[House Hearing, 107 Congress]
[From the U.S. Government Publishing Office]
FOURTH IN A SERIES ON SOCIAL SECURITY DISABILITY PROGRAMS' CHALLENGES
AND OPPORTUNITIES
=======================================================================
HEARING
before the
SUBCOMMITTEE ON SOCIAL SECURITY
of the
COMMITTEE ON WAYS AND MEANS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 26, 2002
__________
Serial No. 107-96
__________
Printed for the use of the Committee on Ways and Means
U. S. GOVERNMENT PRINTING OFFICE
87-112 WASHINGTON : 2003
____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
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Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001
COMMITTEE ON WAYS AND MEANS
BILL THOMAS, California, Chairman
PHILIP M. CRANE, Illinois CHARLES B. RANGEL, New York
E. CLAY SHAW, JR., Florida FORTNEY PETE STARK, California
NANCY L. JOHNSON, Connecticut ROBERT T. MATSUI, California
AMO HOUGHTON, New York WILLIAM J. COYNE, Pennsylvania
WALLY HERGER, California SANDER M. LEVIN, Michigan
JIM MCCRERY, Louisiana BENJAMIN L. CARDIN, Maryland
DAVE CAMP, Michigan JIM MCDERMOTT, Washington
JIM RAMSTAD, Minnesota GERALD D. KLECZKA, Wisconsin
JIM NUSSLE, Iowa JOHN LEWIS, Georgia
SAM JOHNSON, Texas RICHARD E. NEAL, Massachusetts
JENNIFER DUNN, Washington MICHAEL R. MCNULTY, New York
MAC COLLINS, Georgia WILLIAM J. JEFFERSON, Louisiana
ROB PORTMAN, Ohio JOHN S. TANNER, Tennessee
PHIL ENGLISH, Pennsylvania XAVIER BECERRA, California
WES WATKINS, Oklahoma KAREN L. THURMAN, Florida
J. D. HAYWORTH, Arizona LLOYD DOGGETT, Texas
JERRY WELLER, Illinois EARL POMEROY, North Dakota
KENNY C. HULSHOF, Missouri
SCOTT MCINNIS, Colorado
RON LEWIS, Kentucky
MARK FOLEY, Florida
KEVIN BRADY, Texas
PAUL RYAN, Wisconsin
Allison Giles, Chief of Staff
Janice Mays, Minority Chief Counsel
______
Subcommittee on Social Security
E. CLAY SHAW, JR., Florida, Chairman
SAM JOHNSON, Texas ROBERT T. MATSUI, California
MAC COLLINS, Georgia LLOYD DOGGETT, Texas
J.D. HAYWORTH, Arizona BENJAMIN L. CARDIN, Maryland
KENNY C. HULSHOF, Missouri EARL POMEROY, North Dakota
RON LEWIS, Kentucky XAVIER BECERRA, California
KEVIN BRADY, Texas
PAUL RYAN, Wisconsin
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Ways and Means are also published
in electronic form. The printed hearing record remains the official
version. Because electronic submissions are used to prepare both
printed and electronic versions of the hearing record, the process of
converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
Page
Advisory of September 19, 2002, announcing the hearing........... 2
WITNESSES
Social Security Administration:
Martin Gerry, Deputy Commissioner, Disability and Income Security
Programs....................................................... 5
Sarah Wiggins Mitchell, Chair, Ticket to Work and Work Incentives
Advisory Panel................................................. 16
______
ABIL Employment Services, Susan Webb............................. 65
Consortium for Citizens with Disabilities, Work Incentives Task
Force, Susan Prokop............................................ 24
Gadaire, David, Career Point..................................... 71
Gilliland, Amy, Glendale, Arizona................................ 70
Kregel, John, Benefits Assistance Resource Center, Virginia
Commonwealth University........................................ 32
MAXIMUS Program Manager, Ticket to Work and Self-Sufficiency
Program, Mary Satterfield...................................... 51
National Association of Protection and Advocacy Systems, Curtis
L. Decker...................................................... 75
Wisconsin Department of Workforce Development, Division of
Vocational Rehabilitation, Charlene Dwyer...................... 54
Oklahoma Department of Rehabilitation Services, Ticket to Work
and Community Rehabilitation, Dan O'Brien...................... 57
SUBMISSIONS FOR THE RECORD
Alden, Natalie, Independent Living Resource Center of NE FL,
letter......................................................... 102
Council of State Administrators of Vocational Rehabilitation,
Bethesda, MD, Carl Suter, statement............................ 103
National Alliance for the Mentally Ill, Arlington, VA, Steve
Miller, statement.............................................. 105
National Council of SSA Field Operations Locals, and American
Federation of Government Employees, AFL-CIO, Witold
Skwierczynski, statement....................................... 110
National Rehabilitation Association, Bethesda, MD, Patricia C.
Leahy, letter.................................................. 112
FOURTH IN A SERIES ON SOCIAL SECURITY DISABILITY PROGRAMS' CHALLENGES
AND OPPORTUNITIES
----------
THURSDAY, SEPTEMBER 26, 2002
House of Representatives,
Committee on Ways and Means,
Subcommittee on Social Security,
Washington, DC.
The Subcommittee met, pursuant to notice, at 11:47 a.m., in
room B-318 Rayburn House Office Building, Hon. E. Clay Shaw,
Jr., (Chairman of the Subcommittee) presiding.
[The advisory announcing the hearing follows:]
ADVISORY
FROM THE
COMMITTEE
ON WAYS
AND
MEANS
SUBCOMMITTEE ON SOCIAL SECURITY
Contact: (202) 225-9263
FOR IMMEDIATE RELEASE
September 19, 2002
No. SS-17
Shaw Announces Fourth in a Series of Hearings
on Social Security Disability Programs'
Challenges and Opportunities
Congressman E. Clay Shaw, Jr. (R-FL), Chairman, Subcommittee on
Social Security of the Committee on Ways and Means, today announced
that the Subcommittee will hold a hearing to examine the implementation
of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-
170). The hearing will take place on Thursday, September 26, 2002, in
room B-318 Rayburn House Office Building, beginning at 11:00 a.m.
In view of the limited time available to hear witnesses, oral
testimony at this hearing will be from invited witnesses only. However,
any individual or organization not scheduled for an oral appearance may
submit a written statement for consideration by the Subcommittee and
for inclusion in the printed record of the hearing.
BACKGROUND:
Over the past year, the Subcommittee has held a series of hearings
examining the challenges and opportunities facing Social Security's
disability programs. The first of these hearings provided an overview
of the issues and options to decrease the processing time of disability
decisions. During the second hearing, the Subcommittee examined reasons
for delay, complexity, and inconsistency in the disability
determination and appeals process, and explored recommendations for
change. The third hearing in the series examined how disability is
defined and the degree to which the definition addresses the needs of
today's workers, beneficiaries, and the intent of the Social Security
Disability Insurance (SSDI) and Supplemental Security Income (SSI)
programs.
The Ticket to Work and Work Incentives Improvement Act of 1999,
P.L. 106-170, signed into law on December 17, 1999, established the
Ticket to Work and Self-Sufficiency Program, expanded the availability
of health care coverage, and provided for demonstration projects and
studies. The Ticket to Work and Self-Sufficiency program, administered
by the Social Security Administration (SSA), provides greater
opportunities for SSDI and SSI disability recipients to receive
assistance that would help them return to work. As part of the program,
individuals receive a ``ticket'' from the SSA, which they may
voluntarily assign to an Employment Network (EN) of their choice. An EN
is a public agency or private organization that provides employment
services, vocational rehabilitation services, or other support services
necessary to achieve a vocational goal. The ENs are paid by the SSA for
results, and choose between two payment systems, one based on the
individual no longer receiving cash benefits because of work, the other
based on attainment of certain vocational milestones.
``Tickets'' to beneficiaries are being issued at the State level in
three phases, the first began in February 2002, with 13 States. Phase
two is expected to begin in late 2002 and the third and final stage is
expected early in 2003. Since February, about 2 million tickets have
been mailed to beneficiaries, and over 6,400 of these tickets have been
assigned to one of the more than 400 ENs that have become part of this
program so far. The SSA has contracted with Maximus, Inc., to act as
the Program Manager for the Ticket to Work program. Maximus, Inc., is
responsible for the day-to-day administration of the program,
recruiting employment networks, ensuring services are available for
beneficiaries, and answering questions about the program.
The Ticket to Work and Work Incentives Advisory Panel, which was
established to advise the President, the Congress, and the Commissioner
of Social Security on issues related to work incentive programs, made a
number of recommendations in their Second Annual Report. These
recommendations included: the importance of securing necessary
resources to inform the public about the ticket program, expanding the
pool of individuals who may be eligible for a ticket, ensuring a
sufficient number of SSA specialists in SSDI and SSI work incentives
are available to assist ticket holders, and a number of other
administrative and reimbursement recommendations.
In announcing the hearing, Mr. Shaw stated: ``Simply put, the
Ticket to Work program is about work. Its aim is to replace barriers
with opportunities, so that individuals with disabilities may achieve
their goal of working and supporting themselves and their families. We
must ensure implementation of this important program proceeds smoothly
and addresses the concerns and needs of individuals with disabilities
who want to work and organizations that are serving them.''
FOCUS OF THE HEARING:
This hearing will examine the Ticket to Work program's
implementation progress, identify preliminary results, and hear issues
of concern, along with potential remedies.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Please Note: Due to the change in House mail policy, any person or
organization wishing to submit a written statement for the printed
record of the hearing should send it electronically to
[email protected], along with a fax copy to
(202) 225-2610, by the close of business, Thursday, October 10, 2002.
Those filing written statements who wish to have their statements
distributed to the press and interested public at the hearing should
deliver their 200 copies to the Subcommittee on Social Security in room
B-316 Rayburn House Office Building, in an open and searchable package
48 hours before the hearing. The U.S. Capitol Police will refuse
sealed-packaged deliveries to all House Office Buildings.
FORMATTING REQUIREMENTS:
Each statement presented for printing to the Committee by a
witness, any written statement or exhibit submitted for the printed
record or any written comments in response to a request for written
comments must conform to the guidelines listed below. Any statement or
exhibit not in compliance with these guidelines will not be printed,
but will be maintained in the Committee files for review and use by the
Committee.
1. Due to the change in House mail policy, all statements and any
accompanying exhibits for printing must be submitted electronically to
[email protected], along with a fax copy to
(202) 225-2610, in Word Perfect or MS Word format and MUST NOT exceed a
total of 10 pages including attachments. Witnesses are advised that the
Committee will rely on electronic submissions for printing the official
hearing record.
2. Copies of whole documents submitted as exhibit material will not
be accepted for printing. Instead, exhibit material should be
referenced and quoted or paraphrased. All exhibit material not meeting
these specifications will be maintained in the Committee files for
review and use by the Committee.
3. Any statements must include a list of all clients, persons, or
organizations on whose behalf the witness appears. A supplemental sheet
must accompany each statement listing the name, company, address,
telephone and fax numbers of each witness.
Note: All Committee advisories and news releases are available on
the World Wide Web at http://waysandmeans.house.gov/.
The Committee seeks to make its facilities accessible to persons
with disabilities. If you are in need of special accommodations, please
call (202) 225-1721 or (202) 226-3411 TTD/TTY in advance of the event
(four business days notice is requested). Questions with regard to
special accommodation needs in general (including availability of
Committee materials in alternative formats) may be directed to the
Committee as noted above.
Chairman SHAW. Good morning. I apologize, but neither Mr.
Matsui nor I have any control over the schedule on the Floor,
and there were three votes in a row, and that is what took us
away from here, but we will move forward as quickly as we can.
As we continue our hearing series examining the challenges
and opportunities facing Social Security disability programs,
today we turn our focus to the implementation of the Ticket to
Work and Work Incentive Improvement Act of 1999.
Originating in this Subcommittee the legislation's goal is
to remove barriers and increase incentives for disabled
individuals returning or seeking to return to work. These
incentives empower beneficiaries with more choices. They can
choose the services they want, from whom they want in the
public or the private sector. These providers in turn are only
paid for their work when their clients get jobs giving them the
economic motivation to serve their clients quickly and
effectively.
Although it took the Social Security Administration (SSA) 2
years to publish final implementing regulations, the good news
is that the beneficiaries in 13 States received their tickets
beginning in February of this year. These tickets may be used
to obtain vocational rehabilitation (VR), job training and
other support services. By next year the program will be
available in all 50 States.
So far, of the 2 million tickets mailed, over 7,000
beneficiaries have assigned their tickets to one or more of the
400 service providers or Employment Networks (EN) as referred
to in the law, to receive employment services they choose to
help them re-enter or enter the work force. While this program
is still very young, early results are promising. We will hear
today that beneficiaries' interest has overwhelmed service
providers and that the number of beneficiaries actually
participating in the program has quickly outpaced early
estimates.
Welcome news though, not surprising, as it is always the
position of this Subcommittee that given the right support
individuals with disabilities would choose work, if given the
opportunity. Recognized as part of President Bush's Freedom
Initiative, this landmark legislation transforms Social
Security Disability programs from programs of dependency to
programs of opportunity. The ultimate success of the program,
however, will depend upon its effective implementation and
sound management by the Social Security Administration,
supported by key stakeholders. I look forward to the hearing
with many of these stakeholders today, and as we examine the
Ticket to Work program's implementation progress, preliminary
results, along with issues of concern and their potential
remedies.
Last week I had the opportunity to visit one of these
providers down in Palm Beach, it was by Goodwill Industries,
and I was rather impressed with some of the results, the early
results that they are getting. There are still some problems. I
know Florida does not have the Medicaid continuation which is
tremendously important, and it is rather scary if you are
disabled, to lose that type of coverage. Mr. Matsui?
Mr. MATSUI. Thank you very much, Mr. Chairman. I appreciate
the fact that you are holding this hearing.
I think it is very timely with the 13 States now beginning
to implement the Ticket to Work program. I would hope that the
witnesses will be thinking, before they come up here, because
what we will really want to do is find ways to improve the
system. Obviously, as the Chairman has mentioned, there are
going to be a lot of stops and starts and a lot of little bumps
as we go along the way, because it is a very innovative
program, and certainly we want to make sure that at the end of
the day this program works and obviously carries out the
principles that Mr. Shaw and all of us on this Subcommittee
want to happen.
So, we look forward in a very positive way to your comments
and observations. So, with that, Mr. Chairman, I will thank you
again and look forward to hearing from the witnesses.
I may have a little problem, and I would not want to be
presumptuous here, but some of us--there are a lot of briefings
going on now about the whole issue of Iraq and we lost 45
minutes because of the three votes. I may have to leave at
sometime, and I do want to just express my apologies before I
actually do that. Thank you.
Chairman SHAW. Thank you, Bob. We will proceed as quickly
as possible through this very busy agenda we have, a large
number of witnesses, particularly on the last panel.
Our first witness is Martin Gerry, Deputy Commissioner,
Disability and Income Security Programs. Welcome to the
Subcommittee. We have your full testimony, as we do of all the
witnesses, that will be put into the record, and you may
summarize as you see fit.
Mr. GERRY. Thank you, Mr. Chairman.
Chairman SHAW. Thank you, sir.
STATEMENT OF MARTIN GERRY, DEPUTY COMMISSIONER, DISABILITY AND
INCOME SECURITY PROGRAMS, SOCIAL SECURITY ADMINISTRATION
Mr. GERRY. First, let me thank you and the Subcommittee for
inviting me today to discuss the Social Security
Administration's implementation of the Ticket to Work and Self-
Sufficiency Program, which is part of the Ticket to Work and
Work Incentives Improvement Act 1999 (TTWWIIA).
As you know, the goal of the Ticket Act is to help disabled
beneficiaries who want to work by improving employment support
chances, providing enhanced work incentives, and lessening
beneficiaries' fears about losing health care and income during
attempts to work.
I would very much like to express my thanks to you, Mr.
Chairman and Mr. Matsui, and to other Members of the
Subcommittee at the outset for your hard work and support in
making the Ticket program a reality.
My remarks--and I will try to make them a little briefer
than I had otherwise planned--this morning will focus on the
Ticket program, the central feature of the Ticket Act, and of
course my written statement includes the status of the other
work incentives in the Act. I was going to briefly outline the
program, but, I will not do that because I know you have a lot
of people waiting to testify.
Let me talk about where we are with the program. We believe
that the program is off to a good start. As of this month, more
than 7,000 beneficiaries have gone to Employment Networks or to
the State Vocational Rehabilitation Agencies in the initial 13
States. We expect to see higher numbers of beneficiaries
participating as we gain experience and the program matures. We
know we have much work to do to make those expectations a
reality.
The second phase of the program will begin in November of
this year, and during this phase of the program approximately
2.6 million beneficiaries will be eligible to receive tickets
in 20 additional States and in the District of Columbia. Then,
in 2003, we will release tickets to the approximately 3.3
million beneficiaries in the remaining 17 States and the U.S.
territories during the third and final implementation phase, so
that by January 2004 we will have fully implemented the Ticket
program.
Employment Networks operate under agreements with SSA and
can be any qualified State or local government agency, or a
private entity that assumes responsibility for the coordination
and delivery of services under the Ticket program. An EN may be
a one-stop delivery system established under the Workforce
Investment Act of 1998, a State Vocational Rehabilitation
Agency, a single provider of services, or a group of providers
organized to combine their resources into a single entity.
The ENs are already setting up client interviews and are
beginning to provide services to beneficiaries in the 13
initial States. We believe that these activities have increased
demand for their services. That itself has had a positive
impact on demand.
The beneficiary bears none of the cost of employment,
vocational or other support services. It is the Agency that
pays an EN that provides services to a beneficiary. An EN can
elect to receive payments under one of two systems. Under the
Outcome Payment System, an EN will be paid for each month up to
60 months in which a beneficiary that it is serving does not
receive cash benefits due to worker earnings. In the other
payment system, the outcome-milestone payment system, an EN
will receive payments when a beneficiary it is serving achieves
one or more milestones toward self-supporting employment. The
EN will also receive reduced outcome payments for each month up
to 60 months that a beneficiary does not receive cash benefits
due to worker earnings. The Agency has provided up to four
milestones for which an EN can be paid. We have begun receiving
and processing the first requests for milestone and outcome
payments from the ENs. The first milestone payment was made
during May 2002.
The Ticket Act also calls for the Commissioner to enter
into an agreement with a program manager to assist the Agency
in administering the Ticket to Work Program. MAXIMUS, Inc., is
that program manager. Among MAXIMUS's duties are recruiting,
recommending and monitoring the EN selected by SSA to provide
services, facilitating beneficiary access to the ENs,
facilitating payment to the ENs and resolving disputes between
beneficiaries and ENs under the program. I am pleased to note
that the ENs and beneficiaries appear to be satisfied with the
level of service provided by MAXIMUS.
I would like to briefly mention that SSA piloted the
Employment Support Representative position from July 2000 to
September 2001. As you know, SSA is required by the Ticket Act
to provide beneficiaries with employment support information
and services. We have made no decisions as yet as how to best
provide those services.
Finally, I want to thank you, Mr. Chairman, Mr. Matsui, and
all the Members of the Subcommittee for showing continued
dedication to the Ticket program. I look forward to working
with you to successfully implement it.
[The prepared statement of Mr. Gerry follows:]
Statement of Martin Gerry, Deputy Commissioner, Disability and Income
Security Programs, Social Security Administration
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me today to discuss the Social Security
Administration's (SSA) implementation of the Ticket to Work and Self-
Sufficiency Program (``Ticket program''). As you know, Mr. Chairman,
President Bush has a strong interest in disability issues. The
President has said that he is committed to tearing down the remaining
barriers to equality that face Americans with disabilities today. His
``New Freedom Initiative'' will help Americans with disabilities by
increasing access to assistive technologies, expanding educational
opportunities, and increasing the ability of Americans with
disabilities to integrate into the workforce.
I would like to express my thanks to you, Mr. Chairman, Mr. Matsui,
and members of the Subcommittee, for your hard work and support in
making the Ticket program a reality. Established as part of the Ticket
to Work and Work Incentives Improvement Act of 1999 (``Ticket Act''),
it was a crucial element of meeting that legislation's goal to remove
barriers to employment that many Americans with disabilities face.
Because of the Ticket Program, beneficiaries will have more choices in
obtaining employment support services to help them reach their
employment goals.
Today I would like to provide an update on the implementation of
the Ticket program, and touch upon a few related issues.
Implementation of the Ticket to Work Program
First, let me briefly outline this program. A disabled beneficiary
receives a Ticket if he or she is between the ages of 18 and 64 and his
or her medical condition is not expected to improve in the near future.
The beneficiary may take the Ticket to the State Vocational
Rehabilitation Agency or any of the employment service providers who
offer employment support services in the community. These providers are
called Employment Networks (ENs). The beneficiary and the Employment
Network will jointly develop a plan of services leading to employment.
In addition, SSA will not schedule a periodic continuing disability
review (CDR) for a beneficiary who is receiving services from an EN. I
will discuss these provisions in more detail later.
We are implementing the Ticket program in three phases. By using a
staggered approach to implementation we can further develop and refine
the program before it is fully in place. About 2.4 million
beneficiaries with disabilities are eligible to receive Tickets to Work
in the 13 States selected for the first phase of the program. From
February through June 2002, we mailed Tickets to most of these
beneficiaries in a graduated release. (Because of the impact of last
year's terrorist attacks, we developed a slightly delayed release
schedule for Tickets in New York.) Using this method provided time to
develop an infrastructure of ENs within these states to serve the
beneficiaries and to ensure that they were aware of the program's
availability. Currently we have more than 400 ENs in place.
We believe the program is off to a good start. Participation is
voluntary, and I am happy to report that as of this month more than
7,000 beneficiaries out of the 2.4 million beneficiaries eligible to
receive Tickets have assigned their Tickets to ENs or the State
vocational rehabilitation agencies in the initial 13 States. We expect
to see higher numbers of beneficiaries participating as we gain
experience and the program matures, but we know we have much work to do
to make those expectations a reality.
The second phase of the program will begin in November 2002. During
this phase of the Program, approximately 2.6 million beneficiaries are
eligible to receive Tickets in 20 additional States and the District of
Columbia. Then in 2003, we will release Tickets to the approximately
3.3 million beneficiaries in the remaining 17 States and the U.S.
Territories during the third and final implementation phase. By January
2004, we will have fully implemented the Ticket program.
Employment Networks
I would now like to focus on the role of the EN in the Ticket
program. Under the Ticket Act, the Commissioner enters into agreements
with qualified State, local, or private organizations to serve as ENs.
These ENs will then provide vocational rehabilitation, employment, and
other support services to beneficiaries with disabilities to assist
them to find and maintain employment.
Employment Networks operate under agreements with SSA, and can be
any qualified State or local government agency, or a private entity,
that assumes responsibility for the coordination and delivery of
services under the Ticket program. An EN may be a one-stop delivery
system established under the Workforce Investment Act of 1998; a State
Vocational Rehabilitation Agency; a single provider of services; or a
group of providers organized to combine their resources into a single
entity. Employment Networks can provide services directly or by
entering into agreements with other organizations or individuals to
provide the appropriate services. ENs will only be paid based on their
success in assisting beneficiaries to secure and maintain employment
and move off the disability benefit rolls.
On April 13, 2001, the Agency published a Request for Proposals for
organizations in the 13 States in the first phase of the Program
wishing to serve as ENs. On April 25, 2002, SSA published an amended
Request for Proposals from organizations wishing to serve as ENs, based
on the final regulations published on December 28, 2001. Our Program
Manager, MAXIMUS, is currently evaluating and making recommendations on
the organizations responding to the Request for Proposals. MAXIMUS and
the Agency are also marketing the Ticket program to other prospective
ENs through mailings, EN recruitment fairs, and other contacts.
As of September 2002, we have received over 500 applications from
providers to be ENs, and have entered into agreements with more than
425 providers to serve as ENs. We are working hard to attract
sufficient providers of employment services so that beneficiaries will
enjoy the degree of choice when selecting an EN that members of
Congress and people with disabilities envisioned when the Ticket Act
was developed. ENs report that beneficiaries are apparently already
comparing available ENs before deciding where to assign their Tickets.
ENs are already setting up client interviews and are beginning to
provide services to beneficiaries. We believe that these activities
have increased demand for their services. For instance, as of early
September 2002, over 60 percent of the tickets assigned were assigned
by ``new'' participants (beneficiaries who had previously not received
VR services and who first signed plans for services under the Ticket to
Work program). I might note that, out of this group, about one-third
assigned their Tickets to an EN. The remaining two-thirds signed plans
for services with their State Vocational Rehabilitation Agency. We are
and will continue to look carefully at the Ticket assignments to make
sure that beneficiaries have a range of choice of providers envisioned
by the legislation.
A key element of the Ticket program is that the beneficiary bears
none of the cost of employment, vocational, or other support services.
It is the Agency that pays an EN for providing services to a
beneficiary. An EN can elect to receive payment under one of two
systems. Under the Outcome Payment System an EN will be paid for each
month, up to sixty months, in which a beneficiary it is serving does
not receive cash benefits due to work or earnings. Under the Outcome-
Milestone Payment System, an EN will receive payment when a beneficiary
it is serving achieves one or more milestones toward self-supporting
employment. Under this second payment system the EN will also receive
reduced outcome payments for each month, up to sixty months, that a
beneficiary does not receive cash benefits due to work or earnings. The
Agency has provided up to four milestones for which an EN can be paid.
We have begun receiving and processing the first requests for milestone
and outcome payments from the ENs. The first milestone payment was made
during May 2002.
As I mentioned, the Ticket Act also calls for the Commissioner to
enter into an agreement with a Program Manager to assist the Agency in
administering the Ticket to Work Program, MAXIMUS, Inc. Among MAXIMUS'
duties are recruiting, recommending, and monitoring the ENs selected by
SSA to provide services; facilitating beneficiary access to the ENs;
facilitating payment to the ENs; and resolving disputes between
beneficiaries and ENs under the program. I am pleased to note that the
ENs and beneficiaries appear to be satisfied with the level of service
provided by MAXIMUS.
As an Agency, we appreciate the important role our employees play
in successfully implementing any new policy. That is why we arranged
for training sessions on Ticket to Work and employment support topics
during all three phases of the Ticket implementation. We have already
completed the training sessions for the first phase, and will hold the
sessions for the second phase in October 2002. We are also developing
specialized training for field employees on employment supports.
Other Supports for Return to Work
While the Ticket program is the central element of the Ticket to
Work Act, that law includes several other provisions that seek to
encourage disability beneficiaries to return to work. Importantly,
these provisions benefit disabled individuals even if they are not
using their Ticket. I will summarize the implementation status of these
provisions.
Pursuant to Section 121 of the Ticket Act, we established Benefits
Planning, Assistance and Outreach (BPAO) program to fund organizations
to help disability beneficiaries understand the effect of work
activities on their benefits and explain other existing programs which
assist disability beneficiaries who wish to work. In fiscal years 2000
and 2001, we awarded cooperative agreements under the BPAO program to
116 organizations, which are located nationwide and all U.S.
territories. So far, more than 28,000 beneficiaries have received help
from BPAO organizations.
Section 122 of the legislation authorized SSA to make payments in
each State to the protection and advocacy system established pursuant
to the Developmental Disabilities Assistance and Bill of Rights Act.
The payments are made to the Protection and Advocacy (P&A) systems for
the purpose of providing services to assist in protecting the rights of
disability beneficiaries in their return to work efforts. The P&As are
to provide information and advice about obtaining VR and employment
services, as well as advocacy or other services that a beneficiary
needs to secure or regain gainful employment. In FY 2001, we awarded 57
P&A grants nationwide, and in the U.S. territories. All P&A projects
have completed implementation efforts and are providing the required
information and advocacy services. By the end of 2001, they had
provided services to over 10,000 beneficiaries.
The Ticket Act also reduced the need for disability beneficiaries
to choose between returning to work and receiving health care coverage.
It extended Medicare coverage for working individuals with disabilities
by an additional four and a half years, and expanded the Medicaid
program to give the states the option of providing coverage to more
working people with disabilities. This extension of coverage became
effective on October 1, 2000. Twenty-six states already have Centers
for Medicare and Medicaid Services (CMS) approved plans for extending
Medicaid coverage in place and an additional eight states have passed
enabling legislation and are working with CMS to gain approval for
their plans. Additionally, approximately 52,000 persons have benefited
from the extension of Medicare coverage.
Also, the Ticket Act included two sections that sought to eliminate
work disincentives for all disability beneficiaries, even those not
using tickets. Under Section 112, an individual whose benefits
terminated because of work activity can request that benefits start
again without having to complete a new application. While the Agency
determines the requestor's eligibility for reinstatement, he or she can
receive provisional benefits for up to six months. This process is
called expedited reinstatement. Since this provision became effective
on January 1, 2001, we have adjudicated almost 12,000 expedited
reinstatement claims that have been filed. We have completed SSA
instructions and training for field employees, and expect to publish a
Notice of Proposed Rulemaking on the provisions of expedited
reinstatement in the winter.
Under Section 111, a Social Security Disability Insurance
beneficiary's work activity will not trigger a CDR if he or she has
received benefits for at least 24 months. This provision became
effective on January 1, 2002. We have completed instructions and
training for field employees to familiarize them with the new
provision, and we expect to publish a Notice of Proposed Rulemaking on
the provisions of suspending CDRs also in the winter.
One of the systems enhancements we are developing to prevent
triggering a CDR is called the Disability Claims File. This system will
link the software that tracks work information and the end of the trial
work period for beneficiaries to the system that controls medical
diaries. Additionally, because one system will track all work
information and control all continuing disability reviews, we expect to
improve our ability to properly handle work reports, reducing both the
number of incorrect payments and our processing time for these reviews.
We have begun efforts to improve automation of these workloads and
expect further enhancements.
Work Incentive Specialists
Section 121 of the Ticket Act requires SSA to establish a corps of
specialists devoted to issues related to work incentives. From July
2000 to September 2001 we piloted an Employment Support Representative
position as we look for ways to provide that service. We are
considering how best to provide employment support-related information
and services to beneficiaries with disabilities who want to work,
within the context of our overall operations. We have not made any
decisions yet.
Conclusion
Finally, I thank you, Mr. Chairman, Mr. Matsui, and all the members
of the Subcommittee, for showing continued dedication to the Ticket
program. Thanks to that commitment, we look forward toward providing
more beneficiaries with the additional opportunities and tools they
need to enter or reenter the workforce.
I would also like to acknowledge the valuable input we have
received from the Ticket Advisory Panel and the Social Security
Advisory Board. We are committed to achieving the goal set by Congress
to improve access to jobs for Americans with disabilities. I believe,
and I am sure you will agree, that the nation benefits greatly when all
of its citizens have the opportunity to make the most of their talents.
We shall implement the Ticket program with the goal of realizing this
idea.
Again, thank you for inviting me to be here today. I look forward
to working with you to successfully implement the Ticket program.
Chairman SHAW. Thank you, Mr. Gerry.
I think most of us agree that understanding the Social
Security work incentives and how earnings impact benefits is
not easy to do, and the lack of understanding promotes fear,
which has the potential of preventing people from returning to
work. One of those fears that I referred to earlier regarding
loss of medical benefits, which we address in the law, but has
not been implemented in many States including my own.
That is why in the Ticket to Work law we ask the Social
Security Administration to establish a core of trained,
accessible and responsive work incentive specialists. What have
we done in that regard in setting that up, and how is that
working?
Mr. GERRY. Well, of course, the agency did establish a
pilot program where we set up Employment Support
Representatives (ESR), and we have been looking at the
experience. We currently have 24 of those representatives still
working in the original structure. The Commissioner has not yet
decided the best way to fully respond to what is clearly the
mandate that Congress established in the statute. I think one
of the things we have learned is that it is very important for
the Agency as a whole to get involved in this work. That is, we
have been looking at strategies, and I think the Commissioner
will want to look at our entire workforce and try to make it
generally more responsive. This is part of our regular
business, and we need to begin to involve our claims
representatives, our service representatives, the staff of all
of our regional offices in this, not just a particularly small
group of people that might be identified on the margins. I
think the Commissioner believes that we need to integrate this
program totally.
So, we are going to be looking at options to do that, as
well as continue to provide this kind of specific targeted
support. I don't have an exact date at which point she will
probably arrive at the conclusions, but I can tell you that it
is something that we are actively looking at right now. We
actually are just about to complete the roll-out in October
because we had to delay the roll-out in New York State. At that
point I think it would be a good time for us to look at the
experience. We have been doing a lot of internal evaluations.
We want to see how we can relate our staff to the organizations
that we fund and figure out how we can really best serve people
with disabilities in an integrated way across the system and
not just create a separate group of people who, no matter how
effective they might be, may not change the organizational
culture. We need to change the way in which the Agency sees
this job to include actively promoting employment opportunities
for people with disabilities.
Chairman SHAW. Are any of your people out there
specifically assigned to that task?
Mr. GERRY. Currently, we do have people working. As I
mentioned, there are the Employment Support Representatives
that we currently have, and increasingly we have been
conducting training of all of our regional staff, so that there
are people assigned to provide that assistance. We haven't
gotten to the point that Congress wants us to get to, which is
to designate formally in each field office, for example, how we
would respond. Now, of course we are only doing this in 13
States.
One of the issues, and why I think it has been necessary to
take some time to do this, is to look at demand: how much
demand is there, and what is the demand for. We think that we
ought to respond aggressively to the kinds of questions that
were being asked. We are talking with the people who are
fielding those questions and we are gaining a lot of experience
every month about the kind of information we need to provide.
Chairman SHAW. Well, is the system overwhelmed at this
point or under-whelmed or how are we doing now? In my opening
remarks I mentioned that we had, how many millions we had sent
out and 7,000 picked them up.
Mr. GERRY. I don't think the system is overwhelmed. I have
been working, for example, fairly closely with New York. New
York was a State that had grave concerns about being
overwhelmed, particularly after the events of last September,
and the concerns that they had about the potential impact. So,
I have been monitoring New York very closely--and it is the
largest State in the first 13. Actually, the States have
responded well in terms of the demand. I think we have been
able to meet the demand. We have a good volume, and that is
what we wanted. We certainly didn't want to be under-whelmed.
We are going to have to work harder to promote the program
more.
So, it is not so much that we need to measure the demand to
know that we have to do this. It is more measuring the demand
to know how many people we need, where we need them, and in
some cases expanding the training. So, we are already involved
in the systematic training of people in our field offices,
moving more toward the idea that we ought to have people who
work for our Agency to be able to address this issue.
Chairman SHAW. Thank you. Mr. Matsui?
Mr. MATSUI. Thank you very much, Mr. Chairman.
Thank you very much, Mr. Gerry. I want to just follow up on
the Chairman's comments in terms of under-whelmed, overwhelmed.
Do you feel the program is at this time, given the fact that
you have only been really actually in the field, so to speak,
for about 7 or 8 months now, do you feel comfortable the
program is on track and adequately working?
Mr. GERRY. Yes. It was my sense from the beginning--and I
think the Commissioner's sense from the beginning--that it was
going to take some time for this program to fully gear up. As
the Chairman mentioned in his opening remarks, that there is a
lot of concern. There is some fear about what may happen to
people. I think there is a trust issue that has always been
there. A lot of the early experience that we have, and one of
the reasons we have been trying to focus on doing it correctly,
is to try to systematically convey that we can and will
respond. It has always been true that there be some sort of a
ramp in take-up rates, and a lot of it is the experience of the
people who begin the program will have a lot to do with how
many other people participate.
So, given the projections that we had, we are doing a
little bit better than we thought in terms of program
participation. It is not as if a lot of people flooded our
offices. I have not seen any evidence that the delivery system
is overwhelmed. I am a little more concerned about being sure
that we have all the choices and the broadest possible range of
choices for people, more than I am that the people who are
being chosen are overwhelmed. That is something we have to keep
working on because one of the goals of the law, obviously, was
to try to broaden that choice as much as possible.
So, if I have any concerns it is more to be sure that the
competition is there. That is the one thing I notice in terms
of how the tickets are going out. It is not so much the volume,
but it would be good to have even more competition than we seem
to have. It varies a lot from State to State.
Mr. MATSUI. How are the State vocational rehabilitation
programs integrating with what your people are doing on the
field, or is that even an issue yet, or is that something you
are kind of thinking about, how you are going to--or is there
even a need to integrate them, or coordinate them I guess is a
better word?
Mr. GERRY. There is a very real need to integrate and
coordinate, and I have been spending a lot of time with the
U.S. Department of Education, the Assistant Secretary for
Special Education and Rehabilitation Services, which provides
the other funding for the rehabilitation system.
The integration also involves the Workforce Investment Act,
which the VR systems are part of too. As part of that, there is
sort of a three-way tie between the vocational rehabilitation
program, the U.S. Department of Labor programs and ours. The
shared goal, is to have as rich a set of opportunities and
choices for people as possible and for the VR system, along
with our system, to contribute to the overall employment
support needed by people. So, it is very important that we not
end up either having our funds replaced by funds that would
otherwise be spent (and need to be spent) by the vocational
rehabilitation providers, or for us not to coordinate
effectively across and over timeframes. There are orders of
priority in the Vocational Rehabilitation Act that actually put
our beneficiaries high on the list. If things work well--and I
mentioned this in some earlier testimony and some of the
demonstrations that we are working on--it is to bring all these
resources together and aggregate them and provide an integrated
support structure over time. That is what we are trying to do.
Mr. MATSUI. Would that require more legislative--probably
would require more regulations I would imagine, or would it?
Maybe not. I mean, can you do it?
Mr. GERRY. Well, that is actually what we are trying to do
in the demonstrations. We are trying to work at the State and
local level to figure out how this should best proceed. It may
bring up the need for legislation. It may bring up the need for
regulations. I think we will know best when we actually are
doing this, which we have started, and are doing with youth,
and adults, and the VR systems are part of that. For the most
part my own experience would be that most of this is able to be
done without legislative changes. I don't think the laws are
inconsistent.
Mr. MATSUI. No.
Mr. GERRY. There may be some need for regulatory changes.
So far we haven't encountered that, but we are really just
starting this. My experience with demonstrations is that you
only find out once you finally get down to who is going to do
what on Monday or who is going to pay for what. Are there
barriers to doing it the way people at the local level really
want to do it? Then we will find out. I think that will be
within the next several months.
Mr. MATSUI. I guess the turf issue is always a difficult
one to really resolve.
Mr. GERRY. It is, but had the Education Department and
particularly Assistant Secretary Pasternack couldn't have been
more cooperative. We have been working very closely with them,
and I think at this point it is an excellent coordination.
Mr. MATSUI. Is there an interagency task force that is
actually on an ongoing basis now, labor education?
Mr. GERRY. We don't have a formal one that I know of, but
as part of the President's New Freedom Initiative, we have an
ad hoc group of four agencies: the Labor Department, Education
Department, Health and Human Services and the Social Security
Administration. We have been meeting pretty much weekly to
design and work together on a whole set of initiatives which
the President has talked about, some of which are reaching
fruition in terms of these demonstration programs. We are
looking at some regulatory changes on our side, but those four
agencies have been the core of that effort. I don't think we
have an official designation, but it is being done under the
New Freedom Initiative.
Mr. MATSUI. Probably better that way. May I just ask one
last question. The backlog of the disability claims review
process, that is not being impacted in any adverse way by this
program, I would imagine, through different personnel and all
of that? Obviously your time is being taken up, and a few
others probably at the top management level, but it is not
being impacted negatively, I take it; is that correct?
Mr. GERRY. Correct. One of the considerations in looking at
this whole question of how we want to provide this kind of
ongoing support is that there is no overlap. When we get into
questions of how we use field office staff, there will be a lot
of choices. Are we going to work on this workload or are we
going to work on that workload? Those are real issues, because
we have a lot of competing demands, as we have said. Right now
the roll-out of the Ticket and the way we are operating the
program is not creating any kind of a drain of resources from
the working on backlog.
Mr. MATSUI. Thank you.
Thank you, Mr. Chairman.
Chairman SHAW. Mr. Collins?
Mr. COLLINS. Thank you, Mr. Chairman.
Mr. Gerry, just one question pertaining to the
demonstration project which will reduce the benefits one dollar
for every two dollars of earnings above a certain threshold.
Many call it a cash cliff. What is the status of the project
itself and the report that is due in early 2004?
Mr. GERRY. Well, Mr. Collins, we are moving ahead with that
effort. In fact I have a meeting tomorrow in which we are
finalizing the write-up of what amounts to a detailed design of
a demonstration project.
What we have decided to do is to pursue this in the form of
State demonstrations. We will be looking for States who want to
pursue this and help do the research that is necessary to see
what the effect of that one for two offset would be on
employment opportunities. We went through an extended period of
time trying to evaluate whether we could do this on a national
sample basis and the size and cost and complexity of that. I
was very involved with looking at the welfare reform
demonstrations and what has gone on there. I became convinced
that we could do this effectively by using State
demonstrations. I think we could learn a lot about the same
questions and we could do it more rapidly. I think Congress
wanted to get some information about what the actual
consequences would be.
I am hoping we will have something formalized by the end of
this year. We may start with some States using existing funding
before we do a formal competition, or we may go ahead and move
to a formal competition, but we want these demonstrations to
begin as soon as we can. The key is to design them so that we
can learn as much as we can about the contribution that the one
for two feature would make. The complexity is that it is very
hard to keep all the other variables constant, because the
economy changes, the employment demands change, etc. So, what
we are trying to figure out is how to measure that factor so we
can report to Congress with some clarity. That is my sense of
what Congress wanted, whether this particular feature will
contribute significantly and positively, and that is the design
question. We are moving ahead as rapidly as we can at this
point.
Mr. COLLINS. The early 2004 date then seems to be kind of
unreasonable to reach based on 2002 for design concept and
implementation and very little time for actual result.
Mr. GERRY. I think it is going to be difficult to have as
much information as we would like, and I suspect that Congress
wanted by that date. We will have some information, but
probably it will be another 4 to 6 months before we have the
kind of data that I would like. I do think it has been a very
difficult process that we have gone through, but necessary to
look at the design questions. We asked a lot of people. We met
with the Ticket to Work Advisory Panel (Panel), and we
discussed this at some length. We will have more of those
discussions before the final design, but I think the key thing
is that the Commissioner wants to move ahead and has decided to
move on this, on a State demonstration approach. Having made
that decision, I am confident that we will move ahead quickly.
Mr. COLLINS. Very good. Thank you, Mr. Gerry.
Chairman SHAW. If that cliff remains a problem, I have made
some inquiries into that, and it is a question of tremendous
expenses do away with it, but that is something that we should
look at, because it in itself creates a barrier for a lot of
people.
I would like to just go on one further area, but it
involves testimony of the third panel, Ms. Prokop and Mr.
Decker, who will be part of that next panel, raised some
questions that I would like to explore with you, because I will
not have another chance at you after they finish.
First, that most State Vocational Rehabilitation Agencies
are opting to be paid under traditional cost reimbursement
method, which cases are closed after 9 months of work as
opposed to 60 months investment in the client that is required
by private providers.
Second, private providers perceive that if they sign up to
be an employer network, their current relationship with their
State Vocational Rehabilitation Agency may be jeopardized.
Third, there have been reports that some current vocational
rehabilitation clients were threatened with termination from
vocational rehabilitation if they did not assign their ticket
to the Vocational Rehabilitation Agency, or worse, were not
informed that they could be better served by taking their
ticket to elsewhere versus staying on a waiting list at the
Vocational Rehabilitation Agency.
This is most disappointing, and it is completely opposed to
our goal of the Ticket to Work Program. Have you heard an of
these allegations yourself? If so, are they true? What are we
doing to address it?
Mr. GERRY. Yes, Mr. Chairman, I have heard them. The first
item you mention is really a choice that was provided under the
statute, that is, the question of which payment system the VR
Agencies would use. We have seen some States shifting to the
new payment methodologies. So, I would say that although it is
true that most are using the old payment system, many are
shifting, but that Congress permitted them to do that, so it is
not something that we have been pursuing, per se.
We are required by the Act to look at the payment methods
that we use. If we were to conclude that the payment
methodologies that were created for one reason or another were
so unattractive that no one wanted to use them, that would be
something that we would report back. At this point there is no
way we would know that. There are some States that are
shifting. So, as far as the first point, I don't think that
raises any particular concerns, that is, that they are using
the original payment methodology.
The other two points you made I have heard about. Let me
take them separately for a minute. There are anecdotal accounts
that there has been pressure put on some providers to enter
into agreements with Vocational Rehabilitation Agencies, who
also happen to provide funding to them under the Rehabilitation
Act, so even though we are talking about the Ticket to Work,
they have other relationships. That is a concern that I have
raised with the Education Department, along with the third
point you mention, which is this question of whether or not
claimants are being told that they must use a ticket. Although
I am not an expert on the Rehabilitation Act in any sense, I
have talked to the Education Department about their view of
whether or not it would be permissible to make someone use up a
one-time ticket who was otherwise entitled to services under
the Rehabilitation Act. We are talking at some length. I have
also talked with the U.S. Department of Justice about both of
these issues to be sure that we don't have these kinds of
problems. Now, I have no hard evidence of any particular State
where this has occurred, but I suspect I have heard many of the
same reports that you have, and we take them seriously, and we
are pursuing them.
Chairman SHAW. The testimony I have referred to will of
course be made available to you to follow up on it any way you
can, and any further expansion that you can give us, please
keep us advised.
Mr. GERRY. As soon as I learn anything about it, I would be
happy to provide it.
Chairman SHAW. Thank you for your testimony. I appreciate
you being with us here this morning.
Chairman SHAW. Our second witness is Sarah Wiggins
Mitchell, who is the Chair of the Ticket to Work and Work
Incentive Advisory Panel. Ms. Mitchell, we have your full
testimony, which of course will be made a part of the record,
and you may proceed as you see fit, and welcome back to this
Subcommittee.
STATEMENT OF SARAH WIGGINS MITCHELL, CHAIR, TICKET TO WORK AND
WORK INCENTIVES ADVISORY PANEL, SOCIAL SECURITY ADMINISTRATION
Ms. MITCHELL. Thank you. Thank you very much. Now I should
say good afternoon, Mr. Chairman, and Members of the
Subcommittee.
Chairman SHAW. Well, I think it is morning where you are
from.
Ms. MITCHELL. On behalf of the Ticket to Work and Work
Incentives Advisory Panel, I would like to thank you for this
opportunity to speak with you today. We are very appreciative
of the high level of interest this Subcommittee has shown
regarding the implementation of the Ticket to Work Program. We
also would like to recognize the tremendous amount of support
you demonstrate for not only this important law, but also for
the well-being of people with disabilities in general.
When you passed the Ticket to Work Program, you recognized
that there are many people with disabilities currently
receiving benefits to work. You also recognized that certain
policies and procedures acted as disincentives and prevented
people from attempting to work. Further, you also saw that both
within SSA and in the Rehabilitation and Employment Support
arena in general, that customer service supports were not
available to assist with the transition off benefits, and you
recognized also that with the proper supports people would want
to attempt to go to work. Indeed, the early implementation of
the programs authorized by the Ticket legislation is certainly
proving your vision to be true.
Although the Ticket program got off to a later start than
anticipated in the statute, SSA has now mailed out over 2
million tickets, as you noted, to Supplemental Security Income
(SSI) and Social Security Disability Insurance (SSDI)
beneficiaries in 13 States. The response from beneficiaries has
been unexpected. Although ticket distribution did not begin
until February of this year, as you noted, Mr. Chairman, over
7,000 beneficiaries have signed up with Employment Networks or
ENs. I am sure as you are going to hear later, there are now--
at least the last data that we received--438 ENs available to
the service ticket holders.
At our last Panel meeting in August we focused on ENs and
we heard that the response from beneficiaries has been greater
than expected. As one director put it, quote, ``If I had to
express one word that represents the Ticket program in South
Florida, it would have to be ``surprise.'' When the ticket was
first mailed out last February, it was my understanding few of
the Florida beneficiaries would want to work. I have received
over 500 telephone calls from beneficiaries inquiring into the
Ticket program and asking how they may participate.'' Now,
although this was the experience of a particular EN, we heard a
very similar response from all the other ENs that participated
in our quarterly meeting.
People with disabilities also obviously needed somewhere to
go for information and advocacy related to SSA work incentives
and how returning to work would affect their benefits. The
programs established by the Ticket legislation are clearly
helping to meet the needs of beneficiaries for information.
Almost 31,000 beneficiaries have sought information and
assistance from the Benefits Planning Assistance and Outreach
Program, and over 17,000 of those individuals were not
currently employed and were looking to work.
A service provider who visited a benefit planner said,
``The benefit specialist was able to present the information
clearly and in simple terms. For the first time I really
understood how SSI and SSDI work.'' A beneficiary commented to
a benefits planner, ``You were enormously helpful, not to
mention knowledgeable. I have a great challenge in front of me
and you have given me a lot of good information. We shall see
what lies ahead.''
Then there are the protection and advocacy programs, which
have also proven to be enormously helpful to people with
disabilities. At the end of last year more than 10,000 people
have been served by the protection and advocacy programs across
the country. Obviously, advocacy was another service needed by
the beneficiaries of Social Security disability programs.
A significant barrier however to employment for people with
disabilities has always been access to health care. As Deputy
Commissioner Gerry noted in his testimony, approximately 52,000
people have benefited from the extension of Medicare benefits.
In addition, 23 States now have operational Medicaid buy-in
programs enacted the authority created by both the Balanced
Budget Act and the Ticket legislation. An additional 10 States
have passed legislation to establish a buy-in program, but they
are not up and running yet. The best news is that more than
16,500 people with disabilities are working in these 23 States
and participating in the Medicaid buy-in program.
The programs authorized by the Ticket legislation are off
to a good start and are beginning to meet the customer needs of
SSA beneficiaries that have long been neglected. However, the
Panel has serious concerns about whether SSA is devoting
sufficient resources to these programs to allow them a chance
to fulfill their potential. In addition, the Panel is concerned
that SSA will not build the infrastructure and capacity needed
to support the programs as they grow.
To begin with, we believe the resources allocated to public
education, training and marketing of the Ticket program are
insufficient to support the programs through this critical
startup period. The Ticket program represents a dramatic change
in the role of SSA and its relationship to its customers with
disabilities and rehabilitation providers. No longer will SSA
only process claims and disburse checks. It will also offer
employment support and direct help for beneficiaries who return
to work. Based on public comment, the Panel believes that many
beneficiaries who receive a ticket do not know what it is, what
to do with it, or why it has been sent to them. The Panel has
heard at public meetings from ENs, White House staff and senior
SSA executives that a campaign to market the ticket to
beneficiaries, providers and employers is crucial to the
success of this program. As far as the Panel can determine, no
resources have been allocated to marketing the Ticket program
except to recruit new ENs.
Not only must beneficiaries, employers, providers and all
other relevant stakeholders know about the Ticket program, the
Panel believes that for the program to succeed, they must also
be well educated about it. The Benefits Planning Assistance and
Outreach grantees are doing an excellent job, but they simply
do not have the resources to educate everyone about the
program. As far as the Panel knows, SSA has not developed a
campaign to educate the public about the Ticket to Work
Program.
The training budget allocated to these programs by SSA is
also problematic. SSA is spending less than $4 million on
training. For a new program relying on both beneficiaries and
providers to make informed choices and relying on many Federal,
State and private strategic partners to coordinate their
efforts, an intensive and comprehensive training regime is
crucial. The Panel believes the amount of resources dedicated
to training is terribly inadequate. In comparison to the $4
million just noted for the Ticket program, one program, the
Federal and State vocational rehabilitation program spends
about $40 million per year on training activities.
The Panel also thinks that SSA may not be creating the
service capacity both inside the agency and out to adequately
support the programs and work incentive improvements of the
Ticket legislation. One major concern involves the requirement
of the Ticket legislation for SSA to establish the ESR program,
which you were questioning Deputy Commissioner Gerry about. In
order to meet the requirement, SSA established the pilot
program, which was noted previously to test the utility of
full-time permanent SSA staff to fill that ESR role. The pilot
actually involved 36 ESRs and the preliminary findings on the
pilot program were extremely positive. The Panel heard positive
feedback from SSA beneficiaries who interacted with ESRs. In
addition, SSA's only evaluation report made positive
recommendation regarding the ESR position.
The future of the ESR program, however, is unclear. I did
hear what Deputy Commissioner Gerry was saying, that they are
evaluating this as to how they want to go forward with it, but
to date, the Panel has not been advised as to how they will be
proceeding. It is not clear whether they will expand the pilot
to full coverage, hire outside contractors, or use claims
representatives as part-time work incentive specialists. The
Panel strongly believes that the establishment of work
incentive specialists who are full-time permanent employees of
SSA, as in the ESR pilot, is essential. The Panel has expressed
this concern to Commissioner Barnhart, and we are waiting for a
response. We do not know whether SSA intends to continue the
ESR program.
The second capacity issue involves ENs. As we said, there
are now over 400 ENs to serve beneficiaries around the country.
While this represents a good start, and MAXIMUS should be
commended for the work they have done so far, a lot remains to
be done. The Panel is concerned there are not enough providers
with a diversity in both geographic location and specialization
to meet the needs of beneficiaries. The geographic location of
the ENs is a concern. At our Panel meeting last month we heard
from an EN, ``There are 58 Employment Networks in Illinois.''
Chairman SHAW. Could I interrupt? How much longer do you
have?
Ms. MITCHELL. Oh, I am just about finished. This is it.
Chairman SHAW. Thank you.
Ms. MITCHELL. ``There are surprisingly few, maybe eight in
the metropolitan area of Chicago where we provide our service.
The other side of that coin is that the majority of
beneficiaries of course live in the metropolitan area of
Chicago.'' If ENs are not located where the beneficiaries are,
then beneficiaries will not be able to participate in the
program.
I would just like to finally close by indicating that the
Panel was concerned that SSA has not developed the capacity to
handle increased number of beneficiaries returning to work
without exacerbating the overpayment problem. As you know, in
fiscal year 1999 SSI beneficiaries owed SSA more than $3.8
billion in overpayments. For many beneficiaries returning to
work this of course remains a barrier for them.
Now, the Panel is aware that SSA has finite administrative
funds and the Agency must meet all of its needs with the
dollars appropriated by Congress. We are also mindful of the
increased demand for customer service that will be placed on
the Agency as baby boomers begin to retire. We know that they
must establish priorities and the Ticket legislation must
compete with these other programs. However, if the resource and
capacity issues are not addressed, the Ticket program may in
fact fail, not because people with disabilities don't want to
work and not because the program could not be effective, but
rather because it was never given the chance to succeed.
I just would like to, in closing, acknowledge and thank the
Agency. The Agency has been most cooperative with the Panel,
has been very accessible. They have solicited our input, and
Deputy Commissioner Gerry and his staff, I would particularly
like to acknowledge and thank. Thank you for your time and
attention.
[The prepared statement of Ms. Mitchell follows:]
Statement of Sarah Wiggins Mitchell, Chair, Ticket to Work and Work
Incentives Advisory Panel, Social Security Administration
Good morning Mr. Chairman, members of the Committee. On behalf of
the Ticket to Work and Work Incentives Advisory Panel, we would like to
thank you for this opportunity to speak to you today. The Panel is very
appreciative of the high level of interest this committee shows
regarding implementation of the Ticket to Work and Work Incentives
Improvement Act. The Panel would also like to take the time to
recognize the tremendous amount of support this committee demonstrates
for not only this important law, but for the well being of people with
disabilities in general.
When you passed the Ticket to Work and Work Incentives Improvement
Act, you recognized the desire of many people with disabilities
currently receiving benefits to work. You also recognized that certain
policies and procedures acted as disincentives and prevented people
from attempting to work. Further, you saw both within SSA, and in the
rehabilitation and employment support arena in general, that customer
service supports were not available to assist with the transition off
benefits. It was also clear to you that with the proper supports,
people would want to attempt to go to work. Indeed, the early
implementation of the programs authorized by the Ticket legislation is
certainly proving your vision to be true.
Although the Ticket program got off to a later start than
anticipated in the statute, SSA has now mailed out over two million
tickets to SSI and SSDI beneficiaries in 13 states. The response from
beneficiaries has been unexpected. Although ticket distribution did not
begin until February of this year, over 7000 beneficiaries have signed
up with Employment Networks, or ENs, for services.
There are now 428 ENs available to serve ticket holders. The Panel
focused last month's quarterly meeting on ENs. We heard that the
response from beneficiaries has been greater than expected. As one
director put it, ``If I had to express one word that represents the
Ticket program in South Florida, it would have to be ``surprise''. When
the Tickets were first mailed out last February, it was my
understanding few of the Florida beneficiaries would want to work. I
have received over 500 telephone calls from beneficiaries inquiring
into the Ticket program and asking how they may participate.'' Although
this was the experience of a particular EN, we heard a very similar
response from all the other ENs that participated in the Panel's
quarterly meeting.
People with disabilities also obviously needed somewhere to go for
information and advocacy on SSA work incentives and how returning to
work will affect their benefits. The programs established by the Ticket
legislation are clearly helping to meet the need of beneficiaries for
information. Almost thirty-one thousand beneficiaries have sought
information and assistance from the Benefits Planning Assistance and
Outreach program. Thirty-one thousand--a significant number of people.
And over 17 thousand of those people were not currently employed and
were looking to work. A service provider who visited a benefit planner
said, ``The benefits specialist was able to present the information
clearly and in simple terms. For the first time I really understood how
SSI and SSDI works.'' A beneficiary commented to a benefits planner,
``You were enormously helpful, not to mention knowledgeable. . . . I
have a great challenge in front of me and you have given me a lot of
good information. We shall see what lies ahead.''
The Protection and Advocacy Program has also proved enormously
helpful to people with disabilities. At the end of last year, more than
ten thousand people had been served by the P&A programs across the
country Obviously, advocacy was another service needed by beneficiaries
of Social Security disability programs.
A significant barrier to employment for people with disabilities
has always been access to health care. Twenty-three states now have
operational Medicaid buy-ins, enacted under the authority created by
both the Balanced Budget Act and the Ticket legislation. An additional
ten states have passed legislation to establish a buy-in but they are
not up and running yet. The best news is that more than sixteen
thousand five hundred people with disabilities are working in these
twenty three states and participating in the Medicaid buy-in.
The programs authorized by the Ticket legislation are off to a good
start and are beginning to meet the customer service needs of SSA
beneficiaries that have long been neglected. However, the Panel has
serious concerns about whether SSA is devoting sufficient resources to
these programs to allow them the chance to fulfill their potential. In
addition, the Panel is concerned that SSA will not build the
infrastructure and capacity needed to support the programs as they
grow.
To begin with, we believe the resources allocated to public
education, training and marketing of the Ticket to Work Program are
insufficient to support the programs through this critical start up
period. The Ticket program represents a dramatic change in the role of
SSA and its relationship to its customers with disabilities and
rehabilitation providers. No longer will SSA only process claims and
disburse checks. It will also offer employment support and direct help
for beneficiaries who return to work. Based on public comment, the
Panel believes many beneficiaries who receive a ticket do not know what
it is, what to do with it or why it has been sent to them. The Panel
has heard at public meetings from ENs, White House staff and senior SSA
executives that a campaign to market the ticket to beneficiaries,
providers and employers is crucial to the success of this program. As
far as the Panel can determine, no resources have been allocated to
marketing the Ticket Program, except to recruit new ENs.
Not only must beneficiaries, employers, providers and all other
relevant stakeholders know about the Ticket to Work Program, the Panel
believes that for the program to succeed they must be well educated
about it. The Benefits Planning Assistance and Outreach grantees are
doing an excellent job, but they simply do not have the resources to
educate everyone about the program. As far as the Panel knows, SSA has
not developed a campaign to educate the public about the Ticket to Work
Program.
The training budget allocated to these programs by SSA is also
problematic. SSA is spending less than four million dollars on
training. For a new program relying on both beneficiaries and providers
to make informed choices, and relying on many Federal, state and
private strategic partners to coordinate their efforts, an intensive
and comprehensive training regimen is crucial. The Panel believes the
amount of resources dedicated to training is terribly inadequate. In
comparison, one program, the Federal and State Vocational
Rehabilitation program, spends about forty million dollars per year on
training activities.
The Panel also thinks that SSA may not be creating the service
capacity, both inside the agency and out, to adequately support the
programs and work incentive improvements of the Ticket legislation. One
major concern involves the requirement in the Ticket legislation for
SSA to ``establish a corps of trained, accessible and responsive work
incentives specialists within the Social Security Administration--
(emphasis added)'' In order to meet the requirement, SSA established a
pilot program to test the utility of full time permanent SSA staff to
fill that role called Employment Support Representatives or ESRs. The
pilot involved 36 ESRs. The preliminary findings for the pilot program
were extremely positive. The Panel heard positive feedback from SSA
beneficiaries who interacted with ESRs. In addition, SSA's own
evaluation report made positive recommendations regarding the ESR
position.
The future of the ESR position, however, is unclear. SSA has not to
date told the Panel how it intends to proceed. Will SSA expand the
pilot to full coverage? Hire outside contractors? Will SSA use claims
representatives who are part-time work incentive specialists? The Panel
strongly believes that the establishment of work incentives specialists
who are full-time, permanent employees of SSA, like the ESR pilot, is
essential. The Panel has expressed its concern to Commissioner Barnhart
and we are waiting for a response. We do not know whether SSA intends
to continue the ESR program.
The second capacity issue involves ENs. As we said, there are now
over 400 ENs to serve beneficiaries around the country. While this
represents a good start and Maximus should be commended for the work
they have done so far, a lot remains to be done. The Panel is concerned
there are not enough providers, with a diversity in both geographic
location and specialization, to meet the needs of beneficiaries. The
geographic location of the EN's is a major concern. As one EN told the
Panel at our last meeting, ``There are 58 employment networks in
Illinois . . . surprisingly very few, maybe eight in the metropolitan
area of Chicago where we provide our service. The other side of that
coin is that the majority of beneficiaries, of course, live in the
metropolitan area of Chicago.'' If the ENs are not located where the
beneficiaries are, then beneficiaries will not be able to participate
in the Ticket Program.
The Panel has also been told that not very many of these ENs are
new providers. A primary goal of the Ticket program was to expand the
universe of service providers to allow real choice for people with
disabilities. We think the program has a long way to go to make true
choice a reality. As that same Illinois EN reported to the Panel, ``. .
. Very, very few new players have come in, which I think is not what
the intent was . . . it is the same network of players that has always
been there.''
Finally, the Panel is concerned that SSA has not developed the
capacity to handle increased numbers of beneficiaries returning to work
without exacerbating the overpayment problem. As you know, in fiscal
year 1999, SSI beneficiaries owed SSA more than 3.8 billion dollars in
overpayments (GAO-01-778, Social Security Administration: Status of
Achieving Key Outcomes and Addressing Major Management Challenges, June
2001, p.12). Many beneficiaries who have returned to work in the past,
or unsuccessfully attempted to do so, received overpayments and are
required to repay the benefits. If this issue is not resolved, fear of
being charged with an overpayment could act as a powerful disincentive
to participation in the Ticket Program. A variety of factors may
contribute to overpayments, but having the staff capacity to record and
process earnings reports in a timely manner is essential to any return
to work effort, including the Ticket Program.
The Panel is aware that SSA has finite administrative funds and the
agency must meet all of its needs with the dollars appropriated by
Congress. The Panel is also mindful of the increased demand for
customer service that will be placed on SSA as the baby boomers begin
to retire. We know that SSA must establish priorities and the
activities surrounding implementation of the Ticket legislation must
compete with all the other service needs of the agency. However, if the
resource and capacity issues the Panel has brought to your attention
here are not addressed the Ticket program may in fact fail--not because
people with disabilities don't want to work and not because the program
could not be effective, but rather because it was never given the
chance to truly succeed. Thank you.
______
Panel Members
Mary Katherine (Katie) Beckett, IA Richard V. Burkhauser Ph.D.--Cornell
University, Chair, Dept. of Policy Analysis and Management.
NY
Thomas P Golden, MS--Cornell University, Program on Employment and
Disability. NY
Kristin E. Flaten, INITIATIVES/Lifetrack Resources, Mental Health and
Benefits Advocacy Specialist. MN
Frances Gracechild, MA, Resource for Independent Living, Inc.,
Executive Director. CA
Christine Griffin, Disability Law Center, Executive Director. MA
Jerome Kleckley, MSW, CSW--Eastern Paralyzed Veterans Association,
Director, Hospital Services. NY
Bryon MacDonald--World Institute on Disability, Project and Policy
Development Manager. CA
Sarah Wiggins Mitchell, Chair-- New Jersey Protection and Advocacy,
Inc., President/Executive Director. NJ
Vince Randazzo, The Business Roundtable, Director of Public Policy. VA
Stephen L. Start, S.L. Start & Associates, Inc., President/CEO. WA
Susan Webb, MBA-ABIL Employment Services. AZ
Chairman SHAW. Mr. Collins?
Mr. COLLINS. No questions.
Chairman SHAW. Mr. Matsui?
Mr. MATSUI. Thank you, Mr. Chairman.
Ms. Mitchell, you mentioned--and I am still trying to
figure out these--the ESR, which is obviously you feel that has
been working very well, and the issue I guess is whether it
will be phased out and a lot of the folks are really interested
in this program. I should have probably asked Mr. Gerry that
issue, but could that have something to do with the fact that
SSA has to make a decision in terms of its priorities? You have
the backlog, and we had a lot of hearings on that over the last
couple, 3 years now, and that is a substantial problem to deal
with. Then we have obviously this new program coming up, and we
are trying to deal obviously with that. How would you respond
to that? I do not mean to say you have to make a choice,
because I don't know if that is really the case. How would you
respond to that, because I think that is a dilemma that the
Commissioner is facing and Mr. Gerry is facing, and I am trying
to figure that out. I shouldn't say what is more important,
because both of them are extremely important, but how do you
help us resolve that issue? I have to say more money, but I
don't think we could get into that. I mean I think that is a
very difficult issue.
Ms. MITCHELL. Right. We understand, the Panel understands
the Agency's responsibility to weigh and balance resources and
how they are to be utilized and what-have-you. However, I think
we do believe that this ESR program is such a critical
component of the Ticket program, that however that balancing
goes on, that it perhaps deserves, maybe outweighs some other
programs and issues that might be considered.
We have heard from beneficiaries that some beneficiaries
feel that without this program that there will be fairly high
likelihood that there will be really serious difficulties in
this Ticket program succeeding.
Mr. COLLINS. Without that?
Ms. MITCHELL. Yes, without this position.
Mr. COLLINS. Thank you. Thank you.
Chairman SHAW. Mr. Hayworth?
Mr. HAYWORTH. I have no questions. Just thank you, Ms.
Mitchell, for coming, and thank you, Mr. Chairman.
Chairman SHAW. Thank you very much.
Ms. MITCHELL. Thank you.
Chairman SHAW. We will now go to the final panel, which is
quite large. I will call, according to the order in which you
will be asked to give your testimony.
Susan Prokop, who is Co-Chair, Work Incentives Task Force,
Consortium for Citizens with Disabilities; John Kregel, who is
the Director of the Benefits Assistance Resource Center in
Virginia Commonwealth University in Richmond, Virginia; Mary
Satterfield, who is the Project Director of the MAXIMUS Ticket
to Work in Alexandria, Virginia; Charlene Dwyer, who is
Vocational Rehabilitation Administrator, Wisconsin Department
of Workforce Development in Madison, Wisconsin; Dan O'Brien,
who is the Program Manager of the Ticket to Work and Community
Rehabilitation, Oklahoma Department of Rehabilitation Services,
Oklahoma City, Oklahoma; Susan Webb, who's a Director of ABIL
Employment Services, Avondale, Arizona.
Is that in your district?
Mr. HAYWORTH. These are good friends of mine from the
State, but regrettably not my district. We were hoping
realignment might take care of that, redistricting.
Chairman SHAW. She is accompanied by Amy Gilliland, who is
a Ticket to Work Program Participant in Glendale, Arizona. Am I
getting closer? No?
Mr. HAYWORTH. Still good friends.
[Laughter.]
Chairman SHAW. You know, it is amazing, everyone is a good
friend as November comes closer.
[Laughter.]
Mr. HAYWORTH. Hard to believe, Mr. Chairman, but they have
actually been my friends long before November.
[Laughter.]
Chairman SHAW. David Gadaire, who is the Program Director
of Career Point, Holyoke, Massachusetts; and Curtis Decker, who
is the Executive Director of the National Association of
Protection and Advocacy Systems.
We are going to be called for a vote right around 1 o'clock
we have been advised. If you can summarize as best you can. We
have your whole statement, which of course is being made a part
of the record, and we very much appreciate you taking the time.
We can recess and come back this afternoon, but if you can move
quickly through the testimony, it would be helpful, and maybe
we can include it before we are called away again to vote and
delay your departure. Ms. Prokop.
STATEMENT OF SUSAN PROKOP, CO-CHAIR, WORK INCENTIVES TASK
FORCE, CONSORTIUM FOR CITIZENS WITH DISABILITIES
Ms. PROKOP. Thank you, Mr. Chairman, Members of the
Subcommittee. Good afternoon. My name is Susan Prokop, and I am
speaking to you today as Co-Chair of the Consortium for
Citizens with Disabilities Work Incentives Task Force.
First of all, thank you for your continued interest in the
Ticket to Work and Work Incentives Improvement Act. At the
outset, I want to draw your attention to the several positive
developments surrounding Ticket and TTWWIIA implementation that
we note in our written statement. The developments are
encouraging, and I just wanted to point that out. The remainder
of my oral remarks will focus on some other issues that we do
feel need to be addressed in order for this law to be fully
successful.
As has already been mentioned, there is a concern in our
Task Force about the marketing of TTWWIIA and Ticket to Work,
despite the fact that Social Security, MAXIMUS, its marketing
subcontractor, NISH, the Protection and Advocacy for
Beneficiaries of Social Security (PABSS) program and Benefits
Planning, Assistance and Outreach (BPAOs) have made concerted
efforts to promote this program. The extent to which
beneficiaries, at least from what our Members have ascertained,
seem to be aware of TTWWIIA is not as strong as we would
prefer. That is why we would like to see Social Security enlist
more of its counterparts in other agencies involved with
workforce development in promoting TTWWIIA on their own
websites, in their own communications with the public, using
the regional Disabled Business Technical Advisory Commission,
Job Accommodation Network, the Centers for Independent Living,
using the PABSS program more, and even perhaps pursing
partnerships with groups like the Ad Council to put out public
service announcements about TTWWIIA and the Ticket program.
Our Task Force continues to believe that the payment system
for the Ticket to Work Program needs to be improved if it is to
serve all beneficiaries. Beneficiaries inquiring about the
Ticket, being referred to Employment Networks, getting placed
in jobs, seem to be predominantly those on Social Security
Disability Insurance. For some ENs, it can take almost twice as
long to recoup the costs of an SSI beneficiary than for an SSDI
recipient. Impediments to serving those on SSI, often those
with the most severe disabilities, include the longer time it
takes for beneficiaries to reach zero cash benefits, the point
at which an EN gets paid. In addition, an EN gets paid less to
serve clients on SSI than clients on disability insurance (DI)
because the SSI benefits are lower for those on DI.
The zero cash benefits requirement also discourages ENs
from serving beneficiaries who may only be able to reduce their
dependence on benefits by working part time, and those with
vision impairments who must reach the higher blind Substantial
Gainful Activity (SGA) level. Clearly the payment system needs
further improvements, although we do appreciate Social
Security's addition of some more milestones and increase in the
payments. In order to ensure a wide range of Employment
Networks are there to serve the widest range of beneficiaries,
we would like to see further exploration of improvements to the
payment system.
We also feel that Social Security still needs to clarify
its policy regarding disabled adult children or DACs, as they
are called. Disabled adult children, who depend on the higher
benefits afforded them through their parents' earning records,
may lose their DAC status if they go to work, earn above SGA,
and then have to return to the disability rolls. SSDI benefits,
based on their own work record, are likely to be substantially
less. If Social Security won't issue a policy that clearly
supports providing full access for disabled adult children to
all of the provisions of TTWWIIA, including reentry to the
program in DAC status, Congress should resolve this through an
amendment to the law.
I will just conclude with a couple of other issues which,
although they rest with other Committees, are important to the
success of TTWWIIA. The first concern is the troubling signs
that State budget deficits will discourage participation by
additional States in the Medicaid buy-in, or even prompt some
States to drop out. You noted, Mr. Chairman, that Florida has
backed out of or plans to repeal its Medicaid option, and that
was rather distressing.
As we all know, Medicaid covers important benefits not
covered under Medicare and we are concerned that the fiscal
difficulties facing some States may foreclose opportunities
through TTWWIIA for millions of Social Security disability
recipients. State budget woes also appear to be dampening
interest in section 204 of the TTWWIIA, which authorizes
demonstration projects for Medicaid coverage of workers with
potentially severe disabilities that, without medical care and
treatment, may force them onto the disability rolls. Only 4
States have opted for this 204 program, and less than half the
appropriated funds for section 204 will be used under current
projections. Existing deadlines for evaluation of the program
should be extended, or 204 made a permanent option for States
to take advantage of in order to give it time to demonstrate
its feasibility.
We also have ongoing concerns about the relationship of
State Vocational Rehabilitation Agencies in the Ticket program.
I appreciate, Mr. Chairman, your question to Mr. Gerry about
these concerns over VRs' use of the cost reimbursement method,
the relationship of private providers to VR and VRs working
with clients of VR who also get tickets. We are beginning to
think it might be worthwhile to look at the relative advantages
and disadvantages experienced under the Ticket program by
private providers versus State Vocational Rehabilitation
Agencies. We hope that you might add your voice to our own
concerns in pressing Social Security and the Education
Department to really clarify what we view as a distressing
situation concerning the relationship of vocational
rehabilitation clients in the Ticket program and Vocational
Rehabilitation Agencies.
Mr. Chairman, Members of the Subcommittee, our Task Force
commends you for your continued interest in promoting economic
self-sufficiency and opportunity for people with disabilities,
and I look forward to answering any questions. Thank you.
[The prepared statement of Ms. Prokop follows:]
Statement of Susan Prokop, Co-Chair, Work Incentives Task Force,
Consortium for Citizens with Disabilities
Mr. Chairman, members of the Committee, my name is Susan Prokop and
I am Associate Advocacy Director for Paralyzed Veterans of America.
Today, I am speaking to you in my role as cochair of the Consortium for
Citizens with Disabilities Work Incentives Task Force. As you know, CCD
is a coalition of over 100 national disability advocacy and service
organizations based in Washington. Most of CCD's work is done through
task forces. The Work Incentives Task Force was created to monitor the
implementation of the Ticket to Work and Work Incentives Improvement
Act (TTWWIIA) which passed in 1999.
On behalf of the undersigned members of the Work Incentives Task
Force, I want to thank you for holding this oversight hearing on
TTWWIIA's progress. You and your colleagues on this committee were
vital to the passage of the law and we deeply appreciate your continued
interest in its success.
Even as we share with you our thoughts on TTWWIIA, we are mindful
of the fact that it is still early in implementation and that a fuller
picture will not emerge until the Ticket program is operational in all
states and a critical mass of beneficiaries has entered the workforce
and left the benefit rolls. Still, there are a number of observations
that can be made about this program based on our members' experiences
and reports thus far.
At the outset, let me commend the performance of the Ticket Program
Manager MAXIMUS. Recently, several members of our task force toured the
MAXIMUS offices in Alexandria, Virginia. We were shown their extensive
call management systems, how they track recruitment of employment
networks and the methods they use to collect data for program
evaluation purposes while also protecting beneficiary privacy. We came
away impressed with the degree of organization and service provided by
their operation.
In addition, we applaud the work being done by the Protection and
Advocacy for Beneficiaries of Social Security Program (PABSS) that was
authorized by TTWWIIA. As you know, PABSS mission was intended to
provide information and guidance on employment and vocational services
to beneficiaries and to provide advocacy services to help beneficiaries
secure, maintain or regain gainful employment. Despite a late startup
owing to difficulties with SSA, the PABSS program provided in its first
year education and training, information and referral and legal-based
advocacy to over 10,000 individuals.
It has also been heartening to hear reports from the Centers for
Medicare and Medicaid Services about ongoing state plan amendments
being submitted and approved for adoption of Medicaid buy-ins--either
under TTWWIIA or the Balanced Budget Act of 1997 (BBA) and from the
Social Security Administration (SSA) and from MAXIMUS as to the numbers
of beneficiaries assigning Tickets. There is clearly interest among
many states and motivation among many beneficiaries to pursue the
possibilities that TTWWIIA offers. Still, within these positive
developments, there remain several issues that, if left unaddressed,
will impede the fulfillment of TTWWIIA's promise. It is to those
concerns that I will devote the rest of our statement.
Marketing
The saying ``if you build it, they will come'' does not necessarily
apply to TTWWIIA. It is a complicated law. It is not yet in place
throughout the nation. There is a lingering mistrust among
beneficiaries of SSA's intentions. In addition, having gone through the
arduous application process and waited out their first continuing
disability review, many beneficiaries may find the arrival of their
Ticket--inviting them back into the workforce--more than a little
confusing.
Many of our organizations have asked their chapters if they were
getting inquiries about the Ticket to Work program or other elements of
the Work Incentives Improvement Act [TTWWIIA]. Unfortunately, even in
states where the roll out is occurring, the extent to which Social
Security disability beneficiaries seem to be aware of TTWWIIA or asking
about return to work supports and services is not as strong as we would
prefer.
We believe that widespread, repeated marketing of Ticket to Work
and the other elements of TTWWIIA is essential if this law is to have
the impact it was intended to have. We certainly recognize that SSA and
MAXIMUS, along with its marketing subcontractor, NISH, have been making
concerted efforts to publicize TTWWIIA and get the word out about the
Ticket program. Benefits planning organizations (BPAOs) and PABSS
programs have been actively involved in roll out states providing
information and guidance to beneficiaries on the use of Tickets and the
interaction of various work incentives. Those efforts have been well
documented. We also know that limited resources constrain the type of
mass communications that might be undertaken to reach every affected
beneficiary, potential provider and employer.
Nevertheless, we would urge that SSA aggressively explore cost-
effective ways to heighten awareness of TTWWIIA. The Social Security
Administration is already part of an interdepartmental network of
numerous federal agencies involved with workforce development. SSA
should press its counterparts at the Departments of Labor, Education,
Health and Human Services, Commerce and other agencies to offer
information about TTWWIIA and the Ticket on their websites and in their
communications with the public. TTWWIIA was developed to be a multi-
dimensional, cross-jurisdictional program and SSA should not be solely
responsible for getting the word out about this law.
Other avenues to disseminate information about TTWWIIA could
include the regional Disability Business Technical Advisory Committees
or DBTACs, the Job Accommodation Network and Centers for Independent
Living. Enhanced support for PABSS could draw more attention to TTWWIIA
through the nationwide network of protection and advocacy cross-
disability services and programs. SSA might also approach private
concerns like the Ad Council to produce public service announcements in
areas where the Ticket is to be issued. Undoubtedly, there are
additional, relatively economical ways in which to trumpet the return-
to-work program and we hope SSA will devote more attention to utilizing
them.
Implications of the Milestone/Outcome Payment System
At the most recent meeting of the Work Incentives Advisory Panel
created by TTWWIIA, presentations were made by representatives from a
variety of employment networks. Several reports served to reinforce our
belief that the payment system for the Ticket to Work Program still
needs to be improved if it is to assist those with the most significant
disabilities who may need extensive long term supports and services.
For example, Susan Webb, the director of ABIL Employment Services,
noted that only 2 out of 22 of their Ticket clients who are currently
employed are on SSI. Stephen Zwirm with Work Search of Coconut Creek
Florida stated that the overwhelming majority of individuals with
Tickets approaching his firm are those on SSDI. And the Massachusetts
Projects with Industry indicated that three-quarters of Ticket-holders
referred to them are SSDI beneficiaries. An analysis by Steve Start,
CEO of SL Start and Associates, of the payment system for small ENs
concluded that it could be profitable--particularly for SSDI clients.
Start also determined that SSI clients could be served under his model
but that they were ``more risky'' and the return on investment for the
EN takes longer. A small EN would break even on most SSDI clients after
2.4 years versus 5.5 years on a client on SSI. Start suggested it is
better for ENs serving SSI beneficiaries to partner with other entities
to mitigate the front-end cash requirements needed until SSA starts to
pay.
Some of the impediments to serving those on SSI or those with the
most severe disabilities derive from the fact that it takes longer for
these beneficiaries to reach ``zero cash benefits'', the point at which
an EN gets paid. In addition, payments to ENs for serving clients on
SSI are lower because SSI benefits are lower than those for clients on
SSDI. The requirement that a beneficiary go completely off cash
benefits also works against those who may only be able to work part-
time and those with vision impairments who must reach the higher blind
substantial gainful activity (SGA) level.
As we have said in previous testimony, we appreciate the fact that
SSA increased the number and amount of milestone payments. However, we
continue to believe that the payments are inadequate to ensure a wide-
range of employment networks--large and small providers, community
rehabilitation programs, businesses and others--are available to serve
Ticket-holders with the most significant barriers to employment, those
who need intensive employment supports and those who want to work but
may remain on benefits for an extended period of time.
Employment Network Training
Task force members representing providers report a very strong
desire among their members for more in-depth training beyond the half
or whole-day training sessions offered by MAXIMUS and SSA. While those
training programs offer basic information about the Ticket program and
TTWWIIA, providers want practical information about how to make the
program work for them. Providers are also finding a need for benefits
training as they are often the first point of contact for beneficiaries
and their families. As a result, providers are often in a position to
convince beneficiaries that going to work and off benefits and becoming
independent is not only possible but beneficial. We strongly recommend
that ENs be given access to on-line benefits training to help them
fulfill these additional responsibilities.
Disabled Adult Children
Policy clarifications are necessary for people receiving ``disabled
adult child'' (DAC) benefits if the Ticket program is to be successful
for these individuals. For a disabled adult child, leaving the Title II
program as a result of earning above the SGA level after the extended
period of eligibility (EPE) and a re-entry grace period have expired
could mean the loss of ``disabled adult child'' status for life. Our
experience under current law indicates that many beneficiaries and
their families do not understand that the benefits the parent has
earned for the disabled adult child (severely disabled since childhood)
could be permanently lost with no re-entry to DAC status in Title II
after a certain period of time with earnings over SGA. This must be
addressed. Otherwise, the purpose of the Ticket to Work and Work
Incentives Improvement Act will be thwarted for those who qualify for
benefits as disabled adult children. TTWWIIA clearly contemplated the
ability of disabled adult children to move on and off the program to
the same extent that other people with disabilities will be allowed to
do so. TTWWIIA clearly cites the statutory language for disabled adult
children throughout its provisions. We urge that policies clearly
support the goal of providing disabled adult children full access to
all of the provisions of the Ticket to Work and Work Incentives
Improvement Act, including re-entry to the program with disabled adult
child status. If SSA will not act, we urge that Congress resolve it
through an amendment to the statute.
Employment Support Representatives
Section 121 of TWWIIA calls for the establishment of a corps of
trained, accessible, and responsive work incentives specialists within
SSA who will ``specialize'' in disability work incentives ``for the
purpose of disseminating accurate information with respect to inquiries
and issues relating to work incentives to disabled beneficiaries'',
applicants, and benefits planning, assistance and outreach
organizations. We had expected that, in responding to this charge, SSA
would provide ``dedicated'' staff to focus on work incentives and
employment supports, who have undergone extensive and ongoing training,
and are responsible for working directly with beneficiaries and
community agencies.
Indeed, the Social Security Administration seemed to be headed in
that direction with the initiation of the Employment Support
Representative (ESR) pilot program. Although the 32 ESR positions
established under this pilot project did not offer the nationwide
coverage that the law anticipated, it was an important first step. Last
November, an independent evaluation of the ESR program favorably
reported on its success and recommended adoption of an ESR field-office
based model with an increase in the number of ESR positions to cover
the entire country.
This past May, SSA outlined a proposal that would end the ESR pilot
and transfer the position responsibilities to existing staff. Citing
budget and staffing limitations, SSA is proposing to create a Work
Incentives Specialist (WIS) Corps. This corps will consist of
designated SSA staff working part-time on disability work issues and
supporting SSA field employees with their regular workloads. SSA states
that this WIS Corps will receive training in its disability employment
support programs and will have the opportunity to develop further
expertise in this area. The fact remains that these ``specialists''
will not be working solely on disability work-issues. As for the
requirement for ``outreach'' in TWWIIA, those duties to a great extent
are to be transferred to SSA's Public Affairs Specialists with some
support from the WIS Corps.
However the Social Security Administration chooses to structure its
employment support staff, we believe it is critical that beneficiaries
are assured of accurate and timely information about SSA's work
incentives and employment support programs. Failure by SSA to supply
this assistance adequately may also adversely affect beneficiaries'
access to case assistance and other types of benefits such as Medicaid
and Medicare. As we noted earlier, while TWWIIA created new and
important ``work incentive'' programs, it did not simplify the process.
Given this situation, we strongly recommend that SSA be given the
resources to continue providing the level of services to beneficiaries
intended by TTWWIIA and urge this committee to exercise careful
oversight on this important aspect of the law.
Demonstrations and Studies
For many of the reasons outlined above, our task force continues to
be very interested in the Adequacy of Incentives study being planned by
SSA. It is critical that SSA knows what beneficiaries are being left
out of the Ticket program, which providers are being discouraged from
participating as ENs and what can be done to overcome the barriers they
are facing. We appear to be getting preliminary information based on
the experiences of early Ticket-holders and ENs. We trust that MAXIMUS
and SSA are collecting this data for use by the contractor doing the
Adequacy study. We urge this committee to be vigilant in pressing the
Social Security Administration for a thorough evaluation of the issues
surrounding the ability of TTWWIIA to assist those with the most severe
disabilities.
Our task force is very concerned about SSA's lack of progress in
moving forward with the ``1 for 2'' demonstration. Beneficiaries who
fear the adverse consequences of returning to work regularly cite the
``cash cliff'' that SSDI beneficiaries face when they reach SGA
(currently $780 a month or $1300 a month for those with vision
impairments). This demonstration will test the feasibility of reducing
Title II benefits as earned income rises. We understand that the
demonstration may be limited in scope to a handful of states. While
would have preferred a nationwide study, we believe it is more
important for SSA to move on with this demonstration so that we can
begin to answer the many questions surrounding the merits of that
policy.
Medicaid
Recognizing that your colleagues at the Energy and Commerce
Committee have jurisdiction over Title 19, we nevertheless wanted to
share with you our observations about this important element of
TTWWIIA.
According to CMS figures, 22 states, slightly less than half, are
involved in some fashion with a Medicaid buy-in--either through the BBA
or TTWWIIA. That would seem to be cause for some celebration yet the
enrollment figures in some states are frustratingly low--40 in Florida,
75 in Mississippi, 80 in Nebraska. And there are troubling signs that
increasing state budget deficits will discourage participation by
additional states in this important health care work incentive program.
Again, according to a report from CMS, Florida has indicated that it
plans to repeal its Medicaid buy-in option. Just last week, a story in
the Charleston (WV) Daily Mail on the adverse impact of the state
budget on implementation of a work incentives buy-in quoted a
legislator saying, ``If we didn't have that $187 million hole, we could
make it go.'' Assuring beneficiaries that they would retain access to
health insurance coverage was a key tenet of TTWWIIA. Extended Medicare
provided by the law is a critical element of that assurance. However,
the Medicaid buy-ins were meant to supply important additional benefits
not found in Medicare and considered necessary for many disability
beneficiaries to make that leap into the workforce. We are concerned
that fiscal difficulties in some states may foreclose opportunities
through TTWWIIA for millions of Social Security recipients with
disabilities.
Section 204 of TWWIIA authorizes demonstration projects for
coverage under Medicaid of workers with potentially severe disabilities
that, without medical treatment, could place them on SSDI or SSI
disability rolls. A total of $250 million was made available to the
states, at the regular Medicaid matching rate, to provide Medicaid to
such ``pre-disabled'' workers who meet state-set and HHS-approved
medical criteria and are working at least 40 hours monthly (or meet
comparable HHS-approved rules).
However, apparently less than half the appropriated funds will be
drawn down under current projections. This is because--again--
recession-related state funding shortages have prevented all but four
states from taking this option--and even they are only now completing
implementation. (Rhode Island covers individuals with early-stage
multiple sclerosis; Texas, people with early-stage bipolar illness and
schizophrenia; and the District of Columbia and Mississippi, people who
are early-stage HIV-positive.) Moreover, Section 204(e) requires the
Secretary of HHS to submit recommendations by October 1, 2004
evaluating this provision and its possible continuance after Fiscal
Year 2006.
We recommend--because so few states have taken this option, and
those four that have done so have been slow to implement it---that this
provision be extended and that the Secretary's required recommendations
be postponed for at least two years in order to allow more time for the
program to play out. To do so, we suggest that Congress either codify
the Section 204 coverage of ``pre-disabled'' workers with severe
impairments into title XIX as a permanent, regular state eligibility
option--or at least extend and fund Section 204 for several more years.
Vocational Rehabilitation and the Ticket Program
Although this issue also falls under another committee's
jurisdiction, we nonetheless feel it is important to bring to your
attention the ongoing concerns about the relationship of state
vocational rehabilitation agencies (VRAs) and the Ticket program. VRAs
have a long and venerable history as the keystone of our nation's
vocational rehabilitation system. Each year, through Title I of the
Rehabilitation Act they successfully serve millions of people with
disabilities.
However, in order to give beneficiaries additional provider choices
for job training and placement, and to improve through competition the
existing VR system, the Ticket to Work Program was established. Yet,
MAXIMUS reports that most Tickets are being assigned to state VRAs and,
rather than competing with private employment networks (ENs) under the
Ticket payment options, most VRAs are opting to be paid under the
traditional cost-reimbursement method. Opting for the traditional
payment method also allows the VRA to ``close'' a case after nine
months as opposed to the 60 month ``investment'' in the client required
of private ENs. Furthermore, some of our task force members involved
with private providers are finding significant reluctance among those
providers to become employment networks. These private providers
perceive, whether justified or not, that becoming an EN might
jeopardize an existing relationship with their state VRA. This unease,
coupled with the financial risk of the payment system as outlined
above, may discourage providers from becoming ENs, thus further
limiting choice of provider to beneficiaries.
We understand that many of the Ticket assignments have been VR
clients already ``in the pipeline'' and that the assignment of new
Ticketholders to private providers versus VR is nearing a 50/50 ratio.
So, eventually, more beneficiaries may turn to private providers and,
as VRAs become more familiar with the Ticket payment systems, their use
of this option may increase. However, it may be worthwhile to look at
the relative advantages and disadvantages experienced under the Ticket
program by private providers versus state VRAs.
Additionally, there seems to be confusion over VRAs' responsibility
to beneficiaries eligible for services under the Rehab Act who may also
have received a Ticket. There have been reports that some current
clients of VR were threatened with termination of services if they did
not assign their Ticket to the VR agency. While we do not want to see
beneficiaries obtaining services to which they are not entitled,
neither do we want to see beneficiaries denied rightful services under
the law. We hope you can urge the leadership of SSA and the Department
of Education to clarify this distressing situation.
Continuing Concerns about the Final Regulations
Finally, we wish to convey a word about our continued misgivings
about the final regulations for the Ticket to Work Program as they
apply to those designated Medical Improvement Expected. We continue to
believe that denying Tickets to those designated ``medical improvement
expected'' (MIE) and who have not had their first continuing disability
review (CDR) will deny many otherwise eligible beneficiaries immediate
access to vital vocational rehabilitation services. We would prefer
that SSA determine on a disability-by-disability basis those MIEs most
likely to remain on benefits and issue them a Ticket. There is
considerable evidence that earlier rehabilitation interventions result
in better return-to-work outcomes for beneficiaries with disabilities.
We hope that SSA and this committee will monitor this issue closely
and respond quickly to any inappropriate denials of benefits to
eligible individuals.
Conclusion
We commend this committee for its continued interest in promoting
economic self-sufficiency and opportunity for people with disabilities.
In summary, we ask that this committee:
LPress SSA to ensure that all federal agencies
involved with workforce development publicize the merits of
TTWWIIA and to explore creative ways to draw attention to this
program from all stakeholders with an interest in employment of
people with disabilities.
LMakes sure that SSA's in-house employment support
staff, however it is structured, assure that beneficiaries have
access to timely and accurate information about work incentives
and TTWWIIA program benefits.
LBe prepared to adjust the scope and flexibility of
the PABSS program as continued barriers to employment are
identified.
LCarefully monitor the Adequacy of Incentives study
and evolution of the milestone/outcome payment system--and
respond when necessary--to ensure that the Ticket program is
attracting a broad range of providers and serving all
individuals with disabilities.
LUrge SSA to offer more extensive training to
providers in TTWWIIA and work incentives, including access to
on-line assistance, to prepare them to serve as additional
resources for beneficiaries and their families.
LUrge more time for the Section 204 Medicaid option to
demonstrate its merits by extending or making permanent its
authority.
LInsist that SSA's policies regarding disabled adult
children and TTWWIIA offer full access to its provisions,
including re-entry to the program with DAC status, or resolve
this issue through legislative correction.
LUrge SSA to move forward with the 1 for 2
Demonstration to answer conclusively many of the questions
surrounding one of the major remaining barriers to employment
of people with disabilities.
LEncourage SSA to work with the Department of
Education in resolving the confusion and misunderstanding
surrounding the role of the Ticket Program to vocational
rehabilitation agencies' Title I responsibilities and the
relationship of VRAs and ENs.
Thank you, Mr. Chairman and members of the committee for your
attention to our comments. The CCD Work Incentives Task Force looks
forward to working with you in the future to assure employment
opportunities for all individuals with disabilities and the proper
implementation of the Ticket to Work and Work Incentives Improvement
Act.
On behalf of:
American Association on Mental Retardation
American Congress of Community Supports and Employment Services
American Network of Community Options and Resources
American Occupational Therapy Association
Association for Persons in Supported Employment
Brain Injury Association of America
Goodwill Industries International Inc.
International Association of Business, Industry and Rehabilitation--
INABIR
International Association of Psychosocial Rehabilitation Services
National Association of Developmental Disabilities Councils
National Association of Protection and Advocacy Systems
National Alliance for the Mentally Ill
National Multiple Sclerosis Society
National Organization of Social Security Claimants Representatives
NISH
Paralyzed Veterans of America
Title II Community AIDS National Network
The Arc of the United States
United Cerebral Palsy
Chairman SHAW. Thank you. Dr. Kregel.
STATEMENT OF JOHN KREGEL, ED.D., PRINCIPAL INVESTIGATOR,
BENEFITS ASSISTANCE RESOURCE CENTER, VIRGINIA COMMONWEALTH
UNIVERSITY, RICHMOND, VIRGINIA
Dr. KREGEL. Mr. Chairman, Members of the Subcommittee,
benefits planning and assistance is the first stop on the road
to employment for SSA beneficiaries. Authorized by section 121
of the Ticket to Work Act, Benefits Planning, Assistance and
Outreach, BPAO projects, are providing services to SSA
beneficiaries in all 50 States and 5 territories. Collectively,
116 BPAO projects employ over 400 benefit specialists, many of
whom are themselves individuals with disabilities, and they
currently serve 3,000 individuals each month.
The purpose of the national BPAO initiative is to provide
beneficiaries accurate and timely information about myriad
regulations, provisions, work incentives, and special programs
that complicate an individual's decision to enter or re-enter
employment. Benefits planning and assistance is an employment
program providing support to SSA beneficiaries who want to
work. Virtually all individuals who contact a BPAO are either
employed or are actively seeking employment. The BPAO
initiative is not about helping people stay on benefits.
Rather, its purpose is to empower individuals to take charge of
their lives.
Congress, in the Ticket to Work Act, had led to tremendous
innovation and expansion of activity in this particular area.
At the same time the speed at which these changes have occurred
created significant challenges for the BPAO program. The BPAO
initiative simply lacks sufficient capacity to adequately meet
current and future demand. The problem is particularly acute
for BPAOs and ticket roll-out States and programs in rural
areas. For example, in Sacramento, Legal Services of Northern
California is attempting to serve 87,000 beneficiaries in 19
counties in and around Sacramento with just three benefit
specialists. Beneficiaries in Plano, Texas are served by the
West Texas and Panhandle Benefits Planning Services Project in
Odessa, several hours away. In this project one benefit
specialist is attempting to serve a catchment area of 38,000
beneficiaries who live in 59 different counties. In Arizona six
benefit specialists have served over 1,000 beneficiaries across
the State. In Northern Arizona, 1\1/2\ staff people serve
59,000 square miles from the Navajo Reservation to Lake Havasu.
The national BPAO initiative is essential to the successful
implementation of the Ticket program. When the Ticket to Work
Program was launched in 13 States, BPAOs rose to the challenge
and provided assistance to over 9,000 individuals in just a few
months. The Ticket program manager, Employment Networks, local
SSA offices, protection and advocacy agencies, and State VR
Agencies all refer Ticket holders to BPAOs for information and
support.
For example, the Ticket to Work Coordinator in the Arizona
Rehabilitation Services Administration has received over 900
telephone inquiries since the Ticket roll-out began in his
State. He refers each beneficiary to the local BPAO program to
help assist in the decision as to whether or not to make a
Ticket assignment.
The BPAO program is about trust. If beneficiaries are to
accept personal responsibility for their careers and their
economic self-sufficiency, they have to be able to trust the
information they receive and the service providers that assist
them. If individuals with diabetes, epilepsy or psychiatric
disability are told that they will still have access to health
care coverage even though they no longer receive a cash benefit
from SSA, they must be able to depend on this guidance, as
erroneous information may literally put them in a potentially
life-threatening situation. If an individual complies with all
SSA regulations and reporting requirements, and SSA fails to
accurately apply the reported information to the individual's
case, the resulting overpayment can have a catastrophic and
disheartening effect on even the most courageous and patient
beneficiaries.
For example, Goodwill Industries in southern California
describe a number of consumers who have stopped working while
on benefits because of substantial overpayment situations, many
of which are due to improper SSA recordkeeping or insufficient
knowledge of how to report and keep track of earned income.
We need to learn from the lessons of welfare reform.
Beneficiaries need to know and understand the rules and have
them consistently interpreted and applied in order to fulfill
their own responsibilities under the program and accept
responsibility for their economic self-sufficiency. The
national BPAO initiative, if effectively implemented, is an
essential component of congressional efforts to include
individuals with disabilities in our Nation's workforce. Thank
you very much.
[The prepared statement of Dr. Kregel follows:]
Statement of John Kregel, Ed.D., Principal Investigator, Benefits
Assistance Resource Center, Virginia Commonwealth University, Richmond,
Virginia
Benefits Planning, Assistance, and Outreach:
The First Stop on the Road to Employment
Introduction
Benefits planning and assistance is the first stop on the road to
employment and economic self-sufficiency for SSA beneficiaries.
Authorized by Section 121 of the Ticket to Work and Work Incentive
Improvement Act of 1999, 116 Benefits Planning, Assistance and Outreach
(BPAO) programs are providing services to SSA beneficiaries in all 50
states and five territories. Collectively, the 116 BPAO projects employ
over 400 benefits specialists, many of whom are themselves individuals
with disabilities, and have served over 30,000 individuals since their
inception less than two years ago.
The purpose of the national BPAO initiative is to provide
beneficiaries with accurate and timely information about SSA work
incentives and other Federal efforts to remove regulatory and
programmatic barriers to employment for persons with disabilities.
Trained benefits specialists working in local BPAO programs work with
individual beneficiaries to explain the myriad of regulations,
provisions, work incentives and special programs that complicate an
individual's decision to enter or reenter the workforce. Benefits
specialists do not tell beneficiaries what to do or make specific
recommendations. Instead, they allow beneficiaries to make their own
informed decisions based on complete and accurate information. In
addition, they support individuals who choose to enter employment by
assisting them to comply with all relevant regulations and reporting
procedures.
The questions posed to benefits specialists by beneficiaries are
basic and straightforward. What will happen to my benefit check if I
return to work? What is the ticket program and what will it do for me?
I am currently working and got a letter from SSA--can you help me? How
can I notify SSA when I work so I can avoid overpayment situations? As
simple and basic as these questions are, their answers are often
complex and convoluted. Even more frustrating to beneficiaries is the
overwhelming amount of confusing and inconsistent information they
receive from SSA, Employment Networks, Vocational Rehabilitation and
other agencies involved in the employment process. This sea of
misinformation makes employment seem a perilous and terrifying
undertaking and lessens the resolve of many beneficiaries attempting to
pursue their career goals.
Benefits planning and assistance is designed to fill this
information void by providing beneficiaries access to complete,
individualized information from a trained professional in a
confidential setting apart from SSA. Armed with an understanding of the
impact of employment on their benefits, beneficiaries can make informed
choices about entering employment, maintaining health care coverage,
and obtaining necessary supports and services. With the help of
benefits planning and assistance, beneficiaries can take charge of
their own careers without the constant worry that the application of an
unknown rule or a mistake by a federal caseworker will jeopardize their
ability to pay for their basic needs or treat their health conditions.
Viewed in this way, benefits planning and assistance is the most basic
of all employment programs.
This testimony contains four sections. The first section discusses
the achievements and challenges of the national BPAO initiative. The
second section describes the current and future role of BPAOs in the
implementation of the Ticket to Work program. The third section makes
several recommendations for improving the BPAO program. Finally, the
fourth section summarizes current trends in the implementation of
benefits planning and assistance based on information from the National
BPAO Data System maintained by Virginia Commonwealth University.
Section I:
Achievements and Challenges of the Benefits Planning,
Assistance and Outreach Initiative
Accomplishments
The national BPAO initiative is less than two years old. In that
short time 116 local programs have been established, staff members have
been hired and trained, and relationships have been developed between
BPAOs and SSA field offices, Employment Support Representatives,
Employment Networks, Vocational Rehabilitation Agencies and community
advocacy and provider organizations. Several of the key accomplishments
of the BPAO initiative are summarized below.
The national BPAO initiative has grown at a remarkable rate. BPAO
projects are located in independent living centers, advocacy agencies,
State Vocational Rehabilitation agencies, community rehabilitation
providers, legal aid agencies, universities, and other diverse
settings. Over 400 benefits specialists have received ongoing training
and technical assistance to insure program quality. To date over 30,000
individuals have received services from BPAOs, with over 3,000 new
beneficiaries receiving service each month. SSA has done an outstanding
job of launching a major new national service in a very short amount of
time.
Benefits planning and assistance is an employment program,
providing support to SSA beneficiaries who want to work. Approximately
85% of all individuals who contact a BPAO are either employed or are
actively seeking employment. Another 13% are attempting to get
information about work incentives, the ticket, and other programs that
will help them decide whether to pursue employment. Only 2% of persons
contacting BPAOs are in the process of terminating employment or
reducing their work hours. The BPAO initiative is not about helping
people stay on benefits. Rather, its purpose is to empower individuals
to take charge of their lives and enhance their economic self-
sufficiency.
The national BPAO initiative is essential to the successful
implementation of the ticket program. When the Ticket to Work program
was launched in 13 states, BPAOs rose to the challenge and provided
assistance to over 9,000 individuals in a very short time. The Project
Manager, Employment Networks, local SSA offices, Protection and
Advocacy agencies, and State Vocational Rehabilitation agencies all
refer ticket holders for information and support.
Individuals with disabilities are actively involved in the delivery
of benefits planning and assistance services. Approximately half of the
400 benefits specialists working in BPAO programs are individuals with
disabilities. Many of these individuals have personal experience with
SSA disability programs. Individuals with disabilities, serving in paid
professional positions, are using their knowledge, skill, and personal
experience to assist other persons with disabilities to navigate the
maze of SSA work incentives and regulations to obtain employment and
maximize their economic self-sufficiency.
The national BPAO initiative is a major component of a multi-
faceted effort by Congress and SSA to improve services to
beneficiaries. Congress and SSA have developed and launched a network
of services and support structures that have enhanced the overall
efficiency and responsiveness of the agency. The BPAO initiative allows
beneficiaries to get their questions answered by a trained professional
without the fear of losing their cash benefits, medical benefits and
experiencing further financial barriers. At the same time, a cadre of
Employment Support Representatives, working inside the agency, are
indispensable for the success of the overall reform initiative. ESRs
provide crucial access to information and guidance to BPAOs on cases,
thereby making the BPAOs more effective. BPAOs need an SSA ``insider''
with significant work incentives knowledge to assist with developing
work CDRs. Employment Support Representatives provide support to
benefits specialists, as well as provide direct service to
beneficiaries. In addition, the Modernized Return to Work system,
currently being implemented all across the country, has automated and
vastly improved the exchange of information between SSA and the BPAOs.
Challenges
The national BPAO initiative began during a time of tremendous
change in the disability benefit programs. The launch of the Ticket to
Work program, the creation of Medicaid buy-in programs, the
implementation of enhanced work incentives in the TWWIIA, and the
establishment of the Employment Support Representative pilot all
contributed to a spirit of innovation and reform. At the same time, the
speed at which these changes occurred created significant challenges
for the BPAO program. Several of these are summarized below.
The national BPAO initiative lacks sufficient capacity to
adequately meet current and future demand. The number of beneficiaries
requesting services has overwhelmed a large number of local BPAOs. The
problem is particularly acute for BPAOs in ticket rollout states, and
programs in rural areas where extensive travel reduces potential
service time. As a result, a significant number of BPAOs are curtailing
their outreach efforts, so that they do not create a demand that cannot
be met. With aggressive marketing efforts, many programs indicate they
could substantially increase the number of beneficiaries served. The
following examples illustrate the current situation.
LIn northern California, Legal Services of Northern
California is attempting to serve 87,000 individuals in 19
counties in and around Sacramento with just three benefits
specialists.
LBeneficiaries in Plano, Texas are served by the West
Texas and Panhandle Benefits Planning Services project in
Odessa, a full seven hours away. In this project, one benefits
specialist is attempting to serve a catchment area of 38,000
beneficiaries who live in 59 counties.
LMCIL in Baltimore serves a catchment area of over
50,000 beneficiaries with 2.5 benefits specialists. The project
has served over 500 beneficiaries since its inception and is
struggling to handle its current caseload. They have limited
their outreach activities for fear they could not adequately
respond to the resulting referrals.
LIn Arizona, six benefits specialists have served over
1,000 beneficiaries across the entire state. In northern
Arizona, 1.5 staff members serve 59,000 square miles from the
Navajo reservation to Lake Havasu.
LIn Austin, Texas, four staff from the Austin Resource
Center for Independent Living are attempting to serve a
catchment area of 119,000 individuals spread across 58
counties. Beneficiaries frequently wait two weeks to meet with
a benefits specialist, as each specialist is responsible for
serving anywhere from 11 to 15 counties.
LIn Los Angeles, beneficiaries are experiencing delays
of seven to ten business days before seeing a benefits
specialist. Goodwill Industries of Southern California and AIDS
Project Los Angeles have served over 700 individuals, many of
whom have significant cognitive or psychiatric disabilities
that require an extensive amount of service, with just four
benefits specialists.
Youth are currently not significantly represented oin the
population served by the Program. Indeed, less than eight percent of
beneficiaries receiving services from local BPAOs are under the age of
22. At one level this is understandable, as current implementation
efforts have focused on assisting in the rollout of the ticket program.
However, the challenges faced by transition-aged beneficiaries are
unique, and specific work incentives have been developed to assist them
in their employment efforts. Future BPAO outreach activities should
focus on contacting and serving adolescents and young adults.
For many BPAOs, staff turnover is becoming a serious issue.
Stability of direct service staff is essential to the success of a
local BPAO, or any human service program. Unfortunately, for an
increasing number of BPAOs, staff turnover has become a significant
problem. The role of a benefits specialist is a brand new professional
position in many states, and some degree of turnover should be expected
in any new initiative. However, in some instances staff turnover is
resulting from a disparity in salary structures in the various systems
that employ benefits specialists. Specifically, specialists working in
independent living centers and non-profit community organizations are
leaving to take similar positions in State Vocational Rehabilitation
agencies, universities, or Department of Labor settings. Retaining
skilled, experienced benefits specialists may remain a significant
problem for small BPAO programs for the foreseeable future.
Section II:
Role of BPAOs in the Implementation of the Ticket to Work Program
The national BPAO initiative is cruicial to the successful
implementation of the Ticket to Work program. The vast majority of
Employment Networks have little knowledge of SSA benefit programs and
applicable work incentive provisions. Many ENs are ``non-traditional''
providers who may be working with SSA beneficiaries for the first time
and encountering the complex array of rules and procedures with little
knowledge or support.
Similarly, State Vocational Rehabilitation (VR) agencies in the
initial rollout states and the Project Manager are ill equipped to
adequately address questions being asked by ticket holders. Responding
to hundreds of inquiries when tickets are mailed, State VR agencies
simply lack the resources and trained staff to answer questions about
benefit changes, health care coverage, and eligibility for other
programs. Most local VR counselors possess little more than basic
knowledge of work incentives and are unable to provide accurate and
complete information. The Project Manager, faced with receiving tens of
thousands of inquiries annually, is not staffed to provide lengthy,
detailed information to each individual ticket holder.
Without this information, ticket holders will justifiably be
reluctant to jeopardize crucial financial and health care benefits and
assign their ticket to an EN. Local BPAO programs have stepped forward
to meet this need in the initial rollout states. For example:
LGulfstream Goodwill in West Palm Beach, Florida has
responded to over 500 individuals who have contacted the
program inquiring about the use of their ticket. Ticket holders
make up over half of the 900 individuals served by the agency's
BPAO since program inception. While keeping the BPAO and EN
components of the agency separate, Gulfstream Goodwill has
nevertheless been able to provide timely and accurate
information to ticket holders that can aid beneficiaries in
decision-making.
LThe Ticket to Work Coordinator in the Arizona
Rehabilitation Services Administration has received over 900
telephone inquiries since the ticket rollout began in his
state. After explaining the role of the State VR agency, the
Coordinator refers the ticket holder to the BPAO organization
for an explanation of the ticket program and a detailed
analysis of the impact of program participation on an
individual's income and health care. Interested ticket holders
then contact their local VR office to assign their ticket.
LAn Oklahoma benefits specialist reports receiving
several calls from an SSI recipient who had been told by an
agency involved in ticket implementation that he could earn up
to $560 without his benefit being reduced. Her message to
others in her region, ``If you are getting ready to be a Ticket
state get ready to undo a lot of damage!''
LIn Oregon, the Oregon Vocational Rehabilitation
Services staff member who screens Ticket to Work calls explains
program features and goals, but refers all callers to the local
BPAO to address specific benefit and work incentive questions.
However, available BPAO resources in the state make it
difficult to consistently respond in a timely manner and a
number of ticket holders have experienced significant waits for
BPAO services.
LIn Florida, Oklahoma, Arizona and other states, ENs
and BPAOs are implementing innovative strategies to maximize
the availability of BPAO services. BPAO staff are attending and
participating in orientations sponsored by ENs that are
conducted for interested ticket holders. In this way, the ENs
and BPAOs are attempting to make sure that beneficiaries have
all necessary information before beginning the ticket
assignment process.
LThe Houston Center for Independent Living has already
begun to educate and inform the Houston community about the
upcoming ticket rollout. The Center, which serves 13 counties
and 12,500 square miles, estimate that the workload for each of
the four current benefits specialists will double when the
ticket program is launched in Texas in 2003.
Section III:
Recommendations for Improving the National BPAO Initiative
It's about trust. If beneficiaries are to accept personal
responsibility for their careers and their economic self-sufficiency,
they have to be able to trust the information they receive and the
service providers that assist them. If a beneficiary is told that
employment will affect his or her benefit in a certain manner, they
have to be able to trust and act on that information. If individuals
with diabetes, epilepsy or a psychiatric disability are told that they
will still have access to health care coverage even though they no
longer receive a cash benefit from SSA, they must be able to depend on
this information, as erroneous information may literally put them in a
potentially life threatening situation. If an individual complies with
all SSA regulations and reporting requirements and SSA fails to
accurately apply that reporting information to the individual's case,
the resulting overpayment can have a catastrophic and disheartening
effect on even the most courageous and patient beneficiary. The
following examples illustrate these concerns.
LStaff from Project ABIL in Phoenix, Arizona report
talking to many individuals who have received conflicting and
sometimes inaccurate information from the Project Manager, VR,
SSA, and ENs. This confusion increases fear and causes concerns
among individuals bravely attempting to return to work.
LOne benefit specialist in south Florida, discussing
the advantages of the BPAO, stated, ``Beneficiaries are able to
ask questions of a BPAO benefits specialist that they are
simply afraid to ask Social Security.''
LIn Los Angeles, Goodwill Industries of Southern
California describe a number of consumers who have stopped
working while on benefits because of substantial overpayment
situations, many of which are due to improper SSA record
keeping or insufficient knowledge of how to report and keep
track of earned income.
LIn western Kentucky, staff from the Center for
Accessible Living report that beneficiaries have responded
positively to the simple fact that accommodations such as sign
language interpreters are provided by the BPAO project upon
requests. Many beneficiaries have noted they have not been
provided accommodations at the SSA office even when requested.
LThe Sheperd Center in Atlanta has served over 400
beneficiaries throughout the metropolitan Atlanta area,
including Fayette, Henry, and Clayton counties. Sheperd Center
staff report dozens of instances in which beneficiaries
accurately report earnings to SSA, yet these reports are not
acted upon, resulting in significant overpayments to
beneficiaries and loss of trust in SSA. Center staff is relying
on assistance from the local SSA public affairs specialist to
work up and resolve the cases.
LIn Los Angeles County, most beneficiaries contacting
Familia Unida have language and cultural barriers that affect
their communication with SSA. Most of these individuals are
afraid to call the SSA office and are not clear about the
information they have received.
We need to learn from the lessons of welfare reform. Beneficiaries
need to know and understand the rules, and have them consistently
interpreted and applied, in order to fulfill their own responsibilities
under the program and accept responsibility for their economic self-
sufficiency. The national BPAO initiative, if effectively implemented,
is an essential component of Congressional efforts to include
individuals with disabilities in our nation's workforce. To this end,
five recommendations are offered.
Congress should expand the network of local BPAO projects to meet
existing demand for the service and adequately serve beneficiaries
attempting to participate in the Ticket to Work program. The BPAO
program simply lacks the capacity to respond to the overwhelming demand
for services. In some instances, BPAOs have been forced to make
beneficiaries wait up to two weeks for initial appointments. In other
communities, BPAOs have sharply curtailed outreach activities so that
they don't create a demand that they just can't meet. BPAOs estimate
that when the ticket program is rolled out across the nation, benefits
specialists' caseloads will double. Additional program capacity will
enable BPOAs to address current and future demand. In addition,
enhanced program capacity would allow BPAOs to increase marketing
activities that would allow thousands of individuals, who now feel that
they are incapable of employment, to test their abilities without
jeopardizing their livelihood.
SSA should work with the Project Manager, State Vocational
Rehabilitation agencies, and Employment Networks to insure that
benefits planning and assistance supports are available to
beneficiaries early in the Ticket to Work process. When a beneficiary
contacts the Project Manager, he or she should receive information
about the availability of BPAO services in the local area, as well as
the type of services provided by BPAOs. Clear policies should be
developed regarding the extent to which Project Manager staff members
should provide work incentive information to beneficiaries. Similarly,
State Vocational Rehabilitation agencies should provide information
about BPAOs to the hundreds of beneficiaries who contact them during
the initial stages of ticket rollout. Technical assistance should be
provided to local Employment Networks so that they understand the
importance of BPAO services and assist potential ticket holders to
access the service.
Efforts to improve the overall capability of SSA to effectively and
responsibly serve disability beneficiaries should be maintained and
expanded. BPAOs operate independently of SSA, but not in isolation from
the agency. The piloting of the Employment Support Representative
position, the creation of the Modernized Return to Work (MRTW)
software, continued training for field office staff, and efforts to
collaborate with State Protection and Advocacy agencies are all
strategies that support the BPAOs and improve service to beneficiaries.
The Employment Support Representative program should continue and be
expanded. The MRTW automation efforts should be immediately implemented
nationwide.
SSA should begin now to evaluate the effectiveness of the national
BPAO initiative. SSA plans to initiate a consumer satisfaction survey
of beneficiaries who have received BPAO services in the near future. In
addition to consumer satisfaction, SSA should plan and implement an
impact evaluation of the BPAO program. The resulting information can be
used to determine the effect of BPAO services on beneficiary employment
and earnings, as well as the cost-effectiveness of the program.
SSA's national BPAO initiative should coordinate its activities
with other programs and agencies providing benefits planning and
assistance services. In addition to BPAOs, benefits planning and
assistance services are being supported by the Center for Medicaid and
Medicare Services, the Department of Labor, the Rehabilitation Services
Administration and other funding agencies. SSA should coordinate
training, evaluation and quality assurance activities with its Federal
partners to insure that these efforts maximize combined program
capacity and increase long-term program stability.
Section IV:
Benefits Planning, Assistance and Outreach Summary
Results from the National BPAO Data System
Nationally, 116 organizations, 156 sites, 400 benefit specialists,
and 27,502 beneficiary recipients participated in the BPAO Program
between March 1, 2001 and July 31, 2002. An organization, defined as
the primary BPAO awardee, is an entity or agency that has directly
entered into a cooperative agreement with SSA to provide benefits,
planning, assistance, and outreach services to beneficiaries. An
organization may be providing all BPAO services directly, or may have
established agreements with subcontractors to assist with service
delivery. Each organization can have one or multiple sites, a decision
that is dependent upon physical location and data partitioning
preferences.
Many different types of organizations are providing BPAO services.
Centers for Independent Living (CILs) are providing services in 53
communities, accounting for nearly half of all BPAO organizations. Non-
profit communities organizations, ranging from Goodwill Industries to
mental health centers, provide services in 21 locations. State
Vocational Rehabilitation (VR) agencies operate BPAO programs in 18
states. Other BPAO organizations include advocacy organizations (e.g.
United Cerebral Palsy), universities, and legal aid agencies (including
Protection and Advocacy organizations).
------------------------------------------------------------------------
Organization Frequency Percent
------------------------------------------------------------------------
Independent Living Centers 53 45.7
------------------------------------------------------------------------
Non-Profit Community 21 18.1
Organizations
------------------------------------------------------------------------
State Vocational Rehabilitation 18 15.5
and Legal Aid Organizations
------------------------------------------------------------------------
Advocacy Organizations 10 8.6
------------------------------------------------------------------------
Universities and State Agencies 9 7.8
------------------------------------------------------------------------
Legal Aid Organizations 5 4.3
(including Protection and
Advocacy)
------------------------------------------------------------------------
Total 116 100
------------------------------------------------------------------------
Many of the 116 organizations provide their services at a single
site. In many instances staff based at the site may travel locally, or
in some instances across large geographic areas, to meet and serve
beneficiaries. In other instances, in order to adequately serve its
specified catchment area, a project may establish multiple sites across
a region or an entire state. At the present time, 156 sites are
represented across the 116 organizations.
At the present time 400 benefits specialists are submitting data
into the VCU BPAO database. Approximately half of these benefits
specialists are individuals with disabilities, many of whom have
personal experience with the SSA disability programs. This is a key
feature of SSA BPAO program. Individuals with disabilities, serving in
paid professional positions, are using their knowledge, skill, and
personal experience to assist other persons with disabilities to
navigate the maze of SSA work incentives and regulations to obtain
employment and maximize their economic self-sufficiency.
The Benefits Assistance Resource Center at Virginia Commonwealth
University maintains a uniform data management system was developed
that allowed BPAO contractors to submit, revise, and aggregate
information on their clientele via web-based forms. The National BPAO
Data System collects information on:
Beneficiary Name
Social Security Number
Address
Age
Sex
Type of Disability
Current Benefits Received
Current Employment Status
Reasons for Contacting the BPAO
Types of Services Delivered
Work Incentives and Provisions Discussed with Beneficiary
Amount of Time Required to Assist Beneficiary
This national reporting effort is being used to gather information
that documents the degree to which the BPAO Program is achieving the
outcomes intended by Congress when it established the program as a key
component of the Ticket to Work and Work Incentives Improvement Act.
The program continues to expand rapidly, providing an array of services
to SSDI and SSI beneficiaries that will ultimately enable an
increasingly diverse population of people with disabilities to fulfill
their goals of returning to work and achieving self-sufficiency.
Total Number of Beneficiaries Serviced in the BPAO Program
The data reported below reflects the experiences of 27,502
beneficiaries who received services through the 116 organizations on or
before July 31, 2002, based on information submitted to the national
BPAO data system maintained by Virginia Commonwealth University. To
better understand the activities of the local projects, beneficiaries
are grouped based upon the level of services received. One group
consists of 14,044 beneficiaries (51%) who receive only Information and
Referral and/or Problem Solving and Advocacy services. The second group
(49%) includes 13,458 persons who received ``Benefits Analysis and
Advisement,'' ``Benefits Support Planning,'' and/or ``Benefits
Management'' and is referred to as individuals who receive Intensive
Benefit Support. As illustrated in the table below, SSDI and concurrent
beneficiaries are significantly more likely to receive Intensive
Benefit Support services than SSI recipients.
Benefit Status by Type of Service
----------------------------------------------------------------------------------------------------------------
Benefit Status I & R/Problem Solving Intensive Benefit Support
----------------------------------------------------------------------------------------------------------------
SSI 33.8 30.4
----------------------------------------------------------------------------------------------------------------
SSDI 43.5 48.3
----------------------------------------------------------------------------------------------------------------
Concurrent SSI/SSDI 14.6 20.0
----------------------------------------------------------------------------------------------------------------
The number of beneficiaries served by the BPAO Program and the
intensity of services provided varies greatly by state, as the
following table reveals. This information should be interpreted
carefully. The state-by-state data presented in the table below does
not reflect services provided but not reported to the VCU database,
services provided by other funding sources, or services provided or
reported since July 31, 2002.
Persons Served in BPAO Programs March 1, 2001--July 31, 2002
--------------------------------------------------------------------------------------------------------------------------------------------------------
I & R/Problem Solving Intensive Benefit Support
State ------------------------------------------------------------------------------------ Total
SSI SSDI Concurrent SSI SSDI Concurrent
--------------------------------------------------------------------------------------------------------------------------------------------------------
AK 1 0 0 6 18 7 32
--------------------------------------------------------------------------------------------------------------------------------------------------------
AL 129 94 47 46 65 29 410
--------------------------------------------------------------------------------------------------------------------------------------------------------
AR 116 186 61 29 46 26 464
--------------------------------------------------------------------------------------------------------------------------------------------------------
AZ 156 383 69 76 167 51 902
--------------------------------------------------------------------------------------------------------------------------------------------------------
CA 639 380 298 305 319 282 2223
--------------------------------------------------------------------------------------------------------------------------------------------------------
CO 37 71 11 63 119 39 340
--------------------------------------------------------------------------------------------------------------------------------------------------------
CT 16 67 12 59 168 37 359
--------------------------------------------------------------------------------------------------------------------------------------------------------
DC 17 6 4 1 1 3 32
--------------------------------------------------------------------------------------------------------------------------------------------------------
DE 5 15 1 25 77 11 134
--------------------------------------------------------------------------------------------------------------------------------------------------------
FL 494 946 207 363 687 236 2933
--------------------------------------------------------------------------------------------------------------------------------------------------------
GA 73 85 33 97 159 63 510
--------------------------------------------------------------------------------------------------------------------------------------------------------
HI 15 6 2 0 1 0 24
--------------------------------------------------------------------------------------------------------------------------------------------------------
IA 33 32 12 27 22 11 137
--------------------------------------------------------------------------------------------------------------------------------------------------------
ID 37 14 18 53 52 28 202
--------------------------------------------------------------------------------------------------------------------------------------------------------
IL 113 163 36 39 81 16 448
--------------------------------------------------------------------------------------------------------------------------------------------------------
IN 59 90 30 111 233 43 566
--------------------------------------------------------------------------------------------------------------------------------------------------------
KS 4 25 5 8 24 14 80
--------------------------------------------------------------------------------------------------------------------------------------------------------
KY 108 144 44 104 167 95 662
--------------------------------------------------------------------------------------------------------------------------------------------------------
LA 204 188 67 124 94 49 726
--------------------------------------------------------------------------------------------------------------------------------------------------------
MA 75 76 26 244 432 211 1064
--------------------------------------------------------------------------------------------------------------------------------------------------------
MD 25 47 7 43 84 23 229
--------------------------------------------------------------------------------------------------------------------------------------------------------
ME 46 56 30 63 106 45 346
--------------------------------------------------------------------------------------------------------------------------------------------------------
MI 115 172 42 89 115 48 581
--------------------------------------------------------------------------------------------------------------------------------------------------------
MN 23 54 24 7 15 12 135
--------------------------------------------------------------------------------------------------------------------------------------------------------
MO 119 183 55 146 289 123 915
--------------------------------------------------------------------------------------------------------------------------------------------------------
MS 228 195 78 35 48 22 606
--------------------------------------------------------------------------------------------------------------------------------------------------------
MT 5 8 4 10 6 5 38
--------------------------------------------------------------------------------------------------------------------------------------------------------
NC 176 273 103 164 325 148 1189
--------------------------------------------------------------------------------------------------------------------------------------------------------
ND 8 17 3 7 2 1 38
--------------------------------------------------------------------------------------------------------------------------------------------------------
NE 15 36 13 0 11 4 79
--------------------------------------------------------------------------------------------------------------------------------------------------------
NH 2 5 3 14 37 11 72
--------------------------------------------------------------------------------------------------------------------------------------------------------
NJ 40 66 20 68 126 35 355
--------------------------------------------------------------------------------------------------------------------------------------------------------
NM 23 29 7 39 52 21 171
--------------------------------------------------------------------------------------------------------------------------------------------------------
NV 19 39 12 7 6 4 87
--------------------------------------------------------------------------------------------------------------------------------------------------------
NY 418 435 184 299 230 158 1724
--------------------------------------------------------------------------------------------------------------------------------------------------------
OH 126 109 36 368 638 218 1495
--------------------------------------------------------------------------------------------------------------------------------------------------------
OK 47 62 25 28 90 19 271
--------------------------------------------------------------------------------------------------------------------------------------------------------
OR 63 130 29 4 18 5 249
--------------------------------------------------------------------------------------------------------------------------------------------------------
PA 96 124 38 296 390 169 1113
--------------------------------------------------------------------------------------------------------------------------------------------------------
PR 2 4 0 2 34 0 42
--------------------------------------------------------------------------------------------------------------------------------------------------------
RI 13 50 13 32 8 24 140
--------------------------------------------------------------------------------------------------------------------------------------------------------
SC 144 170 54 63 116 44 591
--------------------------------------------------------------------------------------------------------------------------------------------------------
SD 14 45 11 3 19 5 97
--------------------------------------------------------------------------------------------------------------------------------------------------------
TN 47 65 23 36 67 23 261
--------------------------------------------------------------------------------------------------------------------------------------------------------
TX 299 344 123 242 353 96 1457
--------------------------------------------------------------------------------------------------------------------------------------------------------
UT 89 113 40 3 13 7 265
--------------------------------------------------------------------------------------------------------------------------------------------------------
VA 103 100 29 16 29 15 292
--------------------------------------------------------------------------------------------------------------------------------------------------------
VT 7 5 4 7 2 4 29
--------------------------------------------------------------------------------------------------------------------------------------------------------
WA 58 126 26 30 86 18 344
--------------------------------------------------------------------------------------------------------------------------------------------------------
WI 33 55 17 55 121 64 345
--------------------------------------------------------------------------------------------------------------------------------------------------------
WV 19 23 10 131 126 69 378
--------------------------------------------------------------------------------------------------------------------------------------------------------
WY 1 2 0 2 6 3 14
--------------------------------------------------------------------------------------------------------------------------------------------------------
Intensive Benefit Support Recipients
Age--The vast majority of individuals receiving Intensive Benefits
Support services are between the ages of 20 and 59, with less than 10
percent falling either above or below this range. Both sexes were
represented equally.
Age of Intensive Benefit Support Recipients
------------------------------------------------------------------------
Age Percentage
------------------------------------------------------------------------
Under 22 7.4
------------------------------------------------------------------------
23to 39 38.3
------------------------------------------------------------------------
40to 59 50.3
------------------------------------------------------------------------
Over 60 4.0
------------------------------------------------------------------------
Total 100
------------------------------------------------------------------------
Primary Disability--BPAOs serve individuals with a wide variety of
both physical and mental disabilities. The two most common primary
disabilities reported for beneficiaries receiving intensive benefit
support were mental/emotional disorders and system diseases, such as
neurological, endocrine, respiratory and circulatory systems. These two
categories jointly account for more than half of all beneficiaries
receiving Intensive Benefit Support. The categories reported least
often are traumatic brain injury, sensory impairments, and infectious
diseases. Just over seven percent of all intensive benefit support
recipients reported having some sort of special language consideration,
such as the use of sign language or English as a second language.
Primary Disability of Intensive Benefit Support Recipients
------------------------------------------------------------------------
Primary Disability Percentage
------------------------------------------------------------------------
Mental and Emotional Disorders 38.2
------------------------------------------------------------------------
System Diseases (e.g. nervous, endocrine, cardiac, 15.7
etc.)
------------------------------------------------------------------------
Cognitive Disabilities (Mental Retardation) 12.0
------------------------------------------------------------------------
Non-Spinal Cord Orthopedic Disabilities/Amputations 11.6
------------------------------------------------------------------------
Spinal Cord Injury 5.4
------------------------------------------------------------------------
Blind or Visual Impairment 5.1
------------------------------------------------------------------------
Traumatic Brain Injury 4.1
------------------------------------------------------------------------
Hearing, Speech, and other Sensory Impairments 2.9
------------------------------------------------------------------------
Infectious Diseases 2.2
------------------------------------------------------------------------
Other 2.3
------------------------------------------------------------------------
Unknown 0.5
------------------------------------------------------------------------
Total 100
------------------------------------------------------------------------
Employment Status--More than 90 percent of those individuals who
receive intensive benefit support through the BPAO Program are either
employed or in the process of seeking employment. Most are currently
not working, but have a desire to change their employment status.
Slightly more than half indicate that they were not employed, but are
actively seeking employment, and nearly 30 percent are currently
employed part-time, working less than 30 hours a week. Less than six
percent of intensive benefit support beneficiaries were employed full-
time, working 30 or more hours a week.
Current Employment Status of Intensive Benefit Support Recipients
------------------------------------------------------------------------
Employment Status Percentage
------------------------------------------------------------------------
Employed Full-Time 5.8
------------------------------------------------------------------------
Employed Part-Time 29.3
------------------------------------------------------------------------
Not Employed, Seeking Employment 55.7
------------------------------------------------------------------------
Not Employed, Not Seeking 9.2
Employment
------------------------------------------------------------------------
Total 100
------------------------------------------------------------------------
Reasons for Contacting BPAO--Nearly 75 percent of beneficiaries
have requested services in direct response to the outreach efforts of
the BPAO Program. Having an interest in examining new or expanded work
options is another relatively common reason for seeking services, cited
by over 40 percent of individuals receiving Intensive Benefit Support.
Approximately nine percent of beneficiary recipients indicate that
communication from SSA led them to request services. Eight percent of
total recipients indicate that they sought services in response to
Ticket to Work communications from SSA; this finding must be
interpreted with caution, however, since of the 27,502 total
beneficiaries, only 9,583 were in the 13 states included in the first
phase of implementation of the Ticket to Work Program.
Types of Services Provided--Services providing by local BPAO
programs are classified into five distinct service categories to
facilitate comparison and communication across programs. Services most
often delivered to the Intense Benefit Services group are ``Benefits
Analysis and Advisement,'' during which the benefit specialist may
assess the potential impacts of employment or other changes on the
person's financial well being and develop an outline of available
options and projected outcomes. ``Information and Referral,'' which
involves providing basic written and verbal information in response to
inquiries about benefit program, and referral to government agencies or
other resources, has been provided to 80% of beneficiaries. The service
category least frequently provided to this group was ``Benefits
Management,'' although the nature of this category, which involves the
provision of ongoing, comprehensive benefits monitoring and management
assistance to those beneficiaries who are likely to experience dramatic
life changes, makes it critical to those individuals who do receive it.
Services Delivered to Persons Receiving Intensive Benefit Supports
------------------------------------------------------------------------
Service Percentage
------------------------------------------------------------------------
Information and Referral 80.5
------------------------------------------------------------------------
Problem Solving and Advocacy 43.4
------------------------------------------------------------------------
Benefits Analysis and Advisement 94.8
------------------------------------------------------------------------
Benefits Support Planning 32.6
------------------------------------------------------------------------
Benefits Management 10.9
------------------------------------------------------------------------
Amount of Services Provided--The amount of services provided to
individuals varies significantly. About a quarter of beneficiaries
receive one hour or less of services, and nearly half receive between
two and four hours, with an average service time of about 3.4 hours.
Nearly a quarter of beneficiaries received more than five hours of
service; however, only about five percent received more than 10 hours.
Individuals with mental and emotional disorders, and currently
unemployed individuals seeking to obtain employment tend to receive the
largest amount of services.
Amount of Services Provided to Persons Receiving Intensive Benefit
Supports
------------------------------------------------------------------------
Amount Percentage
------------------------------------------------------------------------
Less than 1 hour 12.5
------------------------------------------------------------------------
1 hour 16.2
------------------------------------------------------------------------
2 hours 23.2
------------------------------------------------------------------------
3 hours 16.1
------------------------------------------------------------------------
4 hours 9.7
------------------------------------------------------------------------
5-9 hours 17.0
------------------------------------------------------------------------
More than 10 hours 5.3
------------------------------------------------------------------------
Total 100
------------------------------------------------------------------------
Intensive Benefit Support Recipients Grouped by SSA Benefit Status
In addition to the findings above, it is useful to compare the
experiences of beneficiaries receiving Intensive Benefit Support on the
basis of whether they receive SSI only (n = 4089), SSDI only, (n =
6500), or Concurrent SSI and SSDI (n = 2694). Nearly 90 percent of
those receiving SSI or concurrent SSI/SSDI and just over 30 percent of
those receiving SSDI are currently utilizing Medicaid. SSDI
beneficiaries are more likely to receive private health insurance
(although coverage is quite low in absolute terms), and less likely
than the other two groups to currently receive subsidized housing or
food stamps.
Other Benefits Received by SSA Benefit Status
----------------------------------------------------------------------------------------------------------------
Concurrent
Current Benefit Percentage SSDI Percentage Percentage
----------------------------------------------------------------------------------------------------------------
Medicare 4.8 77.0 81.0
----------------------------------------------------------------------------------------------------------------
Medicaid 87.9 32.4 89.7
----------------------------------------------------------------------------------------------------------------
Private Health Insurance 3.3 11.2 2.2
----------------------------------------------------------------------------------------------------------------
Subsidized Housing 19.5 11.4 24.7
----------------------------------------------------------------------------------------------------------------
Food Stamps 27.8 12.3 30.9
----------------------------------------------------------------------------------------------------------------
TANF 3.1 0.3 2.2
----------------------------------------------------------------------------------------------------------------
Workers Compensation 0 0.8 0
----------------------------------------------------------------------------------------------------------------
Unemployment Insurance 0.3 0.5 0.2
----------------------------------------------------------------------------------------------------------------
Veterans Benefit 0.5 2.3 0.5
----------------------------------------------------------------------------------------------------------------
Other 6.3 9.6 5.9
----------------------------------------------------------------------------------------------------------------
Current Employment Status--The current employment status of the
recipients did not appear to vary much across the three benefit
categories; type of benefit does not appear to predict employment
status among the individuals served by the BPAO Program. Across all
three groups, more than half of the intensive benefit support
recipients were not currently employed, but actively seeking
employment.
Current Employment Status by SSA Benefit Status
----------------------------------------------------------------------------------------------------------------
Concurrent
Employment Status SSI Percentage SSDI Percentage Percentage
----------------------------------------------------------------------------------------------------------------
Employed Full-Time 5.9 6.3 4.3
----------------------------------------------------------------------------------------------------------------
Employed Part-Time 30.3 28.5 30.2
----------------------------------------------------------------------------------------------------------------
Not Employed, Seeking Employment 55.5 56.1 55.5
----------------------------------------------------------------------------------------------------------------
Not Employed, Not Seeking Employment 8.2 9.1 9.9
----------------------------------------------------------------------------------------------------------------
No Response 0.1 0.0 0.1
----------------------------------------------------------------------------------------------------------------
Work Incentives Recommended for Consideration--While benefit
specialists are not responsible for recommending a specific course of
action to beneficiaries, they do describe work incentives and
provisions that are available to particular individual, fully
discussing the requirements of and possible ramifications of each.
The incentives and provisions that described by specialists as
options for beneficiaries to pursue vary across current benefit status,
consistent with expectations. A Trial Work Period, which provides an
opportunity for beneficiaries to test work skills while maintaining
benefits, has been discussed with nearly 80 percent of SSDI and
concurrent beneficiaries, and a subsequent Extended Period of
Eligibility has been described to about three quarters of these
individuals. A Plan for Achieving Self Support was presented to roughly
a third of SSI and concurrent recipients and to 16 percent of SSDI
beneficiaries. Impairment Related Work Expenses were presented to about
half of all intensive benefit support recipients, regardless of benefit
status.
Section 1619(a) has been presented to about a third of SSI and
concurrent recipients, and 1619(b) has been discussed with nearly two
thirds of SSI and concurrent recipients. The Medicaid Buy-In program
was slightly less likely to be presented as an option for SSDI
beneficiaries than for either of the other two groups. Extended
Medicare has been presented to approximately a third of concurrent
beneficiaries and to a slightly greater proportion of SSDI
beneficiaries, while the opposite trend was true for Subsidy
Development.
The incentives presented as options least frequently overall were
Blind Work Expense and Student Earned Income Exclusion, reflecting the
demographic characteristics of the individuals currently served by the
BPAO Program. Indeed, the data must be examined within the context of
the appropriate subgroups to provide a more accurate understanding of
the extent to which these incentives are indicated to beneficiaries.
Student Earned Income Exclusion was indicated for 30 percent of the 989
intensive benefit services youth under the age of 22, and Blind Work
Expense was indicated for over half of the 680 individuals with visual
disabilities who received intensive benefit services.
Work Incentives Discussed with Beneficiary by SSA Benefits Status
----------------------------------------------------------------------------------------------------------------
Incentive SSI SSDI Concurrent
----------------------------------------------------------------------------------------------------------------
TWP 0 79.6 78.6
----------------------------------------------------------------------------------------------------------------
EPE 0 76.0 74.7
----------------------------------------------------------------------------------------------------------------
PASS 32.7 15.8 36.3
----------------------------------------------------------------------------------------------------------------
IRWE 47.5 49.4 52.4
----------------------------------------------------------------------------------------------------------------
1619(a) 41.7 0 34.2
----------------------------------------------------------------------------------------------------------------
1619(b) 71.0 0 68.1
----------------------------------------------------------------------------------------------------------------
Medicaid Buy-In 14.2 17.4 15.8
----------------------------------------------------------------------------------------------------------------
Blind Work Expense 3.7 0 3.3
----------------------------------------------------------------------------------------------------------------
Student Earned Income Exclusion 6.6 0 2.8
----------------------------------------------------------------------------------------------------------------
Subsidy Development 0 17.4 20.2
----------------------------------------------------------------------------------------------------------------
Extended Medicare 0 39.0 34.2
----------------------------------------------------------------------------------------------------------------
Other Provisions--Continuing Disability Review Protections are
discussed as an option for a slightly higher proportion of concurrent
and SSDI beneficiaries than for SSI beneficiaries, Expedited
Reinstatement of Benefits were less likely to be presented to SSI
recipients than to the other two groups, and the provision of Property
Essential to Self Support was least likely to be presented to SSDI
beneficiaries, although the overall trends were very similar across all
three benefits groups.
Other Provisions Discussed with Beneficiary by SSA Benefit Status
----------------------------------------------------------------------------------------------------------------
Provision SSI SSDI Concurrent
----------------------------------------------------------------------------------------------------------------
Property Essential to Self Support 6.3 4.3 6.1
----------------------------------------------------------------------------------------------------------------
Expedited Reinstatement of Benefits 17.0 26.4 26.1
----------------------------------------------------------------------------------------------------------------
Continuing Disability Review Protections 13.0 16.7 17.3
----------------------------------------------------------------------------------------------------------------
Section 301 5.0 5.1 6.5
----------------------------------------------------------------------------------------------------------------
Unsuccessful Work Attempt 0 11.5 13.3
----------------------------------------------------------------------------------------------------------------
Anticipated Change in Employment Status--The overall patterns of
anticipated employment status change are consistent across the three
groups; however, there are a few minor differences. Over half of the
beneficiaries in each group anticipated that they would be seeking a
new or supplemental job in the future. A similar pattern was found for
intention to use the Ticket to Work Program to seek a new or
supplemental job. A smaller proportion of SSDI beneficiaries indicated
that they intended to pursue education/training than was true for the
other two groups. Less than two percent of all intensive benefit
services recipients sought planning assistance due to an intention to
cease employment or decrease work hours. It appears that individuals
receiving Intensive Benefits Support clearly intend to enter employment
or improve their employment situation, regardless of the type of
benefit they presently receive from SSA.
Anticipated Employment Status Change by SSA Benefit Status
----------------------------------------------------------------------------------------------------------------
Status Change SSI SSDI Concurrent
----------------------------------------------------------------------------------------------------------------
Intends to seek new job or supplemental job 54.6 55.2 55.7
----------------------------------------------------------------------------------------------------------------
Intends to increase work hours in current job 8.4 7.4 7.8
----------------------------------------------------------------------------------------------------------------
Intends to cease employment 0.3 0.3 0.3
----------------------------------------------------------------------------------------------------------------
Intends to decrease work hours in current job 0.6 1.1 0.8
----------------------------------------------------------------------------------------------------------------
Does not intend to change current employment status 16.8 16.7 15.7
----------------------------------------------------------------------------------------------------------------
Made no decision 19.3 19.1 19.0
----------------------------------------------------------------------------------------------------------------
Intends to pursue education or training 25.8 21.2 27.0
----------------------------------------------------------------------------------------------------------------
No Response 0.1 0.2 0.9
----------------------------------------------------------------------------------------------------------------
Amount of Services Provided--In terms of the amount of services
provided to Intensive Benefit Support recipients, SSI recipients are
slightly more likely to receive less than one hour of service, while
concurrent beneficiaries are least likely to receive less than one hour
of service. Not surprisingly, concurrent beneficiaries are likely to
receive more services than the other two groups. Mean service hours are
2.6 for the SSI group, 2.8 for the SSDI group, and 2.9 for the
concurrent beneficiary group.
Amount of Services by SSA Benefit Status
----------------------------------------------------------------------------------------------------------------
Amount SSI SSDI Concurrent
----------------------------------------------------------------------------------------------------------------
Less than 1 hour 14.8 12.1 10.3
----------------------------------------------------------------------------------------------------------------
1 hour 18.8 15.4 14.2
----------------------------------------------------------------------------------------------------------------
2 hours 22.6 23.6 23.2
----------------------------------------------------------------------------------------------------------------
3 hours 16.0 16.1 16.1
----------------------------------------------------------------------------------------------------------------
4 hours 9.3 10.2 9.3
----------------------------------------------------------------------------------------------------------------
5-9 hours 14.5 17.5 19.7
----------------------------------------------------------------------------------------------------------------
More than 10 hours 4.0 5.2 7.4
----------------------------------------------------------------------------------------------------------------
Information and Referral/Problem Solving Recipients
The second major category of beneficiaries served by the BPAO
Program includes 14,044 individuals receiving ``Information and
Referral'' and/or ``Problem Solving'' only. In this group, virtually
all beneficiaries receive information and referral services, and
approximately a quarter also receive problem solving and advocacy
services. Nearly half of these individuals receive less than one hour
of total service. The average service time for this group is 1.3 hours,
with less than 14 percent receiving three or more hours.
Individuals in the I & R Problem Solving group receive
significantly less service than the Intensive Benefit Support group,
primarily due to the nature of the various services included in each.
Nearly 70 percent of individuals in the I & R/Problem Solving group
receive one hour or less of total service, whereas most of those in the
intensive benefit support group receive one hour or more of service,
with only 12.5 percent receiving less than one hour.
Amount of Services Provided to Persons Receiving I&R Problem Solving
----------------------------------------------------------------------------------------------------------------
Amount Frequency Percent
----------------------------------------------------------------------------------------------------------------
Less than 1 hour 6394 45.5
----------------------------------------------------------------------------------------------------------------
1 hour 3227 23.0
----------------------------------------------------------------------------------------------------------------
2 hours 2481 17.7
----------------------------------------------------------------------------------------------------------------
3 hours 901 6.4
----------------------------------------------------------------------------------------------------------------
4 hours 383 2.7
----------------------------------------------------------------------------------------------------------------
5-9 hours 499 3.6
----------------------------------------------------------------------------------------------------------------
More than 10 hours 159 1.1
----------------------------------------------------------------------------------------------------------------
Total 14,044 100
----------------------------------------------------------------------------------------------------------------
Due to the less intensive nature of the services received by
beneficiaries in this category through the BPAO program, the submission
of some of the data collected from this group was not strictly required
by the program. Therefore, the data that was obtained may not be
completely representative of this group as a whole, and may
underestimate the general trends that exist within the group.
Results suggest that the level of support received did not appear
to vary based on beneficiary demographics. As in the Intensive Benefit
Support group, no differences in sex emerged, and the majority of
beneficiaries were between the ages of 20 and 59, with slightly more
than 13 percent of I & R/Problem Solving recipients falling above or
below this range.
Mental and emotional disorders are indicated as the primary
disability by nearly a third of beneficiaries in the I & R/Problem
Solving group, followed by system diseases and non-spinal cord
disabilities and amputations. The least commonly reported primary
disability categories were sensory impairments and infectious diseases.
Overall, the pattern of primary disabilities indicated in the I & R/
Problem Solving group was very similar to that in the intensive benefit
support group. Nearly eight percent of I & R/Problem Solving group
reported that they require some sort of special language consideration.
Benefits Received--I & R/Problem Solving recipients received a
broad range of benefits. Nearly 80 percent received either SSI or SSDI
only, with a smaller percentage receiving concurrent SSI/SSDI. Nearly
90 percent received either Medicaid or Medicare. In terms of other
benefits, food stamps and subsidized housing were most common in this
group, and Workers Compensation, Veterans Benefit, and unemployment
insurance were least common. It is possible that the data below for I &
R/Problem Solving recipients underreport the number of individuals
receiving SSA benefits; due to the structure of the databases, a small
number of cases contain missing data on this element. Data from the
intensive benefit support group is repeated in several tables in this
section, for the purpose of facilitating comparisons between the two
service groups.
Benefits Received by Type of Services
------------------------------------------------------------------------
I & R/Problem Intensive Benefit
Benefit Solving Support
------------------------------------------------------------------------
Medicare 40.9 55.1
------------------------------------------------------------------------
Medicaid 46.7 60.7
------------------------------------------------------------------------
Private Health Insurance 4.6 6.9
------------------------------------------------------------------------
Subsidized Housing 8.2 16.5
------------------------------------------------------------------------
Food Stamps 12.3 20.8
------------------------------------------------------------------------
TANF 1.3 1.6
------------------------------------------------------------------------
Workers Compensation 0.9 0.5
------------------------------------------------------------------------
Unemployment Insurance 0.4 0.4
------------------------------------------------------------------------
Veterans Benefit 0.9 1.4
------------------------------------------------------------------------
Other 9.9 8.4
------------------------------------------------------------------------
Employment Status--Just over half of all I & R/Problem Solving
recipients indicate that they were not currently employed, but seeking
employment. Eighteen percent of these individuals were employed part-
time, yet only four percent were working full-time. I & R Problem/
Solving Recipients are less likely to be employed part-time and far
more likely to not be employed and not seeking employment than
individuals receiving Intense Benefit Services.
Although over half of the beneficiaries in each of the two
categories indicate that they were currently not employed, but seeking
employment, a greater proportion of individuals in the Intensive
Benefit Support group are currently employed than was true for the I &
R/Problem Solving group. This is true for both full and part-time work.
The proportion of individuals who are not employed and not seeking
employment in the I & R/Problem Solving group is more than twice that
of the Intensive Benefit Support group.
Current Employment Status by Type of Service
------------------------------------------------------------------------
I&R Problem Intensive Benefit
Status Solving Support
------------------------------------------------------------------------
Employed Full-Time 4.1 5.8
------------------------------------------------------------------------
Employed Part-Time 18.1 29.3
------------------------------------------------------------------------
Not Employed, Seeking Employment 53.8 55.7
------------------------------------------------------------------------
Not Employed, Not Seeking 19.7 9.2
Employment
------------------------------------------------------------------------
Anticipated Employment Status Change--Individuals in the I & R/
Problem Solving group are less likely to be seeking employment when
they contact the BPAO. They are for more likely to not have made a
decision regarding their future employment status. Generally, these
individuals are requesting assistance regarding communication from SSA,
seeking information about the Ticket to Work program, or asking a
specific question about their benefit status.
Anticipated Employment Status Change by Type of Service
------------------------------------------------------------------------
I&R Problem Intensive Benefit
Status Change Solving Support
------------------------------------------------------------------------
Intends to seek new job or 38.3 55.0
supplemental job
------------------------------------------------------------------------
Intends to increase work hours 3.4 7.8
in current job
------------------------------------------------------------------------
Intends to cease employment 0.4 0.3
------------------------------------------------------------------------
Intends to decrease work hours 0.4 0.9
in current job
------------------------------------------------------------------------
Does not intend to change 13.3 16.5
current employment status
------------------------------------------------------------------------
Made no decision 43.7 19.3
------------------------------------------------------------------------
Work Incentives Recommended for Consideration--A variety of work
incentives have been discussed with for the I & R/Problem Solving
recipients; a Trial Work Period and subsequent Extended Period of
Eligibility were presented most frequently, along with Impairment
Related Work Expenses and Section 1619(b). As would be expected,
benefits specialists discuss far fewer incentives with individuals
receiving I & R/Problem Solving services, since a detailed knowledge of
the individuals specific situation is required before the benefits
specialist can provide customized information on a range of incentives.
Work Incentives Recommended for Consideration by Type of Service
----------------------------------------------------------------------------------------------------------------
Incentive I & R/Problem Solving Intensive Benefit Support
----------------------------------------------------------------------------------------------------------------
TWP 35.5 55.6
----------------------------------------------------------------------------------------------------------------
EPE 32.4 53.1
----------------------------------------------------------------------------------------------------------------
PASS 16.3 25.0
----------------------------------------------------------------------------------------------------------------
IRWE 31.2 49.1
----------------------------------------------------------------------------------------------------------------
1619 (a) 12.6 20.9
----------------------------------------------------------------------------------------------------------------
1619 (b) 25.0 39.0
----------------------------------------------------------------------------------------------------------------
Medicaid Buy-In 9.6 16.0
----------------------------------------------------------------------------------------------------------------
Blind Work Expense 2.5 3.1
----------------------------------------------------------------------------------------------------------------
Student Earned Income Exclusion 3.0 3.2
----------------------------------------------------------------------------------------------------------------
Subsidy Development 5.5 15.0
----------------------------------------------------------------------------------------------------------------
Extended Medicare 15.2 26.2
----------------------------------------------------------------------------------------------------------------
Ticket to Work Rollout States
Of the 27,502 total beneficiaries, 9,583 (34%) were in the 13
states included in the first phase of implementation of the Ticket to
Work Program. Within those states, the Ticket was presented as a
provision to 47.2 percent of I & R/Problem Solving beneficiaries and to
42 percent of Intensive Benefit Support beneficiaries. Nearly a third
of the I & R/Problem Solving group and just over 20 percent of the
Intensive Benefit Support group responded to Ticket to Work
communication from SSA as a reason for seeking services from the BPAO
Program. Nearly a quarter of the I & R/Problem Solving group and almost
30 percent of the Intensive Benefit Support group indicated that they
intended to use the Ticket program to seek a new or supplemental job.
It seems apparent that in the Ticket to Work impacted BPAO in at
least two ways. First, the Ticket program creates a considerable demand
for BPAO, accounting for over one third of all beneficiaries accessing
BPAO services. Second, large numbers of beneficiaries in these states
are indicating a desire to use the Ticket to obtain a new or
supplemental job, requiring the BPAO to provide Intensive Benefit
Support services.
Chairman SHAW. Thank you. Ms. Satterfield?
STATEMENT OF MARY SATTERFIELD, PROJECT DIRECTOR, MAXIMUS
PROGRAM MANAGER, TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM,
ALEXANDRIA, VIRGINIA
Ms. SATTERFIELD. Thank you, Mr. Chairman.
As you know, I represent MAXIMUS, who has the program
manager contract with the Social Security Administration to
administer the Ticket program. As the Ticket to Work program
manager, we function as a trusted agent of the Social Security
Administration. They retain program authority. They decide
Ticket eligibility, schedule the roll-out phases, schedule the
graduated delivery of tickets during the roll-out phases,
propose regulations, create and interpret policy, and actually
approve the providers who have applied to become Employment
Networks.
As the program manager, we actually execute all tasks that
are critical to the operation of the program, and that includes
serving as a centralized information source, marketing the
Ticket to Work program to providers and recruiting them to
participate, facilitating that link between the beneficiaries
and the Employment Networks, providing training to a variety of
stakeholders, developing and maintaining a very secure and a
robust information technology system, collecting program data,
which we share with the evaluation contractors and Social
Security, and reviewing all EN requests for payment.
All aspects of the initial startup for Ticket went very
smoothly. This included a very complicated undertaking of a
systems link with Social Security Administration, via which we
at the Program Manager site, exchange information necessary to
the operation of the program with SSA on a daily basis.
Additionally, the start-up of the national call center, which
has been operational since March of last year, went very
smoothly, and to date we have logged over 150,000 calls, the
bulk of which were received after the tickets began to go out
in February.
We commenced our marketing and recruitment campaign
immediately and very aggressively after the release of the
first EN request for proposal, back in April of last year. This
included in-person meetings, presentations at conferences,
exhibits at large disability-related events, targeted mailing,
phone call campaigns, e-marketing strategies, and any other
method that we could think of that would represent an
opportunity for us to get the word out to providers.
Our marketing team makes presentations about Ticket to
dozens of different events every month, including the
recruitment conferences that we host in conjunction with the
administration. To date we have done over 50 of those, covering
the Phase I and Phase II States, and we are planning almost 40
again for next year.
We have made well over 100,000 different marketing contacts
to a broad variety of traditional and nontraditional providers
throughout the country, including employers and educational
institutions.
Although our marketing effort has obviously not been
without challenges, we are encouraged by the 542 applications
we have received to date, and this includes several providers
who have elected to cover all of the States in the country. The
Administration has already formed contracts with 438 of those
providers, and they are on board as ENs, and the remaining
applications are in the review process and should be approved
very soon.
Last year our recruitment efforts were particularly
hampered by provider dissatisfaction with the proposed payment
system, and certainly the more robust payment system that was
presented in the final regulations was very positively
received, and then additionally the release of tickets that
occurred in February also served as a catalyst for this very
market-driven program. However, we continue to find that
providers remain focused on concerns about sufficient start-up
capital, and while there are always various marketing and
recruitment challenges that are specific to each State, these
financial concerns traverse State boundaries, impairment groups
served and affiliations for the providers.
We know this program represents tremendous change for
beneficiaries and providers. Transitioning providers from what
is a very deeply rooted fee-for-service mindset to the outcome-
based concept of the Ticket to Work Program is taking a lot of
time. Providers continue to be reluctant to actively
participate in the program because they might not be able to
afford the up front costs of providing services, or because
outcomes are far from certain, or they may have to wait a
substantial period before payments based on outcomes will be
received.
Ticket is a new way of doing business for them. They must
become accustomed to the idea of forming partnerships and
sharing risk, as well as receiving clients who have not been
prescreened. While beneficiaries have been overwhelmingly
optimistic and positive about the opportunity that Ticket
presents for them, they too remain fearful of ultimately going
off of benefits. Ticket is a mindset change for them as well.
On behalf of the Program Manager and the staff that are
working on the project, we are encouraged by early success
indicators such as the number of tickets assigned, which is
almost 7,500 to date, the number and mix of providers that are
participating and the number of payment requests that we have
received so far, which is somewhere between 80 to 90. We
continue to focus strongly on recruitment and supporting the
ongoing needs of both the ENs and the beneficiaries. We thank
you for this opportunity to speak with you today.
[The prepared statement of Ms. Satterfield follows:]
Statement of Mary Satterfield, Project Director, MAXIMUS Program
Manager, Ticket to Work and Self-Sufficiency Program, Alexandria,
Virginia
LProgram Manager's Briefing on the Ticket to Work Program
Implementation
As the Ticket to Work Program Manager, MAXIMUS functions as a
trusted agent of the Social Security Administration (SSA). SSA retains
Program authority, decides Ticket eligibility, schedules the roll out
phases and the graduated delivery of Tickets during each roll out
phase, proposes regulations, creates and interprets policy, and
approves providers to become Employment Networks (ENs). The Program
Manager executes all tasks critical to the operational administration
of the Program, including:
LServing as a centralized information source for
beneficiaries, Employment Networks (ENs), and the general
public, primarily through our nationwide toll-free call center;
LMarketing the Ticket to Work concept to service
providers and recruiting them to participate as ENs;
LFacilitating the link between beneficiaries and ENs;
LProviding training to a variety of customers
including ENs;
LDeveloping and maintaining a secure and robust
information technology (IT) system;
LCollecting Program data; and
LReviewing EN requests for payment.
All aspects of the initial start-up for Ticket went very smoothly.
This included the complicated undertaking of a systems link with SSA
via which we exchange information necessary to the operation of the
Program on a daily basis, as well as the start up of the national call
center, which has been operational since March 2001. To date we have
logged over 150,000 calls, almost 90 percent of which were received
after the release of the fist Tickets.
We commenced the marketing and recruitment campaign immediately and
aggressively after the release of the first EN Request for Proposal
(RFP) in April 2001. This included in-person meetings and presentations
at conferences, exhibits at large disability related events, targeted
mailings, phone call campaigns, e-marketing strategies, and any other
method that represented an opportunity. Our Marketing team makes
presentations on Ticket to Work at dozens of events every month,
including the recruitment conferences MAXIMUS hosts in conjunction with
SSA, numbering 50 to date throughout the Phase I and Phase II states,
with an additional 35-40 planned for next year. To date, we have made
well over 100,000 marketing contacts with a broad array of traditional
and nontraditional providers including employers and educational
institutions.
Although the marketing effort has not been without challenges, we
are encouraged by the 542 applications received from providers,
including several providers serving all states. SSA has already
contracted with 438 ENs, and the remaining applications are currently
in the review pipeline and we expect them to be approved soon.
Last year, recruitment was particularly hampered by provider
dissatisfaction with the proposed payment systems. Certainly, the more
robust payment system presented in the final regulations was positively
received. Additionally, the release of Tickets in February served as a
catalyst for this market-driven Program. However, we continue to find
that providers remain focused on concerns about sufficient start up
capital, and while there are always various marketing and recruitment
challenges specific to each state, these financial concerns traverse
state boundaries, impairment groups, and affiliations.
We know this Program represents tremendous change for beneficiaries
and providers. Transitioning providers from what is a deeply rooted
fee-for-service mindset to the outcome-based concept of Ticket to Work
is taking time. Providers continue to be reluctant to actively
participate in the Program because they may not be able to afford the
up front costs of providing employment services, either because
outcomes are far from certain or they may have to wait a substantial
period of time before payments based on outcomes are received.
Ticket is a new way of doing business for them. They must become
accustomed to the idea of forming partnerships and sharing risk, as
well as receiving clients who have not been pre-screened. And while
beneficiaries have been overwhelmingly optimistic and positive about
the opportunity Ticket presents, they remain fearful of ultimately
going off benefits. Ticket is a mindset change for them as well.
We are encouraged by early success indicators such as the number of
Tickets assigned, the number and mix of providers participating, and
the number of payment requests received. We continue to focus strongly
on recruitment and supporting the ongoing needs of both ENs and
beneficiaries.
STATEMENT OF CHARLENE DWYER, ED.D., DIVISION ADMINISTRATOR,
DIVISION OF VOCATIONAL REHABILITATION, WISCONSIN DEPARTMENT OF
WORKFORCE DEVELOPMENT, MADISON, WISCONSIN
Dr. DWYER. Good afternoon. Thank you from Wisconsin.
How did the Ticket roll-out fare? As of last week, we had
about 1,200 assignments of tickets in Wisconsin. Wisconsin has
the highest percentage of ticket assignments, based on the
mailing that was made, of the 13 roll-out States.
I think a more interesting question is how much new
interest has been stimulated by the mailing? If we look at who
our current customers were at the time of the mailing and how
many new customers we generated as a result of the mailing, we
can attribute about 300 new customers to the ticket mailing.
That is about two-tenths of 1 percent of the mailing.
Where are the Ticket holders in Wisconsin assigning their
tickets? We have about 1,200 tickets assigned. Ninety-six
percent of those have been assigned them to the Wisconsin VR
Agency.
Why such a high percentage of tickets to the VR Agency?
Well, in Wisconsin, we know that about 70 percent of the people
who have assigned tickets were our current customers when they
received the ticket and chose to assign the ticket to us. We
also know that we had a very positive response in our call
center where we took over 1,000 phone calls, and where we gave
a very positive message about the ticket and the benefits of
the ticket. We offered benefits counseling to every caller, if
they would like to engage in benefits counseling, and we think
that drove up the number of ticket assignments as well. As well
as the fact that we answered our phones. We did hear that
toward the end of the rollout period there were some ENs that
weren't answering their phones. We answered every phone call.
We also know that we had EN providers in Wisconsin
referring ticket holders to us after they conducted their risk
assessment. They just couldn't afford to take the ticket from
the caller, and they referred those individuals to us. We told
EN's that referrals were fine. We will turn around and buy the
services from an EN if the EN is the preferred provider for
that individual.
What needs to be improved? We are going to take on the
ticket referrals, the higher-risk ticket holders from the EN
referrals. We are willing to do that. That is our role and we
are willing to serve those individuals. We are a unemployment
benefits agency that rolled out under ``cost reimbursement.''
We are going to be moving into an outcome payment system by the
end of the year, but right now we are still engaged in cost
reimbursement. We would like to know that if we do the job, if
we meet the goals, if we help that customer achieve the ticket
outcomes, that we can be paid. There are some disconnects in
the current final rules that can prevent us from being paid
even when the outcome is clearly attached to our services. If
the ticket gets moved and another EN places the claim under a
milestone claim, our claim can be trumped. In that case, we get
no reimbursement. Under our standard cost reimbursement, we
also have no recourse for appeals with SSA.
So, we would like to see some changes in the cost
reimbursement system from SSA.
Why is it important? Because last year in a 12-month
period, we earned, for our successes, $1.64 million in SSA cost
reimbursement. We took 700 people off of our wait list with
those funds. We are a State, as all other States are, that is
entering into some very hard economic times at the State budget
level. We do know if we are not able to recover for our
successes--and I am talking about recovering for the outcome
work that we do--that we will have a longer wait list in our
State. We have a wait list now, and we anticipate it will get
longer.
We believe these outcome payment glitches can be worked
out. We would like to continue to focus on the benefits of the
Ticket to the Ticket holder and less on cost recovery and
assignment of tickets. Thank you.
[The prepared statement of Dr. Dwyer follows:]
Statement of Charlene Dwyer, Ed.D., Division Administrator, Division of
Vocational Rehabilitation Wisconsin Department of Workforce
Development, Madison, Wisconsin
Thank you for the invitation to share our Ticket to Work rollout
experience with you today.
In the next five minutes I'll pose and answer 7 questions to help
you understand the impact of the Ticket to Work in Wisconsin from a
public agency's perspective.
1. In general, how did the Ticket roll out fare in Wisconsin?
Early measures of success in the roll out are whether Ticket
Holders elected to use their Tickets and where they are assigning those
Tickets. Another measure is whether the Ticket mailings are stimulating
``new'' return to work interest among the target group.
As if last week Friday (9/20/02), Maximus reported that with more
than 2 million Tickets delivered across 13 roll out states, 6,471 (or
.3%) had been assigned.
With .8% of available tickets assigned, Wisconsin is the state with
the highest percentage of Ticket assignments of any of the 13 roll out
states. (126,449 Tickets mailed; 1,113 assigned in Wisconsin)
2. How much ``new'' interest has been stimulated by the mailing?
Based on our historical application patterns for the target group
and the activity in our Ticket to Work Call Center, about 300 new
applications from Ticket holders might be credited to the Ticket
mailing. We did hear from some callers that they had never heard of DVR
before they received the Ticket mailing. Others had been our customers
in the past, but the mailing stimulated their interest in ``trying
again''.
In the big picture of the statewide mailing of over 126,000
Tickets, 300 individuals responding to the point of applying for
services and assigning a Ticket equates to a .02% ``new business''
rate.
3. Where are Ticket Holders assigning their Tickets?
96% (1,069) of the Wisconsin Ticket holders who elected to use
their Tickets assigned them to the DVR. As of September 20th, only 44
Tickets were assigned to one of the other 20 ENs serving Wisconsin.
4. Why such a high percentage of Tickets to VR?
Some preliminary answers:
Ticket recipients were already our customers (69% were already
working with us prior to receiving their Ticket) or would have become
our customers regardless of receiving the Ticket in the mail (SSA
recipients were 15.4% of our customer base).
We have 650+ SSA beneficiaries engaged in an SSA work incentive
demonstration in our State called ``Pathways to Independence''. During
the past 4 years, the DVR has funded a statewide network of return to
work benefits specialists who provided information on the ``added
value'' features of the Ticket to consumers in our demonstration. We
were able to ``prime the pump'' so to speak in Wisconsin--at least for
that demonstration group.
We know that some EN providers have referred Ticket holders to us
after they received a request from a Ticket holder and following their
outcome payment risk assessment.
The EN decided that either the risk of achieving the outcome, or
the cost to serve the individual was too high. In short, based on the
current outcome payment system, they couldn't afford to take the
Ticket.
VR is the only Ticket services provider that will not reject a
Ticket holder. Wisconsin DVR annually spends $35-40 million for the
purchase of rehabilitation services from the private sector. We have
asked our EN partners who decided not to take a Ticket to give a
positive message to Ticket holders and send them to us. We can simply
buy services from the EN if the Ticket holder wished to receive
services from them.
Initial conclusion for Wisconsin VR
In the roll out period, we were very prepared, and have been
extremely ``underwhelmed'' by the response from Ticket holders.
Conversely, we have been somewhat ``overwhelmed'' by the additional
administrative requirements for collecting the Tickets and getting them
assigned. Instructions for claiming the Ticket have been ``varied and
evolving'' since January. This has added to the confusion and
complexity of getting this program off the ground in our agency.
6. What needs to be improved?
If we are to take on the higher cost and riskier Ticket business
that other EN's refuse--and we are willing to do so--we need a more
equitable system of SSA payment. We only want to be paid when we are
clearly responsible for assisting Ticket Holders in achieving
employment goals that satisfy the Ticket to Work requirements.
Under our traditional ``cost reimbursement'' recovery--SSA ``pays
us back'' in full for the costs associated with the rehabilitation
plan. You might think of these funds as SSA's community reinvestment
funds--or better yet employment reinvestment funds.
In a recent 12-month period we recovered $1.64 million for our SSA
successes--sufficient funding to take 700 people off of our wait list
for services!
When we provide successful rehabilitation services under our
regular cost reimbursement system, the Ticket works well for us when
the consumer
LDecides to use the Ticket and assign it to us
LDecides to assign it to another EN who has an
agreement with us (we have many EN agreements and have not
qualms about sharing the Ticket challenge and payments with our
private sector partners).
The Ticket does not work for us when
LThe consumer uses our services, but then assigns the
Ticket elsewhere with an EN that has refuse an agreement with
us, effectively preventing us from claiming any portion of the
reimbursement.
Under the final rules, when DVR chooses cost reimbursement,
1. An EN can refuse an agreement arrangement
2. The consumer can reassign the Ticket to an EN that can claim
reimbursement after 1 month of SGA activity--under cost reimbursement
VR has to wait for 9 months of SGA activity. An EN can ``trump'' the
claim.
3. VR receives $0 recovery if an EN places the claim first
4. VR has no appeal recourse with SSA.
According to the final regulations--reports from the CBO stated
that the Ticket to Work Program would ``. . . partially displace the
current cost reimbursement program''.
Apparently the final rules are based on ``cost savings to SSA''
without regard for how the SSA reimbursements are ``reinvested'' into
future rehabilitation efforts for the ``next'' customer--perhaps
someone on a wait list.
7. What would work better for an agency electing the cost reimbursement
payment system?
When a VR agency can demonstrate that services provided led to the
desired employment outcome, the agency should:
a. be able to submit claims and recover their cost under the
traditional cost reimbursement as the stand-alone program it was
intended to be--when there is not another EN in the mix.
b. be put on an equal footing with other ENs and be able to appeal
a reassigned ticket claim with SSA if the Ticket is reassigned to an EN
who refuses an agreement, and the VR services and costs are clearly
related to the successful employment outcome.
Why is it important to make these changes in the cost reimbursement
system for the VR agencies?
Because of the reinvestment value of the SSA cost reimbursement.
Wisconsin currently has a wait list for services. We already have
several hundred people and it is growing.
We are facing our next round of very significant state budget
reductions (as most states are).
Lost SSA cost reimbursements for our successes will mean that our
wait list will be longer.
We believe that SSA and RSA can successfully work together to
eliminate the major stumbling blocks so that we can concentrate less on
Ticket assignment procedures and cost recover glitches and more on
selling the benefits of the Ticket to the Ticket holder.
Thank you.
Chairman SHAW. Thank you, Dr. Dwyer. Mr. O'Brien?
STATEMENT OF DAN O'BRIEN, MPA, PROGRAM MANAGER, TICKET TO WORK
AND COMMUNITY REHABILITATION, OKLAHOMA DEPARTMENT OF
REHABILITATION SERVICES, OKLAHOMA CITY, OKLAHOMA
Mr. O'BRIEN. My name is Dan O'Brien. Thank you, Chairman
Shaw and Ranking Member Matsui and Members. I am with the
Oklahoma Department of Rehabilitation Services. I am the
Program Manager for Ticket and Community Rehabilitation.
To give you a sense of what is going on in Oklahoma, we
have had just about 100,000 tickets mailed out. We looked at
our caseloads before they went out. Eighteen percent of our
caseloads were already Social Security customers, which was
4,000 out of 22,000. We have had about 1,500 ticket calls to
our ticket hotline. We set up a hotline to make sure there was
access to services and the phone would be answered. We have had
Outreach meetings at the One-Stops, where we provide work
incentive training to the Social Security beneficiaries, so
that they understand what will happen to their benefits before
they get involved.
I guess we were asked because we are the big user of the
milestone payment system, and that is because in 1992 we
developed the milestone payment concept for contracting out as
a way of risk sharing and improving outcomes. I was a co-
designer of the original milestone system. It has been imitated
in a lot of States, and I think it was suggested as a way for
Employment Networks to be able to take on the risk as opposed
to the outcome system, and that is proven to have been the case
as, if I am reading it correctly, two out of three of the
tickets assigned to Employment Networks are under the milestone
system so that they apparently do feel like it obviates the
risk to their programs.
I want to just highlight a couple of my comments. The
Ticket assignment rate, at this time 6,000 sounds like a lot or
7,000, but that is one-third of 1 percent. Based on our
experience and from what I understand from Social Security you
would have to have a multiple of that to get to the goal that
Susan Daniels, Martin Gerry's predecessor, set of one-half of 1
percent going off rolls, you would have to have a multiple of
one-half of 1 percent assigning their tickets. I think the
multiple would be at least 10 to 1. I understand under Social
Security existing work incentive programs it is more like 14 to
1, the rate of people who engage in work activity and actually
go off benefits. So, that would mean a ticket assignment rate
of about 7 percent would be needed to get half of 1 percent off
the rolls.
At one-third of 1 percent we have a long way to go. I think
that represents some access problems in the system that need
addressed, and the two recommendations that I would have from
the frontline would be to reduce the penalty--and this mainly
affects ENs, other than VR--reduce the penalty for choosing the
milestone payment system. The penalty now is a 15 percent
penalty. They only accrue 85 percent of the funds that they can
under the outcome system. That, in a lot of people's opinion,
was intended to discourage use of the milestone system, which
from the EN's activity appears to be the one that they think
can work. Reduce that penalty to 5 percent instead of 85
percent, and then distribute those funds among the milestone
payments not in the outcome payments. That would make a system
that would lower the bar for getting in the front door, which
is one of the issues with an Employment Network. They have to
make a risk assessment whether this person is likely to be paid
for.
The other thing is that several people have mentioned--
there needs to be a marketing triumvirate: benefits planning,
outreach and Employment Support Representatives. Those three
pieces, for this to work, have to work in conjunction. I think
the outreach, the O in BPAO has not been funded. Actually, the
BP hasn't been well funded either. Benefits planning is way
inadequately funded, but the outreach part hasn't been funded
at all, and that could be done through the one-stops, and
Martin Gerry, I think is working on that with the other
agencies. That is to be commended.
The zero cash benefits. Making the payments contingent on
zero cash benefits I think is a mistake. That makes Social
Security beneficiaries with the one for two undesirable
customers under the Ticket, and if the one for two is extended
to SSDI, it would put the entire Ticket out of business,
because right now the research is that SSDI beneficiaries are
the only ones that make sense to take a Ticket on because of
the cash cliff, because at that point you can be paid. With a
one for two write-down, there will be nobody who will be
desirable. So, that problem has to be addressed. My suggestion,
as a number have suggested is a strategy of partial self-
sufficiency, making payments based on a percentage of benefits
not payable, not necessarily going to zero benefits. If some
benefits aren't payable, a percentage can be paid out.
The roll-out was too aggressive, this will be a particular
problem for California. This is going to be a problem. It needs
to be stretched out a little bit, either 10 percent a month or
10 percent the first 2 months, 20 percent for 4 additional
months. It was the 30 percent and the 40 percent months that
really killed us, and it is going to murder California and
Texas.
The only other thing, I submitted a statement from
Connecticut Rehabilitation. There is a lot of concern about
absorbing the reimbursement system into the ticket system. I
think that sets up the problem the Chairman asked about
earlier, of VR looking at this as antagonistic. If that could
be changed, that would reduce that. Thank you.
[The prepared statement of Mr. O'Brien follows:]
Statement of Dan O'Brien, MPA, Program Manager, Ticket to Work and
Community Rehabilitation Oklahoma Department of Rehabilitation
Services, Oklahoma City, Oklahoma
Chairman Shaw, Ranking Member Matsui and members of the
subcommittee, thank you for asking the Oklahoma Department of
Rehabilitation Services to share it's experience as one of the 13
initial rollout states for the Ticket to Work. My name is Dan O'Brien;
I am the Program Manager for the Ticket to Work for the Oklahoma DRS,
the State Vocational Rehabilitation and Visual Services Agency.
Oklahoma's Experience with the Ticket--Just the Facts
LTickets mailed--99,915
L4,000 existing SSA cases (18% of DRS caseload)
LTicket Hotline Calls--1456 calls (1.5% of Tickets
mailed)
LOutreach/Ticket Orientation Meetings at One Stops--
100+
LOK Tickets Officially Assigned as of 9/10/02--462
LAbout 92% of all OK tickets assigned have gone to VR
LNew applications for services from Ticket--150+
LIn over 50% of OK DRS Ticket cases Milestone/Outcome
payment system was chosen, the remainder are traditional
reimbursement.
LOK DRS is the VR leader in Ticket Milestone System,
OK DRS had 90% of all VR Agency Milestone Cases nationally on
8/12/02.
LCounselors are recommending the Milestone system be
used instead of traditional reimbursement if they determine the
beneficiary is not likely to go off benefits or the case cost
is projected to be low.
L90 of 254 Milestone cases had some work activity
since Ticket issued, only 13 worked above SGA (14%).
LMilestone claims billable on the 13 beneficiaries
working over SGA worth about $5000 as of 9/23/02.
The Oklahoma Ticket Model (see attachment A)
Oklahoma DRS designed the Milestone Payment system in 1992 as a
method for sharing risk and improving service outcomes. It has been
widely imitated and was a finalist in the 1997 Kennedy School of
Government Innovations in American Government awards. As a result of
the success of the Milestone system it was included in the Ticket
legislation. In 1998 we were the recipients of a 5 year SSA State
Partnership Initiative Grant to pilot an assertive engagement/outreach
system for a vocational voucher system.
In 2001 we developed a Ticket implementation model based on our SSA
SPI grant assertive engagement/outreach model. The Oklahoma Model
involves specially trained outreach staff working through the One Stop
system, who conduct work incentive training, make referrals to the BPAO
and expedite the application and eligibility.
General Comments and Recommendations:
Comment #1: The low Ticket assignment rate, as of September 2002,
\1/3\ of 1%, is a red flag that there may be substantial barriers to
service access. In order for the stated goal of \1/2\ of 1% of the
Ticket holders to leave the rolls a substantial multiple of that figure
will be needed in entries to the program. I have been told that the
current ratio of employment effort to exits is 14 to 1, thus at least
7% assignments would be needed. One of the barriers to access is the
high level of risk that EN's must accept, the milestones were meant to
obviate some of this risk. The 15% reduction in total ticket payments
available for the milestone/outcome over the straight outcome payments
seems excessive. Another barrier is fear, misunderstanding and
mistrust. Assertive engagement and outreach techniques are needed to
increase participation.
LRecommendation #1.1: Reduce the penalty for choosing
the milestone/outcome system from 15% to 5%. Therefore, the
total payment for the milestone/outcome system would be 95%
rather than 85% of the total funds available under the outcome
only system. In addition invest all of that addition money in
increasing the milestone payments. See attachment B for
details.
LRecommendation #1.2: Fully fund an Outreach effort
that has three prongs, the Benefits Planning Grantees (BPAO),
the ESR and an Outreach effort that has a local presence in the
Comprehensive One Stops. Engage DOL and the One Stop system in
funding and implementing an Assertive Outreach effort. See
attachment C, for details.
Comment #2: The focus on going off benefits as opposed to a goal of
increasing self-sufficiency misses the big savings to SSA. The sole
focus on leaving the rolls does not recognize the reality that many SSA
beneficiaries take a series of steps, each time increasing their work
activity, leading to leaving the rolls over a period of years. An all
or nothing strategy makes these customers undesirable to EN's and
generally discourages participation from EN's by raising their level of
risk unreasonably high. See attachment B for detail.
LRecommendation #2: Implement a partial self-
sufficiency return to work strategy. Milestone and outcome
payments should be paid as a percentage of benefits not
payable. When partial cash benefits are paid to the
beneficiary, the milestone and outcome payments would be based
on a percentage of benefits not payable. For administrative
simplicity a two tier payment structure could be implemented, a
lower milestone and outcome payment at the Trial Work level and
the full milestone and outcome payment at SGA. (See Attachment
B).
Administrative Issues:
Comment #3: Rollout schedule was too aggressive--SSA sent Tickets
out over 5 months--10% the first month, 20% the third month, 30% the
fourth month and 40% the fifth month. The fourth and fifth months were
difficult to keep up with phone calls and created a lag in determining
eligibility that took several months to clear up.
LRecommendation #3: Consider either a ten month 10%
per month rollout or a six month rollout, 10% first two months
and 20% the last four months. This will allow the larger states
particularly Texas and California to manage the increase in
applications.
Comment #4: The procedure for confirming whether a Ticket is
assignable is cumbersome. OK DRS had about 4,000 SSA beneficiaries on
caseloads when the Ticket program began. To confirm whether a Ticket
was assignable DRS staff had to call or fax in a list of names to
Maximus. Maximus staff initially refused to take lists longer than 20
names. Ultimately DRS staff were told they could no longer fax in lists
and had to read hundreds of names to the Maximus staff over the phone.
This verbal only system is not a particular burden for an EN building a
caseload one client at a time, but for a state agency with thousands of
SSA customers it is a huge burden.
LRecommendation #4: Allow states to electronically
submit lists of existing customers with SSN's before the mail
out so that they can be alerted to those who are expected to
have a Ticket mailed.
Comment #5: DRS Ticket Unit staff report that some Maximus phone
staff are lacking in English proficiency, making the aforementioned
hours of phone confirmation take two or three times longer than
necessary.
LRecommendation #5: Verbal English proficiency should
be a requirement for Maximus phone staff.
LConcern from Peter Baird, Connecticut Bureau of Rehabilitation
Services shared by many of the Rehabilitation State Agencies
We have significant concerns regarding ticket assignment procedures
for a ``new case.'' New cases are defined by Social Security as those
individuals who sign an IPE after becoming eligible for the ticket. SSA
has determined that for a ``new case,'' a State VR Agency will need to
have the ticket assigned to receive either cost-reimbursement or one of
the new EN outcome payments. (Section 12.2B)) SSA considers the
signature on the IPE to be an indication that an individual has decided
to use the ticket to obtain services from the State VR Agency. As a
result, a State VR agency is allowed to have the ticket assigned to
them for a ``new case'' even when the person does not sign the Ticket
Assignment Form. Section 12.10(C) states:
If the beneficiary (or the beneficiary's representative) does
not sign the form, submit the unsigned form, with the front (or
cover) page and last (or signature) page of the IPE, to
MAXIMUS.
We have two concerns regarding the issues above, and are seeking
guidance from RSA on these matters.
1) SSA has subsumed the traditional cost-reimbursement system under
the Ticket to Work Program for all ``new cases.'' SSA has verbally
cited that the basis for this opinion can be found in section 101(b) of
The Ticket to Work legislation. We do not believe that this is the
intent of the legislation, and we are unaware of any authority SSA has
to subsume the cost-reimbursement system under the Ticket to Work
Program, thereby making reimbursement contingent upon ticket
assignments. We also believe that the provisions allowing for
reimbursement for non-ticket holders and for pipeline cases demonstrate
that the reimbursement program is in fact separate from the ticket
program.
2) We have significant concerns regarding confidentiality. SSA has
stated that the Ticket Assignment form and IPE can and should be
submitted to Maximus without the consumer's explicit signed consent. We
believe that the principles of confidentiality, informed choice and the
Ticket legislation's principles of ``voluntary assignment'' (see
Chapter 12.1 (B)) are violated by the assignment of Tickets without a
consumer's explicit consent. We do not believe that we have the
authority to share the IPE with Maximus without the consumer's explicit
consent.
______
Attachment A.
LOklahoma DRS and Workforce Oklahoma Collaboration on Ticket to Work
(aka ``THE OKLAHOMA TICKET MODEL'')
In Oklahoma, 100,000 SSI/SSDI recipients received a Ticket to Work
from the Social Security Administration between February and July 2002.
Recipients were instructed to call the program manager, Maximus for
Employment Networks in their local area. The DRS asked that Maximus
only give out the Ticket Unit toll free number for the OK DRS Ticket
Unit (866) 882-4515. The toll free number is staffed by Rehab
Technicians who are trained on SSA work incentives by the Benefits
Planning Assistance and Outreach contractor (BPAO), the Ticket and VR/
VS services. The callers are invited to a Ticket Orientation meeting at
the One Stop where detailed work incentive information is presented at
the meeting or individually using WorkWorld software at the One Stop.
The presentation uses a simple scenario based PowerPoint slide show,
developed by OK DRS specifically to answer the two main customer
questions ``what will happen to my benefits if I go to work'' and ``how
can VR help me accomplish my career goals.''
Purpose of the Ticket Unit
1) Inform Ticket Holders about VR services and available Work
Incentives so that they can make an informed choice to pursue
employment.
2) Expedite application and eligibility determination for Ticket
customers.
3) Increase SSA reimbursement by creating follow-along caseloads of
closed (26) cases that are eligible for reimbursement or milestone
payments from SSA.
Procedure:
1) When the Ticket Holder calls the DRS Ticket Hotline their call
will be routed to the Ticket Unit in OKC. They will be offered an
opportunity to attend a three-hour orientation session on the Ticket
and VR services. One-Stop staff will also invite Ticket holders to the
Ticket Orientation sessions who call or come to the center. Sessions
are scheduled at all the Comprehensive One-Stops on a regular basis.
2) The Ticket Orientation will cover the Ticket, VR services
available and a brief overview of Social Security Work Incentives. The
orientation is not required; it is intended as a step in the Ticket
holder making an informed choice of employment service provider. Ticket
holders who wish to immediately apply for VR services will be directed
to the local DRS office.
3) The One-Stop will have Work World available in their resource
room. The Work World program allows consumers to enter several work
scenarios into the computer and advises them on the use of work
incentives.
4) At the end of the presentation consumers will have an
opportunity to apply.
5) The Ticket Unit Tech III or the assigned local staff will take
an application. The Ticket Unit VR Counselor IV, will review the
documentation and determine the customer eligible within 3-5 working
days following the application.
6) The case will be referred back to the local counselor after
eligibility determination. The home counselor will obtain the Ticket
from the beneficiary when the IPE is signed, keep the original and fax
a copy to Ticket unit.
7) When the case is moved to an employed status (status 18 for SE
and 22 for all others) the Ticket unit will be alerted by ORMIS. After
26 closure a Ticket Unit Tech III will begin tracking the case until
all SSA reimbursement is submitted.
Questions: email Dan O'Brien at [email protected] or
[email protected]
______
Attachment B.
LExample of a Ticket Scenario that Addresses a Number of the Equity of
Access Issues
Prepared by Dan O'Brien, Ticket Program Manager OK Dept of
Rehabilitation Services
Potential Breakeven scenario for SSI recipients
If the intent of the Ticket is to create a breakeven scenario for
the SSA then SSI must be considered separately from SSDI, as the
baseline assumptions are different. At least until a 2 for 1 work
incentive system is in place for SSDI.
Specifically, savings accrue, i.e., some benefits are not payable,
from any SSI work activity that exceeds $85 per month. This allows a
breakeven scenario for SSI based on payment of Milestone and Outcome
payments as a percentage of the benefits not payable due to work
activity.
The chart below reflects a recommendation that the total payments
available under the Milestone/Outcome system be increased from 85% to
95% of the Outcome only system. This increases the total payment (2002
figures) available under the Milestone system from $9,720 currently to
$10,887. The additional $1167 is distributed evenly among the milestone
payments in this example. The payment threshold is set at the Trial
Work level, $560 for 2002, for the first three milestone payments, to
allow Ticket holders to work up to SGA. The dual level of Outcome
payments recognizes the reality that some beneficiaries will not
achieve SGA but SSA will accrue savings. This involves a slightly
higher level of risk sharing on the part of SSA but still results in
savings to SSA from a partial reduction of benefits scenario rather
than the ``0'' benefits level and overall could lead to substantially
higher cumulative savings.
Two payment tiers are envisioned for the two levels of significant
work activity recognized and tracked by the Social Security
Administration, the Trial Work (TW) level, currently $560/mo. and the
SGA level, currently $780/mo. For the lower TW level the last Milestone
payment would not be paid until achievement of SGA. This withholding of
funds would serve as an incentive for EN's to boost work hours to the
SGA level at the appropriate time. When a higher level of work activity
was achieved an additional Milestone payment would be paid and a higher
level of Outcome payments would begin.
With this shift in risk sharing and marketing of ``partial self-
sufficiency'', a reasonable goal would be for 5% of SSI beneficiaries
(200,000 of 4 Million) to work part-time at the Trial Work level or
above. This level of work activity is generally achieved now in RSA
Supported Employment programs that predominantly serve SSA
beneficiaries. This work activity level is achievable and would result
in a savings to SSA of $159 per month per worker ($237-$78) for a net
of $32 Million per month. This scenario could also apply to SSDI if the
2 for 1 was applied to Title II, as is being considered.
----------------------------------------------------------------------------------------------------------------
Payment Milestone Net Benefits SSA Net
Milestone Criteria Payment Threshold Payment not payable loss/gain
----------------------------------------------------------------------------------------------------------------
Job 1 month Earnings of at least $454 $237 -217
Placement work $560 \1\
----------------------------------------------------------------------------------------------------------------
Job 3 months Earnings of at least $616 $711 -359
Training work $560
Complete
----------------------------------------------------------------------------------------------------------------
Integration 7 months of Earnings of at least $940 $1659 -410
into work $560/month
Worksite
----------------------------------------------------------------------------------------------------------------
Attainment Minimum of Earnings in last 5 $1102 $2701 -$411
of 12 mo. work months at least $780
SGA
----------------------------------------------------------------------------------------------------------------
Monthly Monthly Monthly Earnings at Outcome Breakeven After 24
Outcome Point Months
Payment Payment Payment \2\
a) After 7 a) $560+/Mo. a) $78 a) 10 mo. of a)+$2226
Mo. Mlstn work @ $560
b) After 12 b) $780+/Mo. b) 14 mo.
month b) $118 Work @ $780+ b)+2295
milestone
----------------------------------------------------------------------------------------------------------------
\1\ Trial Work Level for 2002 $560/mo.
\2\ 34% of benefits not payable
______
Attachment C.
LAssertive Engagement/Outreach of SSA Ticket Holders as a method to
increase workforce participation rates
There are troubling signs of service access barriers in the
assignment rate of Tickets from the initial rollout states. Less than
one-third of 1% of the Tickets mailed out in the first 13 states have
been assigned as of September 10, 2002. Part of the rationale for the
Ticket program was to give the SSA beneficiary greater access to
services through choice of vocational provider beyond the VR system.
Assertive Engagement/Outreach may help with this problem.
Key elements of Assertive Engagement/Outreach approach include the
staff work in the community in the clients own settings, outreach
includes the possibility of home visits, clients are not dropped
because they don't take the initiative or miss appointments, contact is
frequent even if there is no initial response, staff make use of
families and client support systems. Assertive Engagement is a concept
borrowed from the Mental Health field. Participation rates in MH
treatment were recognized as inadequate, the etiology of the problem
could be traced to fear, lack of trust and disengagement in social
support systems. Reports indicate that SSA beneficiaries suffer from
similar low levels of trust and fear; front line workers report that a
common reason given for not using the Ticket is that it is a trick. One
of the OK-DRS Ticket Outreach staff, Judi Fretwell, writes of her
experience.
L ``Both in the meetings and on the telephone, I've noticed a
high degree of suspicion among most of the attendees but those
who have been diagnosed with mental disorders seem almost
paralyzed with fear about the program, sometimes to the extent
that they can't seem to grasp the idea that it is a voluntary
program and that non-participation will not come back to hurt
them. Most consumers have been so traumatized by the process
they have had to follow to reach the status of SSI or SSDI
recipient and have been so man-handled by the system (however
they might define it), that any ``official''-looking envelope
will be immediately put aside as a threat they can't deal with
right away. This initial reaction complicated by the very
nature of their illness will extend the response time far
beyond that of those with physical limitations only.
Eventually, peer pressure or family pressure or a combination
of things will embolden them to call (hurdle number one) but
the process is so cumbersome (call Maximus for a list, call the
list etc.) that even people with no thought disturbances and
those with no depression would find it highly confusing and
very discouraging to follow such a ``trail of breadcrumbs.''
Assertive engagement is a term used for a group of strategies meant
to address barriers to service access. Traditional helping systems have
developed self-protection strategies that increase barriers to entry as
the work load increases. Long periods of unemployment such as many
Ticket holders have experienced lower self-esteem and reduce resilience
and consequently the Ticket holder's ability to tolerate long waits for
services and assertively advocating for their needs.
At least one new barrier to access has been created under the
Ticket program. The EN risk assessment, a business requirement for a
successful EN, presents a barrier to access and may represent an even
higher bar than the access barriers in the public program. The danger
is that the Ticket program has only increased the choice of the chosen,
those who have good prospects of obtaining and retaining high-income
employment. Worse yet it may simply result in payment for those who
would have gone to work without help, paying for something that SSA got
free last year. Creaming, selection or profiling of the best candidates
is implicit in the outcome payment system. The Milestone payment system
was included in the Ticket legislation to obviate some of the risk to
the EN and lower the threshold for entry into the program. Milestone
rates will need to increase in order to reduce EN risk, for an
assertive engagement strategy to lead to higher levels of employment,
rather than rising rates of rejection.
Assertive engagement involves investing in interactive information
delivery through a trusted, objective and stable helper. The
beneficiary must have the sense that the information is being provided
from their point of view with their interests as a central focus.
The assertive engagement requires multiple outreach efforts through
all available means, mail, phone, home visits and third party contact
through trusted helpers, advocacy organizations and family members.
Consistency and physical availability to meet and answer questions are
essential. The goal of assertive engagement is to get the individual in
the front door. The front door could be a Ticket holder Orientation
session held at an easily accessible location such as a Workforce/One
Stop Center. The Orientation session should cover basic work incentives
available, the effect of work on benefits and information on available
EN's. Ideally the available EN's would be represented at the sessions
and be available to take applications after the session. Many of the
existing EN's are Workforce Partners and would support this function
for the One Stop Centers.
The Benefits Planning Assistance and Outreach (BPAO) grants are a
good example of this focus. The benefits planners are independent of
the service provider system and SSA and can provide objective
information. The BPAO effort is woefully under funded, at $23 million
for the entire country the funding is a fraction of what it should be
just for the Benefits Planning portion of their mission. The outreach
function has little possibility of being operationalized unless
adequate funding is available for the core service of Benefits
Planning. A team effort would be ideal that included three components,
a Ticket Outreach/Disability Specialist at the Comprehensive One Stops,
the BPAO Benefits planner available for difficult cases and the SSA
Employment Support Representative to attend the outreach meetings, lend
credibility, handle earnings reports and work generated CDR's.
Chairman SHAW. There is a vote on the Floor, and we think
we have only got just a few minutes to make that vote, so I am
going to recess just a few moments. Mr. Hayworth left early,
you note, to go vote, and he will come back and call on Ms.
Webb to testify, and then I will return just as quickly as I
can too. So, we will recess just for a few moments, don't go
far.
[Recess.]
Mr. HAYWORTH. [Presiding.] The Subcommittee will come to
order.
If this resembles some sort of power grab, let me assure
you, that is not the case. With the generous cooperation and
assent of the minority, and the Chairman, as the vote is going
on on the Floor, they asked me to return and resume the
Subcommittee hearing, and I am very pleased to do so, because
as I understand it, the portion of the hearing picks up with
what we might call home cooking.
[Laughter.]
Mr. HAYWORTH. My friends from Arizona, and I welcome our
friend, Susan Webb, for her testimony now.
STATEMENT OF SUSAN WEBB, DIRECTOR, ABIL EMPLOYMENT SERVICES,
PHOENIX, ARIZONA
Ms. WEBB. Well, Congressman Hayworth, you are going to know
everything I have to say.
Mr. HAYWORTH. The important thing, if you would yield, and
I thank you, ma'am, the important thing is that our folks here
and our friends who join us via C-SPAN will get to know the
success that we have experienced in Arizona.
Ms. WEBB. Well, then that is a deal. Thank you for allowing
me to come and speak with you today.
As you know, ABIL Employment Services is a participating
Employment Network in the Ticket to Work Program, and it is
indeed a pleasure to be here today with you. What I want to do
is start with a brief overview of our program and our outcome
so far. Now that, I haven't spoken to you about, and I think
you will be pleased. Then I want to comment on the different
elements of the TTWWIIA that have helped us to implement our
program. I think that the comments that I am going to make
today are actually quite positive about the program. I think
there are a number of reasons for that, and I think that many
Employment Networks around the country can share in our success
if given the same opportunities that we have had.
First of all, we began as part of a Center for Independent
Living. We are a 501(c)(3) nonprofit, CIL, authorized by Title
VII of the Rehabilitation Act. So, what that means is that we
enjoy the infrastructure of the CIL. They pay our bills. They
do our payroll. But ABIL Employment Services is a completely
separate program within the center. We are located in a
different building, a totally different funding stream, a
totally different staff. I think the beauty is that ABIL
Employment Services does only the Ticket. Everybody that
participates in our program is a Ticket participant, so it
allows us to focus just on this program. We have not basically
dumped it on top of existing staff doing other things. We
started from scratch. We were able to do that because we did
apply for and got a very generous grant from the Nina Mason
Pulliam Charitable Trust, which is a local foundation, and that
was matched 100 percent by the Center for Independent Living,
so the Center made that commitment and did provide that up-
front funding, and we have just been approved for our second
year, and we believe that those 2 years of up-front funding
before we start generating the break-even point that we need to
sustain the program long term.
I am also happy to say that when it gets into our outcomes
we have five people on our staff. We have built up to five
people specifically for this program, and two of those, Mr.
Chairman, are in fact Ticket participants. We are very proud of
that. We have taken them off the program, trained them to
provide services to other participants in this program.
Our results so far have exceeded our expectations and I
want to take just a few moments to tell you what those are. We
have accepted 109 Tickets, which is on a part with our State
agency. It is a little different than we have heard from
Oklahoma and Wisconsin. Our State agency and our agency in
particular are about neck and neck in terms of Ticket
acceptances. We have had 48 placements, so we have been putting
people to work, and currently we have 26 people that are out
there today working, and next you will hear from Amy Gilliland
who is one of our Ticket participants who is in fact employed.
We have the honor of being the Employment Network who did
receive the very first outcome payment from the Social Security
Administration under the Ticket program and a very lovely note
from the Commissioner congratulating us on that.
Now, these results are early, and I don't want to suggest
that we have all the answers. There are challenges that any
Employment Network will experience. For example, that startup
funding is going to be a challenge for many Employment
Networks, and another is collecting and reporting the earnings
information to SSA so that we can get paid. That is proving to
be a very, very cumbersome and almost impossible process right
now. I know the Agency is working real hard on it, but right
now it is taking about 120 days to get paid, and there is not a
whole lot of Employment Networks out there that are going to be
able to sustain that kind of cash flow problem.
Let me tell you now, these are the operational issues that
we went under and I believe that these are important for any
Employment Network to be successful. As I mentioned, we are
only doing the Ticket. We did not dump it on top of other
staff. What that means is that we recruited staff specifically
for this program who have the background and skill in operating
like business, and specifically like a staffing agency. That is
what we operate like. We focus primarily on participation's
abilities, not on their disabilities. We are finding is because
the majority of our staff are people who ourselves have
disabilities, have been on the system, know what that is like.
We are finding that participants love that our advocacy and our
peer support is what motivates them to participate, to put up
the good fight, and to keep going until we do achieve the
actual job. You know the ropes, so to speak.
Now, another key element, and I want to read this from my
testimony because it is so important, and that is that we know
the market. We knew going into this program a majority of
people who are on SSI and DI are not the same people normally
served by the State's ER system. We have known for many years
that most people on this program were not being served at all,
and that is not to disparage my good friends here from the VR
system. They are very effective in working with people who
truly need their intensive services, but the majority of people
in SSI and DI are not those same people. The Ticket program
requires a completely different approach, one that views Ticket
holders as the customer and one that maintains an almost
compulsive focus on employment, not on delivering services.
We operate like a staffing agency, we are able to
effectively work with employers, and because the Ticket program
allows for 60 months of ongoing support after the beneficiary
goes to work, we are also finding that we are a tremendous
resource to that employer as well to keep that person working
after they get the job.
I have to tell you, since we operate like a staffing
agency, one of the things we love most about this program is
its flexibility. There is nobody in my face when I sit across
the desk from that consumer telling me I can't do something
because I am not funded to do it. We can sit down one on one,
face to face, and do whatever it takes for that person as an
individual to get off the benefits and back into the workforce.
I love that flexibility. There is nobody I have to ask
permission to. MAXIMUS has been wonderful. We send off the
Individual Work Plan. When that thing is signed by me and by
that consumer, that Ticket is assigned. We are off and running.
We are ready to work.
I also want to take a moment to say that in our State, and
I know, Congressman Hayworth, you will love to hear this, our
State Agency, our State Vocational Rehabilitation Agency is
being wonderful. We are cooperating, collaborating. The
agreement we have with them is fabulous. They have it with
every Employment Network signed up in the State who chooses to
be part of that. We are looking at doing some joint cases with
them right now for those who truly do need those intensive
services but also want the advocacy and peer support that we
provide. We haven't done any yet, but we are sitting down, we
are talking, we are identifying, we are getting ready to do
some of those. I am real happy about that as well.
No matter how effectively we operate, we would not be
successful without the specific provisions of the Ticket to
Work and Work Incentives Improvement Act, and we are finding
those comprehensive reforms that are included in the TTWWIIA,
as we expected, are proving extremely beneficial. The Ticket
going directly to the beneficiary is fabulous. It sends a
strong message that we respect them and their ability to direct
their own lives. It also says that we expect them to direct
their own lives. The TTWWIIA provisions that include the
Medicare extension, the Medicaid buy-in, expedited reentry, CDR
protections are doing their job of eliminating those fears that
we have historically seen that prevent people from doing the
job.
I am going to move along quickly. The availability of
MAXIMUS, the BPAOs as you have heard, absolutely excellent.
SSA's been terrific. I give them a lot of credit for a very,
very difficult program to implement. They are doing well. Where
we see improvement, as you have heard, there is not enough ENs.
More people need to be doing this work. The payment system is
still a challenge. We need the ENs to be able to choose on an
individual case basis which payment program they want to use
for a particular consumer. We need Congress to allow us some
payment for some work and get away from the zero out.
In closing, let me say while I realize that I am being very
positive here today, I know there are many who believe the
program creates seemingly insurmountable challenges. From an EN
perspective I believe that effective marketing, training and
technical assistance is essential, cannot be overemphasized,
and we need to get some nontraditional folks in here. We need
to market better to them or find a way to market better to
them, and then I think the potential increase is there in this
program, in this legislation. Thank you again for the
opportunity to be with you here today.
[The prepared statement of Ms. Webb follows:]
Statement of Susan Webb, Director, ABIL Employment Services, Phoenix,
Arizona
Mr. Chairman, Members of the Committee, my name is Susan Webb and I
am Director of ABIL Employment Services in Phoenix, Arizona. AES is a
participating Employment Network in the Ticket to Work Program. I am
also a member of the Ticket to Work Advisory Panel, but today I am here
commenting only as an Employment Network. It is indeed a pleasure to be
with you today, and I thank you for inviting me to comment on how
things are going with this new initiative. I will begin with a brief
overview of our program and our outcomes so far. Then I will comment on
the different elements of the TWWIIA that have helped us implement our
program.
We began as a separate program of the Arizona Bridge to Independent
Living (ABIL). ABIL is a 501(c)(3) non-profit Center for Independent
Living authorized by Title VII of the Rehabilitation Act of 1973, as
amended. ABIL Employment Services enjoys the existing infrastructure of
the CIL, but AES is located in a separate building with its own staff.
This specific program ONLY serves people eligible for the Ticket
Program. We started with just myself and an employment coordinator with
a grant from the Nina Mason Pulliam Charitable Trust, a local
charitable foundation. ABIL matched the grant 100%. The grant has now
been funded for a second year. This foundation funding along with the
CIL's match enables us to operate for the two years we estimate that it
will take before the program achieves self-funding through SSA
reimbursements from the Ticket to Work Program. Since we began we have
added three more staff members, two of whom are ticket participants.
Our results thus far have exceeded our expectations. We believe
this program has tremendous potential to finally make a significant
difference in the ability of those on SSI and/or SSDI to achieve
employment with which they can support themselves and their families.
So far we have screened/interviewed/counseled over 900
participants. We have accepted 109 Tickets, placed 48 people into jobs
and have 26 currently employed. We are the first EN nationally to
receive a payment from SSA under the Ticket Program.
These results are early, and I don't want to suggest that we have
all the answers. Yes, there are challenges that any employment network
will experience. For example, start-up funding and collecting and
reporting earnings information to SSA so we can be paid are major
issues. But there are some aspects of our operation that I want to
highlight. I believe it is the combination of all these things that has
made us succeed so far. These are elements that I believe are necessary
for any EN's operations if this program is to succeed nationally.
1. Our program started new just for the Ticket Program. We did not
dump it on top of already overworked staff and try to weave it in with
other programs.
2. We recruited staff specifically for this Program who have
background and skill in operating like a business and specifically like
a staffing agency. As such, we focus primarily on participants'
abilities, not their disabilities.
3. Advocacy and Peer Support are our two most important services.
Since the majority of our staff are people with disabilities who know
firsthand what it feels like to live on these benefits and also how
hard it is to get off of them, we are able to engender trust
immediately. We ``know the ropes.''
4. We know the market. We knew going into this program that the
majority of people who are on SSI and/or SSDI are not the same people
normally served by the VR system. We have known for many years that
most people on this program were not being served at all. That is not
to disparage the VR system; they are very effective in working with
people who truly need their intensive services. But the majority of
people on SSI and/or SSDI are not those same people. The Ticket Program
requires a completely different approach--one that views Ticket holders
as the customer and one that maintains an almost compulsive focus on
employment as the outcome, not delivering services.
5. Because we operate as a staffing agency, we are able to
effectively work with employers. Because the Ticket Program allows for
60 months of ongoing supports after the beneficiary goes to work, we
are also an ongoing resource for the employer.
6. The program is flexible. We are able to sit down with a
participant and do whatever we need to do to get them working. We are
not faced with a traditional program that calls the shots and makes the
rules. We are not told by a funder what we can and cannot do. We don't
have to go through bureaucracy and approval processes before we can
work with someone. For us as an EN and also for the beneficiaries this
has proven to be refreshing at the very least.
7. In Arizona the State VR agency is being wonderful to work with
in implementing this program. They have established the required
agreement with all the ENs who wish to participate so that we can work
some joint cases together. We haven't actually done any yet to see how
things will work out, but the spirit of collaboration and cooperation
is very evident. I am confident that the Ticket Program will greatly
expand the availability of services through the State agency since it
will bring them more reimbursements too.
No matter how effectively we operate we would not be successful
without the specific provisions of the Ticket to Work and Work
Incentives Improvement Act. We are finding that the comprehensive
reforms included in the TWWIIA, as we expected, are proving extremely
beneficial:
1. The Ticket is going directly to the beneficiary. This sends a
strong message that we respect them and their ability to direct their
own lives; it also says we expect them to do so. We are seeing
incredibly motivated, talented people with tremendous work ethic who
are so excited about this new opportunity. People with all types of
disabilities, all levels of education and all ethnic groups are
included in our program. They are wonderful people, and we are honored
to have the opportunity to help them find the direction they need to
get themselves out of poverty and add to our nation's productivity.
2. TWWIIA's provisions for the Medicare extension, the Medicaid
Buy-In, Expedited re-entry and CDR protections are easing the fears
participants have that have historically prevented them from trying to
work. They now can at least try without fear of losing those safety
nets.
3. The availability of a private entity, MAXIMUS, and local
Benefits Planning and Assistance is providing much-needed, timely and
accurate information to participants so they can truly understand their
own specific situation and how work will affect their benefits.
4. By virtue of the TWWIIA being so comprehensive, it is also very
complex. I give many KUDOS to the SSA itself for doing such a yeoman's
job, even during the switch to a new Administration, in implementing
this program. It has been an amazingly huge job to get this thing
going. They have done a fantastic job and have done it in a timely
manner when they could have found all sorts of reasons to delay things.
The areas that still need the greatest amount of work are:
1. We have not yet achieved enough choice for consumers. There are
not yet enough ENs and those who have signed on are traditional
providers for the most part who seem to be doing business much the way
they have always done it. It is my fervent hope that more providers
with a different approach can be recruited to participate in this
Program.
2. The EN payment system is a real challenge. There are three
things I think would help. First, ENs should be able to choose on an
individual case basis as to whether they want to use the milestone/
outcome plan or outcome only plan. This would better enable ENs to
serve people regardless of which work incentives they might use.
Second, Congress should allow some form of payment even when a
beneficiary does not totally leave benefits. I believe all work is
valuable and some work is better than none. We are turning people away
who need or want to work part time simply because the payment structure
does not allow us to serve them. We are also turning SSI beneficiaries
away whose initial earnings potential is not above the $1,174 break-
even point. Third, the SGA level for purposes of being paid should be
the same for blind and non-blind beneficiaries.
In closing, let me say that while I realize that I am being quite
positive here today, I know there are many who believe the program
creates seemingly insurmountable challenges. From an EN perspective I
believe that effective marketing, training and technical assistance is
essential for ENs, especially non-traditional ones, to be able to
successfully participate. We need all our stakeholders working
together. The potential increase in employment and savings to the Trust
Fund are enormous and long-overdue. I firmly believe the TWWIIA
includes the basis for great success. Thank you again for the
opportunity to be with you today.
Mr. HAYWORTH. Susan, we thank you for the testimony, and
appreciate hearing your perspective, and think back to actually
issuing a couple of tickets with Commissioner Barnhart in
Tempe, and one such recipient, though I don't believe that
particular day, is our next witness, the aforementioned Amy
Gilliland, who is a participation in this program. Amy,
welcome, and if you can summarize your testimony in 5 minutes,
your complete statement of course is submitted for the record.
STATEMENT OF AMY GILLILAND, PARTICIPANT, TICKET TO WORK
PROGRAM, GLENDALE, ARIZONA
Ms. GILLILAND. Yes. I kind of changed around my testimony
if that is okay with you.
Chairman SHAW. That is great, Amy.
Ms. GILLILAND. First I would like to say thank you for
letting me come here to Washington, DC, to share my testimony
with each and every one of you. It is such an amount of
gratitude that I have to be a part of something critical and
essential for public users, you know, people like me who
desperately need a little extra help.
I grew up pretty rough. I truly think I did a little bit of
damage to my brain through chemical structure, through drugs
and alcohol, to be honest with you. My disability happens to be
psychiatric, and I am on medications and so forth, and luckily
enough I just celebrated 4 years on sobriety on September 5.
I am not quite sure why it is that the government is
willing to go above and beyond their obligations. To me it
makes no sense. I work and they are still going to pay me. I
don't get that, but I think it is amazing. It is wonderful. I
mean, how could I ask for anything more?
I turned in my Ticket to other companies. ABIL responded to
me instantaneously. That feels great to feel that I am able to
stand on my own two feet, that I am able to participate in life
again. It is amazing. You wonder when you have such a low self
esteem why it is. Then you get a job and you actually get into
that working field and you are getting that regular paycheck,
and you are paying your bills and things such as that, and you
are going, ``Oh, God, that is it. That is what it is about.''
And ABIL, I can only speak on ABIL because like I said, they
responded to me, and they have been nothing but compassionate,
proficient and have treated me as a human being. They haven't
treated me as someone who is disabled. They haven't treated me
as somebody who is crazy. They have treated me as a human
being, as themselves, no lower, no higher, just the same, which
has been wonderful.
Thank you from the bottom of my heart for giving me this
opportunity amongst you all to share my experience, strength
and hope. Like I said, I hope that you stick with this Ticket
to Work program, because it certainly has made a profound
impact in my life. It has allowed me to start feeling as though
I am a--I am learning to be a productive Member of society
again, and it is really nice. I really do appreciate it. So,
thank you very much for letting me share.
[The prepared statement of Ms. Gilliland follows:]
Statement of Amy Gilliland, Participant, Ticket to Work Program,
Glendale, Arizona
Mr. Chairman, Members of the Committee, my name is Amy Gilliland
and I am a participant in the Ticket to Work Program. Thank you for
inviting me to be with you today. I am 22 years old and am a SSDI
beneficiary due to a psychiatric disability. I also have a long history
of drug and alcohol abuse, and I am proud to say that on September 5 of
this year I celebrated four years of sobriety.
It is safe to say that I have led a rocky life, one complicated by
my psychiatric disability. Earlier this year I received the Ticket to
Work in the mail. I saw the Ticket as a great opportunity to change my
life--to realize my aspirations to become somebody. I don't want to sit
around doing nothing. I don't want to suck the system dry. Until I
received the Ticket I really didn't think I had much chance to get the
help I needed to go to work and become self-supporting again.
I called a few of the Employment Networks on the list that was sent
to me. None called me back except ABIL. They were very encouraging. I
liked the fact that there were people willing to spend the time with me
to explore my options. We talked about what I wanted to do and how I
might get there. We really went into depth. We explored my interests
mentally and socially as well as professionally. I chose to deposit my
Ticket with ABIL and they accepted.
Unfortunately, I was still having a lot of trouble with my mental
illness. I really wasn't ready. I have training as a Certified Nursing
Assistant so initially I told ABIL I wanted to go in that direction. I
guess I felt obligated to use that training since I worked so hard to
get it. ABIL was very helpful in continuing to call me with different
job opportunities in that field.
After several months of trying to get my health stabilized I
realized that I didn't want to go into nursing. Lynda at ABIL was very
understanding. She encouraged me to pursue new and different ideas. She
was there when I needed a sounding board. She told me not to push
myself too hard and to be sure I was really ready to work before I did
so. But she kept checking in with me to be sure I was okay. Each time
she was patient and spent the time I needed to feel comfortable with
going back to work. She had a way of pushing me just hard enough so
that I wasn't languishing but not too hard to shove me over the edge.
I'm proud to say that I am now working at Albertson's as a customer
relations representative in their store. I make $8.65 an hour and feel
I can build a career there. Albertson's is a great employer and offers
lots of training to their employees so we can move ahead and make
really good money. My prescription drugs are still supplied by Value
Options, a public mental health program in Arizona. Eventually, I will
receive full benefits from Alberston's. I plan to stay in the grocery
business but I also want to get my Bachelor's degree and maybe even a
Master's degree someday. I even have a dream to publish a series of
children's books.
But because of the Ticket to Work Program I know that if I lose my
job tomorrow, Lynda will be there to help me find something else. I
really love the Trial Work Period. You need the most help when you're
just starting out. And to keep my benefits for a full year while I
increase and stabilize my earnings potential is just great!
Thank you for the Ticket to Work Program. This Program will not
only help me be successful but many others just like me. And thanks for
inviting me here today for my very first visit ever to Washington, D.C.
Chairman SHAW. [Presiding.] Thank you for that moving
testimony. It makes you feel good to be able to pass laws like
that, and we appreciate your testimony. Mr. Gadaire.
STATEMENT OF DAVID GADAIRE, PROGRAM DIRECTOR, CAREER POINT,
HOLYOKE, MASSACHUSETTS
Mr. GADAIRE. I am not sure I want to follow that.
[Laughter.]
Mr. GADAIRE. After following home cooking, that may be the
most powerful testimony. I feel like this might be a bit of a
set up. I don't think I can match that.
I guess I would want to start with a thank you, and maybe
more importantly a thank you to the staff who somehow managed
to get me here. I am not sure how that happened, but to get
something this size from Holyoke to here and back again in 1
day is pretty much an impressive thing, and I am impressed by
that, so thank you.
I am here as a supporter of the Ticket. I am here as an
operator of a one-stop career center, and I guess that makes me
a little bit out of place. I am here hopefully to make some
ideas and some suggestions. Given my 20 years of disability
employment advocacy before I got into the one-stop management
business, I feel like I know a little bit about this stuff,
although certainly I am humbled by the panel.
I will say that I think this is probably maybe the best
equal rights legislation for employment of people with
disabilities that I have seen in my lifetime, and the
suggestions I offer, I offer as enhancements and not as
anything other than that. They come, frankly, from a little bit
of hands-on experience. They come from a constant dialog with
other ENs and other community based organizations, frankly,
that have decided not to be ENs. So, with that, let me just
kind of throw it out here.
I basically have nine suggestions or thoughts or opinions,
and I will do my best to get that done in 5 minutes. First, I
would absolutely concur that benefits planning is the key to
this. I think an educated customer makes this whole thing work.
We brought a benefits planner into our center about a year
before we became an EN, and upon her arrival, a number of
people living with disabilities who came through our doors
quadrupled. We were able to hit the ground running when the
Ticket became available, when we became an EN. I am told that
we were the first career center to become an EN, the first to
get an actual Ticket assignment, the first to actually get a
successful employment out of it, but given how I think poorly
the career centers have stepped up to this, I am not sure I say
that with pride, but it is my shot, I will take it.
Second, I think that it is absolutely imperative that the
Employment Networks have the opportunity to toggle back and
forth on payment plans. I actually believe that if we are
forced to make that decision upon application, we then will
market to a certain type of customer, and I believe eventually
we will be more motivated by the revenue than the actual
service. I think that is a mistake. I think we should build
systems that are customer driven and are revenue driven. I
think that we can change that. I don't think that would be a
hard thing.
Third, I also think there needs to be provisions for part-
time employment. As a workforce development professional, part-
time employment is an absolute integral part of anyone's career
plan, and I would suggest that it needs to be taken seriously
here. My greatest fear is without making that change, this
legislation would slowly start to move away from the people
with the most severe barriers, and frankly, we would provide
ammunition to those people who are willing and quickly going to
call that this is a ``creaming'' program, and frankly, I don't
want to be a part of that.
Fourth. I think that the employment services representative
concept is a brilliant one. We tell people that changes in your
employment really become one of the four major stressors in
one's life. If that is the case, dealing with SSA is the fifth.
[Laughter.]
Mr. GADAIRE. I absolutely believe that an employment
service representative can act as a buffer and can minimize the
amount of distraction that needs to happen or that does happen
when a person takes on new opportunities through employment.
Chairman SHAW. I would say, sir, that happens to us every 2
years.
[Laughter.]
Mr. GADAIRE. I am not going to disagree with you on that
one. I would say that number five, I think that the Employment
Networks and the State VR systems ought to be compensated in a
similar way. My greatest fear is there is great talent on both
sides, and that if they are compensated differently, we will
eventually drive a wedge between them. I know that already
happens in the one-stop system, so I am concerned about this. I
believe we would rather build a bridge to each other's system
because I don't want to replicate what they do so well, and I
certainly don't want them to spend time and money replicating
what I do well.
I would say, number six, that now that we have Ticket on
demand, I would say that in spite of what was said earlier, I
am nervous that the Employment Networks--we need more of them--
could get overwhelmed, and I think if they get overwhelmed, we
will start to do quantity management as opposed to quality
management. Now that you can get Ticket on demand, we could
probably slow that down a little bit.
Number seven, there is a significant capacity issue,
especially given how we are funded. The people that are
eliminated from becoming ENs in this system are the small
community based organizations, and in some cases, the small
community based organizations are the lifeline for people with
the most severest of disability. So, I am concerned about that.
I think we have to find a way to come up with some kind of up
front or planning resource to help them get off the ground.
Number--what number I am on, you keep track--I think that I
would suggest that we let the Employment Networks actually do
the employment marketing to the employers. I think that in
spite of what we want to think here, there is still an
overwhelming perception of stigma and fear that exists in
employers. I think that if we are going to make a change, we
are only going to do it from a trusting relationship. I mean no
disrespect by this: I think when we say that comes from the
government, I frankly don't think they are listening, so I get
concerned about that.
My last suggestion is I believe we need to spend time and
effort and resources to develop a cross-match between the
computer systems that issue the SSI and SSDI payments to the
computer systems that monitor and track the Employment
Networks, because all of this is all based on relationship, and
I believe that there is a relationship between the Employment
Network and the customer, and there is a relationship with the
employer. I don't believe asking somebody personal financial
information is a natural relationship builder. I actually
believe it becomes a force, a blockade. I believe the
technology exists. I understand resources are a problem, but I
think in the long run, this suggestion will actually save more
money over time.
With that said, I thank you for the opportunity to be here.
I am not sure I am home cooking, but I know I am hungry.
[Laughter.]
Mr. GADAIRE. I would suggest that if we can be of any help
personally or our organization, we are willing to do so. So,
thank you very much.
[The prepared statement of Mr. Gadaire follows:]
Statement of David Gadaire, Program Director, Career Point, Holyoke,
Massachusetts
First let me express my appreciation for the efforts put forth to
get me here. I appreciate the efforts and feel bad for y'all if you
need to expend this amount of effort and all you get is to listen to
me.
I am told that I need to get my point across in five minutes or
less, so let's dispense with the chitchat and get to it.
Before running a OSCC I spent 20 plus years in the disability
employment business and the concepts of `Universal Access' and `no
wrong door' are what attracted me to the OSCC business. Categorical
funding challenges these concepts but that is an argument for another
day and another committee.
The decision to become an Employment Network The Ticket to Work
opportunity was a `no brainer' for CareerPoint, and I proud to report
that CareerPoint was the first One Stop in the nation to become an
`employment network', the first to have a ticket assignment and the
first to realize an employment outcome based on our efforts.
Having said that, I feel that the Ticket to Work legislation is the
finest example of equal rights legislation for people living with
disabilities that I have encountered in my humble career. I fully
believe it is a perfect match for the mission of the OSCC's, and
although I fully support this legislation, I do believe there are
potential improvements that will enhance the impact and just maybe
actually put a dent in the unemployment rate for people living with
disabilities.
Simply put the following 9 suggestions are the results of our
(CareerPoint's) hands-on--experience combined with a continual
commentary with other `employment networks' and/or Community-based
organizations either deciding to become an `employment network' or
having made the decision not to.
L1. Enhance to role of benefits planning in the
legislation. Although we have a benefits planner out-stationed
at our center, not all EN's have full access to this. We added
the benefits planner before becoming and EN, and our numbers
have quadrupled since benefits planning became part of our menu
of services. An educated customer has the greatest chance at
success, and benefits' planning improves the potential for
success.
L(N.B. CareerPoint has a co-location memorandum of
agreement with The Resource Partnership & shares any
interpretation of success with talent and quality they bring to
our table)
L2. I strongly suggest building in the ability to
toggle back and forth between payment choice options. By
mandating this decision in the application process we are
forcing to the EN's to cater to recruiting based on revenue
potential. The ability to modify the payment option based on
the needs of the customer is a time-tested concept. The very
legislation designed to open employment doors can close them
for some of the recipients. Our goal needs to be to flex our
programs to the needs of the customer, not find customers that
meet the design of our programs.
L3. Whether intentional or not, the legislation is
geared toward people that have the ability to work full time,
and minimizes the options for people needing or wanting to work
part time. I suggest that part time work is a crucial part of
almost any career plan at one time or another, and `people
living with disabilities' are not different. I further suggest
that failure to address this will unintentionally invite those
deterrents prepared to suggest this is a `creaming' program.
L4. I understand we are considering legislation to
include the support of an Employment Support Representative.
This simple addition would legislate a circle of support for
our customers. As a Career Center, identifying and developing
an individuals `circle of support' may be the most valuable
career counseling advise we offer.
L5. I fully acknowledge that I have no idea how to do
this, but the payment mechanisms for EN's and State VR need to
be the same. Neither side would suggest this is a good system
as it now stands, and, at least for Career Centers, I believe
will only serve to widen the gap between the two service
provision models. For the people benefiting from this
legislation, we need to combine our respective expertise, and
not compete. The Person living with the disability should not
be put in the middle of this growing turf-driven debate.
L6. Now that we have added the concept of a `ticket on
demand', I fully support spreading out the mailing and
marketing strategies, so the limited numbers of EN's don't get
so consumed that quality might suffer to quantity.
L7. I truly don't have an idea on how to do this, but
if we really want to maximize the number of EN's we need to
come up with some way of building in some up front or planning
money. Capacity is forcing potential EN's away from the table,
and people living with disabilities are experiencing lesser
choices as a result.
L8. Let the organizations do the marketing and
outreach to employers. Although support is needed at so many
levels, I think the employer world is still dominated by stigma
and fear, and therefore needs recognize the positive business
aspect of a diverse workforce. This will only come when it is
outlined and presented through and existing relationship.
Although many organizations may need and use supportive
research, I believe the actual communication with employers,
maybe the most important ingredient in the future success of
this program should be done by the local EN.
L9. Finally, and maybe the most difficult suggestion
to solve, I strongly, strongly believe that a cross match needs
to be developed between computer systems tracking SSI and/or
SSDI payments to the computer systems tracking EN progress. The
success of this program may ultimately lie somewhere in the
relationship between the EN and the person living with the
disability. As long as either side of this relationship is
forced to either request personal financial information or
forced to provide this information, there is an unnatural
component that would challenge even the most positive of
relationships.
I realize I have flown through these ideas in an attempt to play by
the five minute rule and need to be back in Holyoke by 5PM, but I can
be reach for comment, rebuttal or some good old fashion debate at 413
532-4900 or on the web at [email protected].
Finally, I would be remiss is I didn't offer the fact that as
Executive Director, I am somewhat of a figure-head in this process. The
true success is based on the work of Leslie Brooks (Career Counselor
extraordinaire), Teri O'Shea (benefits planner), Lucy Carlson (Employer
Account Representative), Joanne Tyler (ground breaking Career
Counselor), Jane Peoples (Director of Operations) and a full compliment
of the best staff that has ever been assembled. CareerPoint has been
voted the Nation's best Career Center by the National Alliance of
Business, and that honor is truly the result of the hard work and
dedication of the people making up the CareerPoint team and family.
My sincerest thanks for the opportunity to express my opinions and
offer my personal and organizational support to the resolution of these
or other enhancements.
Chairman SHAW. Thank you. Mr. Decker.
STATEMENT OF CURTIS L. DECKER, EXECUTIVE DIRECTOR, NATIONAL
ASSOCIATION OF PROTECTION AND ADVOCACY SYSTEMS
Mr. DECKER. Thank you, Mr. Chairman. Thank you for the
opportunity to appear before you today. I am Curt Decker, and I
am the Executive Director of the National Association of
Protection and Advocacy Systems.
The Protection and Advocacy Systems are 57 programs
throughout the country in every State and territory that have
been providing legally based advocacy services to people with
disabilities for over 25 years. The Ticket to Work Program
added funds to our program to build our capacity to be
available to represent individuals who would take advantage of
this program.
Now, people come to me when they are unhappy, so my
testimony may not be as positive. That said, we are an integral
part of the Ticket to Work constellation of services, and
support this effort, and want to see it reach its full
potential. I also want to thank the Subcommittee for addressing
some of the technical problems in the first round with H.R.
4070 and we hope to see that bill passed by the full Congress,
which will address a couple of issues that I want to raise, and
hope that you will revisit those as a result of the testimony
you receive today.
We are in every State and territory, we are in a unique
place to see how the Ticket is working in the 13 roll-out
States, and also at the range of barriers to full employment
that people with disabilities face, and some of these things
have already been mentioned, but let me just reiterate.
We think that the lack of information up front to consumers
about the Ticket to Work Program has probably led to the large
volume of questions. For many people, their first thought about
going back to work was a letter from Social Security saying,
``Here is a ticket. Why don't you go back to work?'' We think
that if there was in the States that are about to be rolled
out, more information provided to the general public, e.g.,
that this program is in place, and its purpose that a lot of
the volume of initial queries, there would decrease. There is a
lot of confusion and fear on behalf of consumers. We might be
able to use those resources that the ENs and the BPAOs and
other agencies involved would have to disseminate information.
We are concerned about the fact that while the programs
intent was to expand the choices and opportunities for people
with disabilities in work, that it looks like the VR system is
the big winner, and that they are providing about 80 percent of
EN services, and that was not the intent of the law when it was
first enacted, and we have seen cases of some very aggressive,
over aggressive in our feeling, or trying to convince Ticket
holders to place their Ticket with the VR agency. We have been
able to negotiate with some of those VR agencies in several
States to make sure that we think might be something verging on
coercion is not in fact going to continue. It does raise the
whole issue of this fight for reimbursement and the attempt at
trying to maximize payments out of this program, and we think
that that is going to be something that this Subcommittee needs
to look at.
We are disappointed in the fact that there are not a larger
number of ENs out there providing more choice and opportunity,
and we are also concerned about some ENs not willing to take on
the more difficult clients to serve and just simply turning
people away.
While we support the benefits planning activity and think
it is essential to the success of this program, there are some
conflicts inherent in that program as well. Many VR agencies
are also BPAOs, and so if there in fact is an effort to try to
direct people to place their tickets in the VR agency, if the
benefit planning agency is in fact that very same agency, there
may be some conflicts that need to be looked at.
We are seeing, not only in the Ticket States, but in the
other States, as people attempt to go to work prior to
receiving a ticket, a whole range of barriers to employment
that have to be addressed, and again, these are not always in
your jurisdiction, but it is quite a daunting list of things
that have to be in place to make sure that people cannot only
get jobs but maintain their jobs. They range, everything from
just architectural barriers to discriminatory actions by
employers; the very complicated number of work incentive
programs which we feel are not all that adequately understood,
even by the agencies that have the responsibility to explain to
clients what these programs are, things like Plan for Achieving
Self Support plans and Impairment Related Work Expenses, things
that Social Security has in place. We find that many of the
Social Security staff have not been adequately trained to be
able to explain how those programs work so people can take
advantage of them.
Obviously, the problem that has been addressed before of
overpayments, a major problem, been in place for many years. It
is great to hear that Social Security is trying to figure out a
way of dealing with that, but until they do, overpayments, the
threat of overpayments, the perception that you will get an
overpayment, is very great out there in the field, and a great
disincentive to people pursuing this program. That is worsened
by the fact that Social Security has forbidden the Protection
and Advocacy Program to represent people in that area. I have
not had the same experience that Ms. Webb has had. Our program
has been constantly told what we couldn't do, argued with about
the role we have, trying to restrict our services, when in
fact, I think the intent of Congress was to make sure that we
were there in place to protect people in the full range of
issues that they would face in returning to work, and we would
ask that you look at those issues as well.
We are concerned about some of the programs that do not
work well together. Just one, and then I will close, is the
fact that in 37 States, VR agencies have orders of selection,
and under the Ticket program if you are in an order selection
State and placed on a waiting list, you really aren't still
protected with the fact that you may be exempted from a
continuing disability review, and these are the kinds of
complicated inter workings that need to be understood and
explained to clients to make their experience a useful one.
So, in closing I would just say that we ask you to review
the payment system to ensure that there are stronger safeguards
for clients, provide better information to beneficiaries and
provide better flexibility to our program so that we can
fulfill our mandate to protect people in this program. Thank
you.
[The prepared statement of Mr. Decker follows:]
Statement of Curtis L. Decker, Executive Director, National Association
of Protection and Advocacy Systems
Chairman Shaw, Representative Matsui, and Members of the
Subcommittee, I am Curtis Decker, the Executive Director of the
National Association of Protection and Advocacy Systems, the membership
organization for 57 federally-funded state and territorial systems that
protect the rights of individuals with disabilities. P&As comprise a
nation-wide network of federally-mandated, disability rights agencies.
P&As teach self-advocacy skills, provide education, training,
counseling and advice, engage in mediation and negotiation, conduct
investigations, monitor services, and bring legal challenges to civil
rights violations based on disability. Our services provide enduring
improvement to the quality of life for children and adults with
disabilities and their families.
The P&A system is the one longstanding system of disability-related
advocacy services that is available in every state. P&As provide
advocacy services under the following programs: Protection & Advocacy
for Persons with Developmental Disabilities (PADD), Protection &
Advocacy for Individuals with Mental Illness (PAIMI), Protection &
Advocacy for Individual Rights (PAIR), the Client Assistance Program
(CAP) Protection & Advocacy for Assistive Technology (PAAT), and the
newest P&A program, Protection & Advocacy for Beneficiaries of Social
Security (PABSS).
The PABSS program was established in 1999 when the bipartisan
Ticket to Work and Work Incentive Improvement Act (TWWIIA) which was
enacted into law. The intent of this Act was the provision of health
care, employment preparation and placement services to individuals with
disabilities. The legislation also established a return to work
``Ticket'' program to allow individuals with disabilities to seek the
services necessary to obtain and regain employment, thus reducing their
dependency on cash benefit programs. At that time, Congress recognized
that many people with disabilities face major barriers in their efforts
to leave the benefit rolls for full employment. Therefore, Congress
authorized the Commissioner of SSA to make payments to the protection
and advocacy (P&A) system in each state for the purpose of providing
information and advocacy services to beneficiaries with disabilities
who want to work and to provide advocacy or other services that
beneficiaries with a disability may need to secure or regain gainful
employment. These State Grants for Work Incentives Assistance to
Disabled Beneficiaries are better known as Protection and Advocacy for
Beneficiaries of Social Security (PABSS).
Because PABSS programs are providing advocacy services directly to
beneficiaries with disabilities, P&As are keenly aware of what is--and
is not working--with respect to the implementation of the Ticket to
Work and Work Incentive Improvement Act. There are numerous issues that
we believe pose challenges not only for Social Security beneficiaries
involved in the implementation of the Ticket to Work and Work Incentive
Improvement Act, commonly known as TWWIIA, but for all people with
disabilities who want to work. We look forward to working with Social
Security and the Subcommittee in meeting these challenges and
fulfilling the goals of the legislation.
HR 4070--Advocacy to Maintain Jobs
There are a number of things that NAPAS' wants to accomplish with
this testimony today. The primary thing is to respond to the
Committee's request for information on TWWIIA implementation so far.
However, before I get into specifics in that area, I want to thank the
Committee for recently including language in H.R. 4070 which will help
PABSS Programs be even better advocates for beneficiaries with
disabilities seeking employment. As we all know, getting a job is only
the first step. Once beneficiaries with disabilities get jobs, they
need help to maintain their jobs. They need somewhere affordable to
live close to their jobs. They need accessible and affordable
transportation to get to work. They need to know that they have the
right to reasonable accommodations in their jobs. When beneficiaries
can't keep their jobs because of these and other barriers, they go back
on cash benefits, thus reducing the savings to the Social Security
Disability Trust Fund. Therefore, we believe that helping beneficiaries
keep their jobs is just as important as helping beneficiaries get jobs.
Congress recognized this when it enacted TWWIIA, expressly stating that
purpose of the legislation was to ``establish a return to work ticket
program that will allow individuals with disabilities to seek the
services necessary to obtain and retain employment and reduce their
dependency on cash benefit programs.'' The Committee recognized this
when it clarified in HR 4070 that advocacy to ``maintain'' employment
was an important PABSS program activity.
Unfortunately, the Social Security Administration has instructed
the PABSS program to remove advocacy services for beneficiaries who are
trying to ``maintain'' employment from its list of program activities,
even though it is obvious that it is a critically important PABSS
function. If Social Security's restrictive interpretation of the scope
of PABSS services were adopted, the following beneficiaries would have
lost their jobs and gone back on full cash benefits:
LIn Delaware, an SSI beneficiary hurt himself on the
job because his job coach was sitting in a car reading a book,
rather than supervising and coaching him on his job tasks. The
Delaware P&A got the negligent job coach fired and advocated
for a new job coach at a different work site. The beneficiary
is working today because the Delaware PABSS program got him the
job coaching he needed.
LIn Illinois, a woman stopped working when she got a
letter from Social Security informing her that her trial work
period and cash benefits had ended. She contacted the Illinois
P&A, which provided her with information about trial work
periods and helped her explain her absences to her employer.
Without the Illinois P&A, she would not be working today.
LIn Michigan, an SSDI beneficiary who is blind, was
working as a reservation clerk. She needed a screen reader to
access computer data. When the employer refused, the P&A and
her union intervened. She got the reader and is continuing to
work.
LIn New York, the P&A is representing a beneficiary
with a disability who cannot get to her job because the para-
transit company does not have a usable wheelchair lift. Without
this advocacy, the woman would stop working.
Thank you committee members for approving HR 4070 and recognizing
that people with disabilities who return to work need advocacy to stay
at work.
What P&As Report in the 13 Roll-out States
While the intent of TWWIIA was to remove barriers to employment,
the changes in the law have yet to eliminate previously known barriers,
nor enhance the service delivery system. While this is an immediate
problem in the 13 roll-out states, it also will be a problem in future
states if substantive changes are not made to the program. People with
disabilities still face a number of significant barriers to employment
including (a) a lack of public understanding of TWWIIA; (b) the fact
that at state VR agencies, it is still ``business as usual''; (c)
problems specific to Employment Networks; and (d) problems specific to
Benefit Planning Assistance and Outreach.
The Public's Understanding of TWWIIA is limited
Although the legislation makes significant changes to the work
incentive provisions under the SSA programs, there has been no public
education campaign to inform the disability community at large of the
improved work incentives, including extended access to Medicare or the
``easy back on'' provisions for trying work. In fact, until the
beneficiary received his ticket in the mail, they had probably given
little thought to working, perhaps remembering the problems they faced
before, or perhaps recalling the overpayment horror story told by their
neighbor when they went back to work. While training for professionals
has been fairly common, consumer training has been pieced together by
provider and disability organizations, or other community groups. These
groups have been attempting to convey information to a confused
beneficiary population. As a result, the public perceptions about what
the ticket is--and how it works--is muddled. For instance, while a
community group may understand the importance of benefit planners, they
may not understand why the Employment Network has so much discretion to
determine the services they will provide to a beneficiary. There have
been at least two articles published in the national media blasting the
limitations of the Ticket program where beneficiaries were not able to
access the type of services they wanted and therefore felt the program
did not meet the stated goals.
With little information available, ticket holders have flooded the
MAXIMUS call center with requests for information. Staff there have
struggled with deciding how much information to provide at one time,
taking criticism from advocates who believed that callers should be
told about all the services and supports available to help them go to
work, and that all of this information should be provided without
regard to the question being asked by the caller.
P&As have also received it's share of calls and questions and have
spent a great deal of time talking to beneficiaries about returning to
work, their employment rights under the ADA, and how to choose an
Employment Network.
State Vocational Rehabilitation Agencies/Business as Usual
In the provider community, VR is viewed as controlling and
``raiding'' the ticket program. Although Vocational Rehabilitation
agencies came together at the Seattle Symposium to plan for the Ticket
implementation, counselors have not been trained on TWWIIA or the
Ticket Program. What they have received is instruction on how to handle
the tickets. Following their agency direction, many counselors have
placed pressure on existing clients to assign their ticket to VR.
Counselors believe this is a requirement for the continued receipt of
VR services. They do not realize that use of the ticket is voluntary
and that the provisions and procedures of Title I of the VR program
apply to Ticket holders, despite TWWIIA.
Another issue is when, and how, the Comparable Services and
Benefits provisions (of the Title I VR program) apply. Clients who have
assigned their ticket to an Employment Network are often told that they
cannot receive services from VR because it would be a duplication of
services, even though different services are being provided. For
example, VR may be providing computer training and the EN may be
providing job readiness and job search assistance. Yet, in more than
one state, clients have been told that they must choose one service
provider, preferably VR, over the other. According to the
Rehabilitation Act, ``comparable services and benefits'' are services
provided or paid for in part or whole by other Federal, state, or local
agencies. These services are available to the individual at the time
needed to further the progress of the individual toward achieving his/
her identified employment outcome. The intent of this provision is to
ensure the identification of financial responsibility by a variety of
agencies for providing such services. It is not intended to preclude
the individual from receiving such services.
Thirty-seven (37) state VR agencies are operating with budgets that
restrict services to individuals with ``significant disabilities'',
which includes Social Security beneficiaries. These states have
established an Order of Selection, which establishes strict criteria to
be met in order for an applicant to receive services. If they do not
qualify, based on the established criteria, the clients are placed on
``waiting lists'' for in indefinite period of time. Counselors in
certain roll out states, that have adopted an Order of Selection, have
accepted, and ``held onto'' beneficiary tickets without advising the
beneficiary that they could be better served by taking their ticket
elsewhere. Since tickets are not assigned until an individual plan is
developed, clients often are under the false assumption they are
complying with TWWIIA requirements and are exempted from a CDR. In
fact, they are not in compliance with TWWIIA, not getting services, and
not protected.
Employment Network Issues
Despite active recruitment on the part of the Program Managed, the
number of Employment Networks continues to be limited in the roll out
states. This restricts a client's ability to choose from a range of
services and service providers. ENs under contract with SSA have the
ability to reject a beneficiary's ticket, further limiting a ticket
holder's option to obtain services needed to go to work. While there
has been considerable debate over the voluntary design of the program,
many advocates feel that ENs have too much discretion to pick and
choose. There is concern that clients may be refused services based on
severity of disability, or some other discriminatory basis, which is
never explained. Ticket holders are simply told, ``We are not suited to
assist you. Your needs would be better met by someone else''.
Benefit Planning Assistance and Outreach
Funding for the BPAO program at $23 million dollars under TWWIIA
was a welcome addition to this fledgling, and under-funded service. The
new BPAO programs have been energetically implemented and
enthusiastically viewed as a vital link to the return to work efforts
of beneficiaries with disabilities. SSA funded three technical
assistance centers to provide work incentive training. These centers
have done a commendable job training benefits planners, and the
curriculum is well regarded. But the addition of these programs has
created some additional concerns.
In many states, however, the BPAO contractor is the state VR
agency. Given the competition for program funding, this arrangement may
result in inaccurate advice, which could lead to job loss rather than
continued employment. One anecdote concerns a beneficiary who secured
employment with the help of a private EN. After securing employment the
beneficiary also contacted the BPAO project. The BPAO project was the
state VR agency. The client reported that the BPAO advised him/her to
quit his/her job and assign the ticket to VR.
An EN, who is a private provider, worked with a beneficiary to help
them secure employment. The EN advised them (early on) to check in with
the BPAO project. The beneficiary did this, but not before they
accepted a job and began working. The BPAO project is with the state VR
agency. According to what was reported to me, the BPAO advised them to
quit their job and to assign their ticket to VR. Now we have a formerly
employed beneficiary, once again unemployed and continuing benefits.
This appears to be two parts of the program working at cross-purposes
due to a struggle for reimbursement.
In another state, the BPAO program was not a part of the VR agency.
This BPAO refused to accept VR clients for services because the state
VR agency has long paid for benefits counseling. The BPAO was hoping to
receive additional funding from the VR agency for services that they
were already contracted by SSA to provide.
Barriers to Employment Identified by the PABSS Program
In May 2001, the Social Security Administration awarded the first
grants to the PABSS program. Although this was the last program to be
funded by SSA under TWWIIA, the PABSS Program is up and running in all
57 P&A agencies. The infrastructure is in place, outreach activities
are occurring, caseloads are increasing, and Social Security
beneficiaries are beginning to return to work. During the first year of
operations, the PABSS programs assisted 10,755 individuals (2001) by
providing education and training, information and referral, or legal
based advocacy. There were 8,023 individuals participating in training
events; 2,182 individuals with disabilities received Information and
Referral services; and 550 Social Security beneficiaries were provided
individual representation.
PABSS programs developed PABSS brochures, informational flyers,
posters, and postcards for placement in SSA and Vocational
Rehabilitation offices, One-Stops, and community organizations. They
engaged in extensive education and training of Social Security
beneficiaries, their representatives, other individuals with
disabilities, family members, community groups, disability
organizations, and supporting professionals. Recognizing the need to
coordinate services--P&As began to build external relationships with
other key elements of the ``Ticket to Work'' and workforce development
system, including, for example the Benefits Planning Assistance and
Outreach offices and Medicaid Buy-in Working Groups. Many PABSS
programs also convened statewide workgroups and monthly meetings with
key disability programs and experts on return to work issues. P&As
provided information and referral, mediation and legal services to
beneficiaries.
When establishing the problem areas and setting up the annual
reporting requirements, NAPAS assumed--as did others in the disability
community--that beneficiaries with disabilities would encounter
problems primarily in the areas of vocational rehabilitation,
Employment Networks, benefits planning, and employment or employer
benefits, with some concerns falling into the category of ``Other.''
However, direct advocacy services and P&A representation has been
needed to secure rights and overcome barriers to employment presented
by entities apart from those previously mentioned. Roadblocks were
found to often include the discriminatory effects of architectural,
transportation and communication barriers and failures to make
modifications to existing facilities. Specific areas of concern
include:
LAccessing employment and placement services;
LDefaulted student loans (preventing continued
employment)
LMedicaid eligibility and 1619 (b) issues;
LPASS and work incentive concerns, including the
correct application of Impairment Related Work Expenses
(IRWES);
LIn-home support services;
LSocial Security overpayments;
LInadequate special education transition planning;
LDeficient institutional discharge planning;
LInadequate Medicaid and public benefit supports;
LLack of employer adherence to employment
discrimination laws, and
LAccess to services such as transportation.
Recently, NAPAS prepared an Annual Report of PABSS Activities,
which was submitted to SSA for review and approval (Draft, Summer
2001). After SSA review, we were asked to delete certain bulleted items
from the list of ``barriers to employment'' because SSA did not
consider them to be barriers. These include Medicaid eligibility and
1619(b), PASS, and work incentive concerns including the (correct)
application of Impairment Related Work Expenses (IWREs) and SSA
overpayments. We also were instructed to delete these same items from
``areas of concern'' under the `Source of Individual Concerns'. It is
clear from this that SSA does not understand the types of problems
confronting beneficiaries, nor the advocacy needed to get beneficiaries
back to work. To get jobs, beneficiaries require advocacy to, among
other things: get services from state VR agencies; have physical access
to employment service providers, especially One-Stop centers; have
accessible transportation to service providers and jobs; and receive
reasonable accommodations from employers. Social Security should not be
permitted to narrow the protection and advocacy services that Congress
mandated in TWWIIA.
One additional problem facing SSA beneficiaries who return to work
is overpayments. This can be a major barrier to beneficiaries'
willingness to take advantage of work incentives programs, including
the new Ticket to Work program. Beneficiaries may be very conscientious
in reporting their earnings, but the overpayments still occur over
significant periods of time, and beneficiaries continue to be fearful
of owing SSA thousands of dollars for working. Beneficiaries do not
know whether the benefit amount they are receiving is correct or
whether SSA has made an error or failed to record their earnings. They
get stuck and are not able to access advocacy services or assistance on
overpayment issues from PABSS programs because SS has restricted P&As
from using this money to address problems related to SSA programs/
services.
Recommendations
Based on the observations of the PABSS program, NAPAS is providing
a number of specific recommendations, which we believe will improve the
effectiveness of the TWWIIAA program.
We recommend that Congress:
LReview the TWWIIA payment system to enhance the
involvement of non-VR providers and to eliminate the ``business
as usual'' actions of VR agencies.
LEnsure strong safeguards are in place so that
individuals with disabilities, who take advantage of the TWWIIA
program in order to become meaningfully employed, are not put
in jeopardy of losing their benefits.
We recommend that the Social Security Administration:
LProvide better information on the TWWIIAA program to
beneficiaries and others through a variety of methods and
vehicles, including their public information resources, the
BPAO and the PABSS program.
LProvide necessary flexibility to the PABSS program so
that, as additional barriers to employment are identified, such
as overpayments, the scope of the PABSS program, as intended by
Congress, is broadened to reflect these new discoveries.
Conclusion
Thank-you again for inviting NAPAS to testify here today. We look
forward to working with the Committee and with the Social Security
Administration to ensure effective TWWIIAA implementation. Hopefully,
working together, we can resolve problems that have arisen during the
first year of implementation--not only in relation to the
implementation of the overall bill, but also to the implementation of
the PABSS program. Again, we thank the committee for its work to help
broaden the scope of the PABSS program so that it can address more and
more of the barriers that people with disabilities face as they work to
secure, regain, or maintain employment.
Chairman SHAW. Thank you very much for that testimony. I
continue to be concerned, as I think all of us are, with regard
to the earnings limitation, but as I understand it, the first
year there is no limitation, which gets people into the
workforce and see how they feel and how they are doing, and
then they can move forward if perhaps they want to get out of
the program entirely if it is very successful. We have heard a
lot about welfare reform. I chaired that committee when we
passed welfare reform back in 1996, and it is a question of
people believing in themselves.
Ms. Gilliland, you talked very much about self esteem. That
has a lot to do with it. People's self esteem goes up when they
get into the job market. They become more and more self
sufficient, and the whole purpose of the Ticket to Work was to
give people that chance without the fear of losing everything
and going forward with it.
I have just a couple of questions, and I would like to
throw this one out to the entire panel. The first tickets to
beneficiaries were mailed out 7 months ago, and based upon your
experience--I think perhaps all of you have answered this to
some degree--but I am assuming that all of you think it is
really working at this point, perhaps not as inclusive as we
want it to be.
Mr. Gadaire, you talked about your concern about the system
becoming overwhelmed. Well, I hope it does get overwhelmed, and
I hope we have to come back here and figure out ways so that we
can better service all of these people. Would you like to
comment on that?
Mr. GADAIRE. Well, I guess my concern is, I would like to
try to address it before it gets overwhelmed. When it gets
overwhelmed, my greatest fear is we start to create what I
would call bad practices, and second and third-generation bad
practices are almost impossible to retract. So, my concern is
now before it is overwhelmed we have frankly a chance to do
something about it.
Ms. WEBB. Mr. Chairman?
Chairman SHAW. Well, that is one of the purposes of this
hearing, is to do our oversight responsibility. Ms. Webb?
Ms. WEBB. One element I think that we are experiencing in
the first 13 States is that the Tickets are out now, and so the
initial demand is now starting to diminish for those who are
contacting us, and now what we are thinking about is what are
we going to do to contact them. What is going to be the
additional marketing approach that we are going to use, and are
we going to see the same level of enthusiasm and motivation
when we start calling people again, a kind of a second phase of
the roll-out.
Once you get through those initial people--because
obviously the ones that are calling us, which is where we are
now, are the ones that are motivated to begin with. What about
the ones who have not chosen to call us? Now the impetus is
upon us to go ahead and start contacting them again and say,
``Hey, you have this Ticket. We would really like to talk with
you.'' So, I think we are entering into perhaps the second
phase in the roll-out States at this time, and it will be
interesting to see how that goes.
Chairman SHAW. I have here a sample of what the Ticket
looks like, and we have been talking a great deal about the
Ticket to Work, and some people watching this hearing probably
are wondering what does a Ticket look like. Did you have your
hand up?
Ms. GILLILAND. Well, I just wanted to say that originally
when I got the Ticket to Work in February, I was one of the
first to receive the Ticket to Work. I mean literally I think I
must have asked Susan Webb at least a dozen times, ``Are you
sure this is real? Are you sure this is real, that if I go back
to work the government is going to continue with my benefits?''
At that point it was critical that not only did I have my
money-wise benefits, my financial, I also needed my mental
benefits, as far as medications for mental, psychiatric and
stuff like that. Maybe suggestion-wise, as far as making it
more clear in the actual format of the Ticket to Work that it
is true, that it is not some kind of farce, that it is not some
kind of scheme to get you involved in something like that, that
it is something that is very much true and very much important
and very much that if you sign up and that you are willing to
go forth with this, that there is nothing to worry about, that
the government will take care of you, which is people get
real----
Chairman SHAW. It is like the old joke, ``I am from the
government and I am here to help you.''
[Laughter.]
Ms. GILLILAND. Right, right.
Chairman SHAW. Ms. Webb, I assume that in Arizona you keep
your medical benefits.
Ms. WEBB. Mr. Chairman, we have the Medicaid buy-in in
Arizona, but our State has experienced the budget crunch like
everyone else. Our State legislature did vote to keep the
Medicaid buy-in, but it will not be implemented until January.
Currently we have 10 of our Ticket participants on the waiting
list, purposely not working until the Medicaid buy-in goes into
effect. We are finding that 75 percent of the people we are
placing, we are placing into jobs where the employer does
provide health care including prescription drug coverage, but
as in Amy's case--she is an example of this--where there is a
waiting period often before those benefits kick in. Where we
are going to find the greatest use for the Medicaid buy-in is
for those people that need that help between the time that they
are not eligible because of earnings in the Medicaid program,
but now they are working above that eligibility, but their
employer-provided benefits haven't kicked in yet. So, I see
where the Medicaid buy-in under this program will be a good
buffer to get people into the workforce and then eventually the
employer provided health care will kick in.
We believe, and we are going to prove it to our State, that
the Medicaid buy-in will actually save our State money.
Chairman SHAW. Thank you. Mr. Hayworth?
Mr. HAYWORTH. Well, Mr. Chairman, let me again thank the
entire panel, and I guess David, your ``home cooking'' kind of
works. I say my friends from home have been working with the--
and Amy, especially since you are living this, your perspective
kind of--well I won't set conditions on it--it is of immense
value to us. You mentioned one improvement in terms of saying,
``This is real. It is not false. Let us clear this up with the
Ticket.'' You have characterized this from your perspective as
almost too good to be true, I think to paraphrase.
Ms. GILLILAND. Absolutely.
Mr. HAYWORTH. Is there any downside that you have
experienced, anything other than that constructive criticism of
making it a little more blatant, and I don't know, if we put
like neon writing or make it fluorescent or what, to glow in
the dark, really let people know about this, but is there
anything else that in this imperfect world would make this a
little better from your perspective?
Ms. GILLILAND. Well, Congressman Hayworth, I know that for
ABIL, which is a company, and I promised Susan I wouldn't get
too involved in it, but I was fortunate enough to be blessed
with such a wonderful, wonderful Agency, and I am not sure----
Ms. WEBB. I didn't tell her to say that.
[Laughter.]
Chairman SHAW. Well, you will have a chance to correct her
if you like.
Mr. HAYWORTH. This is completely spontaneous and
unrehearsed.
[Laughter.]
Ms. GILLILAND. That I think, like this gentleman at the end
was saying, that a lot of agencies don't want to take on the
more people that need more help. I have a friend that is on
disability, who he is one that needs extra help, extra care,
extra concern, that in fact did call an agency--I am not sure--
but lives in Arizona that did call an agency. Didn't get back
to him. Called another agency, didn't get back to him. Finally
I said, ``Listen, you have to call ABIL. You call ABIL.
Somebody is going to get back to you.'' So, I think that is
definitely an important issue, and that is making sure that no
matter what, no matter what the case is, no matter how severe
the case is as far as how your health is or your physical or
mental status, that we are all human beings, and we all need
help sometimes, and that is definitely--that has to be more
proficient. I know that for ABIL, ABIL is a great, wonderful
company, and I really was blessed, but I don't know about the
other companies.
Mr. HAYWORTH. In fairness, I don't know why I think of
this, maybe my burgeoning waistline, but I see those ads on TV,
``Results not typical. Your experience may vary.''
[Laughter.]
Mr. HAYWORTH. I don't know why I think about that. In
fairness, Mr. Decker touched on some points here, and maybe you
would like to amplify what you see, if you had to prioritize
the things that can be better, as you have looked at this
across the country from the roll-out in States like Arizona,
the places where now it is just coming online, other places
that unfortunately are having to hang back. If you had to
prioritize the A-number-one imperative that we missed, what
would that be?
Mr. DECKER. Well, I guess I would put it probably in tiers
of what you could accomplish quite easily, what I think, or is
going to require a little effort, and then some things that are
probably going to have to be statutorily changed, which is not
that easy.
I guess I go back to the whole issue of the initial
information. It seems to me Social Security Administration has
a pretty large public information resource that they should be
using to get the word out early so when these Tickets do
arrive, that some of that initial doubt, and in some cases
fear--the Commissioner herself I think has stated that if she
got this letter in the mail, she wouldn't be so sure that it
was something to be taken seriously. So, I think you could get
a lot of interest and getting people thinking about the fact
that, ``Gee, maybe I can go back to work even though''--again,
remember that these folks have maybe spent a year trying to get
on benefits, have had a fair amount of issues with Social
Security over the years, and now suddenly get this letter
saying ``It is okay. We are here to help you.'' I think there
is a real learning curve and an attitude to get over. I think
that is pretty simple to do.
The issue of course of making sure that there is
coordination with all these different components that have been
put in place, so that when some person decides to come forward,
they are getting the best information, the most accurate
information and the full approach. Again, I think that is
something they can accomplish, reinforce all of the groups at
this table, we have some obligation at the local level to be
working together and trading information, and not just passing
clients around up and down the line, but making sure that a
client is getting the right information and the right service
at the time they need it.
The last thing, and more difficult, is going to be some of
the payment incentives to make sure that we get more ENs in,
that they are willing to take on more difficult to serve
clients, and try to undercut some of this fighting over the
reimbursement, so that we get the full range of people involved
in the program.
Mr. HAYWORTH. Thank you, sir. Again, thank you to the
entire panel for being here today.
Chairman SHAW. Thank you. This has been most enlightening.
You all come from all the way up to Massachusetts, all the way
out to Arizona. We very much appreciate all of you being here.
We appreciate the work you are doing and the good that you are
accomplishing, and really helping out some people who certainly
need the help, but can become very productive, self-sufficient
individuals with just a little bit of faith and a little bit of
self esteem. Thank you very much.
We are now adjourned.
[Whereupon, at 1:52 p.m., the hearing was adjourned.]
[Questions submitted from Chairman Shaw to the panel, and
their responses follow:]
Social Security Administration
Baltimore, Maryland 21235-0001
November 29, 2002
1. LWhere does the Social Security Administration (SSA) stand in
developing an alternative to the Employment Service Representative
(ESR)? How can we be assured that an alternative will result in
improved service, and not merely continue the problems of the past?
Will the duties so ably performed by the ESR be diffused throughout all
SSA staff, which was part of longstanding problem with addressing this
workload? Will you be sure to keep us informed as you consider
alternatives?
Answer:
SSA executives are still considering how best to provide,
nationally, information and services related to SSA's disability
employment support programs to beneficiaries with disabilities who want
to work.
We will keep you informed as we finalize this decision and move
toward implementation.
2. LWhat is the relationship between the ticket program and the
existing Federal-state vocational rehabilitation (VR) system? Can
beneficiaries use their ticket with another provider and still receive
VR services? Is the ticket designed to replace the VR system, or is it
designed to complement it? Do beneficiaries still need the VR system?
Is any clarification needed in the law to assure that the intent of the
ticket program to maximize choice is achieved?
Answer:
LWhat is the relationship between the ticket program
and the existing Federal-state vocational rehabilitation (VR)
system?
The relationship between the ticket program and the Federal-State
VR system is one that affords increased access for beneficiaries to
vocational rehabilitation (VR), employment, and other support services
with the goal of providing beneficiaries with the services needed to
obtain employment and reduce their dependence on cash benefits.
State VR agencies can elect to be paid under the Employment Network
(EN) payment system or receive traditional cost-reimbursement payments
for providing VR services to beneficiaries who assign their ticket to
them, on a case-by-case basis. This option affords the State VR
agencies with the opportunity to elect the method for recouping the
cost of the VR services they provide to a beneficiary. This provides
access to additional funding, which they can use to provide VR services
to more beneficiaries. In practice so far, a minority of States in our
initial roll-out group have elected to enroll beneficiaries using the
EN payment system.
LCan beneficiaries use their ticket with another
provider and still receive VR services?
Answer:
A beneficiary can, after assigning his or her ticket to an
employment network, receive services from the State VR agency. The
Rehabilitation Act 1973, as amended, does not require ticket assignment
as one of the requirements to be eligible for VR services.
LIs the ticket designed to replace the VR system, or
is it designed to complement it?
Answer:
The ticket program complements the VR system by affording the VR
system with access to additional funding, the EN payment system, which
can be used to increase the delivery of VR services to more
beneficiaries. Additionally, through the agreements State VR agencies
enter into with employment networks the State VR system can contribute
to the service delivery capacity of the employment network and increase
the services available to beneficiaries.
We are concerned that during our initial Ticket roll-out in some
States, ENs and potential ENs believe that State VR agencies control
the marketplace. This perception can have a chilling effect on
participation by providers and can have the same effect on beneficiary
choice.
LDo beneficiaries still need the VR system?
Answer:
Beneficiaries still need to have access to the State VR system.
There are beneficiaries whose employment service needs can be handled
by State VR agencies, which can wield significant resources under the
Title I of the Rehabilitation Act. Some beneficiaries with expensive
service needs may find ENs reluctant to serve them.
Is any clarification needed in the law to assure that the intent of
the ticket program to maximize choice is achieved?
Answer:
We believe that it is too early to tell whether the current law is
achieving the intended effect relative to choice. We are closely
monitoring the activities of the State VR agencies, employment networks
and beneficiaries as we continue the roll-out of the ticket program.
3. What kinds of activities is SSA undertaking to publicize and
explain the ticket program to beneficiaries? Are resources specifically
budgeted for this marketing effort, or has SSA contracted with other
organizations to market the ticket to beneficiaries?
Answer:
We have undertaken a number of activities to publicize and explain
the Ticket to Work program to beneficiaries and other interested
parties. For example:
Notices
We send eligible disability beneficiaries a letter and booklet with
the ticket explaining what the program involves. As of October 21,
2002, we have mailed 2,329,127 tickets to eligible beneficiaries in the
Phase One States.
Web Sites
We developed and launched a Ticket to Work Program section within
SSA's website, with information specifically for beneficiaries.
Information on this part of the website, called ``The Work Site'',
includes fact sheets, frequently asked questions and a Ticket to Work
calendar of events open to the public. The Work Site was featured in
SSA's electronic newsletter, E-News in the March 2002 issue. The Work
Site is available at http://www.ssa.gov/work/Ticket/ticket_info.html.
Under its contract with SSA, the Ticket to Work Program Manager
(PM), MAXIMUS, has developed and launched another web site with
information
on the Ticket to Work program specifically for beneficiaries.
Information provided
includes frequently asked questions and employment network and State
Vocational
Rehabilitation contact information. The PM's Web site is available at
www.yourtickettowork.com.
Bookmarks with the Web site addresses referenced above were created
in August of 2001, and are distributed at conferences, conventions, and
other meetings related to the Ticket to Work program and work
incentives. The website address is also included in our public
information materials for people with disabilities.
Video
In partnership with the Maternal and Child Health Bureau, we
developed a Ticket to Work video in December of 2001. The video is
available online at http://www.ichp.edu/videos/TTW2.htm.
Publications
We have developed publications titled Ticket to Work and Work
Incentives Improvement Act (June 2002) and Your Ticket To Work: What
You Need To Know To Keep It Working For You (September 2002)which are
available online at http://www.ssa.gov/pubs/pubs_whatsnew.htm. Other
publications were updated with Ticket information in 2001 and 2002. We
are developing the 2003 edition of the Red Book on Employment Support,
which will update this resource for employment practitioners, and which
will include the latest Ticket to Work information. This publication is
expected to be complete in December of 2002 and will be available
online, in SSA field offices, and by direct order from SSA.
Poster
We are developing a Ticket to Work poster that will be distributed
to SSA field offices, for beneficiaries inquiring about the Program.
Toll-Free Telephone Numbers
We have worked with the PM, MAXIMUS, to develop and maintain toll-
free telephone numbers to provide Ticket to Work information to
beneficiaries, employment networks, and other people interested in the
Ticket to Work program. (1-866-968-7842 and TDD 1-866-833-2967) As of
October 21, 2002, MAXIMUS had handled a total of 112,337 calls from
beneficiaries.
Press Events
We sponsored kick-off events in three of the 13 Ticket States,
Delaware and Massachusetts in February 2002, and Arizona in April 2002,
in which the first tickets were issued to beneficiaries directly by
Commissioner Barnhart. Local media beneficiaries, advocates, service
providers, business community representatives and others were present.
SSA's Regional Offices also organized similar press events in other
First Phase Ticket States. Similar events are being planned for the
Second Phase Ticket States.
Meetings
We participate in numerous conferences, conventions and meetings
with disability advocacy groups, educational institutions and non-
profit organizations nationwide. In these settings, we do presentations
and speeches, exhibit at booths, participate in forums, and provide
training on the Ticket to Work Program and other employment support
programs. SSA staff in the Office of Employment Support Programs,
regional and local offices and MAXIMUS staff are actively involved in
this activity. Over the first year of roll-out, we have appeared at
hundreds of such events.
Partnerships
We have established partnerships with other Federal agencies who
serve individuals with disabilities, including the Department of Labor
(DOL), the Department of Education, the Small Business Administration,
the Centers for Medicare and Medicaid Services (HHS), and the Agency
for Children and Families (HHS). We have established the SSA-DOL
Partnership to pilot the Disability Program Navigator (DPN) Position,
which will provide an expert on SSA's employment support programs in
local One-Stop offices.
A number of our regional offices have established successful
networks for information sharing. Members include various State and
local agencies, organizations, and advocates.
Grants and Cooperative Agreements
We have awarded cooperative agreements to Benefits Planning,
Assistance, and Outreach organizations in all 50 States, Washington,
D.C., and the U.S. Territories American Samoa, Guam, Northern Mariana
Island, Puerto Rico and the U.S. Virgin Islands. These organizations
are charged with providing SSA beneficiaries with disabilities
(including transition-to-work aged youth) access to benefits planning
and assistance services. They also provide information on the Ticket to
Work program to beneficiaries and organizations that provide services
to people with disabilities. We have also awarded grant funds to 57
protection and advocacy agencies in the States and territories to
provide information and assistance directly to beneficiaries.
Employment Networks
As our contractors, the Employment Networks are encouraged to
market and publicize the Ticket to Work program directly to SSA
beneficiaries.
4. We understand that a number of employment networks have
expressed the need to obtain additional capital up front to better
absorb such risks. What can SSA do to assist employment networks
seeking additional capital?
Answer:
Section 1148 of the Social Security Act provides for payment to
Employment Networks (ENs) only for assisting beneficiaries to achieve
outcomes and, if the EN has elected, milestones. Some ENs and
prospective ENs have indicated that they are reluctant to actively
participate in the Ticket to Work program because they may not be able
to afford the up front costs of providing employment services, either
because outcomes are far from certain, or because they may have to wait
a substantial period of time before payments based on outcomes are
received. While an issue for most ENs, the need for a stream of up
front funding is especially critical to smaller organizations that do
not have a variety of funding sources available to them, such as
grants, endowments, and charitable contributions. Traditionally, such
organizations have relied upon immediate payment for services provided,
which is not an option for them under the Ticket to Work program.
For this reason, we are working with our program manager, MAXIMUS,
to identify potential funding sources and to train ENs on how to take
advantage of them. Tasks involved in this activity:
LPerform an ongoing nationwide review of available
funding sources to support EN activities;
LReview the terms and conditions of these funding
sources, as well as the application procedures, to determine
their appropriateness for ENs;
LCodify the funding sources and application procedures
in a directory accessible to ENs, to be maintained by the PM;
LDevelop and maintain a training module on EN
capitalization sources and procedures as part of the standard
EN training program;
LArrange for the delivery of EN capitalization
training to ENs; and
LProvide information regarding EN capitalization to
prospective ENs via the Ticket to Work toll-free number, EN
Recruitment Fairs, and other EN marketing activities.
We expect that these activities will significantly assist the ENs
in obtaining additional funding to assist them in performing the EN
function.
5. What are your specific plans to address the depth of choice
available to consumers in terms of employment networks?
Answer:
From the beginning of the Ticket to Work program, we have
recognized that, in order for the Program to be successful, it is
critical that an extensive recruitment of ENs occur. Accordingly, we
have required MAXIMUS, as the PM, to manage an ongoing nationwide
recruitment of ENs. MAXIMUS is specifically responsible for enrolling a
sufficient number of ENs to ensure the availability of adequate
services and reasonable access to EN services for all beneficiaries
within a State, including rural areas. To accomplish this requirement,
MAXIMUS:
Lutilizes an in-house marketing staff that is
responsible for contacting prospective ENs and encouraging
these prospective ENs to formally make a proposal to SSA.;
Lorganizes and operates EN Opportunity Fairs, designed
to provide prospective ENs (both organizations and individuals)
with detailed information on the Ticket to Work and the EN
process, in all States;
Lattends National, regional and State events exclusive
of the EN opportunity conferences to market the Ticket program
to over 11,000 different provider organizations; and
Lactively assists prospective ENs in completing and
submitting the necessary documents (Request for Proposal) to
become ENs.
We have been pleased to note recent accomplishments--one-stop
agencies under the Workforce Investment Act in several States have
joined the rolls of ENs. Other ENs include a Native American
rehabilitation agency, a DOL-funded business leadership network,
several general-purpose employment agencies, and a number of
independent living centers. We continue to assess our progress in this
area and will keep you informed as we move through our ticket
implementation.
6. The Ticket to Work Act requires the Commissioner of Social
Security to periodically review the payment schedules to determine if
there are adequate incentives for employment networks to assist
beneficiaries to enter the workforce. Witnesses expressed concern that
the payments are inadequate to ensure a wide range of employment
networks and that the current structure contains inequities in
financial incentives to serve certain beneficiaries. Please describe
what efforts are underway to review and evaluate the milestone payment
systems.
Answer:
The evaluation of the Ticket program's payment structure, both
outcome and milestone payments, for providing adequate incentives for
Employment Networks (ENs) is a part of the overall evaluation of the
Ticket program, mandated as part of the Ticket to Work legislation. The
work activity and earnings of beneficiaries who are served by ENs
receiving milestone payments will be compared with that of
beneficiaries with tickets who are not served by ENs receiving
milestone payments, beneficiaries with tickets who are not served by
ENs at all, and beneficiaries who do not have tickets. Special emphasis
will be given to those beneficiaries who are difficult to serve.
7. One of our witnesses, Dr. Kregel, expressed his concern that
individuals may be receiving conflicting information about Ticket to
Work from many fronts, including SSA, Maximus, VR agencies, and
Employment Networks. How is SSA ensuring information provided to
consumers is accurate and consistent?
Answer:
Over the past year, we have developed and provided an extensive
range of training to our field staff on work incentives, including the
Ticket to Work program. In addition, we have engaged a consortium of
university-based trainers and providers of technical assistance. They
work from a common curriculum and operate in constant contact with SSA
and its other contractors such as MAXIMUS.
MAXIMUS also ensures that their personnel are trained in providing
consistent and accurate information on these programs, and maintains a
quality assurance review to ensure that this level of accuracy is
maintained. As we learn of any misinformation being provided by ENs,
MAXIMUS is ensuring that the ENs are advised of the correct information
to be provided to beneficiaries. We continue to advise the
Rehabilitation Services Administration and individual State vocational
rehabilitation agencies as we learn of instances of misinformation
being given by State vocational rehabilitation agencies.
8. When SSA needed administrative money to review disability cases,
the Congress set aside a separate source of funds that was part of
Social Security's Limitation on Administrative Expenses, but exempt
from the budgetary caps in the Budget Act and earmarked specifically
for continuing disability reviews. Those budget caps and the funding
amounts have expired, leaving SSA's administrative funding somewhat in
limbo. How much money do you think it will take to successfully
administer the Ticket Act, and do you have a plan for assuring the
Congress will give you those funds for that designated purpose?
Answer:
Our Administrative budget for FY 2003 includes $44 million for
Return to Work activities. This funding is for Benefits Planning and
Assistance Cooperative Agreements ($23 million), Protection and
Advocacy grants ($7 million), and the Program Manager contract ($14
million).
In addition, our administrative budget supports other costs related
to Return to Work activities such as the Work Incentives Advisory
Panel, Employment Support Representatives, and research evaluation
activities.
9. As you know, the law requires that within 3 years of enactment,
SSA is required to report to Congress with recommendations for methods
to adjust payment rates to ensure there are adequate incentives for
service providers to ensure that ``hard to serve'' populations are able
to participate in the program. Any necessary changes must be
implemented before the full implementation of the program is complete.
Could you give us an update on the status of the recommendations and
the report?
Answer:
The report on Adequacy of Incentives will be part of the overall
evaluation of the Ticket to Work program. Special emphasis will be
given to analyzing the degree of successful outcomes for those
beneficiaries designated as hard to serve. Recommendations for changes
in the Ticket program will be developed based on the findings of the
evaluation. The contract for the evaluation of the Ticket program will
be awarded in early 2003 with initial results reported in 2005 and a
final report in 2007.
10. SSA is required to provide independent evaluations to assess
the cost-effectiveness and outcomes of the Ticket to Work program. The
first evaluation report to Congress is due 4 years after enactment of
the Act, which means it's due at the beginning of 2004. Could you give
us the status of this report? Since implementation of the program was
initially delayed, and the first tickets were not sent out to
beneficiaries until February of this year, do you expect the evaluation
report will be on time, or will it be delayed?
Answer:
The delay in the start of the Ticket program means that the initial
report in 2004 will be a preliminary or interim report with status of
the program to that point. Annual reports in subsequent years will
provide more complete pictures of the progress of the Ticket program.
The evaluation report in 2007 will provide the first accurate
assessment of the cost-effectiveness and outcomes of the program.
11. SSA's proposed rule provided that an individual would be
eligible to receive a ticket in a month in which he or she is age 18 or
older and had not attained age 65. Many, including the Ticket Advisory
Panel, have advocated that individuals younger than age 18 should be
eligible to receive a ticket to ensure that they do not begin a
lifelong dependency on public benefits. In issuing its final rule, SSA
maintained age 18 as the threshold for receiving a ticket. Can you
provide the reasons for continuing age 18 as the threshold? Do you plan
to adjust the age? Why or why not?
Answer:
Beneficiaries in this age group generally are in school, still
pursuing completion of their formal elementary and secondary education.
For this group, participation in an employment plan under the Ticket to
Work program could interfere with their pursuit of an education,
completion of which many believe should be the primary focus and goal
for school-age youth. Therefore, we have not made these beneficiaries
eligible to receive tickets under the Ticket to Work program.
We were aware of strong interests in this transition-age
population, and we (concurrently with the final rules) published a
request for public comment regarding appropriate ways to assist youth
with employment services. We received over a hundred comments and also
received input regarding those issues through several public-input
discussion sessions. We are currently working with this input and other
data in a review of this policy. We will keep you informed of
developments in this area.
12. Individuals designated by SSA as ``medical improvement
expected'' cannot participate in the Ticket program until after their
first continuing disability review, which is scheduled for 1 year after
eligibility is determined. The Ticket Advisory Panel, among others, has
suggested these individuals also receive tickets, because providing
services sooner often leads to the best outcomes. Can you provide your
reasons for this exclusion? Are there any plans for SSA to reverse its
position? Is so, why? If not, why?
Answer:
Because beneficiaries in this category could be expected to return
to work without the need for services under the Ticket to Work program,
we have decided not to give them tickets. We also believe limiting
eligibility to tickets in this manner strikes the proper balance
between equitable treatment of disability beneficiaries and ensuring,
to the extent possible, that the resources that will be available in
the Ticket to Work program are distributed in the most effective and
efficient manner. However, we are reviewing our policy in regard to
this population. We will keep you informed of developments in this
area.
13. Under the Ticket to Work Act, SSA was authorized to complete a
demonstration project to examine the effect of reducing benefits by $1
for every $2 in earnings above a certain amount. Could you update us on
the status of the project and when Congress will see the results?
Answer:
The $1-for-$2 demonstration is undergoing a thorough reexamination
and redesign. SSA will work with research experts and the Work
Incentives Advisory Panel to develop the best research design that is
feasible to produce a reliable estimate of the potential national
impact of the benefit offset. After input from the experts, SSA will
solicit proposals for the design and implementation of the
demonstration. The demonstration will begin by early 2004 with first
results available by 2006.
Ticket to Work & Work Incentives Advisory Panel
Washington, DC 20024
November 4, 2002.
Honorable E. Clay Shaw, Chairman
Subcommittee on Social Security
U.S. House of Representatives
Committee on Ways and Means
B-316 Rayburn House Office Building
Washington, DC 20515
Dear Chairman Shaw,
The Ticket to Work and Work Incentives Advisory Panel appreciates
the recent opportunity to provide testimony before the Subcommittee
regarding the Social Security Disability Programs' Challenges and
Opportunities. We have received your follow up questions of October 17,
2002 and submit the following in response.
Where possible the answers reflect specific recommendations in the
Panel's reports and discussions on the general topics relevant to your
questions. In some cases, we are unable to answer the question at this
point because we have not yet had an opportunity to gather the data
needed nor reach a conclusion on the issue. However, in order for the
hearing record to be complete, we are submitting our response for your
consideration at this time. To aid in clarity of this response, we have
separated the five questions as follows:
1. In the opinion of the Advisory Panel, what made the Employment
Support Representatives (ESR) pilot so successful? What are the key
features that would need to be continued in whatever alternative
structure the Social Security Administration (SSA) develops to meet the
mandate in the law?
The Panel believes the ESR pilots were successful because they
identified and trained work incentive specialists within SSA to assist
beneficiaries and their advocates in making informed choices about
returning to work and the use of existing work incentives. Local SSA
offices have not historically demonstrated great expertise in this
area.
The Panel believes the key features that need to continue in any
structure SSA develops should follow the specifics outlined in the
Statute.
The Ticket to Work and Work Incentive Improvement Act states in
Subtitle C, section 1149(a)(2)(C), ``the Commissioner shall establish a
corps of trained, accessible, and responsive work incentives
specialists within the Social Security Administration who will
specialize in disability work incentives under titles II and XVI. . .
.''
The Panel also strongly believes national implementation of the ESR
position is key to the successful implementation of the programs and
work incentives improvements under the Act. It is also critical to
improving customer service for beneficiaries who attempt to work and
report earnings or attempt to use any of the current work incentives in
the SSI and SSDI programs. The Panel's position is that all interested
beneficiaries across the country should have reasonable access to work
incentive specialists who are dedicated to this task full-time.
2. You indicated the Panel believes the resources allocated to
public education, training and marketing of the Ticket program are
insufficient. What specific recommendations has the Panel made to SSA
on educating the public, conducting better training, and improving the
program marketing? How does the Panel plan to assist in these efforts?
In its recent annual report the Panel specifically recommended that
SSA dedicate extensive increases in budget to develop outreach,
training and technical support in the areas of SSA's disability and
return to work programs and work incentive provisions, as well as,
other Federal benefit programs and work incentive provisions
administered by agencies. Based on public comment, the Panel is
convinced that most beneficiaries who will receive a ticket do not know
what it is, what to do with it, or why it has been sent to them. In
recent public forums, White House staff and senior SSA executives have
acknowledged the need for an outreach campaign to market the Ticket
Program, not only to beneficiaries but also to employers and providers.
An immediate, coordinated public information campaign to explain the
provider and employer opportunities, and beneficiary choices and
protections under the Ticket Program, is crucial. The Panel is
concerned SSA has not allocated sufficient resources for this effort.
Given the potential impact of the Ticket Act Programs on the lives of
individuals with disabilities and other stakeholders, and the amount of
information needed to ensure the effectiveness of these programs,
adequate resources must be allocated to training and technical support
on national, regional, State and local levels. Readily available,
accurate information is key to helping people with disabilities return
to work.
The Panel is an advisory body with a very limited staff allotment
and budget. As such, it does not foresee the ability to assist SSA
directly in these efforts. However, the Panel does continue to
publicize the programs on our Web site, www.ssa.gov/work/panel, and to
continue to work very closely with the Agency and the Congress in
expanding efforts in these areas.
3. You expressed concern that there are not enough service
providers, in terms of both geographic location and specialization.
What specific recommendations have you made to SSA to remedy this
situation?
As the roll out of the Tickets continues, this issue is just
beginning to emerge. The Panel first heard complaints about capacity
and specialization at its August 2002 meeting. Apparently there has
been a much greater response to the Ticket roll out than ENs had
anticipated. Many ENs reported being overwhelmed with the volume of
calls and contacts from beneficiaries who had received their Ticket.
The Panel is very concerned with building service provider capacity and
will continue to investigate this issue.
4. Is the Panel addressing the issue of obtaining up-front capital
for employment networks in need? Have you made suggestions to SSA?
The Panel is concerned about this issue as a result of testimony
received at its most recent meeting in August 2002 but it has not, as
yet, made any suggestions to the Social Security Administration.
5. Would you tell us more about why the Panel believes ticket
eligibility should be expanded to those under 18 and those whose
conditions are expected to improve?
First, the Panel recommended that 16- and 17-year-old beneficiaries
should be eligible to participate in the Ticket Program. The Panel
takes the position that making transition-aged youth ineligible for the
Ticket Program sends the wrong message to youth and could encourage
lifelong dependence on benefits. The Panel believes short-term costs
were the primary reason youth were excluded, however, the long-term
benefits to young beneficiaries and long-term program savings could far
outweigh the short-term costs. Numerous studies have found the sooner
someone begins receiving employment services, the more likely the
person will be to go to work. Delaying the onset of those services,
even by a short time, makes it substantially less likely that the
individual will attempt to work or succeed.
Second, the Panel takes issue with SSA's assumption that because
beneficiaries with Medical Improvement Expected (MIE) designations have
medical conditions expected to improve in a relatively short time, they
could be expected to return to work without the services under the
Ticket Program. Currently, few beneficiaries with the MIE designation
are leaving the rolls voluntarily to return to employment. In addition,
on average, only 16 percent of beneficiaries with this designation are
ceased for medical improvement after their initial continuing
disability review (CDR). A substantial number of beneficiaries (51,044
in 1999, for example) will therefore be denied this important benefit
for up to 2 years on average, based on what the Panel believes is a
faulty assumption.
The Panel also believes the decision to exclude beneficiaries with
the MIE designation was based primarily on short-term cost
considerations which may have failed to take into account the long-term
savings to the programs that could be realized through early
intervention. The Panel remains convinced that beneficiaries with the
MIE designation will benefit significantly from participation in the
Ticket Program and should be included.
We greatly appreciate your interest in the Panel's views on Social
Security Disability Programs' Challenges and Opportunities. We look
forward to continued involvement with the Subcommittee on these and
other Social Security disability concerns. Thank you again for this
opportunity. If you need any further information or clarification,
please contact Marie Strahan of our staff at 202-358-6419.
Sincerely,
Sarah Wiggins Mitchell
Chair
CC:
Ticket to Work and Work Incentives Advisory Panel
Marie P. Strahan
JoAnne Barnhart
Martin Gerry
Kenneth McGill
Consortium for Citizens with Disabilities
Washington, DC 20006
November 1, 2002
Hon. Clay Shaw, Chairman
Committee on Ways and Means
Subcommittee on Social Security
US House of Representatives
B-316 Rayburn House Office Bldg.
Washington, DC 20515
Dear Mr. Chairman:
This letter is in response to your request for additional
information concerning the testimony of the Consortium for Citizens
with Disabilities Work Incentives Task Force to your Subcommittee's
hearing on September 26, 2002--``The Social Security Disability
Programs' Challenges and Opportunities.'' On behalf of the Task Force,
I appreciate this opportunity to supply additional information to the
following questions:
1. L``We were disappointed to hear your concerns about Vocational
Rehabilitation and the Ticket program. In your view, what can SSA do to
address the issues raised in your testimony?''
First of all, we want the Subcommittee to understand that our
criticisms were not lodged against all state vocational rehabilitation
agencies (VRAs). There are numerous VRAs who are making a concerted
effort to make the Ticket program successful and to be genuine partners
with the wider provider community in their states. However, there are
occasions where confusion still exists among VRA staff over the Ticket
to Work and Work Incentives Improvement Act (TTWWIIA) and conflicts
occur over VRAs' Title I Rehabilitation Act responsibilities versus
their role in the Ticket program.
We believe that the Ticket regulations are being interpreted by the
Social Security Administration (SSA) and consequently VRAs in ways that
conflict with the Vocational Rehabilitation Act. Section 411.585 of the
Ticket regulations states in subsection (b) that ``if an EN or a state
VR agency serving a beneficiary as an EN is paid by us [SSA] under one
of the EN payment systems with respect to a ticket, such payment
precludes subsequent payment to a State VR agency under the cost
reimbursement payment system based on the same ticket.'' This has led
some VRAs to insist that a Social Security disability beneficiary must
assign his or her ticket to the VRA in order for services under Title I
to be provided to that beneficiary. VRAs are supposed to assess clients
for eligibility for VR services independent of the Ticket but, in some
cases, the VR process is being short-circuited because of a VRA's
insistence on deposit of the Ticket as a condition of providing
services.
The Social Security Administration has contracted for Training and
Technical Assistance to Benefits Planning Assistance and Outreach
(BPAO) and Protection and Advocacy for Beneficiaries of Social Security
(PABSS) staff which includes SSA programs and work incentives and other
Federal programs such as TANF, housing subsidies, Unemployment
Insurance, Workers Compensation, earned income tax credit, Medicaid and
State Childrens' Health Insurance Program (SCHIP). Unfortunately, these
mandated training sessions do not include information about the
vocational rehabilitation system or process. Reportedly, SSA contends
that training about the vocational rehabilitation system is the
responsibility of the Department of Education. Yet, SSA has not invoked
similar restrictions when it comes to including information at these
training sessions about housing and welfare benefits, even though those
programs fall under the jurisdiction of other Federal agencies. We fail
to see why SSA is not including information about state VRAs and their
role in the Ticket program in its internal training sessions.
At the same time, the Rehabilitation Services Administration (RSA)
needs to promote training for vocational rehabilitation counselors to
be better acquainted with all aspects of TTWWIIA, not just the Ticket
program. Counselors need to understand and more effectively communicate
the voluntary nature of the Ticket program. Additionally, counselors
need to inform consumers that they are not obligated to use their
Ticket even if they receive one, and that Title I rules and regulations
are not trumped by any provisions of TTWWIIA. Furthermore, counselors
need to know how to advise consumers about the protections from
continuing disability reviews, the opportunity for expedited reentry,
expanded Medicare and, where applicable, the existence of a Medicaid
buy-in.
The VR system is severely underfunded and, as a result, 37 state
VRAs have imposed an ``order of selection''. This means the state
agency has insufficient resources to serve all clients seeking its
assistance and will be able to serve only those most severely disabled
clients under very tight criteria. Fortunately, in most states, SSI and
SSDI beneficiaries meet the criteria to be served even under the
state's order of selection. However, in states such as Massachusetts,
the order of selection criteria is so strict that SSI and SSDI Ticket
holders do not necessarily qualify for immediate help. Consequently,
some eligible individuals are placed on waiting lists for as long as 12
months. Ticket holders in states with restrictive orders of selection
need to be informed that they may not be served immediately and that
they have the option of exploring other employment networks.
We have also received reports that the Social Security
Administration has advised VRAs that the Individual Plan for Employment
[IPE] signed by a VRA client when he or she contracts with the agency
can substitute for a signed Ticket assignment form. This seems contrary
to the concept of informed consent under TTWWIIA given that the IPE
says nothing about the assignment of the Ticket. If SSA is permitting
VRAs to submit an IPE without a statement that the beneficiary is
choosing the VRA as his or her employment network, this should be
stopped.
Certain Members of our Task Force have reported that, during the
early implementation of the Ticket program, some of their affiliates
who provide direct services to beneficiaries have been threatened with
loss of their contract with the State VR Agency if they became an EN in
competition with the VRA. Several providers of mental health services
in Massachusetts, Wisconsin, Illinois, Oklahoma and Wyoming have
reportedly made such claims. Admittedly, some of this information may
be considered anecdotal and the Council of State Administrators of
Vocational Rehabilitation (CSAVR) is working to verify if these
accusations have some validity or if they represent problems that have
since been corrected. However, we remain concerned that, absent any
concerted intervention by SSA and RSA, some state agencies may continue
to pursue such practices.
Recent reports on the progress of the Ticket program have indicated
most VRAs participating in the Ticket program are doing so under the
traditional cost reimbursement method. This is, admittedly, something
that PL 106-170 allows. However, under the cost reimbursement method,
once a beneficiary returns to work above the substantial gainful
activity level, the VRA may close that case after 9 months of sustained
employment at that level and receive reimbursement from Social
Security. This differs from the obligations imposed on other ENs that
must follow a beneficiary for up to 60 months in order to receive the
full complement of outcome payments. While we understand that
individuals with closed VR cases may be eligible for post-emplyment
services, we are still concerned about the impact that this option may
have on Ticket holders who use VR and who may lose their job after the
initial 9 months of sustained employment. While such individuals may
quickly return to the disability rolls under the new provisions for
expedited reentry, they may not be eligible for another Ticket.
Consequently, such individuals may be denied the long-term employment
supports that are available through some ENs.
Social Security officials have insisted that they are engaged in
ongoing discussions with officials for the Office of Special Education
and Rehabilitative Services at the Department of Education concerning
the issues surrounding the Ticket, Ticket-holders and the vocational
rehabilitation program. However, it is our understanding that the
official with the most knowledge about the VR system and most directly
responsible for its administration, Rehabilitation Services
Administration Commissioner Joanne Wilson, has not been a part of these
conversations. We strongly suggest that the leadership of both agencies
ensure that those with line responsibilities over the affected programs
are integrally involved when matters of policy are under consideration.
These are some of the most immediate concerns that have been
brought to the attention of our Task Force. We suspect that, as time
goes by, additional questions may arise regarding the interplay of the
public Vocational Rehabilitation Program and the Ticket to Work
program. As we encounter these questions, we will be happy to share
them with the Subcommittee.
2. L``Many have expressed concern over the effect of the employment
network payment system on their ability to serve individuals with
disabilities. Some individuals may never reach the point of having zero
benefits, and thus the employment network would not receive payments.
This means that some ENs may choose not to serve `harder to serve'
individuals. What are some potential solutions you see to this
problem?''
Although our Task Force has not formally endorsed such an approach,
some critics of the current payment system have advocated partial
outcome payments for partial reduction in benefits. They argue that the
law allows for partial payment for reduction of benefits but that SSA
has interpreted the statute too narrowly. However, given the current
level of milestone/outcome payments, any diminution of the already
small reimbursement paid to providers is unlikely to encourage ENs to
assist the ``harder to serve.''
Obviously, one way to resolve the inadequacy of milestone-outcome
payments would be for SSA to readjust them to an amount that is closer
to the outcome payment level. Certainly, in the course of developing
the law, most advocates had expected there would be only a very small
difference between outcome and milestone-outcome payment levels.
Additionally, the law allows for outcome payments to be set at 40
percent of the average benefit. However, SSA chose to set the outcome
payment rate at 34% of the payment calculation base. Adjusting that
level upward might also attract more ENs.
When our task force commented on the proposed Ticket regulations,
we identified the Report on Adequacy of Incentives mandated by P. L.
106-170 as a ``key initiative to assure that certain people with severe
disabilities are able to participate fully in the ticket program.''
Among the four groups of people whose circumstances are to be addressed
in that report are: people with a need for ongoing supports and
services; people with a need for high cost accommodations; people who
earn a subminimum wage; and people who work and receive partial cash
benefits. That report is supposed to be delivered to Congress ``not
later than 36 months'' after enactment. If the Social Security
Administration adheres to the direction provided by Congress, that
report should be issued by the end of this year and should offer some
specific recommendations for assisting these populations. We encourage
the Subcommittee to examine that report when it is published and to
consult with the disability community on the most effective means to
address particular employment needs of those with the most severe
disabilities.
3. L``What should SSA specifically do to effectively market the Ticket
to Work program to its target audience?''
As we indicated in our written testimony, we certainly recognize
that SSA and MAXIMUS, along with its marketing subcontractor, NISH, as
well as many state VRAs have been making concerted efforts to promote
and publicize TTWWIIA and the Ticket program. Benefits planning
organizations (BPAOs) and Protection and Advocacy for Beneficiaries of
Social Security programs (PABSS) have been actively involved in Phase I
roll out states providing information and guidance to beneficiaries on
the use of Tickets and the interaction of various work incentives.
Nevertheless, we believe a variety of additional avenues are
available to SSA to heighten awareness of the various programs and work
incentives provisions of TTWWIIA. For example, the Social Security
Administration is part of an interdepartmental network of numerous
Federal agencies involved with workforce development. SSA should press
its counterparts at the Departments of Labor, Education, Health and
Human Services, Commerce and other agencies to offer information about
TTWWIIA and the Ticket on their websites and in their communications
with the public. TTWWIIA was developed to be a multi-dimensional,
cross-jurisdictional program and SSA should not be solely responsible
for publicizing this new option for people with disabilities.
SSA could request that the regional Disability Business Technical
Advisory Committees or DBTACs, the Job Accommodation Network and
Centers for Independent Living offer information about TTWWIIA if they
are not doing so already. Enhanced support for PABSS could draw more
attention to TTWWIIA through the nationwide network of protection and
advocacy cross-disability services and programs. SSA might also
approach private concerns like the Ad Council to produce public service
announcements in areas where the Ticket is to be issued. Undoubtedly,
there are additional, relatively economical ways in which to trumpet
the return-to-work program and we hope SSA will devote more attention
to utilizing them.
While marketing the Ticket Program and the other complementary
pieces of TTWWIIA is critically important, our Task Force also believes
that all the publicity in the world will be insufficient if
beneficiaries believe the risks involved with going off benefits to
work are too great. Widespread confusion and misinformation about the
Ticket and the other aspects of TTWWIIA may lead many beneficiaries
with disabilities to forego using their Tickets. By addressing some of
the issues raised in this letter, your Subcommittee could enhance the
willingness of beneficiaries to take those risks.
Thank you for giving our Task Force the opportunity to elaborate on
our testimony. We look forward to working with you and the Members of
the Subcommittee to ensure the successful implementation of the Ticket
to Work and Work Incentives Improvement Act. Please do not hesitate to
call upon our Task Force if you need additional information.
Sincerely,
Susan Prokop
Co-chair
Virginia Commonwealth University, Benefits Assistance Resource
Center
Richmond, Virginia 23284
Question 1: What can SSA do to ensure its marketing efforts regarding
the ticket program are effective?
The initiation of the Ticket program has been a major challenge for
SSA. The agency and the Program Manager have done an excellent job of
designing and implementing operating procedures that have enabled a
significant number of Employment Networks (ENs) and beneficiaries to
participate in the program. At the same, SSA, advocates and
beneficiaries are concerned that the program has not resulted in either
increased competition among service providers or the emergence of
``non-traditional'' ENs providing services to SSA beneficiaries.
To address these concerns, SSA should immediately plan and launch a
multi-faceted marketing initiative designed to (1) significantly
enlarge the number ENs available to beneficiaries, (2) ensure that
agencies and organizations that sign up to be ENs actually participate
in the program, (3) increase the number of non-traditional services
providers, especially employers, who are participating in the Ticket
program, (4) target marketing efforts toward those segments of the SSA
population most likely and least likely to participate, and (5) prepare
beneficiaries to receive their Ticket and make informed choices about
Ticket assignment. Each of these areas of emphasis is briefly described
below.
Significantly Enlarge the Number of ENs
SSA should develop and implement a multi-faceted marketing
initiative that combines targeted marketing approaches with intensive
technical assistance for ENs. Marketing efforts should continue to be
directed toward community rehabilitation programs, private
rehabilitation agencies, State Vocational Rehabilitation agencies,
advocacy organizations, and similar organizations. Many of these
organizations are already serving as ENs. However, many agencies have
attended recruitment fairs conducted by the Program Manager and have
subsequently not applied to be ENs. Others have completed the
application, been approved as ENs, but have made a conscious business
decision not to participate in the program. Both these groups need
intense technical assistance, in addition to further marketing efforts,
to promote their full participation in the program.
Many agencies express initial interest in the prospect of becoming
an EN. However, upon closer examination, the reimbursement rates
available to the ENs, and the perceived risks involved in maintaining a
beneficiary in employment for an extended period of time, lead many
organizations to view participation with skepticism. However, it should
be kept in mind that many of the organizations, both for-profit and
not-for-profit, truly want to assist individuals with disabilities.
They will be predisposed toward program participation if they believe
they can do so in a way that is not financially irresponsible. The
purpose of Ticket related technical assistance should be to show these
programs potentially effective business models that will allow them to
successfully participate in the program.
Several models have begun to emerge that hold promise for potential
replication across many ENs nationwide. These models involve combining
Ticket reimbursements with foundation funds or other grant monies,
collaborating with businesses, combining Ticket reimbursement with
support from other funding agencies, and specialized job placement
programs. While the clinical services required to implement these
models are well within the capacity of many employment service
programs, the budgeting and financial management of these approaches is
quite sophisticated for programs used to funding mechanisms based on
fee-for-service or managed care approaches.
In the Ticket legislation, the Program Manager is responsible for
recruiting ENs and operating the program under the direction of SSA. It
is not charged with the responsibility of assisting ENs to successfully
participate in the program. Based on initial Ticket implementation,
many agencies are unwilling to complete the EN application because they
believe the program is unworkable. SSA should establish a Ticket
related technical assistance capacity that will provide potential ENs
the knowledge and support they need to serve beneficiaries in their
communities. Technical assistance should go beyond basic program
operation and address customized business models that can make the
program financially viable for many different types of organizations
Ensure Program Participation
Those organizations who have signed up to be ENs, but have not yet
accepted any Tickets, should considered a specific target of the SSA's
Ticket marketing efforts. It appears that approximately 75% of the ENs
in the 13 initial rollout states have yet to accept a Ticket
assignment. While there may be many different reasons for the lack of
Ticket assignments, if over half of the organizations signed up for the
program are in fact not participating in the program, it should be
viewed as a cause for concern. Additional marketing efforts should be
targeted toward this group to increase the number of eligible entities
accepting Tickets and serving beneficiaries.
SSA should assume that, in addition to further marketing efforts,
these ``non-participating ENs'' require technical assistance to assist
them in effectively participating in the program. Based on site visits
I have made to ENs in three states, a sizable number of ENs applied to
the program without first developing a business plan for successful
program implementation. After learning more about the program, the ENs
have made the determination that program participation is not
economically feasible for them. SSA sponsored technical assistance
activities should provide these organizations information on the
business models that have proven most successful for other ENs and
encourage them to actively participate in the program. Additional
marketing efforts in the absence of technical assistance will not be
successful.
Increase the Number of Employers Participating as ENs
SSA should develop and implement a major marketing initiative
directed specifically at businesses. The employer marketing initiative
should have two purposes. First, it should encourage employers to
become ENs. Employers, particularly large national corporations, may be
ideally suited to participate in the Ticket program. Since they receive
virtually no Federal or State rehabilitation funds, Ticket payments
would not replace an existing funding source, but rather represent a
new source of income for them. Many employers are highly skilled at
providing accommodations and promoting return to work for their
employees through disability management programs. With their existing
payroll and billing infrastructures, the administrative features of the
program would create little burden for them. Ticket participation would
provide employers a powerful incentive for retaining beneficiaries once
hired and working in their company. The powerful potential of employers
as ENs has not been tapped and should be the focus of a specific
marketing campaign. SSA should consider partnering with business
organizations in this effort.
The second purpose of an employer marketing program should be to
encourage employers to hire Ticket holders when approached by ENs. A
consistent theme emerging from site visits I made to ENs in three
states was that ENs would like brochures and other marketing materials
directed toward employers that would explain the program and promote
hiring efforts. This is particularly true for ENs that have limited
prior experience providing employment supports to beneficiaries. SSA's
Ticket marketing program should directly encourage employers to hire
Ticket holders and assist ENs in marketing the program to employers.
Develop Targeted Marketing Efforts
SSA should aggressively analyze available data on beneficiary and
EN participation in the Ticket program in order to more systematically
target its marketing efforts. A basic principle of marketing requires
the marketer to fully understand who is, and who is not, using their
product. At the present time, SSA is seemingly unaware of the basic
characteristics of beneficiaries who have assigned their Ticket to an
EN in one of the 13 initial rollout states. The agency should look
carefully at the current benefit status (SSI, SSDI, or concurrent),
age, and primary disability of individuals who have made a Ticket
assignment, and develop marketing plans that reflect these trends. For
example, if SSDI beneficiaries are assigning Tickets at a significantly
higher rate than SSI recipients, the agency should expand its marketing
efforts toward the segment of the population that is most likely to
participate in the program. Similarly, if younger beneficiaries are
assigning Tickets at a higher rate than older individuals, or if
persons with psychiatric disabilities are participating at a higher
rate than individuals with orthopedic disabilities, customized
marketing efforts should be developed that are targeted specifically at
the subgroups with the highest ``take up'' rates.
At the same time, if a particular segment of the SSA beneficiary
population is not presently participating in the program, it does not
mean that these individuals should be ignored, or marketing efforts
directed toward these individuals should be reduced. Rather, it should
be assumed that current marketing efforts are not successfully reaching
these individuals, and alternative approaches should be used to include
them in the program. SSA's Ticket marketing program should study the
reasons why individuals are not assigning their Tickets and develop
specialized marketing efforts that will maximize their participation in
the program.
Similarly, SSA should investigate the characteristics of the
entities and organizations that have applied to become ENs. Are these
organizations public or private, for profit or not for profit, large or
small? To what extent do these organizations have prior experience
providing employment supports to individuals with disabilities? Are
employers, one-stop centers, educational institutions, and other non-
traditional entities participating in the program? Marketing efforts
should be customized to reach out to specific sectors of the potential
EN population. The SSA Ticket marketing program should not be designed
using a ``one size fits all'' approach. Instead, a series of highly
targeted campaigns should be used to maximize the diversity and
increase the supply of ENs.
Prepare Beneficiaries for Ticket Receipt
SSA should develop and implement an aggressive marketing program
that prepares beneficiaries to receive their Ticket and make informed
choices about Ticket assignment. The first time beneficiaries become
aware of the Ticket program should not be when they actually receive
the Ticket in the mail. For individuals who have not participated in
the workforce for protracted periods of time, and who depend on cash
benefits and health care coverage for their economic well-being, the
Ticket program may be viewed as quite risky. Receiving information
about the Ticket program prior to actual receipt may allow
beneficiaries to gradually learn about the program over time and
carefully consider the implications of program participation.
Marketing efforts should focus on, and work in collaboration with,
agencies and organizations that are frequented by and have contact
with, SSA beneficiaries. Centers for Independent Living, mental health
centers, Benefits Planning, Assistance and Outreach (BPAO) programs,
rehabilitation clinics and hospitals, community rehabilitation
programs, and advocacy organizations should all be considered SSA
partners in providing information to beneficiaries about the Ticket
program. SSA sponsored marketing activities should target beneficiaries
directly, as well as provide assistance and support to community
agencies that can assist in the information sharing process.
SSA marketing activities targeted toward beneficiaries should
continue after the receipt of the Ticket. The Web site maintained by
the Program Manager provides basic information on the Ticket program,
but it is simply not written in a manner that will enable beneficiaries
to understand and feel comfortable with the program. SSA's marketing
program should work with advocacy organizations to develop materials
and create information sources that are understandable and will foster
beneficiary confidence in the program.
Question 2: Do the individuals providing these services typically meet
the beneficiaries in-person for discussions, or is the majority of work
conducted over the telephone?
Benefits planning, assistance and outreach programs (BPAOs) provide
services through a combination of telephone calls and face-to-face
contacts. In order to fully address this question, it is important to
distinguish among the different levels of service provided by BPAOs.
While the projects provide a variety of different services, most BPAO
activities can be grouped into (1) Information and Referral, or (2)
Intensive Benefits Support.
Information and Referral--Information and Referral is defined as
providing basic written and verbal information in response to inquiries
regarding all Federal and State benefit programs. Information provided
may include initial and continuing eligibility for programs, impact of
employment and other changes on benefit status and amount, and
information on work incentive provisions. This includes referral to
government agencies and other community services/resources and may
involve one contact to several contacts over a relatively short period
of time. Information and referral services may be delivered in person,
but is generally provided via telephone or written communication. BPAO
projects indicate that the majority of these services are provided via
telephone. Some examples of Information and Referral questions that the
projects might receive include:
LAn individual knows what SGA is but needs to know the
current limit.
LA consumer wants to understand work incentives in
general but doesn't want to discuss his or her situation.
LCan you help me get those stamps that people use at
the grocery store?
LI got this letter from the Social Security
Administration saying that my SSI is going down because of my
income. Can you tell me how that works?
LMy landlord is raising my rent. Can you tell me where
to get subsidized housing?
In some instances, Information and Referral services may also
involve problem solving and advocacy activities that provide time-
limited assistance to beneficiaries/recipients in solving specific
Federal and State benefit and work incentive problems. This level of
assistance may sometimes require contacting other agencies and programs
on behalf of the individual. It requires in-person, telephone and/or
written communication with the individual and other involved parties
generally over a period of several weeks. Again, BPAO projects indicate
that the majority of these services are provided via telephone.
Examples of these types of beneficiary questions might include:
LI get SSI and am getting married. Can you tell me
what will happen?
LI got a letter saying that my Medicaid is going to
stop. I need the Medicaid for my attendants. Can you help me
get it back?
LYou did my benefits analysis last year. I have been
telling the SSA about my work, but they haven't stopped my
check, should I be worried?
Intensive Benefit Support--Intensive Benefit Support may include
activities such as benefits analysis and advisement, benefits planning,
and benefits management. It is considered a more intensive service than
those previously stated. Benefits analysis and advisement can be
defined as a thorough review of the comprehensive information gathered
for the beneficiary/recipient and an assessment of the real or
potential impacts of employment and/or other life changes on the
person's Federal and State benefit programs and overall financial
status. It also includes development of a comprehensive outline of
possible options available to the individual and projected outcomes
associated with each option, as well as providing advisement to support
an informed choice. The majority of these types of services are
performed face-to-face rather than via telephone. An example of this
type of service is as follows:
LEmily receives SSI and SSDI benefits. She wants to
understand how work might affect those benefits, but doesn't
have a job goal in mind. In Benefits Analysis and Advisement,
the benefits specialist verifies Emily's benefits situation and
meets with her to explain everything. An analysis of all of the
work incentives that Emily may access is developed. An
explanation of how the SSI and SSDI programs work together is
prepared. Since Emily also receives food stamps and subsidized
housing, these programs are explained to her. Finally, a
written analysis is prepared and one or more meetings conducted
so that she fully understands how work income will affect her
benefits.
Benefits Support Planning involves direct assistance to
beneficiaries/recipients in the development of a comprehensive, long-
term plan to guide the effective monitoring and management of the
individual's Federal and State benefit programs and work incentives.
Benefits support planning addresses desired benefit and work incentive
outcomes, related steps or activities necessary to achieve outcomes,
and associated dates or timeframes. Benefits Support Planning services
are time-limited, generally ranging from several weeks to several
months. An example of this service is as follows:
LA benefits analysis was prepared for Emily 6 months
ago. She is now ready to work. In Benefits Support Planning,
her current situation is verified, and assistance is provided
to help Emily plan for her new job. A PASS plan may be prepared
to pay for interviewing clothes and resume preparation. The
benefits specialist explains all relevant work incentives to
Emily again and helps her map the points at which she needs to
let the SSA know about changes, when things will end or begin,
and how to keep track of the PASS receipts and details. These
steps are written out for Emily, and calendars and other tools
are created so she can keep track of things herself.
In benefits management, the benefits specialist and beneficiary/
recipient design, implement, monitor, and evaluate the outcome of a
long-term support plan. It involves ongoing, comprehensive, benefits
monitoring and management assistance to beneficiaries/recipients who
are likely to experience employment, benefits, or other changes that
may dramatically affect their benefit(s) status, health care, or
overall financial situation. Benefits management services generally
build on previous planning and assistance services and include periodic
updates of the individual's specific information, reassessment of
benefit(s) and overall impacts, education and advisement, and
additional planning for monitoring and managing benefits and work
incentives.
Long-term benefits management services are provided on a scheduled,
continuous basis, allowing for the planning and provision of supports
at regular checkpoints. An example of this type of service is as
follows:
LSusie has severe mental illness and has just been
offered a job through a special mental health program making
$12,000 per year. She receives SSDI of $942 per month, and pays
$435 per month for her medications out-of-pocket. Susie has a
severe mental illness. Through benefits management services
provided through the BPAO, Susie discovers she will be eligible
for the State's Medicaid buy-in program as soon as she begins
to work. Susie has a case-manager that she likes, but the case
manager doesn't understand Social Security benefits or
Medicaid. The benefits specialist works with Susie and the case
manager to develop a plan and a detailed analysis is prepared.
The analysis may determine that the special program may
represent a subsidy and that either the cost of the
prescriptions, or prescription copayments if Susie applies for
Medicaid, may possibly be used as an IRWE.
LEach month the benefits specialist meets with Susie
and her case manager to monitor her situation. SSA determines
that Susie has a 40% Subsidy. Susie applies for Medicaid, and
now pays only $30 per month in co-payments. The benefits
specialist continues to provide support to Susie and her case
manager on how to keep receipts and how to continue reporting
to SSA. As soon as Susie and her case manager take over this
reporting requirement, the benefits specialist backs out,
letting them know that they can call if something unexpected
happens.
In summary, BPAO programs provide two distinct types of services.
Each service requires a different level of communication and
interaction with the beneficiary/recipient. Information and Referral
services are less intensive services and in most situations these
questions can be handled over the telephone. In contrast, Intensive
Benefits Supports (benefits analysis and advisement, benefits support
planning, and benefits management) require more in-depth discussion,
review of records, explanation of specific benefits and review of
specific calculations. These types of services are very difficult to
effectively provide over the phone. As of September 30, 2002:
LInformation and Referral services had been provided
to 17,762 individuals nationwide. BPAO projects report that
approximately 75% to 85% of all Information and Referral
services are provided via telephone.
LIntensive Benefits Supports had been provided to
16,953 individuals nationwide. BPAO projects report that
approximately 75% to 95% of these services are held in a face-
to-face setting.
Question 3: Are there standards for services that the BPAOs must meet,
similar to the performance goals that SSA imposes on its 800 number
calls? How is the accuracy of the information provided measured?
Before providing services to beneficiaries, benefits specialists in
SSA funded BPAO programs are required to attend a 5-day training class
on SSA programs and work incentives conducted by one of three Regional
Training Centers (RTCs). The RTCs are operated by Virginia Commonwealth
University (Regions III, IV, VI, and IX), Cornell University (Regions
I, II, and V), and the University of Missouri (Regions VII, VIII, and
X). After attending the training class, the prospective benefits
specialist must successfully complete a field assignment that tests
knowledge of general SSA information and specific work incentives.
Benefits also receive an additional 2 days of training on other benefit
programs (TANF, food stamps, HUD, and so forth) within 6 months of the
initial training.
After completing the field assignment, the benefits specialist is
allowed to deliver services in the local BPAO. There are no specific
performance standards that the programs are required to meet, other
than to fulfill all aspects of their cooperative agreement with SSA.
After beginning to deliver services, benefits specialists receive
extensive technical assistance provided by the RTCs, attend 2-day
follow-up training sessions, participate in distance education courses,
receive information through Web sites and list serves, and communicate
regularly with other benefits specialists in their state and region.
By contract, the RTCs provide only training and technical
assistance. They do not formally monitor the delivery of services by
the BPAOs. In a number of instances, particularly with new benefits
specialists, staff from the RTCs may review some or all of the benefits
analyses and benefits plans developed by a particular specialist for
accuracy and completeness. However, the purpose of the analysis and
plan reviews are to verify that the specialist has acquired the
competencies taught in the 5-day class session, and to target specific
technical assistance, rather than to monitor the quality of services
provided by the BPAO.
SSA program regulations and work incentives are extremely complex
and any inaccurate or incomplete information provided to beneficiaries
is a serious concern. I am aware of situations in which benefits
specialists have made mistakes during analysis and advisement. These
instances are shared with the SSA Office of Employment Support
Programs. For the most part, however, the quality of services provided
by the BPAOs is very high, especially for a new program and
particularly in relation to the information provided by other
organizations involved in the implementation of the Ticket legislation.
BPAOs routinely encounter beneficiaries who have received inaccurate
information from an EN, the Program Manager, a Protection and Advocacy
organization, a State Vocational Rehabilitation agency, or even an SSA
field office. Correcting the inaccurate information provided by others
is a major function of the BPAOs.
To further improve the quality of services provided by BPAOs, SSA
could consider conducting program audits of the benefits analyses and
benefits plans developed by local specialists. Given the fact that
there are 116 local BPAO programs and nearly 150 individual sites,
monitoring the telephone contacts of these programs might prove to be
impractical. However, SSA could review a number of analyses or plans
developed by benefits specialists through a simple file review that
could be conducted on a regular schedule. Such a monitoring function
would require a cadre of highly skilled and experienced experts to
detect mistakes and inaccuracies in these highly detailed reports.
[Submissions for the record follow:]
Independent Living Resource Center of NE FL
Jacksonville, Florida 32207
October 7, 2002
Subcommittee on Social Security
Room B-316
Rayburn House Office Building
[email protected]
FAX (202) 225-2610
Dear Members of the Ways and Means Committee:
I write this letter because of my interest in helping people with
disabilities and as a disabled person myself. I also was move by the
statement made by Mr. Shaw in announcing the hearing. Mr. Shaw stated:
``Simply put, the Ticket to Work program is about work. Its aim is to
replace barriers with opportunities, so that individuals with
disabilities may achieve their goal of working and supporting
themselves and their families. We must ensure implementation of this
important program proceeds smoothly and addresses the concerns and
needs of individuals with disabilities who want to work and
organizations that are serving them.''
ESR's and BPAO
I believe these programs have been instrumental in many facets of
the lives of people with disabilities on benefits and wanting to try to
work. So many myths and misinformation are floating about and this
leaves consumers confused and scared.
I am a disabled individual. I was on benefits and very much feared
losing my medical benefits through employment. I took a job as a
Benefit Specialist in Colorado with the idea, if they could show me how
to maintain my medical benefits I would continue the employment. During
the training, my fears were lifted and I saw that employment was an
option.
As a Benefit Specialist, I was amazed at all the people on Benefits
I met that had that same fear. All the misconceptions I cleared up, the
information on old and new work incentives I gave, and the empowerment
I gave people to take control of their own lives makes me firmly
believe that this program is essential for all beneficiaries and
recipients of Social Security. We have the time and knowledge to help
CR's with consumers thinking about employment to make sure accurate
information is dispersed making everyone's lives easier. The BPAO
program is an invaluable part of the ticket legislation.
I have had the incredible fortune of being able to work with the
ESR program. This program has been an intricate part of helping
individuals on benefits who want to work. This includes consumers that
find employment then find out for some reason their records are
inaccurate. These people can get help from an ESR, get their record up
to date and accurate so they can feel good about working without the
stress of what's going to happen to them from SSA.
SSI and families
When you really look at the program, it is anti-family. I say this
because if you have a disability and are on SSI, if you marry and that
spouse works, you the recipient is penalized by losing medical and cash
benefits. Now the loss of the $545.00 or less is not as much of an
issue as the loss of the medical benefits. For instance, take a SSI
recipient that is working and overcoming the barrier of medical
insurance through the 1619(b) provision of SSI. Now that they are
working and feeling more independent and just wanting `life, liberty
and the pursuit of happiness', they find out that if they were to marry
and start a family they will lose everything they have worked for. But
it is OK for them to have illegitimate children or out of marriage
sexual relations.
Some of these individuals have no choice but to be on SSI. For
example, the child who becomes disabled before age 22. Has had no
opportunity to earn enough work credits for SSDI, neither parent is
disabled, retired or dead and needs medical assistance in order to
live. This individual, not knowing what they can accomplish with their
disability, ends up on the SSI roles. Not only are you keeping them in
poverty if they can't work but if they do take the initiative to chase
the American dream, they are quashed if they want a family of their
own.
Another example, you have the already married couple that are both
SSI recipients. In this case, not only if one of them becomes employed
does the non-employed spouse fear losing their benefits, but they are
treated as one person and get less benefits all together because of
their being married.
Solution. Have a provision for SSI where a SSI recipient who has
earned income can have spousal protection. Spousal protection: meaning
that the SSI recipient's non-cash benefits would be calculated based on
only the SSI recipient's earned income. As a safety net, if that person
become unemployed, due to their disability, They could retain their
medical benefits (even if their spousal income pushes them into no-pay
status) for up to 93 months, like Medicare does in the Expedited
reinstatement process.
I thank you for reading my comments and please feel free to contact
me with any questions.
Sincerely,
Natalie Alden
BPAO Project Coordinator
Statement of Carl Suter, Executive Director, Council of State
Administrators of Vocational Rehabilitation, Bethesda, Maryland
Chairman Shaw, Ranking Member Matsui, and Members of the
Subcommittee, I am Carl Suter, the Executive Director of the Council of
State Administrators of Vocational Rehabilitation, known as the CSAVR.
The CSAVR is composed of the chief administrators of the public
rehabilitation agencies serving persons with physical and mental
disabilities in the States, District of Columbia, and the Territories.
These agencies constitute the state partners in the State-Federal
program of rehabilitation services provided under the Rehabilitation
Act of 1973, as amended. The State Agencies supervise the
rehabilitation of more than 1.2 million eligible individuals with
disabilities annually. Of those eligible individuals served each year,
by the State Agencies, more than 233,000 are placed in competitive
employment.
On behalf of the CSAVR, I submit this written testimony in response
to the September 26, 2002, oral and written testimony provided by the
National Association of Protection & Advocacy Systems (NAPAS) before
the Subcommittee on Social Security of the House Committee on Ways and
Means.
My response is focused on the section of NAPAS' testimony that
addresses the State Vocational Rehabilitation Agencies' (VR)
implementation of the Ticket to Work. I respectfully request that this
testimony be entered in its entirety into the September 26, 2002,
permanent hearing record of the Subcommittee.
First, I would like to provide some background information on the
unique role that the Public VR Program plays in the Ticket to Work
Program. The Ticket to Work and Work Incentives Improvement Act of 1999
(TWWIIA) was designed to increase employment opportunities for
beneficiaries who receive cash benefits under the Social Security
Disability (SSDI) and Supplemental Security Income (SSI) programs to
encourage them to enter or re-enter the workforce. According to the
U.S. General Accounting Office, less than one percent of these
individuals leave the SSDI and SSI rolls each year as a result of paid
employment. While State VR Agencies serve thousands of beneficiaries
with disabilities each year, a majority will choose not to seek
assistance from VR for fear of losing needed health care coverage,
which has been the pervasive and persistent problem for SSI and SSDI
beneficiaries not entering or returning to work.
Prior to the Ticket, the Social Security Administration (SSA) would
reimburse VR for client services and administrative costs when VR was
successful in placing individuals on SSDI and SSI in employment that is
sustained over a nine-month period with earnings equal to substantial
gainful activity (SGA). I am pleased to report that for FFY ending 9-
30-2002, the amount of reimbursement from SSA to the State VR Agencies
was $131,014,755. This was the largest amount ever received, and an
increase of $27,000,000 over FFY 2001. This record reimbursement
demonstrates the State Vocational Rehabilitation Agencies' commitment
to serving individuals who are SSDI and SSI recipients and
substantiates the results.
The Ticket to Work Program expands SSA's options for providing
compensation to State VR agencies, and for the first time, permits SSA
to compensate private providers, when the provision of services and
supports results in an individual working and earning SGA. Private
providers can apply to SSA for approval to serve beneficiaries with
tickets and receive compensation, either through an outcome payment or
milestone and outcome payments combined, when a beneficiary's earnings
from work result in the discontinuation of cash benefits. Approved
providers are referred to as Employment Networks (ENs).
Since VR is the only program that will be automatically approved to
provide services to beneficiaries under the Ticket Program, the impact
on the Public VR Program is likely to be dramatic. Over the next two
years, tickets will be mailed to eligible beneficiaries along with
information on how to use the ticket to obtain training and employment
services. Many beneficiaries will call local VR agencies to find out
more about the Ticket Program. With the complementary work incentives
provisions in TWWIIA, it is expected that larger numbers of
beneficiaries will be willing to attempt work than in the past.
State VR Agencies were extremely disheartened by the manner in
which they were portrayed by the oral and written testimony presented
by NAPAS on September 26, 2002, in implementing the Ticket to Work
Program. The State VR Agencies in the first 13 states to implement the
Ticket had to move forward in planning for Ticket implementation before
issuance of the final regulations governing the Program. In the case of
the Ticket to Work Program, many difficult policy decisions were left
up to the Social Security Administration (SSA) to interpret through
regulation. The final regulations were published in the Federal
Register in December 2001.
Part of SSA's interpretation of the Ticket Program is that State VR
Agencies must participate in the Ticket to Work Program to receive any
type of payment for successfully serving a beneficiary with a
disability who has a ticket. There are many policy questions inherent
in VR's participation in the Ticket Program. The CSAVR has been in
discussions with SSA over a number of policy issues since tickets were
first mailed in February 2002. TWWIIA is clear, however, that State VR
Agencies must still operate in compliance with the requirements of
Title I of the Rehabilitation Act and its governing regulations. This
means that the interface between the requirements in Title I of TWWIIA
and Title I of the Rehabilitation Act must be clarified and addressed
through policy guidance.
In August 2002, SSA issued a new chapter to the procedures manual
that State VR Agencies must use to secure compensation from SSA for
successfully serving beneficiaries with disabilities. The SSA chapter
specifically addresses what State VR Agencies must do to participate in
the Ticket to Work Program, establishing both policies and procedures
for VR's participation. For example, the chapter establishes a policy
whereby a beneficiary who approaches VR for services after receiving a
ticket, and who, through informed choice, decides to sign an
Individualized Plan for Employment (IPE) with VR, has, for SSA's
purposes, assigned their ticket to VR. This policy interpretation has
led some advocates to believe that VR Agencies are ``forcing''
beneficiaries to assign their tickets to VR, when in fact; VR is merely
following SSA's procedures.
State VR agencies, like all stakeholders involved with the Ticket
implementation, have acknowledged that implementing the Program is a
work in progress. To date, approximately 80 percent of the
beneficiaries who have decided to participate in the Program have
assigned their tickets to State VR Agencies. Since the structure of the
Ticket Program does not provide any ``upfront'' funding to serve
beneficiaries, EN's who want to participate in the program will have to
absorb considerable costs, pending payment from SSA, after the
beneficiaries they serve obtain and maintain employment at SGA. In some
states, the State VR Agency is partnering with other providers to form
a coalition which functions as a single EN. In other States, the State
VR Agency will be operating independently and competitively with other
ENs.
Some State VR Agencies acknowledged that early on, missteps might
have occurred in information communicated to VR customers. These
missteps, however, were remedied as quickly as possible, upon receipt
and clarification of information from the SSA.
That said, State Agencies, have not now nor ever have been
``raiding'' the Ticket program as alleged by NAPAS in their written
testimony. Relatedly, the State Agencies have not and do not pressure
existing clients into assigning their tickets to VR.
Indeed, some State VR Agencies have reported that EN's are
referring individuals to VR that they are choosing not to serve. These
are predominantly individuals with the most significant disabilities
and high support needs, who are and will be more costly to serve and
individuals who need services that are not available through the EN.
It is difficult to comprehend how NAPAS has determined that VR
Agencies are ``raiding,'' the ticket program, when it is the Public VR
agencies who serve eligible individuals with the most significant
disabilities, among others, unlike all of the other Employment Networks
who can refuse to serve any individual with disabilities who may seek
services and supports from them. In some States, State VR Agencies have
entered into Memoranda of Understanding with other EN's, which define
how they will share in the costs of services for mutual clients and
share in the reimbursement from SSA.
NAPAS stated in their testimony that State VR Agencies who are
operating under an Order of Selection (OOS) are taking tickets from
beneficiaries and placing them on waiting lists, if they do not meet
the States' OOS criteria to receive services. SSDI and SSI recipients
who want to work are presumptively eligible for VR services, and, in
most cases, are also individuals with the most significant
disabilities. These individuals are among the first to be served under
any States OOS, second only to serving existing VR clients and
providing diagnostic services to new clients.
NAPAS implied in their testimony that State VR Agencies adopt an
OOS at will. You should be aware that implementing an OOS is not an
option at the discretion of the State Agency, but a requirement under
the Rehabilitation Act of 1973, as amended, if VR Agencies have
insufficient resources or staff to serve all eligible individuals who
seek services from VR.
On more than one occasion, staff from the CSAVR have invited NAPAS
staff to work with us on identifying State Agencies that they have
reason to believe may not be serving Ticket customers appropriately. We
have assumed, and will continue to assume, a leadership role in working
with these Agencies to identify--not by innuendo as NAPAS did during
the hearing--but by actually identifying the alleged instance(s) of
non-compliance and working in concert with one another to correct a
misinterpretation or problem.
Anecdotal accusations and criticisms cannot--and should not--be
tolerated by anyone, including the Congress. Individuals who have
inflated the size and scope of anecdotal incidences and unsubstantiated
charges should be held accountable for making them.
In this regard, the CSAVR has requested from NAPAS that we be made
privy to any and all information that suggests or implies that VR
Agencies are not in compliance with the law in their implementation of
the Ticket to Work.
Notwithstanding these unsubstantiated charges, the CSAVR plans to
continue to work with State VR agencies and other stakeholders to
remedy any alleged missteps or misinformation that may, or may not, be
occurring at the VR Agencies and elsewhere.
Like hundreds of thousands of others, we are very proud of the
Public VR Program, a proven, evidence-based service delivery system
that is indisputably the most successful employment program in the
history of the workforce.
Perhaps that is the reason so many individuals with disabilities
continue to choose overwhelmingly the Public VR Program for the
services and supports they need to enter the world of work.
Thank you for the opportunity to share our concerns with you on the
testimony presented at the September 26 hearing regarding State
Vocational Rehabilitation Agencies' implementation of the Ticket to
Work program.
We look forward to working with you in ensuring that beneficiaries
with disabilities--including those with significant disabilities--are
served and served well by all employment networks.
In closing, we again acknowledge that there are isolated incidences
where misinformation may have occurred; however, these do not translate
to the overwhelming negative criticism of State VR Agencies'
implementation of the Ticket to Work for thousands of beneficiaries
with disabilities.
Statement of Steve Miller, Member, Board of Directors, National
Alliance for the Mentally Ill, Arlington, Virginia
Chairman Shaw, Congressman Matsui and members of the Subcommittee,
I am Steve Miller of Cedar Rapids, Iowa. I am pleased to submit this
testimony to the Social Security Subcommittee on behalf of the National
Alliance for the Mentally Ill (NAMI). Since 2001, I have served on the
Board of Directors at NAMI--the largest national organization
representing people with severe mental illnesses and their families--
220,000 members and 1,200 affiliates in all 50 states. NAMI strongly
supported the Ticket to Work and Work Incentives Improvement Act
(TWWIIA) when it passed Congress in 1999 and is on record in strong
support of its full implementation in reaching all people with severe
disabilities that want to participate in the American workforce. NAMI
applauds President Bush for his support of full implementation of
TWWIIA as part of his ``New Freedom Initiative'' for people with
disabilities. We embrace the President's goal of ensuring that TWWIIA
works to remove barriers to employment and full participation in
society and eliminate perverse incentives that leave consumers better
off by staying on government benefit programs, rather than working.
For NAMI, the goals of TWWIIA are central to the NAMI vision for
recovery from mental illness and full participation in community life.
At NAMI we know that mental illnesses are real, with symptoms that are
disabling and capable of destroying lives. We also know that treatment
for mental illnesses such as schizophrenia, bipolar disorder and major
depression are effective and based on a large and growing body of
scientific evidence. We know that when consumers are able to access
evidence-based treatment and supportive services--a process that is
often difficult as a result of our country's fragmented and underfunded
public mental health system--they can achieve recovery and a full life.
Further, there is substantial evidence that work actively reduces the
symptoms of mental illness and can prevent relapse. NAMI's consumer and
family membership feels strongly that genuine recovery from mental
illness can and should mean the opportunity to work.
More importantly, NAMI also believes that real recovery cannot be
realized so long as consumers are forced to spend their entire adult
lives trapped on programs such as SSI and SSDI (and the Medicare and
Medicaid eligibility that go with them)--not because they do not want
to work or cannot work, but because these government programs operate
as barriers to employment. TWWIIA can and should be an instrument to
recovery from mental illness and away from lifelong dependence.
Unfortunately, TWWIIA has not achieved these goals thus far for people
with severe mental illness. As I will discuss in my testimony, more
needs to be done to resolve long-standing problems with the way the
Social Security Administration (SSA) administers its current programs
(both TWWIIA and others). In addition, changes need to be made to the
final TWWIIA regulations to ensure that more beneficiaries can access
the program.
Before moving on to NAMI's comments on TWWIIA implementation, I
wanted to note for the record my own background and personal experience
in dealing with Social Security's disability programs. I was first
diagnosed with schizophrenia in 1979 when I was 19 years old. I became
eligible for SSI in 1990 and was shifted to the SSDI in 1996 when my
father retired. A few years ago, I made major progress toward recovery
when I was able to access one of the newer more effective atypical
anti-psychotic medications that has consistently improved my
functioning to the point that I am now working as the coordinator of
``Peer-to-Peer'' programs for NAMI Iowa. Since this past summer, I have
been collecting a salary--something I am very proud of. At the same
time, like all other SSDI beneficiaries I have to be careful to keep my
earnings below substantial gainful activity (SGA) in order to avoid
compromising eligibility for cash benefits (and more importantly)
health care coverage.
TWWIIA is intended to help consumers like me achieve enhanced
recovery and independence--and NAMI hopes that it one day will. As part
of my testimony, I would like to highlight a few concerns (both with
the TWWIIA regulations and the way SSA continues to do business) that
NAMI believes the Subcommittee needs to address.
1) SSA's handling of beneficiary earnings reports is incompatible with
making TWWIIA effective.
This concern predates passage of TWWIIA and goes straight to the
experiences of many consumers struggling to move off of SSI and SSDI
toward employment. Currently, SSA does not have the means to intake and
track earnings of beneficiaries who work. Frequently, beneficiaries who
work continue to receive disability checks, despite the fact that their
earnings have made them ineligible for benefits. Further, SSA takes
months, usually years, to ``catch up'' with a beneficiary who should
have had their checks stopped. When SSA does catch up with a
beneficiary, the person usually owes thousands, and maybe tens of
thousands of dollars, in overpayments. This creates havoc with a
beneficiary who in the course of attempting to work finds themselves
financially worse off. SSA ignores this problem despite the impact on
individuals. However, under TWWIIA with the payment to Employment
Networks (ENs) and the Continuing Disability Review (CDR) protection
now dependent on SSA stopping checks in a timely fashion, this problem
can become catastrophic for Ticket holders.
Although SSA has not proposed a rule on this issue, this matter is
critical to the success of the Ticket program. In NAMI's view, SSA must
address this issue in order for the program to be effective and to
ensure that beneficiaries have sufficient confidence in the system in
order to take the risks inherent in using the Ticket program to go to
work. NAMI strongly recommends that SSA initiate a change to ensure
that an EN's report to the Program Manager (PM) on a beneficiary's
income and earnings be given by the PM to SSA within 30 days. Further,
as an additional requirement SSA should make clear that if within 60
days of the PM's report to SSA, SSA has failed to appropriately stop or
adjust a beneficiary's check, SSA cannot hold the beneficiary liable
for overpayments and SSA must make payment to the EN as though the
benefit has been adjusted or ceased.
2) Restrictions on Ticket eligibility are preventing beneficiaries with
mental illness from accessing the program.
In our comments to SSA on both the Draft and Final TWWIIA
regulations, NAMI expressed two major concerns with respect to
eligibility for the Ticket program: limitations for those labeled as
``Medical Improvement Expected'' (MIE) and the limitation of one Ticket
per period of eligibility. Citing administrative feasibility, SSA's
final regulations kept in place a bar on eligibility for a Ticket to
anyone designated MIE that has not had their first CDR. At the same
time, SSA claims that it plans to ``evaluate'' the methodology used to
classify individuals MIE to ``assess possible ways to improve the
system for use in identifying those beneficiaries for whom near-term
medical improvement should preclude the immediate receipt of a
Ticket.''
This is particularly troubling for several reasons. First, a high
proportion of SSI and SSDI beneficiaries classified as MIE have severe
mental illness as the primary basis for their successful disability
claim. Second, historically, SSA has had a tremendous backlog in
completing CDRs, resulting in significant delays until these mandated
reviews are completed. There is growing evidence that this MIE
restriction is resulting in significant delays in beneficiaries with
severe mental illnesses getting Tickets. This runs counter to a large
body of research indicating that early employment and rehabilitation
interventions are more effective in serving most consumers.
With respect to the one Ticket per period of eligibility
limitation, SSA again appears to be using an overly narrow view of the
statute. In NAMI's view, SSA ought to allow individuals to be eligible
for another Ticket when the cash value of their first Ticket is
exhausted, i.e. when the first 60 non-consecutive month limit had been
reached. This one Ticket per eligibility period limit is especially
troubling for SSI beneficiaries participating in 1619 programs that
allow for extended health and cash benefits for beneficiaries entering
the workforce. These SSI beneficiaries often retain ``eligibility'' for
benefits under 1619(b) even though they are not receiving any cash
benefits. For these individuals, the Ticket could be fully paid out and
the person would come back into payment status and not be able to get
another Ticket because they are still considered to be in the same
``period of disability.''
In addition, some individuals with high upfront rehabilitation
costs who are served by their state vocational rehabilitation (VR)
agency are seeing their chance to fully benefit from a Ticket limited.
In many cases, VR agencies are reimbursed for the full costs of
services, even if the cost is higher than the total value of the
Ticket, so long as a person achieves nine months of Substantial Gainful
Activity (SGA). Since nine months of SGA still leaves a person eligible
to receive SSI or SSDI, the person will still be on the rolls, not
having achieved full independence. However, these same individuals no
longer have access to services because they do not have a Ticket. This
result is especially unjust in the rehabilitation of individuals with
severe mental illness, since state VR agencies have generally done a
strikingly poor job of tailoring VR programs to their need for ongoing
job related supports.
3) Slow recruitment of Employment Networks (ENs) is preventing the
development of real consumer choice for employment and
rehabilitation services.
Under TWWIIA, SSA is supposed to enter into agreements with ENs to
provide vocational, employment rehabilitation services to Ticket
holders. The idea is to promote consumer choice and shift incentives
toward paying for specific outcomes (long-term successful job
retention), rather than short-term results (job placement alone). Under
TWWIIA, beneficiaries with disabilities would no longer be limited to
seeking services from a public VR agency that is ill-equipped to
provide longer term job-related supports designed to help hold down a
job. More importantly, innovative programs in the employment and
rehabilitation field such as clubhouses, consumer-run services and
psychosocial rehabilitation programs would be able to serve consumers
outside of the cumbersome and outdated payment rules governing VR.
According to SSA and Maximus, as of this month 425 providers have
signed up to be ENs. While this appears on its face to be a large
number given that it is only in the 13 pilot states, NAMI is
nonetheless disappointed that only a handful of these approved ENs have
significant experience in serving individuals with psychiatric
disabilities. In NAMI's view, more needs to be done to bring innovative
and cutting edge providers into the program ENs in order to ensure that
meaningful consumer choice is realized. This is especially needed in
the case of innovative programs such as clubhouses, psychosocial
rehabilitation programs and Peer-to-Peer programs that NAMI believes
have greater potential to produce positive long-term employment
outcomes for people with mental illness.
4) The Outcome-Milestone payment system in the regulations makes SSI
beneficiaries a bad risk for providers.
The payment systems for ENs are perhaps the most complex and
important provisions in the TWWIIA regulations, particularly with
respect to the ``outcome-milestone'' payment system. As you know,
Congress provided SSA with wide discretion in how to craft this system
with general guidance to ensure that providers are rewarded for helping
beneficiaries meet individualized goals that are short of getting
completely off of cash benefits--the latter being a major concern for
SSI beneficiaries.
There is growing evidence that most ENs view SSI clients as more
risky with a much longer return on investment for the EN. As TWWIIA
Advisory Panel member Stephen Start has noted, a small EN would break
even on most SSDI clients after 2.4 years versus 5.5 years on a client
on SSI. He and others have suggested it is better for ENs serving SSI
beneficiaries to partner with other entities to mitigate the front-end
cash requirements needed until SSA starts to pay.
Some of the impediments to serving those on SSI, or those with the
most severe disabilities, derive from the fact that it takes longer for
these beneficiaries to reach ``zero cash benefits'', the point at which
an EN gets paid. In addition, payments to ENs for serving clients on
SSI are lower because SSI benefits are lower than those for clients on
SSDI. The requirement that a beneficiary go completely off cash
benefits also works against those who may only be able to work part-
time and those with vision impairments who must reach the higher blind
SGA level.
As our CCD colleagues have noted, NAMI appreciates the fact that
SSA increased the number and amount of milestone payments. However, we
continue to believe that the payments are inadequate to ensure a wide-
range of ENs are available to serve Ticket holders with the most
significant barriers to employment, i.e. those that need intensive
employment supports and those who want to work but may remain on
benefits for an extended period of time.
5) Ongoing frustrations regarding the lack of coordination between
public vocational rehabilitation (VR) and TWWIIA.
As noted above, one of the major policy objectives of TWWIIA was
fostering consumer choice and maximizing long-term successful
employment outcomes for people with severe disabilities. Despite this,
Maximus (SSA's national Program Manager) is reporting that most Tickets
are being assigned to state VR agencies and, rather than competing with
private ENs under the Ticket payment options, most VR agencies are
opting to be paid under the traditional cost-reimbursement method.
Opting for the traditional payment method also allows the public VR
agency to ``close'' a case after only nine months, as opposed to the 60
month ``investment'' in the client required of private ENs.
Furthermore, there are persistent reports among private providers of
significant reluctance of private providers to become employment
networks. These private providers perceive, whether justified or not,
that becoming an EN might jeopardize an existing relationship with
their state VRA. This unease, coupled with the financial risk of the
payment system as outlined above, may discourage providers from
becoming ENs, thus further limiting choice of provider to
beneficiaries.
6) Current budget crises in the states are severely hampering the
development of Medicaid ``buy-in'' programs.
Recognizing that your colleagues at the Energy and Commerce
Committee have jurisdiction over Medicaid, NAMI nevertheless wanted to
share with you our observations about this important element of TWWIIA.
According to CMS figures, 22 states, slightly less than half, are
involved in some fashion with a Medicaid buy-in--either through the
1997 BBA or TWWIIA. While this is encouraging, the actual enrollment
figures in some states are frustratingly low, e.g. only 40 in Florida,
75 in Mississippi, 80 in Nebraska. In addition, there are troubling
signs that increasing state budget shortfalls are already discouraging
participation by additional states in this important health care work
incentive program. According to a report from CMS, Florida has
indicated that it plans to repeal its Medicaid buy-in option. Assuring
beneficiaries that they would retain access to health insurance
coverage was a key tenet of TWWIIA. Moreover, Medicaid buy-ins were
meant to supply important additional benefits not found in Medicare and
considered necessary for many disabled beneficiaries to take the risks
inherent in entering the workforce. NAMI remains very concerned that
fiscal difficulties in nearly every state are foreclosing opportunities
through TWWIIA for millions of SSI and dual eligible beneficiaries.
A similar phenomenon is occurring with respect to the ``pre-
disabled'' demonstration option for the states under Section 204, i.e.
Medicaid coverage for workers with potentially severe disabilities
that, without medical treatment, could place them on SSDI or SSI
disability rolls. A total of $250 million was made available to the
states, at the regular Medicaid matching rate, to provide Medicaid to
such ``pre-disabled'' workers who meet state-set and HHS-approved
medical criteria and are working at least 40 hours monthly (or meet
comparable HHS-approved rules). However, apparently less than half the
appropriated federal funds will be drawn down under current
projections. This is because--again--recession-related state funding
shortages have prevented all but four states from taking this option--
and even they are only now completing implementation (including the
Texas programs covering people with early-stage schizophrenia and
bipolar disorder). NAMI would like to join CCD in recommending that the
authority for this option be extended and that the Secretary's required
recommendations be postponed for at least two years in order to allow
more time for the program to play out.
7) SSA has been slow to develop the required ``1 for 2'' demonstration
program under the SSDI program.
NAMI remains concerned about SSA's lack of progress in moving
forward with the mandatory ``1 for 2'' demonstration authorized as part
of TWWIIA. Beneficiaries that fear the adverse consequences of
returning to work regularly cite the ``cash cliff'' that SSDI
beneficiaries face when they reach SGA (currently $780 a month). This
demonstration will test the feasibility of reducing Title II benefits
as earned income rises. NAMI respects that this demonstration may be
limited in scope to a handful of states and would certainly have
preferred that it be a nationwide study. At the same time, NAMI
believes it is more important for SSA to move on with this
demonstration expeditiously so that we can begin to answer the many
questions surrounding the merits of that policy.
8) Confusion regarding eligibility is especially difficult for
``disabled adult children'' (DACs).
The overwhelming confusion and complicated rules governing
eligibility beneficiaries classified as ``disabled adult children'' or
DACs requires some attention from SSA and this Subcommittee if the
Ticket program is to be successful for these individuals. For a DAC,
leaving the SSDI program as a result of earning above the SGA level
after the extended period of eligibility (EPE) and a re-entry grace
period have expired, could mean the loss of ``disabled adult child''
status for life. The experience of many NAMI families under current law
indicates that some do not understand that the benefits a parent has
earned for their disabled adult child (severely disabled since
childhood) could be permanently lost with no re-entry to DAC status
under SSDI after a certain period of time with earnings over SGA. This
must be addressed to avoid completely undermining the purpose of TWWIIA
for those who qualify for benefits as DACs. TWWIIA clearly envisioned
the ability of DACs to move on and off the program to the same extent
that other people with disabilities will be allowed to do so.
Conclusion
Mr. Chairman, thank you for the opportunity to share NAMI's views
on this important issue for individuals with severe mental illnesses
and their families. We are committed to working with every member of
this Subcommittee and SSA to ensure that TWWIIA meets its goal of
assisting all SSI and SSDI beneficiaries in trying to reach toward
recovery, greater independence and full community integration.
Statement of Witold Skwierczynski, President, National Council of SSA
Field Operations Locals, and Representative, American Federation of
Government Employees, AFL-CIO, Baltimore, Maryland
Chairman Shaw, Ranking Member Matsui, and members of the Social
Security Subcommittee, I respectfully submit this statement regarding
the implementation of Ticket To Work and Work Incentives Improvement
Act. As a representative of AFGE Social Security General Committee and
President of the National Council of SSA Field Operations Locals, I
speak on behalf of approximately 50,000 Social Security Administration
(SSA) employees in over 1300 facilities. These employees work in Field
Offices, Offices of Hearings & Appeals, Program Service Centers,
Teleservice Centers, Regional Offices of Quality Assurance, and other
facilities throughout the country where retirement and disability
benefit applications and appeal requests are received, processed, and
reviewed.
Ticket to Work
AFGE has advocated and testified since the enactment of TWWIIA for
the implementation of the Employment Support Representative (ESR) in
SSA's field offices throughout the country. This position is the key to
delivering service to the public in the beleaguered and complex area of
work incentives. The success of TWWIIA is dependent on implementation
of this legislatively mandated position as SSAs corps of trained,
accessible and responsive work incentives specialists.
As members of the subcommittee know, this legislation mandating
specialists within SSA is the result of the failure of SSA to both
provide accurate information on work incentives and also process work
CDR cases timely and accurately. SSA created the Employment Support
Representative (ESR) position as this federal work incentives
specialist. The pilot of 32 ESRs testing models of how best to service
the disabled community concluded in August 2001.
The final Evaluation Report of the ESR position was completed in
November 2001. Findings of the report clearly showed that the ESR was
resoundingly successful in serving beneficiaries, communities, and
organizations in all return to work issues encountered in both the SSDI
and SSI programs. Beneficiaries and community organizations were
overwhelmingly appreciative of the services the ESR performed, finding
them to be compassionate, responsive, accessible, and highly
knowledgeable. The investment of the ESRs in outreach programs resulted
in increased trust of SSA by the communities, and increased program
knowledge on the part of professionals and consumers.
Furthermore, the ESRs were able to develop a single point of
contact with beneficiaries, monitor their work progress in a timely and
supportive manner, and process work reports and work-issue Continuing
Disability Reviews (CDRs) timely. This resulted in reducing large
benefit overpayments and a reduction in anxiety for the beneficiary.
ESRs gave examples of customers who, with ESR guidance, were able to
reliably predict the outcome of their work activity and viewed benefit
cessation as a mark of achievement.
The significance of the single point of contact within SSA that the
ESR provides cannot be overemphasized. GAO recently published a report
called: ``Enhanced Procedures and Guidance Could Improve Service and
Reduce Overpayments to Concurrent Beneficiaries''. Currently, little
coordination exists in offices between the work incentives in SSI and
SSDI. This confuses beneficiaries, and often results in discouraging
them from working, or not effectively utilizing all available work
incentives. The ESR is a specialist in both SSDI and SSI work
incentives, and processes TWP, work issue CDRs, promotes PASSes, posts
wages to SSI records, explains Medicare and Medicaid entitlements.
Furthermore, the ESR as a specialist in work issues for both programs,
would recognize and develop timely entitlement to SSDI benefits on the
part of the SSI recipient.
Work reports of disabled beneficiaries are currently not
effectively processed. SSA does not have in place an adequate mechanism
to process work reports. It is frequently difficult for beneficiaries
to report return to work or stopping work. Again, because of
insufficient resources, reports are not acted on in a timely manner,
the reports may be in multiple locations and the file in a different
location, and employees cannot currently obtain accurate systems
information showing current reports or a history of reports. Processing
work reports currently receives no workload credit, is not a high
priority, and is frequently backlogged. Beneficiaries may receive
confusing information on what they need to report. As Ticket expands,
and Employment Networks expect payment, these delays will only cause
further chaos. The ESR handles work reports effectively and promptly.
Mental impairments are the most common disabilities in the SSDI and
SSI population returning to work. Work activity is a key element in the
therapeutic treatment of mental conditions. The nature of work activity
on the part of these individuals characteristically includes frequent
work attempts, many different employers, and work under special
conditions. These beneficiaries especially require the consistency and
expertise that a single point of contact within SSA provides.
AFGE, SSA, and other agencies and organizations have previously
testified that hundreds of millions of dollars in benefit overpayments
would be saved nationally if work issues are reported and worked
promptly. In the GAO Report referenced, field office employees cited
delays in receiving cases from the Program Centers ranging from one to
ten years! This delay is eliminated in ESR work locations, because the
ESR controls and monitors the case on a continuing basis from the
initial return to work.
Anecdotal evidence from employees throughout the country indicates
that work issue CDRs are backlogged for up to several years in some
field offices. Overpayments on these cases can reach $250,000 for an
office, and employees have encountered overpayments on individual
records reaching $100,000! Unfortunately, the Union is unaware of any
statistical data regarding the numbers of work CDRs processed, the
number pending, and the cessation rate due to work activity. SSA should
be required to maintain and produce such data. In processing the
medical issue CDRs, SSA contends that for every dollar spent, seven to
twelve dollars in benefits are saved. The cost savings are greater for
``work'' CDRs since the cost of medical decision-making is eliminated,
and the cessation rate on work issues is higher. AFGE estimates cost
savings approaching $30 to the Trust Fund, for every dollar spent.
Investing in the ESR position is a perfect example of applying
stewardship responsibilities effectively and investing resources in a
high cost: benefit manner.
The Evaluation Report recommends that the ESR should be made a
permanent position within SSA, and that the ESR position be expanded to
as many SSA offices as possible. The Report cautions: ``Failure to
institutionalize a position to perform the duties that the ESR has
piloted could in effect deny the public and community the opportunity
to interact with an accessible and responsive SSA specialist. This
could eliminate an important element in SSA's plan to improve its
employment support service delivery to the public. It could also
negatively affect our ability to effectively train and advise other SSA
staff in the provisions of the law, with implications for increased
incorrect payments and the denial of benefits to beneficiaries.''
Community organizations, BPAOs and other advocates for the disabled,
and the Ticket to Work Advisory Panel's Annual Report to the President
and Congress, Year Two have endorsed these conclusions as well.
Unfortunately, SSA does not plan to implement the ESR position, due
to shortages of staff and resources in field offices. SSA's latest
strategy is apparently a combination of: training all employees again
on work incentives, providing ``systems enhancements'' and designating
additional duties called ``Work Incentives Liaison (WIL)'' or ``Work
Incentives Specialist (WIS)'' as collateral functions of existing
Claims Representatives, Technical Experts, Management Support
Specialists, Public Affairs Specialists, or other management personnel.
The ESR Evaluation Report addressed the ineffectiveness of this
approach: ``. . . Currently, these types of activities are handled by a
myriad of positions--including management, field representatives,
public affairs specialists, and claims representatives. Usually, all of
the activities related to Return To Work (RTW/WI) are split among these
various positions; there is no single point of contact. Many Field
Offices have a designated employee identified as a work incentive
liaison (WIL), but this duty is but a small portion of the overall job
responsibilities of the WIL. Experience shows that the WIL is often not
an effective answer in carrying out SSA's new RTW/WI
responsibilities.''
SSA's latest strategy of adding this workload as collateral duties
to that of employees already overburdening with many workloads and
priorities will set SSA back to the point that the public outcry led to
enactment of legislation to begin with.
SSA also touts systems enhancements in processing return to work as
another reason a dedicated specialist is not needed. Planned systems
enhancements, such as Modernized Return to Work (MRTW) and Disability
Claim File (DCF) are but a piece of improving service and complying
with Congress's mandate in the legislation. Following are comments from
ESRs addressing the role of dispersing return to work duties and
systems enhancements in performing their functions:
L``Congress should be concerned with the person being
treated fairly and getting the full benefit of the law, not
just how many work CDR's were cleared for an office. Cases laid
for 2-3 years and were never worked and then the claimant had a
tremendous overpayment to pay back. the whole point in the
ticket legislation calling for this position was to correct
what was going on in the offices.''
L``The other part of our job, which has been the
outreach, has been an invaluable service to the public. I have
provided training in most offices in my state on the MRTW and
Work CDRs. Still, most of the CRs, SRs and even TEs in the
field do not know work CDRs. They also were stupefied by the
complexity of the MRTW. It's not that they can't learn it, it
is that they don't have time for it!''
L``These relationships, both with the claimants and
beneficiaries, and with the community, are essential if we are
to be serious in our endeavor to help individuals with
disabilities to work. The CRs, though most of them are
excellent servers of the public, cannot be dedicated to only
the task of work issues. There are just too many other issues
to be dealt with. It was necessary to have the ``dedicated''
language in the legislation because an effort like this merited
one on one and on going attention. That was the problem with
the WILs; they were not dedicated and they could not
concentrate on the problem of work issues. This is the reason
we have so many overpayments. However, if you dedicate someone
to be the point person for these issues, then you curb these
negative effects.''
L``The ESR acts as an ombudsman to the community,
resolving public relations problems, solving complex work
incentive issues, teaming with community leaders to form best
practices in addressing vocational needs in their area, and
acts as an expert resource for field office employees. There is
no computer program that can ``take over'' for these duties.''
L``Additionally the outreach fosters better
relationships with organizations. This eliminates the fear
factor and fosters faster reporting, which also minimizes
overpayments. Overpayments are a major disincentive to keeping
the disabled in the workforce. When claimants receive an
overpayment letter the most likely course of action is for the
person to stop working. This is particularly true when the
nature of the impairment is mental rather than physical. The
added stress of the overpayment very frequently is enough to
trigger a relapse.''
AFGE believes an Agency decision not to implement the ESR would be
a tragic mistake when the ESR has proven to be a winner for all
parties. For SSA, it shows superb service to the public, provides
stewardship in reducing benefits and overpayments, and results in SSA
compliance with the legislative mandate for work incentive specialists
within SSA. For the public, it provides stellar service, a single point
of contact, and assists beneficiaries in leaving the disability rolls.
For the taxpayer, it saves money and prolongs Trust Fund solvency.
AFGE respectfully poses this question to members of this
subcommittee: How many of you are aware of spouses, siblings, children,
or close friends or relatives who are disabled and could potentially
seek assistance from Social Security in return to work? What kind of
service are they entitled to receive? By implementing the ESR, SSA has
the opportunity to provide service long overdue.
AFGE requests that Congress and this Subcommittee support
legislation to provide the additional resources to SSA to meet the
requirements of the Ticket to Work and Work Incentives Improvement Act
and fund a ``work incentives specialist within SSA''. Legislation is
also required for continuous funding beyond FY 2004. AFGE requests this
Subcommittee support an amendment proposed to HR 4070 to provide such
funding, which is currently before the Senate Finance committee. A copy
of this amendment is attached to this statement. It would cost
approximately 120 million dollars to staff SSA's 1300 field offices
with 1500 ESRs. The potential return of $3.5 billion indicates that
this would be a prudent expenditure. Additionally, legislation should
also require SSA to report on continuance and cessation rates of work
issue CDRs, overpayments due to work cessations, and benefits saved the
Trust Fund by work cessations.
AFGE thanks the Subcommittee for its consideration of the issues
raised in this statement.
National Rehabilitation Association
Bethesda, Maryland 20814
October 10, 2002
Chairman Shaw, Ranking Member Matsui, and Members of the
Subcommittee on Social Security, I am proud to serve as the Director of
Governmental Affairs of the National Rehabilitation Association (NRA).
I am also the parent of a child with multiple, significant
disabilities.
I have requested, and have received, the concurrence of the
President of the NRA and the Executive Director respectively, John Lui
and Michelle Vaughan, to response to what I, and they, consider to be
very unsettling--and more importantly unsubstantiated--testimony
presented by some in the disability community to the Members of the
Subcommittee on Social Security.
The National Rehabilitation Association was founded in 1925 and is
the longest-standing and one of the strongest advocates ensuring that
the rights of individuals with disabilities are both respected and
realized.
With Chapters in all 50 States, the NRA's mission is to provide
advocacy and awareness for the employment of qualified professionals in
the field of vocational rehabilitation. The NRA has a national
membership of nearly 10,000, comprised of consumers, physical, speech
and occupational therapists, qualified rehabilitation counselors,
private providers, career counselors, and others who provide employment
services on behalf of individuals with disabilities.
I appreciate the opportunity to respond to written and oral
testimony to the September 26, 2002, Subcommittee hearing examining the
implementation of the Ticket to Work and Work Incentives Improvement
Act (P.L. 106-170), with a specific focus on the role of the Public
Vocational Rehabilitation Program in this implementation.
As a preface to responding to certain testimony presented at this
hearing, I would like to provide a brief background of the Public VR
program which has been engaged in decades in productive, private/public
partnerships.
Like you, the National Rehabilitation Association strongly believes
in the dignity of work and the power of partnerships, while recognizing
that those partnerships, if they are to be truly productive for
individuals with disabilities, must fully recognize and respect the
integrity of the programs administered under the Rehabilitation Act of
1973, as amended (also known as the Public Vocational Rehabilitation
(VR) Program).
The Public VR Program, which is authorized under the jurisdiction
of the House Education and the Workforce Committee and the Senate
Health, Education, Labor and Pensions Committee, respectively, is an
eligiblity employment program which just last year served approximately
1.2 million eligibile indivdiuals with disabilities--many of whom were
indivdiuals with significant disabilities--placing more than 233,000
eligible individuals into competitive employment.
The Public VR Program is housed in the U.S. Department of
Education's Office of Special Education and Rehabilitative Services
(OSERS) and is administered by the Commissioner of the Rehabilitation
Services Administration (RSA) in the U.S. Department of Education and
in conjunction with its State Partners.
The Public VR Program is a successful service delivery system that
exemplifies the ABCs of public vocational rehabilitation--it is
Accountable, Bipartisan, Comprehensive and Cost-Effective, with ample
supporting documentation, which I believe makes it one of the most
successful, accountable education and job training programs in the
history of the workforce world.
The Public VR Program has been serving, and continues to serve,
Social Security Disabilitity (SSDI) and Supplemental Security Income
(SSI) beneficiaries/recipients, who are presumed eligible under the VR
Program since many of these beneficiaries are individuals with the most
signifciant disabilities.
Indeed, 38 States are presently on an Order of Selection (OOS)
which, mandated by the VR statute, places a priority on individuals
with the most signifciant disabilities who walk or wheel through VR's
doors.
When the originally-titled ``Work Incentives Improvement Act''
(WIIA), was proposed by the Congress, the principal reason for this
legislation was to help alleviate the single greatest barrier to SI/DI
individuals entering or re-entering the world of work.--that of losing
their precious Medicaid benefits if they exceed the Substantial Gainful
Activity (SGA). Indeed, according to the U.S. General Accounting Office
(GAO), less than one percent of SI/DI indivdiuals will choose not to
seek employment services from the Public VR Program, or any other
Employment Network (EN), because employment that produces income in
excess of $750 per month for non-blind, disabled individuals and $1,200
for blind individuals, results in forfeiture of their health care
Medicaid coverage.
The loss of health care coverage for those SI/DI individuals who
want to work is many times missing in the discussions as the
overarching reason why the original Work Incentives Improvement Act
(now TWWIIA) was proposed.
One of the issues that I (and I assume others) had advocated for in
this legislation was safety net legislative language for the States
should a downturn in the economy occur. This argument was,
understandably, a hard-sell in a record-booming economy that most of us
thought would never end. Now that the booming economy has ebbed, it is
not surprising that some States which agreed to participate in the
Medicaid buy-in are, understandably, reconsidering (at least for now)
their participation in the Medicaid buy-in option under TWWIIA. Those
States include, Georgia and Florida, and there may be others of which I
am unaware.
Given only a brief background of the original intent of the Work
Incentives legislation, I would now like to address what I consider to
be unsubstantiated testimony from a few of the advocates who testified
before your Subcommittee.
As I know you fully appreciate, anecodotal allegations of fraud,
waste and abuse have never been, nor are now, acceptable venues of
veracity.
The anecdotal allegations advanced by certain advocates testifying
before the Social Security Subcommittee on September 26, 2002, that the
VR Agencies were ``raiding'' the Ticket and strong-arming customers
into depositing their Tickets with Public VR attempted to paint the
public VR Program with the broad brush of being the bully on the block,
rather than the best on the block.
These faceless--and in most if not all cases baseless--charges
should never find a forum in the U.S. Congress or in any Body that
enjoys a reputation of fundamental fairness.
With all due respect, the Social Security Administration cannot
have it both ways. The Public VR Program has served and will continue
to serve SI/DI individuals with the same respect and responsibility
that has characterized the Public VR Program thoughout its 82-year
history.
Because SI/DI receipients/beneficiaries are continuing to choose
the Public VR Program over other Employment Networks may have nothing
to do with anecdotal allegations and much more to do with inadequate
information and incentivization from SSA to all ENS (including VR)
regarding their participation in the Ticket to Work program. Indeed, it
speaks volumes to me that only 400 additional Employment Networks
(additional to VR) have opted to become Employment Networks in the
States.
Relatedly, I believe that the Social Security Administration must
recognize its responsibility to the Congress and the American public,
especially to those individuals with disabilities, to provide clear,
crisp and consistent regulatory and sub-regulatory guidance. That
sought-after succinct and consistent guidance has been absent the
Ticket process from the beginning and is causing enormous confusion and
frustration in the States, with ENs and among individuals with
disabilities.
One final, important consideration. All private employment networks
have the option, under TWWIIA, to refuse to serve any SI/DI
beneficiary. This option is especially concerning regarding individuals
with the most significant disabilities, many of whom are SI/DI
individuals, and are the most costly and challenging to serve. This, to
me as a parent of a child with multiple, significant disabilities,
qualifies as one of the greatest disability disconnects in D.C.
While private ENs can pick whomever they choose to serve, the
public VR program presumes that SI/DI individuals are eligible for
services from the successful State/Federal, public/private partnership
known as the Public VR Program which has been serving millions of
eligible individuals with disabilities for more than 82 years with the
dignity and dedicated and qualified staff that individuals with
disabilities deserve and demand.
Thank you for the opportunity to share with you the National
Rehabilitation Association's views, and those of myself both as as a
professional and as a parent. We appreciate this opportunity for
outreach to you and are ready to work with you in the future as we have
in the past.
Respectfully submitted,
Patricia C. Leahy,
Director of Govermental Relations