THE TICKET TO WORK and
WORK INCENTIVES IMPROVEMENT ACT of 1999

Public Law 106-170

Referred to in FACT SHEET as "the Work Incentives Act"

FACT SHEET with EFFECTIVE DATES

The Work Incentives Act Provides:

• Increased health care coverage for workers with disabilities
• Increased choice in rehabilitation and employment services
• Social Security Work Incentive upgrades and reform

For:
Social Security Disability Program Beneficiaries
and
Workers with Disabilities

Date of Enactment: December 17, 1999

The Work Incentives Act is an expansion of services and choices available to Americans with disabilities who work, or are planning to work. The Act begins the redesign of public long-term disability programs to keep pace with medical advances, assistive technologies, and the changing dynamics of the new workplace. The Act’s provisions are voluntary and grounded in the consumer’s control of when and what decisions will be made about work.

FACT SHEET BY:
The California Work Incentives Initiative
A CIL Berkeley - WID Collaboration
510 16th Street, Suite 100, Oakland, CA 94612
Phone 510-251-4352 - Fax 510- 763-4109 - TTY 510-208-9493

THE TICKET TO WORK and
WORK INCENTIVES IMPROVEMENT ACT of 1999
Public Law 106-170

Website for Work Incentives Act Text and Grant Applications/News:
www.wdsc.org/disability/ -- Bobby Approved Text Edition

“The Work Site” – The Social Security Employment Website:
www.ssa.gov/work

FACT SHEET with EFFECTIVE DATES

Continuing Health Care Coverage for Workers With Disabilities

ALL HEALTH CARE PROVISIONS EFFECTIVE OCTOBER 1, 2000

* MEDICAID: Buy-In for Workers with Increased Earnings/Resources

The new federal law allows a state Medicaid buy-in option for workers with disabilities who earn over 250% of the federal poverty level. States may set their own income and resource limits and charge a premium for access to Medicaid services for workers with disabilities.

* MEDICAID: Buy-in for Workers who “Medically Improve”

State Medicaid buy-in option for workers with disabilities who lose eligibility for Social Security benefits due to medical improvement but continue to have severe medically-determinable disabilities.

* MEDICAID: Demonstration to Maintain Independence

A time-limited Medicaid buy-in demonstration program allowing states to extend Medicaid to certain workers who have a disability that, without ongoing health care, would become severe enough to qualify them for Social Security disability benefits. Federally funded at $250 million over six years.

Grant available at: http://www.hcfa.gov/medicaid/twwiia/twwiiahp.htm

* MEDICAID: State Infrastructure Grants

Grants to states to develop and establish infrastructures to support working individuals with disabilities, for those states that provide personal assistance services (PAS) in their Medicaid state plan to the extent necessary to enable individuals with disabilities to remain employed. Funds may be used to set up Medicaid buy-ins and demonstrations for workers with disabilities. Federally funded at $150 million over five years.

Grant available at: http://www.hcfa.gov/medicaid/twwiia/twwiiahp.htm

* MEDICARE:

A 4.5 year extension over current law for no-cost Medicare Part A.

Net effect: SSDI beneficiaries will access a minimum of 8.5 years of no-cost Medicare Part A after work begins. Effective date: October 1, 2000.

Note: Medicare is available indefinitely, after 7.5 years of work credits are paid to a worker's FICA account, at a premium cost of $170.00/month, for as long as a worker remains disabled.

Increasing Employment Services

The Ticket-to Work and Self-Sufficiency Program

PROVISIONS

• SSI and SSDI beneficiaries receive a "Ticket-to-Work" from the Social Security Commissioner that allows them to choose a rehabilitation provider, employment services or other supports from a wider pool. Use of a Ticket and The Ticket Program is voluntary. You must be a Social Security beneficiary to receive a Ticket from Social Security. You assign the Ticket to an Employment Network service provider that meets your needs when you and the provider sign a written agreement, an Individual Work Plan, or IWP. Social Security will reimburse an Employment Network when cash benefits stop for a beneficiary in the Ticket Program due to work activity. Payments to Employment Networks will be based on one of two reimbursement systems, a milestone payment system or an outcome based payment system.

• The Ticket Program will be phased in nationally over a three year period beginning in 2001. The first 13 states that will get Tickets and begin the program in late 2001 are:
  
  AZ, CO, DE, FL, IL, IA, MA, NY, OK, OR, SC, VT, WI.
  
  The Final regulations and the first Ticket distribution for the Ticket program are expected to be made public in the fall of 2001. See Appendix I or www.ssa.gov/work

• Organizational Structure of the Ticket Program
  
  Social Security has contracted with a private Program Manager, MAXIMUS, which will recruit, monitor and oversee the Employment Networks, or ENs. An EN will consist of Social Security approved public and private sector service providers authorized to accept a Ticket based on the choice of the beneficiary.
  
  For example, an existing community service provider with other funding, a cooperative of individuals, or an employer could be in an Employment Network or could be their own Employment Network.

• An EN is not obligated to accept a Ticket and a beneficiary can switch providers without creating a problem. State Department of Vocational Rehabilitation (DOR in CA) and One Stop Centers may elect to be service providers in an EN. VR or One Stop Centers will not be a Program Manager in the Ticket Program. The Program Manager will NOT provide actual employment services in an Employment Network.

• Continuing Disability (medical) Reviews or "CDRs"
  
  CDRs, as in Continuing Disability (medical eligibility) Reviews, will not take place while a Ticket holder is enrolled and using the Ticket Program. Effective date: Upon implementation of Ticket Program in a region. (Cash benefits may still be subject to termination if earnings are substantial.)

• A beneficiary may change Ticket service providers. Program managers shall make payments to more than one Ticket Program service provider when a Ticket holder changes providers.

• The Social Security Commissioner has written proposed dispute resolution rules and other regulations when state and private providers serve the same Ticket user.

• A new and timely Report to Congress is mandated in the law to recommend provider payment rates for those who work with:
  

  • Individuals with a need for ongoing support and services
  • Individuals with a need for high cost accommodations
  • Individuals who earn subminimum wages, and
  • Individuals who work and receive partial cash benefits
    
    

Social Security Work Incentive Upgrades and Reforms

PROVISIONS

* Benefit Planning, Assistance and Outreach Program – BPAO

Community based, cooperative agreements and competitive grants: a statewide community based program to work with consumers using work incentive rules and programs. $23 million dollars authorized per year for five years. 117 organizations across the country have been awarded BPAO grants from Social Security (September 2001) For CURRENT grants and status: http://www.ssa.gov/oag/grants/ssagrant_info.htm

2001 CURRENT Grants and status: http://www.ssa.gov/oag/grants/ssagrant_info.htm

* Twelve Member Ticket to Work and Work Incentives Advisory Panel

Consumers of services and other experts appointed by the President and Congress to advise the Social Security Commissioner, the President and Congress, and other federal agencies on the implementation of the Act and work incentive provisions. At least one-half of the panel members are required to be individuals with disabilities, or representatives of individuals with disabilities, with consideration given to current or former Social Security disability beneficiaries. Effective upon enactment. The Panel was sworn in by Social Security Commissioner Apfel and met for the first time July 24, 2000, in Washington. For information, go to: www.ssa.gov/work

Please write directly to this Panel at: TWWIIAPanel@SSA.GOV

Demonstration Projects

* Extension of Disability Insurance Program Demonstration Project Authority:

Demonstration authority extended five years from date of enactment.

* "2/1" Demonstration Projects.

Social Security is required to conduct adequate demonstration projects to provide for and study reductions in disability insurance benefits (SSDI) by $1 for each $2 that a beneficiary earns over a certain amount.

Titles III and IV of THE WORK INCENTIVES ACT describe GAO studies and revenue "offsets."

APPENDIX I

2001 - CURRENT SSA WORK INCENTIVE RULES

For current law and rules on the Social Security Disability Application Process and Work Incentives, go to:

The Social Security Red Book -- www.ssa.gov/work

CLICK ON RESOURCES/TOOLKIT, CLICK ON REDBOOK

OR http://www.ssa.gov/work/ResourcesToolkit/redbook.pdf

FEDERAL POVERTY GUIDELINES

Federal Poverty Level Guidelines

From: http://aspe.hhs.gov/poverty

2001 HHS Poverty Guidelines

SOURCE: Federal Register, Vol. 66, No. 33, February 16, 2001, pp. 10695-10697.

APPENDIX II

SELECT WEBSITES
for
The Ticket to Work and Work Incentives Improvement Act (PL 106-170)
and
The Workforce Investment Act (PL 105-220)

JOBS, HEALTH CARE AND PUBLIC PROGRAMS

PRESIDENTIAL TASK FORCE ON
EMPLOYMENT OF ADULTS WITH DISABILITIES
http://www.dol.gov/dol/_sec/public/programs/ptfead/main.htm

SOCIAL SECURITY ADMINISTRATION
“The Work Site”
http://www.ssa.gov/work/

Social Security State Partnership Systems Change Initiative (SPI Programs)
http://spiconnect.org/

US HEALTH CARE FINANCING ADIMINISTRATION
WORK INCENTIVE ACT Informational Website – What’s New?
http://www.hcfa.gov/medicaid/twwiia/whatsnew.htm

US DEPARTMENT OF LABOR
Employment Training Administration
WORK INCENTIVE ACT - Federal Grants and other Resources
disAbility Online
http://www.wdsc.org/disability/

WORKSUPPORT.COM
Information, resources, and research regarding the employment of people with disabilities.
http://www.worksupport.com/

MEDICAID BUY-INS -- BACKGROUND and PROGRESS REPORTS

State of Connecticut: First to adopt the Work Incentives Act Medicaid Buy-In
Summary and Legislation
http://www.dgne.com/terry/pres/index.html

Comprehensive, Person-Centered State Work Incentive Initiatives
A Resource Center for Developing and Implementing Medicaid
Buy-in Programs and Related Employment Initiatives for Persons with Disabilities
http://www.uiowa.edu/~lhpdc/work/index.html

National Conference of State Legislators
Ticket to Work: Medicaid Buy-In Options for Working People with Disabilities: by Julie Scales, NCSL, Donna Folkemer, NCSL, Allen Jensen, GWU
http://www.ncsl.org/programs/health/Forum/tickettowork.htm

The California "Workforce Inclusion Act" - AB 925, introduced February 23, 2001 Pending Legislation

The provisions in AB 925, taken together, provide needed health care and information systems for workers with disabilities when they choose to seek services that support employment outcomes. Available at: www.leginfo.ca.gov

EMPLOYMENT, HEALTH CARE, PUBLIC BENEFITS AND RELATED ISSUES

Neighborhood Legal Services, Inc.
A Legal Reference on the Net
http://www.nls.org

Work Incentives NEWS at World Institute on Disability (WID)
http://www.wid.org/

Rehabilitation Research and Training Center (RRTC) on Workforce Investment and Employment Policy for Persons with Disabilities
A exceptional clearinghouse for policy briefs on both Acts:
http://www.comop.org/rrtc/rrtc.htm

The Law, Health Policy & Disability Center:
An emerging leader in technology, education, and research, focused on improving the quality of life for persons living with disabilities
http://disability.law.uiowa.edu/

ONE STOP CENTERS AND THE WORKFORCE INVESTMENT ACT

Institute for Community Inclusion
Got a question about One-Stop Centers or the Workforce Investment Act? Want to share your experience in using a One-Stop Center? Do you have any tips for people with disabilities using One-Stop Centers? Post your comment or question on our message board.
http://web1.tch.harvard.edu/ici/programs/wia.html