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Ticket to Work….
Great Opportunities
&
Room for Improvement

Marsha katz
Abridged Version Reprinted from
Rural Exchange (vol. 17, no. 1, 2004)

The Ticket to Work and Work Incentive Improvement Act of 1999 is now in full swing. By the end of 2004, every person between the ages of 18 and 65 who was receiving Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) benefits should have received a “Ticket” in the mail from the Social Security Administration. They can then use that “Ticket” to purchase employment services from any enrolled “Employment Network.” Employment Networks (EN) are service providers who work with Social Security to assist SSI or SSDI beneficiaries to transition to work.

If the Employment Network performs any service for the person that results in the person earning over what Social Security calls the “Substantial Gainful Activity” (SGA) level ($830/month in 2005), the Employment Network has an opportunity to receive extended monthly payments for up to five years, depending on how long the person continues to earn over SGA or is not due any SSDI or SSI payments. The Employment Network is paid only if the person is satisfied with their service.

Upon enrollment, an EN elects to receive payment under one of two payment options:

  • The “Outcome” option promises greater payments to the EN over a five-year period, but requires that the worker not be due any SSI or SSDI check at all in order for the EN to receive payment. In 2005, an SSI recipient would need to earn $1243/month to lose their SSI payments; an SSDI recipient would need to earn over $830/month to lose their SSDI payments.
  • The “Outcome Milestone” option provides up to four reduced payments to an EN in a 15-month period, providing the worker earns at least SGA for up to 12 out of the 15 months. Additionally, the EN can then continue to receive the reduced payments for the remainder of five years if the person continues to earn over SGA.

While there are clearly some opportunities presented by Ticket to Work, it should be noted that they are actually accessible to a very few people. According to the Ticket program manager, Maximus, Ticket to Work was never intended to serve everyone, and if the ENs are successful with only one half of one percent of all “Ticket” holders, Ticket will have more than paid for itself. Because Ticket is meant to serve so few people, despite the broadly aimed exposure it has received, it contains some features that are frankly inequitable, and others that exemplify one of my cardinal rules when dealing with Social Security: “Don’t Look for Logic.”

What’s Working with Ticket to Work?
The greatest opportunity Ticket to Work provides is that some SSI/SSDI recipients will now have real choice in who provides their employment services. They can now choose to receive services from any Employment Network providing services to their geographic location, as an alternative to the services provided by their state Vocational Rehabilitation (VR) agency.

Benefits Analysis and Protection of Rights
One of the most constructive opportunities Ticket to Work provides is the creation of a national cadre of Work Incentives Planning and Assistance (WIPA) workers. These WIPAs partner with SSI/SSDI recipients to examine the impact of work on benefits before the person actually makes a decision to go to or return to work. They share accurate information about a range of benefits so individuals can make informed choices that will not see them risking the loss of more than they stand to gain by working.

Along with the WIPAs, Ticket to Work provided money to the nation’s Protection and Advocacy (P&A) organizations to assure SSA does not inadvertently target people who took advantage of Ticket with Continuing Disability Reviews (CDRs), contrary to protections in the law. Many of the P&A organizations and their WIPA counterparts are also assisting SSI/SSDI recipients to write Social Security Plans for Achieving Self Support (PASS plans) to help them achieve their vocational goals.


Extended Medicare Coverage
A third Ticket opportunity is that working SSDI recipients can continue to receive free Medicare (Part A) hospital coverage even when they are no longer eligible for an SSDI check because they are earning over SGA. This free extension of Medicare Part A can continue for 8 ½ years. When the free Medicare hospital benefits run out, people can choose to buy-in to the Medicare hospital benefit. In addition, when a working SSDI recipient loses eligibility for SSDI because of earnings over the SGA level, and that person later must stop working because of their disability, they can immediately begin to receive their SSDI checks again, if they notify SSA.

Medicaid Buy-In Potential
A fourth opportunity under Ticket exists in those states that have elected to provide a Medicaid buy-in to working SSDI recipients. This means that SSDI recipients don’t have to fear losing Medicaid if they go to work. When their earnings put them over their state’s income eligibility limit, working SSDI recipients can buy-in to Medicaid at very affordable levels.

Ticket is an opportunity for the federal government to reduce the amount of disability benefits paid out, thus saving money and slowing the growth of the SSI and SSDI programs. The beauty of this cost savings is that it is not accomplished by selective, hurtful budget cuts that put vulnerable people at risk. On the contrary, it is accomplished by providing choice, supports, and assistance to people so they can go to/return to work and not lack health care insurance. It’s a win-win situation.

Room for Improvement… What Isn’t Working….
There is practically no access to services from Employment Networks for SSI recipients with significant disabilities. SSI is a disability-based public assistance benefit that poor people with disabilities who have little or no work record can receive. In most states, SSI comes with Medicaid, which provides the funding for general health care and for medications, personal assistance services, and developmental disability and mental health services. Depending on their state, persons on SSI can gross up to $14,916 - $45,095/year before they risk the loss of their Medicaid. This potential for high earnings would seemingly make SSI recipients very desirable customers for Employment Networks.

Under the Ticket to Work regulations, Employment Networks can choose whether or not to serve a consumer, in the same way the consumer can choose from whom to buy employment services. Employment Networks can receive reduced payments for their services when a consumer they assist grosses over the SGA level. Or, they can choose to receive full payments over a 5-year period, if the consumer they assist is earning enough to not be due any benefit check. For an SSI recipient, this typically means earnings of $1,243/month in 2005 (as opposed to earnings of $830/month for SSDI recipients). Therefore, Employment Networks providing services under the “Outcome” payment option will most often choose to serve only those SSI recipients who are likely to earn at least $1,243/month.

Persons born with significant developmental disabilities typically receive SSI for much of their lives. They also frequently have work histories that are very limited from years in work activity centers and sheltered workshops. Even those in Supported Employment often work only part-time for minimum wage. At the minimum wage of $5.15/hour, even a full-time job would produce only $824-$927/month, which is less than the $1,243/month the person would have to earn in order for the EN to receive full payments for their services. Therefore, Employment Networks providing services under the “Outcome” payment option are much less likely to choose to serve persons with significant developmental disabilities, because there may be practically no chance the Employment Network will receive payment for those services.

Even when the Employment Network has chosen to provide services under the “Outcome Milestone” payment option, a person earning $5.15/hour would have to work nearly full-time in order to gross over SGA, thus making the Employment Network eligible for payment. Once again, Employment Networks will be far less likely to serve persons with significant disabilities because they are not as likely to receive any payment for their services.

In essence, SSI recipients—the persons with the best health care safety net, who can afford to try earning more without losing essential services—are also the people who have the least chance of earning enough to make it worthwhile for an EN of their choice to serve them. The result is that Ticket to Work does not provide people with significant developmental and other disabilities the same freedom of choice and opportunity for self-determination that it provides to people with less significant disabilities. Ticket, as it reads today, sets up a situation where Employment Networks are likely to consistently refuse services to persons with significant disabilities. Outside the realm of Ticket to Work, consistent denial of government or other services to one segment of the population would likely be termed as discrimination.

A second drawback of Ticket is the loss of essential health care for SSDI recipients. Conversely to the above situation, many SSDI recipients have significant work histories. Often having worked before acquiring their disabilities, they understand the world of work and typical workplace behaviors and rhythms, and are thus retrained for a new job more easily. This means they are often better candidates for a return-to-work than are many SSI recipients, and are more likely to have higher earnings, or the prospect of earning over the SGA amount each month.

Employment Networks can receive the reduced payments for serving SSDI recipients when they earn $830 or more/month in 2005, if the Employment Network chooses the “Outcome Milestone” payment option. If the SSDI recipients earn the Substantial Gainful Activity amount or more for enough months, SSA will deem them not eligible to receive their SSDI checks, and the Employment Network can then receive full payment for providing employment services, if the Employment Network has elected to provide services under the “Outcome” payment option.

While SSDI comes with Medicare, Medicare doesn’t yet cover all prescription costs, personal assistance services, and most developmental disability and mental health services. (In late 2003, Congress passed a Medicare prescription bill that will provide partial assistance with prescription costs for SSDI and SS Retirement recipients.) If SSDI recipients need Medicaid in addition to their Medicare, in order to cover their expensive medications, personal assistance services, or mental health and developmental disability services, they must keep their income within specific low limits to become or stay financially eligible for Medicaid in their state, unless that state is one with a Medicaid buy-in program. Since working means having additional income, many SSDI recipients are fearful of working because they can’t afford to lose their essential Medicaid.
So, the people with the best chance of earning enough to make them desirable candidates for Employment Networks, and for whom the Employment Networks are most likely to receive payment for services, are the least likely to seek out those services for fear of losing Medicaid. Many have noted that there appears to be a lack of logic in many current Ticket to Work regulations and policies that prevents accomplishing the very things the law initially said it wanted to accomplish.

The only light at the end of the tunnel currently is in the states that already had a Medicaid buy-in program before Ticket to Work, or that created one pursuant to the provisions in the Act. However, because the Medicaid buy-in provision was not mandatory for all of the states in Ticket to Work legislation, even this bit of potential light comes with pitfalls. First, faced with the option, states may choose to not create a Medicaid buy-in program, and secondly, again because the program is optional, it can easily end up on the chopping block during state budget negotiations since states cannot by law cut mandatory Medicaid services.

Why Participate in Ticket?
Despite the preponderance of inequities and problems in Ticket to Work, there are definitely reasons for SSI/SSDI recipients to assign their Ticket to an Employment Network, and there are definitely reasons for an employment provider to enroll as an Employment Network. The trick is to remember that Ticket to Work only applies in very select situations. Therefore it is best thought of as only one more option in an array of options available to SSI/SSDI recipients and employment providers.

Employment providers have nothing to lose by enrolling as an Employment Network, and when the situation is carefully selected, they can gain by providing services under Ticket. Whether or not an SSI/SSDI recipient uses their Ticket must be decided on a one-person-at-a-time analysis of the particular costs and benefits in that particular situation. Use of Ticket is just one more piece to include in the comprehensive Benefits Planning process.

For the right person, and the right employment provider, Ticket to Work has great potential to result in a win-win situation where all parties reap the benefits.

 

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