By David Hammis and Nancy Maxson at the Rural Institute

On December 17, 1999, President Clinton signed into law the Ticket to Work and the Work Incentives Improvement Act of 1999 (TWWIIA). Disability activists lobbied Congress for more than four years to get approval of this legislation that reduces or eliminates some "disincentives to work" (such as the loss of medical coverage) for Social Security beneficiaries with disabilities. One of the most important parts of this act is the Ticket to Work and Self Sufficiency program, which offers SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income) beneficiaries a "ticket" to purchase vocational rehabilitation services and employment supports from networks of local employment service providers. While the Ticket to Work offers "ticket-holding" beneficiaries a choice of employment service providers, it simultaneously offers providers financial incentives to provide high-quality services. This translates into new opportunities and outcomes for beneficiaries and providers. This article outlines some of the benefits of Ticket to Work and discusses how the critical players need to "get ready" as Social Security rolls-out this landmark legislation.

The Magic $700 Mark

The Social Security Administration considers any employee or small business owner with a disability who earns more than $700 per month ($1170 if a person is blind, in the year 2000) working above the "Substantial Gainful Activity" (SGA) level. Prior to passage of this act, when a beneficiary began earning $700 per month, his/her SSDI, Medicaid, and/or Medicare benefits could be eliminated completely. Some people lost all of their Social Security and medical benefits. Consequently, some employment advisors (including case workers, job coaches, Social Security claims representatives, parents, employers, and just about anyone involved in supporting workers with disabilities) counseled and SSDI beneficiaries into NEVER earning more than $700. The SGA amount has been a magic ceiling in the minds of beneficiaries and consultants, and they have actively tried to limit earnings so beneficiaries do not cross that line, keeping beneficiaries trapped in poverty.

The Ticket to Work and the Work Incentives Improvement Act potentially make it possible for working SSDI beneficiaries earning more than $700 to keep medical coverage if needed, either indefinitely or for longer periods of time—the biggest disincentive to working above the SGA level. The legislation allows and encourages states to modify their financial criteria for Medicaid eligibility. States choosing to participate would allow working SSDI beneficiaries to earn up to 250% of poverty level ($20,000) and still retain Medicaid at no cost. SSDI beneficiaries earning more than 250% of poverty level could buy into Medicaid at reasonable rates. With the Ticket to Work, the $700 earnings level becomes the goal to surpass for SSDI beneficiaries rather than a barrier to cower beneath. Working beneficiaries benefit because earnings potential expands when many of the current work disincentives are either reduced or eliminated. It is a win-win situation with life-transforming outcomes for employees with disabilities. As income climbs, employees with disabilities can climb out of poverty.

Benefits for Employment Service Providers

Removing disincentives to work is just part of the Ticket to Work; it also provides new incentives, particularly to employment service providers, when beneficiaries earn more than the SGA level. Through the Ticket to Work, Social Security financially encourages providers who use high-quality employment services that support working beneficiaries to find and keep good paying jobs. Providers can receive up to 40% of the average SSI or SSDI benefit check if a "ticket-holder" remains employed beyond the first nine out of twelve months. This 40% provider payment from SSA can continue up to 60 months, as long as the employee with a disability continues to earn more than the SGA amount. This 40% is an incentive or bonus for the provider. It is anticipated that provider incentives will encourage employment service providers to structure high-quality supports for beneficiaries so that each employee will choose to earn more than $700 per month and continue employment, not only for the first nine months, but for the full 60 month period and beyond. Supporting "ticket-holders" to continue long-term employment means providers will need to find beneficiaries personally satisfying work, not simply work that pays well.

Beneficiaries with Substantial Employment Support Requirements

Beneficiaries with substantial employment support requirements are often labeled "incapable of working." Employment advisors try to rationalize these labels with disability stereotypes and misinformation, or claim the additional costs associated in providing substantial supports are prohibitive. These are without a doubt mistaken ideas. Adults in our society work. Period. Any adult not working costs our world society and world economy much more than an adult who is not working, no matter how substantial his/her support requirements are.

More than 150,000 American employees with substantial support requirements are benefitting from supported employment (Griffin, RuralFacts, Rural Supported Employment, 1998). And the costs associated with those supports are not excessive. Vocational Rehabilitation case closures (Status 26 Closures) in supported employment cost only $1,255 more that sheltered employment closures (U.S. Department of Education, Rehabilitation Services Administration, 1994).

Employees with substantial employment support needs are and can be part of the work force and the Ticket to Work potentially could provide new funding and employment service tools to support quality employment opportunities for all beneficiaries. Providers who understand and use high-quality supported employment techniques—such as Systematic Instruction, assistive and universal technology, augmentative/alternative communication supports, and natural supports—are successfully supporting beneficiaries. Ticket to Work, because it will encourage employment service entrepreneurs and reward providers who offer high-quality services, will mean that "ticket-holders" with substantial support requirements will be able to leverage more and better services from providers.

Getting Ready for the Roll-Out

There is a strong concern that beneficiaries with substantial employment support requirements will not access or benefit from the Ticket to Work provisions. If we are to ensure that all beneficiaries receive equal access to Ticket's benefits, we must begin thoughtful and inventive preparations for Social Security's roll-out of this legislation. There is a common misconception that people with disabilities need to "get ready to work" or must be "made ready." Adults with disabilities are ready for work and do not need to "get ready" for work. The actual situation is that we need to get ready. And we must get ready now.

The four critical players about to implement Ticket to Work— beneficiaries, employers, employment service providers, and Social Security—are currently involved in varying levels of preparations for the three-year roll-out (from 2001 - 2003) of this massive landmark legislation. At the time of this writing (October, 2000), only one of the four critical players, Social Security, is preparing in any significant way. Social Security is writing policies, selecting states for year one, two, or three roll-outs, printing Tickets and preparing to mail them to beneficiaries, and sending out general and specific information. A few employment service providers are engaged in some minor preparations and discussions. A few beneficiaries with disabilities are discussing the new law. And a few employers have been engaged in some discussions. But local communities need to bring the four key players together to begin preparations for implementing Ticket to Work.

What needs to be done in local communities is for all four critical players to sit at the table. Employers and employees need to be brought into this picture to discuss what is required for success and how it can be put together in a way that everyone wins. Employers may negotiate for equipment or customized on-the-job training and supports. Employees may negotiate for better transportation options. Of the four critical players (beneficiaries, employers, service providers, and Social Security), who will be involved in the process of successfully implementing the Ticket to Work, the players who have the most flexibility and control over the employment outcome are the employee and the employer. Social Security can continue to remove some of the remaining work disincentives, but certainly cannot control the outcome. A provider can develop a job, assist with on-the-job training and supports, but in the end cannot control the outcome. Only the employee can show up to work each day, choose to earn more than $700 per month, and choose to remain employed for an additional 60 months. Only the employer can agree to employ someone, pay more than $700 per month, and choose to retain that employee. So the employers and the employees in each community need to be at the table with the service providers and Social Security.

Finally, the other key players are the "employment service providers." There are now a significant number of local employment service providers: Developmental Disability services providers, Mental Health providers, Department of Labor/Job Service providers, Veteran's Services providers, Vocational Rehabilitation, employer service providers, temporary personnel services providers, et al. All of these providers could become "approved ticket providers" of services. In the Ticket to Work legislation, providers will be called "Employment Network Providers," which is an excellent title for the diverse and yet collaborative efforts of all providers that support people with disabilities in securing and excelling in community employment.

During the roll-out preparation meetings, providers can learn what employers and beneficiaries will need to make Ticket to Work successful. Then the providers can tailor their services to meet these needs. They will have time to build their agencies' capacities to provide the high-quality services that beneficiaries will need to get and keep jobs. Providers will have time to learn how to use Systematic Instruction, access assistive and universal technology, find augmentative/alternative communication supports, and take advantage of natural supports. With these skills in place, providers will be able to achieve Ticket to Work's goals and their agencies will grow and prosper. If the providers plan well, all beneficiaries should be able to access Ticket to Work services. Beneficiaries who require substantial employment supports will not be left behind again.

Summary

The Ticket to Work and the Work Incentives Improvement Act of 1999 is about to become a reality around the country. It has clear benefits for beneficiaries and providers. Now is the time to begin local preparations for implementing it. Beneficiaries have fought long and hard for this legislation and have waited lifetimes for employment providers and employers to move forward. It's time to become "early adopters" and put together inventive and innovative plans to utilize the tools of Ticket to Work now. Making people with disabilities wait in line again was not Congress's intent when it passed this legislation. Every person with a disability is ready now. But the question is, "are we ready?" Let's work to bring employers, beneficiaries, employment providers, and Social Security together now in each of our communities, and develop action plans and working agreements so that when ten million beneficiaries receive their Tickets to Work in the mail, our communities and employment networks are "ready!"