disability and health care benefits had been terminated because of earnings from work activity may request reinstatement of benefits without filing a new application. Such individuals must be unable to continue working on account of their medical condition and must file a reinstatement request during the 60-month period following the month of employment termination. While the Social Security Administration is making a determination on their reinstatement request, individuals are eligible for provisional benefits for up to six months.
Work activity will no longer automatically result in a continuing disability review. Under the new rules, such reviews will be conducted on a regularly scheduled basis and determination of an individual’s continued eligibility will be made at these scheduled times, rather than being based on an individual’s work status.
The Ticket to Work and Self-Sufficiency
This program can provide SSDI and SSI beneficiaries with a ticket they can use to obtain vocational rehabilitation services, employment services, and other support services from an employment network of their choice. These employment networks can be comprised of either public or private agencies. Agencies may choose to provide services directly, or to enter into agreements with other (subcontracting) providers, who can furnish portions of the services. These selected agencies will be required to develop and implement an individual work plan (IWP) in partnership with each beneficiary.
Each collaboratively developed IWP must include a statement of: (1) the beneficiary’s vocational goal; (2) services and supports necessary to accomplish that goal; (3) terms and conditions related to the provision of those services and supports; (4) rights and remedies available to the beneficiary; and (5) the beneficiary’s right to modify his/her work plan if needed. Each individual work plan is effective upon written approval by the beneficiary and a representative of the employment network.
The Social Security Administration (SSA) is authorized to pay an employment network under either an outcome payment system or an outcome-milestone payment system, and each employment network will notify SSA as to which payment system is preferred. State vocational rehabilitation (VR) agencies will be able to participate in the program as employment networks. They will provide services under plans approved under Title I of the Rehabilitation Act of 1973. If a state VR agency wants to accept a referral of a disabled person from another employment network, there must be a written agreement between the VR agency and the employment network outlining the services to be provided by each entity and their respective rights and responsibilities.
The Social Security Administration is prohibited by this act from initiating any continuing disability reviews while a person is using a Ticket to Work and Self-sufficiency. Congress has expressed the hope that this will encourage beneficiaries to participate in this program.
Demonstration Projects
The Work Incentives Improvement Act authorizes SSA to conduct several demonstration projects and studies over the next five years aimed at evaluating the effectiveness of additional proposed work incentives. One of the most significant of these involves an evaluation of the effects of a $1 for $2 withholding of SSDI payments for earnings over a level specified by the Social Security Administration. This would extend to SSDI beneficiaries the same gradual benefit reductions which SSI recipients are currently allowed. Because both the Social Security Administration and members of Congress were concerned about the potential increased cost of such a change in SSDI rules, provision was made for gathering information about the actual fiscal impact it would have before implementing it across the country.
Stay tuned for further information about who is eligible to participate in these demonstration projects. We will try to keep you informed as SSA publishes its implementing regulations and makes other information available. If we don’t answer your question here, you can, of course, call the ACB national office and I’ll try to answer it or put you in touch with someone who can.