[House Hearing, 105 Congress]
[From the U.S. Government Publishing Office]
``TICKET TO WORK AND SELF-SUFFICIENCY ACT OF 1998''
=======================================================================
HEARING
before the
SUBCOMMITTEE ON SOCIAL SECURITY
of the
COMMITTEE ON WAYS AND MEANS
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTH CONGRESS
SECOND SESSION
__________
MARCH 17, 1998
__________
Serial 105-35
__________
Printed for the use of the Committee on Ways and Means
----------
U.S. GOVERNMENT PRINTING OFFICE
50-548 cc WASHINGTON : 1998
COMMITTEE ON WAYS AND MEANS
BILL ARCHER, Texas, Chairman
PHILIP M. CRANE, Illinois CHARLES B. RANGEL, New York
BILL THOMAS, California FORTNEY PETE STARK, California
E. CLAY SHAW, Jr., Florida ROBERT T. MATSUI, California
NANCY L. JOHNSON, Connecticut BARBARA B. KENNELLY, Connecticut
JIM BUNNING, Kentucky WILLIAM J. COYNE, Pennsylvania
AMO HOUGHTON, New York SANDER M. LEVIN, Michigan
WALLY HERGER, California BENJAMIN L. CARDIN, Maryland
JIM McCRERY, Louisiana JIM McDERMOTT, Washington
DAVE CAMP, Michigan GERALD D. KLECZKA, Wisconsin
JIM RAMSTAD, Minnesota JOHN LEWIS, Georgia
JIM NUSSLE, Iowa RICHARD E. NEAL, Massachusetts
SAM JOHNSON, Texas MICHAEL R. McNULTY, New York
JENNIFER DUNN, Washington WILLIAM J. JEFFERSON, Louisiana
MAC COLLINS, Georgia JOHN S. TANNER, Tennessee
ROB PORTMAN, Ohio XAVIER BECERRA, California
PHILIP S. ENGLISH, Pennsylvania KAREN L. THURMAN, Florida
JOHN ENSIGN, Nevada
JON CHRISTENSEN, Nebraska
WES WATKINS, Oklahoma
J.D. HAYWORTH, Arizona
JERRY WELLER, Illinois
KENNY HULSHOF, Missouri
A.L. Singleton, Chief of Staff
Janice Mays, Minority Chief Counsel
______
Subcommittee on Social Security
JIM BUNNING, Kentucky, Chairman
SAM JOHNSON, Texas BARBARA B. KENNELLY, Connecticut
MAC COLLINS, Georgia RICHARD E. NEAL, Massachusetts
ROB PORTMAN, Ohio SANDER M. LEVIN, Michigan
JON CHRISTENSEN, Nebraska JOHN S. TANNER, Tennessee
J.D. HAYWORTH, Arizona XAVIER BECERRA, California
JERRY WELLER, Illinois
KENNY HULSHOF, Missouri
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 March 10, 1998, announcing the hearing............... 2
WITNESSES
Social Security Administration, Susan M. Daniels, Ph.D.,
Associate Commissioner for Disability.......................... 7
______
Abbot, Quincy, The Arc of the United States...................... 29
American Congress of Community Support and Employment Services,
Joe Miller..................................................... 52
Arc of the United States, Quincy Abbot........................... 29
Burns, Robert, Council of State Administrators of Vocational
Rehabilitation................................................. 47
Consortium for Citizens with Disabilities Task Force on Social
Security, Subcommittee on Work Incentives, Tony Young.......... 18
Council of State Administrators of Vocational Rehabilitation,
Robert Burns................................................... 47
Keller, Earl, National Alliance for the Mentally Ill............. 24
Kentucky Association of Community and Employment Services, Joe
Miller......................................................... 52
LifeSkills Industries:
Joe Miller................................................... 52
Joe Mobley................................................... 57
Miller, Joe, LifeSkills Industries, Kentucky Association of
Community and Employment Services; and American Congress of
Community Support and Employment Services...................... 52
Mobley, Joe, LifeSkills Industries............................... 57
National Alliance for the Mentally Ill, Earl Keller.............. 24
National Association of Rehabilitation Professionals in the
Private Sector, Steven D. Shedlin.............................. 43
National Center for Disability Services, Francine M. Tishman..... 59
National Council on Independent Living, Susan Webb............... 34
Ramstad, Hon. Jim, a Representative in Congress from the State of
Minnesota...................................................... 5
Shedlin, Steven D., National Association of Rehabilitation
Professionals in the Private Sector............................ 43
Tishman, Francine M., National Center for Disability Services.... 59
United Cerebral Palsy Associations, Inc., Tony Young............. 18
Webb, Susan, National Council on Independent Living.............. 34
Young, Tony, United Cerebral Palsy Associations, Inc., and
Consortium for Citizens with Disabilities Task Force on Social
Security....................................................... 18
SUBMISSIONS FOR THE RECORD
EXCEL! Networking Group, Inc., Merrifield, VA, Robert S. Rudney,
statement...................................................... 70
Mental Health Liaison Group, Columbia, MD, statement............. 71
Minnesota Consortium for Citizens with Disabilities, Golden
Valley, MN, Anita Boucher, statement and attachments........... 74
Paralyzed Veterans of America, statement......................... 76
``TICKET TO WORK AND SELF-SUFFICIENCY ACT OF 1998''
----------
TUESDAY, MARCH 17, 1998
House of Representatives,
Committee on Ways and Means,
Subcommittee on Social Security,
Washington, DC.
The Subcommittee met, pursuant to notice, at 3 p.m., in
room 1100, Longworth House Office Building, Hon. Jim Bunning
(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
March 10, 1998
No. SS-15
Bunning Announces Hearing on the
``Ticket to Work and Self-Sufficiency Act of 1998''
Congressman Jim Bunning (R-KY), Chairman, Subcommittee on Social
Security of the Committee on Ways and Means, today announced that the
Subcommittee will hold a hearing on the ``Ticket to Work and Self-
Sufficiency Act of 1998.'' The hearing will take place on Tuesday,
March 17, 1998, in the main Committee hearing room, 1100 Longworth
House Office Building, beginning at 3:00 p.m.
In view of the limited time available to hear witnesses, oral
testimony will be from invited witnesses only. However, any individual
or organization may submit a written statement for consideration by the
Committee and for inclusion in the printed record of the hearing.
BACKGROUND:
Social Security programs are vital to all Americans. The disability
program is particularly important because it protects workers and their
families against severe financial hardship that occurs when workers
sustain severe illnesses or disabling conditions that prevent them from
working. Due to advances in medicine, technology, and the field of
rehabilitation, there are people who, despite serious disabilities,
want to work and could work if provided the kind of rehabilitation
services they need.
Chairman Bunning and Rep. Barbara Kennelly (D-CT), expect to
introduce this week the ``Ticket to Work and Self-Sufficiency Act of
1998,'' to help Social Security and Supplemental Security Income
recipients return to a life of economic security and self-sufficiency.
The major provisions of the legislation would ease the transition of
Social Security and Supplemental Security Income disabled beneficiaries
into the workforce. Generally, the bill would provide Social Security
beneficiaries with choice in selecting providers of services and choice
in selecting the specific services they need to help them achieve
gainful employment. Generally, the providers of services would be paid
for outcomes and long-term results. The payment process would be
designed to ensure that as many providers as possible are available to
serve consumers of these services.
One of the primary barriers confronting beneficiaries who would
like to work is the fear of losing health care coverage. To help
alleviate that fear, the ``Ticket to Work and Self-Sufficiency Act''
would extend Medicare an additional two years beyond current law to
these individuals. This means that recipients would have Medicare
coverage for a total of six years from the time they first make an
attempt to work.
Due to the nature of their disability, many individuals incur
extraordinary costs in trying to get a job and maintaining that job.
The legislation would create a tax credit of 50 percent of impairment-
related work expenses up to $10,000 a year. Also, to better help
consumers transition into work, the bill would include a requirement
that the Social Security Administration (SSA) test a gradual offset of
Social Security Disability Insurance benefits by reducing monthly
benefits $1 for every $2 in earnings over a determined level.
In addition, the bill would create an Advisory Panel, made up of
consumers, providers, and employer representatives. Finally, the new
program would be gradually phased in, closely monitored, and thoroughly
evaluated over time.
In announcing the hearing, Chairman Bunning stated: ``During the
last three years, we have learned a great deal about the barriers that
prevent beneficiaries with disabilities from attempting return to work.
The `Ticket to Work and Self-Sufficiency Act of 1998,' includes many
provisions that help remove those barriers. I look forward to hearing
the views of our witnesses to ensure that we are taking the best
possible legislative action to provide real opportunities to persons
with severe disabilities.''
FOCUS OF THE HEARING:
The Subcommittee will receive the views of SSA, individuals with
disabilities, and providers on the ``Ticket to Work and Self-
Sufficiency Act of 1998.''
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Any person or organization wishing to submit a written statement
for the printed record of the hearing should submit at least six (6)
single-space legal-size copies of their statement, along with an IBM
compatible 3.5-inch diskette in ASCII DOS Text or WordPerfect 5.1
format only, with their name, address, and hearing date noted on a
label, by the close of business, Tuesday, March 31, 1998, to A.L.
Singleton, Chief of Staff, Committee on Ways and Means, U.S. House of
Representatives, 1102 Longworth House Office Building, Washington, D.C.
20515. If those filing written statements wish to have their statements
distributed to the press and interested public at the hearing, they may
deliver 200 additional copies for this purpose to the Subcommittee on
Social Security office, room B-316 Rayburn House Office Building, at
least one hour before the hearing begins.
FORMATTING REQUIREMENTS:
Each statement presented for printing to the Committee by a
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but will be maintained in the Committee files for review and use by the
Committee.
1. All statements and any accompanying exhibits for printing must
be typed in single space on legal-size paper and may not exceed a total
of 10 pages including attachments. At the same time written statements
are submitted to the Committee, witnesses are now requested to submit
their statements on an IBM compatible 3.5-inch diskette in ASCII DOS
Text or WordPerfect 5.1 format. 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
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3. A witness appearing at a public hearing, or submitting a
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clients, persons, or organizations on whose behalf the witness appears.
4. A supplemental sheet must accompany each statement listing the
name, full address, a telephone number where the witness or the
designated representative may be reached and a topical outline or
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supplemental sheet will not be included in the printed record.
The above restrictions and limitations apply only to material being
submitted for printing. Statements and exhibits or supplementary
material submitted solely for distribution to the Members, the press
and the public during the course of a public hearing may be submitted
in other forms.
Note: All Committee advisories and news releases are available on
the World Wide Web at `HTTP://WWW.HOUSE.GOV/WAYS__MEANS/'.
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
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noted above.
Chairman Bunning [presiding]. The Subcommittee will come to
order.
We welcome all our witnesses and our guests who have joined
us today.
We are here to discuss the Ticket to Work and Self-
Sufficiency Act of 1998, introduced on behalf of myself and
Mrs. Kennelly, bipartisan legislation that will assist
individuals who receive Social Security and Supplemental Social
Security Disability benefits.
Due to advances in medicine and technology and the field of
rehabilitation, there are people who, despite serious
disabilities, want to work and could work if they were provided
the right kind of rehabilitation and support services. This
legislation will help provide those supports and open the door
to those wanting to pursue employment.
In our Subcommittee hearings over the last 3 years, we have
heard from individuals with disabilities, their advocates, and
various providers of services. We learned a great deal about
barriers that prevent beneficiaries with disabilities from
attempting to work. Mrs. Kennelly and I have worked on a
bipartisan basis to produce a bill that will help tear down
those barriers. Let me emphasize the key elements of this
legislation.
The bill puts the beneficiary first. Beneficiaries can
choose the providers they want and the services they want to
assist them to enter the work force. Medicare will be extended
2 additional years. The bill creates a tax credit equal to 50
percent of up to $10,000 in impairment-related work expenses to
workers with disabilities.
To help beneficiaries more easily transition from benefits
to wages, our bill includes a requirement that SSA test a
gradual offset of SSDI cash benefits by withholding $1 for
every $2 in earnings over a certain level.
And finally, our bill enables as many providers of services
as possible to participate through a payment system that
rewards results.
My goal in crafting this legislation was to provide
individuals with disabilities the opportunity to obtain the
tools and services they need to return to self-sufficient
lives.
I look forward to hearing the feedback of our witnesses
today, so that we may move forward with the best legislation
possible.
In the interest of time, it is our practice to dispense
with opening statements except from the Ranking Democrat
Member. All Members are welcome to submit statements for the
record.
I yield to Congresswoman Kennelly for any statement she
wishes to make.
Mrs. Kennelly. Thank you, Chairman Bunning.
I am very pleased to be holding this hearing today on
helping disabled Social Security beneficiaries return to work.
Chairman Bunning and I have worked on a bipartisan approach to
this problem, and we are anxious to have additional input from
both people with disabilities and providers of vocational
rehabilitation services.
The bill we have introduced offers three important bridges
to employment. First, it gives beneficiaries a greater choice
of vocational rehabilitation. Second, it offers more security
in health care by extending Medicare coverage for an additional
2 years. Third, it makes work pay by instituting a credit of 50
percent of work expenses related to a person's disability--up
to $10,000 in expenses.
Finally, and equally important, it directs the Commissioner
of Social Security to study a program under which Social
Security disability benefits would be reduced gradually, as an
individual's earnings increase. This would help to soften the
loss of the disability benefits and further encourage
individuals with disabilities to return to work.
I appreciate the expression of support we have already
received from a wide variety of groups representing people with
disabilities and providers of service. I look forward to
working with them and with Chairman Bunning and the
administration to pass this legislation.
I want particularly to welcome today Quincy Abbot, who is
from my home district, and I'm delighted that he could be here.
Thank you, Mr. Chairman.
Chairman Bunning. Thank you, Ms. Kennelly.
First, we will hear from our colleague from the Ways and
Means Committee, Congressman Jim Ramstad of Minnesota. Jim,
would you like to begin?
STATEMENT OF HON. JIM RAMSTAD, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF MINNESOTA
Mr. Ramstad. Thank you, Mr. Chairman, Ranking Member
Kennelly, Members of the Subcommittee. I really do appreciate
the opportunity to be here today before the Subcommittee to
discuss the critical need to eliminate obstacles that prevent
people with disabilities from working.
I've been working to knock down the barriers for people
with disabilities who want to work since I was first elected to
the Minnesota Senate in 1980. When I came to Congress in 1991,
I was surprised to find that, among all the caucuses and task
forces in Congress, there was no group specifically focused on
issues affecting people with disabilities. At that time, I
started the Republican Task Force on Disabilities, and
appreciate the help of the Chairman and other Members in
focusing on these issues even back then.
Because of my commitment, Mr. Chairman, to helping people
with disabilities return to work, I introduced legislation back
in 1993, not too dissimilar from this legislation, to remove
some of the barriers. And like you, I've heard countless
stories of frustrated people with disabilities who desperately
want to work to better themselves and their families and to
contribute to society. Unfortunately, as you know, they're
literally prohibited from doing so because of the confusing
Federal programs and rules that make working all too difficult
or expensive.
This legislation, thanks to you working in a bipartisan,
pragmatic, thoughtful way, begins the process to finally let
Americans with disabilities live up to their full potential.
Preventing people from working, Mr. Chairman, runs counter to
the American spirit, a spirit that thrives on individual
achievements and the larger contributions to society that
result. Creating work incentives for people with disabilities
is not just humane public policy; it's sound fiscal policy.
Removing the barriers to discourage people with disabilities
from working will mean they can earn a regular paycheck, pay
taxes, and move off public assistance. Eliminating the current
barriers to work that so many people face is both the right
thing to do and the cost effective thing to do.
I have a very dear friend, Tom Haben, who happens to be a
person with quadriplegia. Tom worked in my Minnesota office
when I was first elected, but it became counterproductive. He
had the risk of losing benefits, and quite frankly, couldn't
have a high enough salary to justify working. Such a
disincentive to work is wrong, and I appreciate your efforts
here at correcting that situation, so that the many Tom Habens
out there are able to work and be productive, as they want to
be. So that they can enjoy the dignity of independent living
and be like the rest of us who happen to be able bodied.
I realize, Mr. Chairman, that some of the elements of
comprehensive reform that I and many members of my own Advisory
Committee on Disabilities back in Minnesota would like to see
enacted are not part of the current legislation, but I am
committed to working with you to pass this bill and future
related legislation to achieve our goals. I realize that we
have to do it in an incremental way, and I applaud your efforts
at so doing.
So let me just say, in concluding, Chairman Bunning and
Mrs. Kennelly and Members of the Subcommittee, thanks again for
your leadership on these critical issues. I also want to thank
your Subcommittee staff for their excellent work on this
important foundational legislation.
I look forward to continuing to work with you on our shared
goal of helping people with disabilities return to work, a
very, very important goal. Again, I applaud your efforts and
thank you for your leadership. Thank you, Mr. Chairman.
[The prepared statement follows:]
Statement of Hon. Jim Ramstad, a Representative in Congress from the
State of Minnesota
Mr. Chairman, Mrs. Kennelly, I very much appreciate the
opportunity to be here today before the Subcommittee to discuss
the critical need to eliminate obstacles that prevent people
with disabilities from working.
I have been working to knock down the barriers for people
with disabilities who want to work since I was first elected.
In fact, when I came to Congress in 1991, I was surprised
to find that among all the caucuses and task forces on the
Hill, there was no group specifically focused on issues
affecting people with disabilities. That's why I started the
Republican Task Force on Disabilities.
And because of my commitment to helping people with
disabilities return to work, I introduced legislation in 1993
to remove some of the barriers.
I have heard countless stories of frustrated individuals
who desperately want to work and contribute to society.
Unfortunately, they are literally prohibited from doing so
because confusing federal programs and rules make working too
difficult or expensive. This legislation begins the process to
finally allow Americans with disabilities to live up to their
full potential.
Preventing people from working runs counter to the American
spirit, a spirit that thrives on individual achievements and
the larger contributions to society that result.
Creating work incentives for people with disabilities is
not just humane public policy, it is sound fiscal policy.
Removing the barriers that discourage people with disabilities
from working will mean they can earn a regular paycheck, pay
taxes and move off public assistance.
Eliminating the current barriers to work that so many
individuals face is both the right thing to do and the smart
thing to do.
I realize that some of the elements of comprehensive reform
that I, and many members of my own Advisory Committee on
Disabilities in Minnesota, would like to see enacted are not
part of this legislation right now, but I am committed to
working with you to pass this bill, and future related
legislation, to achieve our goals.
Chairman Bunning and Mrs. Kennelly, thanks again for your
leadership on these critical issues. I would also like to thank
your subcommittee staff for their excellent work on this
important foundational legislation. I look forward to
continuing to work with you on our shared goal of helping
people with disabilities return to work.
Chairman Bunning. Thank you, Jim, and we appreciate your
testimony and look forward to you working with us next week
when we bring it to the Committee. Thank you.
Mr. Ramstad. Thank you.
Chairman Bunning. Testifying on our first panel today is
Dr. Susan Daniels, Associate Commissioner of Disability. Dr.
Daniels, you can start any time you choose.
STATEMENT OF SUSAN M. DANIELS, PH.D., ASSOCIATE COMMISSIONER
FOR DISABILITY, SOCIAL SECURITY ADMINISTRATION
Ms. Daniels. Thank you, Mr. Chairman. Good afternoon,
Chairman, Members of the Subcommittee. Thank you for inviting
me here today to discuss the initiatives to ensure that SSA
beneficiaries with disabilities who want to work have an
opportunity to work.
As Administrator of the largest disability program in the
world and as a member of one of our Nation's largest
minorities, Americans with disabilities, I'm excited about the
initiatives that will increase work force participation of
individuals with disabilities. I would like to summarize my
remarks and request that my full statement be submitted for the
record.
Chairman Bunning. Without objection.
Ms. Daniels. I join Commissioner Apfel in applauding the
spirit and intent of the proposed legislation, specifically,
the SSA-related provisions. We believe that the ticket approach
included in your proposal and in our proposal will allow many
more beneficiaries to enter the work force. The ticket is a
public/private partnership to give people receiving disability
benefits what they want and what they need: Control and
flexibility to secure services tailored for their individual
requirements from their choice of providers.
The provisions mandating that SSA develop a demonstration
project to assess the effectiveness of reducing an individual
disability benefit according to an amount of earnings are
challenging and may be cause for concern. Our concerns are
three: First, the cost constraints of conducting such a
demonstration; second, testing features, especially induced
demand, will be difficult; and third, ensuring fairness for
current and future beneficiaries is of primary importance. We
prefer the greatest possible flexibility.
Our goal, like yours, is to provide customer choice, pay
for outcomes and results, rather than services, and encourage
innovation.
Choice--Social Security beneficiaries desire and need
choice and flexibility in pursuing services that will help them
become gainfully employed.
Paying for results--beneficiaries and providers alike
should focus on the goal of stable, long-term employment. Our
goal is to frugally use public funds by rewarding success.
Innovation--the ticket will encourage innovations in the
private and public sectors by creating opportunities for State
agencies, providers, employers, and beneficiaries to work
together.
Based on our experiences and extensive collaboration with
professional groups, advocates, and our customers, we have
learned that many individuals with disabilities want to work
and will work if they have access to the services they need. We
have been working closely with you to refine the return-to-work
proposals to ensure that they meet the needs of beneficiaries,
the provider community, and the American taxpayer.
Through our own current initiatives, we have, and will
continue to gain, valuable experience that will ensure the
success of this legislation. We are encouraged by results we
have seen.
First, it is clear that there are many results-oriented
providers in the private sector who want to help. Over the last
year, we have received 500 proposals in response to a
solicitation and currently we have over 270 providers under
contract. We have several providers with national areas of
scope and contracts specifically in 41 States. We soon hope to
have providers in every State. Many providers in our current
reimbursement program have told us that they are eager to
participate in a ticket-type program.
Second, SSA's experience with the RSVP Project will help us
better understand the concept of using a program manager, as in
your legislation, to oversee service provision. Project RSVP is
a project that uses private contractors to ensure that return-
to-work services are more readily available to SSA-referred
individuals and improves the administration and cost
effectiveness of our program.
Third, we have been working to find new and innovative ways
to bring more information about the work incentives to our
beneficiaries. I'd like to mention four specific methods for
delivering this information.
First, we have a Web site now within the Social Security
Web site with information about our work incentives.
Second, we have developed new training and information
packets that are user friendly and are issued in a variety of
formats.
Third, as part of our research agenda, we have been working
with Virginia Commonwealth University to develop and test a
decision-support software package called WorkWORLD for use in
assisting customers and service providers in determining the
effects of work on benefits. This will allow our beneficiaries
to be making more informed choices and they will be able to see
the advantages of working.
And, we have created a kit called ``Graduating to
Independence,'' aimed specifically at young people in
transition to work. The kit contains a videotape and computer
software that gives the facts about work incentives and
introduces young people to adults with disabilities who are
working.
As a final point, Mr. Chairman, using our current SSI
demonstration authority, we plan to solicit well-researched and
comprehensive projects that will strengthen and facilitate
coordinated service delivery at the State level, including
benefits and health care. As you know, our demonstration
authority under the Social Security Disability Insurance
Program expired in 1996. We want to thank you and all of the
Committee for your support in extending that authority, and we
eagerly await action in the Senate.
Mr. Chairman, I want to thank you and Representative
Kennelly again for your efforts to assist people with
disabilities who would otherwise remain on the rolls to return
to work. We stand ready, willing, and able, when you enact this
legislation, to implement it. I would be delighted to take any
questions.
[The prepared statement follows:]
Statement of Susan M. Daniels, Ph.D., Associate Commissioner for
Disability, Social Security Administration
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me here today to discuss initiatives
to assure that the Social Security Administration's (SSA)
beneficiaries with disabilities who want to participate in the
workforce have the opportunity to do so. As administrator of
the largest disability program in the world, and as a member of
one of the country's largest minorities, Americans with
disabilities, this month, I have witnessed initiatives that I
believe will be invaluable in increasing workforce
participation for individuals with disabilities.
Four days ago, the President signed his executive order,
Increasing Employment of Adults with Disabilities, which is the
largest national effort to date to increase the employment of
adults with disabilities to a rate that is as close as possible
to the employment rate of the general adult population and to
support the goals of the Americans with Disabilities Act of
1990. And just two days before that, you, Mr. Chairman and you,
Representative Kennelly, introduced legislation which furthers
this effort. Thanks to the President's leadership, and your
efforts, we hope we can make real progress in this area, so
that those individuals with disabilities who want to work can
do so.
When the President first offered a proposal for a ``Ticket
to Independence'' last year, and when I accompanied then-Acting
Commissioner Callahan as he testified before this subcommittee
in July, we recognized that there were a number of issues that
needed to be addressed. Today, I join Commissioner Apfel on
behalf of our beneficiaries with disabilities to applaud the
spirit and intent of the Social Security Administration (SSA)-
related portions of your proposed legislation.
No one solution will be all things to all people, but the
time has come, and the Agency is prepared, to work toward
making the concepts of economic independence a reality. Today,
I would like to reinforce the principles behind the SSA
``Ticket'' proposal, which are similar to the provisions for
improved access to VR services in the Bunning-Kennelly bill,
and to give you some information about other initiatives we are
involved in to help our beneficiaries return to work. Of
course, as a representative of SSA, I cannot speak to the
bill's Medicare or tax provisions which are beyond SSA's
purview.
We believe that the ``Ticket'' approaches included in our
proposal and your bill, will result in many more opportunities
for our beneficiaries to receive the services they need in
order to work. The ``Ticket'' is a public-private partnership
to give people receiving disability payments what they want and
need--the control and flexibility to secure services tailored
to their individual requirements from their choice of
providers. The ``Ticket'' maintains fiscal discipline, since
providers would be paid only for results.
The President's proposal for a ``Ticket to Independence,''
which is similar to your bill, Mr. Chairman, is based on the
following sound fundamental principles:
Customer Choice: SSA's beneficiaries desire and need
maximum flexibility and choice in pursuing services which will
help them to become gainfully employed. Beneficiaries with
disabilities must be able to choose a participating public or
private employment or rehabilitation provider to access the
services that they need to participate in the workforce.
Paying for Outcomes: Beneficiaries and providers alike
should focus on the goal of stable employment. A focus on
outcomes and milestones is best achieved by linking it to
financial rewards. Our goal is to reward success and frugally
use public funds in an accountable and targeted way.
Encouraging Innovation: We hope the competition in the
proposed legislation would encourage innovations in the private
and public sectors by creating opportunities for State
agencies, local non-profit and for-profit providers, employers,
and beneficiaries.
The Administration-proposed ``Ticket,'' like the Bunning-
Kennelly bill, is based on a structure of bringing new service
providers into this process. Both are based on developing new
and innovative ways to return beneficiaries with disabilities
to the workforce based on actual outcomes, working with service
providers outside of the public program, and providing a good
infrastructure of information and support services. Many of
these concepts are currently underway at SSA, and I would like
to take this opportunity to discuss some of our initiatives.
First, however, there is one activity contained in your
proposal that is a cause for concern. That is the provision
that mandates SSA develop a demonstration project to assess the
effectiveness of reducing a disabled individual's benefit
amount on account of earnings. Planning this type of
demonstration project presents certain challenges: meeting cost
constraints; designing a demonstration project that would truly
test the features, especially the potential for induced demand;
and ensuring the fairness of the demonstration for current and
future beneficiaries. Rather than this mandate, we would prefer
the flexibility to examine the relevant issues and design any
demonstrations through a general demonstration authority.
Where We Are Today
As you are well aware, a very limited number of our
approximately 8 million Social Security and Supplemental
Security Income (SSI) disability recipients leave the
disability rolls each year because of successful
rehabilitation. In fiscal year (FY) 1997, SSA paid State VR
agencies about $89 million for their services provided to
approximately 8,300 beneficiaries with disabilities who worked
at least 9 months at the substantial gainful activity level.
Based on our experience and extensive collaboration with
professional groups and advocates, we have learned that many
more individuals with disabilities want to work and will do so
if they have access to the rehabilitation services they need to
reenter the workforce. We recognize the myriad of complex and
sensitive issues that must be addressed to achieve the goal of
removing barriers for our beneficiaries with disabilities to be
successfully rehabilitated and participate in the workforce.
With this is mind, we have made tremendous progress on a
number of other initiatives in the return-to-work arena which I
would now like to share with you.
Alternate Provider
It is clear that there are many providers in the private
sector who are willing to help. In March 1994, the SSA amended
the VR regulations to provide more opportunities for people
with disabilities to receive employment and rehabilitation
services they need to return to work or enter the workforce for
the first time. These regulatory changes allowed SSA to refer
Social Security Disability Insurance (SSDI) beneficiaries and
SSI recipients who are blind or disabled to VR service
providers in the public or private sectors. The option of
serving the beneficiary continues to be offered first to the
states; however, if SSA does not receive notification that the
state has accepted a beneficiary for services by the end of the
4th month after the month of referral, we may arrange for an
alternate provider to serve that individual. (Of course, this
process will change when the ``Ticket'' legislation is passed.)
During 1996, SSA mailed a presolicitation notice to more
than 500 potential providers who had previously contacted us
regarding participation in our program. Later in that year, we
released a Request for Proposal (RFP) describing the
requirements for the VR program and requested interested VR
service providers to apply. As part of their proposals,
potential alternate participants were required to specify the
type of impairment(s) and geographic area(s) they can serve.
We received 500 proposals in response to the solicitation,
and currently have over 270 providers under contract. We have
contracts with providers in 41 states and, although we
currently do not have contracts with providers in every state,
we do have several providers with national service areas. This
is an indication that there are providers who are ready to work
with our beneficiaries with disabilities and with SSA.
It is important to note that this is not a competitive
procurement with limits on the number of contracts awarded. SSA
intends to expand the pool of providers who can serve our
beneficiaries with disabilities, and, in fact, we expect to
release another RFP later this spring to solicit more
providers. We are very encouraged by the number of contracted
providers who have already expressed interest in participating
in SSA's VR program. The current list of qualified providers
are serving a number of the approximately 86,000 available
beneficiaries.
Project RSVP
Our experience with Project RSVP (Referral System for
Vocational Rehabilitation Providers) will help us better
understand the concept of using a program manager to oversee
service providers. The objective of Project RSVP is to assure
that return to work services are more readily available to SSA-
referred individuals while improving the administration and
cost-effectiveness of the program. RSVP is a 3-year
demonstration project to test the advantages and the cost
effectiveness of contracting out certain administrative
functions under SSA's VR referral and reimbursement programs.
On September 27, 1997 a contract was competitively awarded to
Birch & Davis Associates, Inc. of Maryland. Birch & Davis has
begun marketing efforts to alert potential VR providers about
the project. In addition, a toll-free number to respond to
questions as well as the contractor's bulletin board to refer
individuals to Alternate Providers have become operational.
Delivery of Work Incentive Information
As a part of our research agenda, we are working with the
Virginia Commonwealth University to develop and test a decision
support software package called WorkWorld for use in assisting
consumers and service providers in determining the effects of
work on their entitlement to SSA benefits as well as other
federal/state benefits, such as food stamps. This will allow
our beneficiaries to make more informed choices regarding
employment opportunities.
We have created an attractive education kit called,
``Graduating to Independence'' (GTI), that is aimed
specifically at youth in transition from education to
employment and their families. It was designed for use by
educators or professional organizations to instruct young
beneficiaries and their families about SSA's work incentives.
This multimedia kit contains a videotape and several computer
disks, in addition to written materials, that combine facts
with motivational examples. We have been very aggressive in
distributing the GTI kits, sending them to school districts
across the country, and handing them out at national
conferences.
Additionally, we publish a number of other training and
public information materials on work incentives. These
materials are provided in multiple formats and have been
designed with significant consumer input to be user-friendly.
And, we have developed an Internet website within the
Social Security website which contains information about work
incentive provisions, access to our publications, and
information on our rehabilitation and employment programs.
Through all of these initiatives, we have and will continue
to gain valuable insight and experience that we will use to
ensure the success of this proposed legislation. We are
encouraged by the results. We have learned that many highly
skilled, outcome-focused agencies and professionals are eager
to assist our diverse population to return to work. And, we
have learned that individualized planning and support is
essential to successful work re-entry.
Demonstration Authority
I would be remiss if I did not remind you that the
demonstration authority of section 505(a) of P.L. 96-265
expired June 9, 1996. I do thank those on this Committee for
their support for an extension passed by the House and we
eagerly await Senate action. In order to initiate any new
projects under the SSDI program for promoting return-to-work,
we seek the permanent demonstration authority as is available
in the title XVI program so that we can test new approaches to
accomplish our goals in this area. With this renewed authority,
SSA can develop a comprehensive strategy that integrates
earlier intervention, and identification and provides necessary
assistance in removing barriers to work for applicants and
beneficiaries.
Using our SSI demonstration authority, under Section 1110,
SSA plans to solicit projects which will determine the degree
of interaction of State and Federal systems and benefits, and
look for ways to overcome barriers to employment. We will
initiate powerful, well researched, and comprehensive
demonstration projects which are designed to: strengthen and
facilitate the coordination and delivery of services and
benefits at the State or local level; increase income through
earnings; and be cost-neutral. To this end, at each site, the
State will implement a team-based, comprehensive package that
coordinates vocational planning and support, employer and
employee coaching, financial planning, risk management, job
search, job placement and ongoing job support, transportation,
training, and other necessary supports.
Just as these programs have already provided important
information, we would continue to pursue other projects that
bring us closer to our goal of supporting the active
participation of our beneficiaries with disabilities in the
workforce.
Conclusion
Mr. Chairman, I want to assure you that the Social Security
Administration stands ready, willing, and able to work with
lawmakers on both sides of the aisle to enact fiscally
responsible legislation to help thousands of Americans with
disabilities, who with appropriate services and support, can be
successful in obtaining work. We want to thank you and
Representative Kennelly for your efforts to assist persons with
disabilities, who would otherwise remain dependent upon the
disability rolls, to participate in the workforce. I want to
thank you for your time and would be happy to answer any
questions.
Chairman Bunning. Thank you, Doctor.
Let me start off by, while I recognize that our Medicare
and tax provisions are, as you pointed out, beyond SSA's
purview, in SSA's deliberation regarding the ticket to
independence, didn't SSA discuss extending providing health
care benefits for individuals who leave the rolls to return to
work?
Ms. Daniels. As we began to discuss within SSA the likely
policies that support return to work, we certainly did hear
from our customers that health care was an important provision.
We also heard from our customers that they don't understand the
current provisions that allow them to continue to receive
Medicare premium-free for 3 years after they return to work and
to buy in indefinitely in the future if they pay a premium. So
we did take heed that the health care connection was an
important one for our beneficiaries.
Chairman Bunning. In almost every hearing that we've had
over the last 3 years, from the community providers and those
that are disabled and want to return, that was the number one
issue with almost all of them.
One of our witnesses today, Tony Young, who is testifying
on behalf of the Consortium for Citizens with Disabilities, is
suggesting that we include a provision to allow individuals to
buy into Medicare, as you suggested, once their income reaches
$15,000 for a premium of 10 percent of income. What is SSA's
view on such a proposal?
Ms. Daniels. Well, I can tell you that today the current
law allows a beneficiary to buy in at a premium that's
considered the fair actuarial value. It's a little over $300 a
month. We have not analyzed this particular provision because
it's not really within our purview, but we are very supportive
of our current provisions.
Chairman Bunning. OK. My last question: Has SSA or the
Health Care Financing Administration researched this issue or
discussed such an approach? How would such a provision be
administered and by whom?
Ms. Daniels. I'm afraid I would have to submit an answer to
that question for the record. We have not discussed
implementation.
[The following was subsequently received:]
Because it is not within the purview of the Social Security
Administration, SSA has not developed an analysis of Mr.
Young's proposal that would allow:
individuals earning income less than $15,000 to
receive Medicare premium-free, and
individuals earning $15,000 or more to buy-in to
Medicare at 10 percent of earned income above $15,000 capped at
the full Part A Medicare premium amount.
This question should be directed to the Health Care
Financing Administration.
Chairman Bunning. OK, I have some other questions that I
will submit to you in writing, and I would appreciate you
responding in writing.
Ms. Daniels. I'd be delighted.
[The following was subsequently received:]
Questions and Subsequent Answers from Ms. Daniels
1. In your testimony, you mention that in 1997, SSA paid
State VR agencies about $89 million for services provided to
approximately 8,300 beneficiaries. How many of these were SSDI
beneficiaries, how many were SSI beneficiaries, and how many
were concurrent beneficiaries?
Out of the 8,337 vocational rehabilitation claims, 2,688
were SSDI beneficiaries, 2,914 were SSI beneficiaries, and
2,735 were concurrent beneficiaries.
2. One of our witnesses suggests that Work Incentive
Specialists be supported by customized software. You mention
that you have worked with Virginia Commonwealth University to
develop and test a decision support package called
``WorkWORLD.'' Do you plan to make this software available to
your employees or to consumers directly? How do you see this
working?
Virginia Commonwealth University (VCU) has begun
development of WorkWORLD as decision support software for use
with beneficiaries. The new decision support software will be
in two iterations:
Basic WorkWORLD-Personal (Basic WW-P), will permit
users to determine the effect of work and earnings on benefits
authorized under the Social Security Act (i.e., SSI, SSDI,
Medicaid, and Medicare).
Advanced WorkWORLD-Personal (WW-P) will contain
all of the features of Basic WW-P. In addition, it will show
the effect of work and earnings on food stamps, Section 8
Housing, Temporary Aid to Needy Families, and other State
programs.
We will test both versions of the software in various
demonstration settings.
We expect Basic WW-P to be useful for our field offices and
for others who counsel beneficiaries about working and work
incentives. Whether work incentive specialists are SSA
employees, rehabilitation counselors, teachers or others, we
will make both the Basic and Advanced WW-P software available
to them so beneficiaries may be as informed as possible. We
believe beneficiaries will also be able to use WW-P themselves.
Our goal is to have Basic and Advanced WW-P available to
users, including beneficiaries, as a disk and/or as an
interactive Internet tool. Our current work with VCU is
intended to make the software very easy to use. The beneficiary
will be asked to answer some simple questions, such as the
types of benefits he or she is receiving, the number of people
in the family, etc. WW-P will then calculate net income from
all sources at varying levels of earnings and display it
graphically as well as in text and tables.
3. Mr. Young also suggests a provision which protects
individuals from unwarranted CDRs. Under current law, payments
to a beneficiary are protected against termination or
suspension if the individual is participating in a program of
vocational rehabilitation approved by the Commissioner. Why
perform CDRs on beneficiaries who are currently receiving
Vocational Rehabilitation services?
As you noted, the current law provides that an SSI or SSDI
beneficiary may continue receiving cash benefits after a
determination of medical improvement if he/she is actively
participating in an approved State or alternate vocational
rehabilitation program. This ``301'' provision applies if
completion or continuation of the program is likely to enable
the person to work permanently. Our current process for
determining when and how CDRs should be performed is well known
to you, and we would not envision the ``Ticket'' environment to
significantly change that process.
We recently provided technical assistance to your staff
about concerns raised by some on the need for performing CDRs
for people who might be receiving return-to-work services under
a future ``Ticket'' system. We discussed options that would
encourage beneficiaries to take advantage of such services
without fear that a CDR would be performed as a result of their
actions. We have always envisioned that selection for issuance
of a ticket would take into consideration the likelihood of
early medical recovery, i.e., beneficiaries in the category
would only receive a ticket upon continuation after an initial
CDR. Where scheduled CDRs occur during a course of return-to-
work services, we believe your bill contains language which
would extend the current ``301'' provisions to a ``Ticket''
environment. Other options to explore might be the potential
deferral of CDR diaries for those in active ``Ticket'' status.
Chairman Bunning. Barbara.
Mrs. Kennelly. Thank you, Mr. Chairman.
Doctor, many smaller providers argue that they need
milestone payments; that is, payments made before the
individual's benefits cease in order to help finance the early
costs of rehabilitation. The bill authorizes SSA to develop
such payments. Have you taken a position on that?
Ms. Daniels. As you know, our proposal did not include
milestone payments. However, we believe it is possible to
structure a milestone that is based on results. Mrs. Kennelly,
we had proposed to pay the provider when the individual no
longer received cash benefits, but we do think it is possible
to structure a milestone payment, for instance, when a person
starts a job or under some other scenario.
I think it's also important to recognize that any
additional milestones based on services will require SSA to
monitor and account for those services and ensure that they
are, in fact, provided. We thought focusing on outcomes is a
better option because it keeps everybody focused on what it is
we're there to do--not the services, but actually get jobs.
Mrs. Kennelly. Thank you. Doctor, nearly every witness
today, when you read the testimony, both the consumers and the
providers, have suggested more involvement by outside experts
in the return-to-work program. Now we also include that in our
bill. We call it an advisory panel to assist the Commissioner.
How do you feel about that?
Ms. Daniels. I think we're very excited to work with
providers and customers. I am not a lawyer, but I think there
might be some technical problems with how people are appointed,
but the Office of Government Ethics can advise you on that
issue. We are eager to work with providers and customers in a
collaborative way.
Mrs. Kennelly. One last question, Doctor, and maybe it's
not fair because you haven't heard the testimony, but a Mr.
Burns, who is testifying later, cites rehabilitation services
data which says that 210,000 people entered employment as a
result of public rehabilitation in 1995, and then you go on to
say, your testimony says, ``The State vocational rehabilitation
agencies were paid for only 4,800 cases, SSI and SSDI benefits
in 9 months of trial work that you had. Can you tell me why
these numbers are so different, or is that unfair right now?
Ms. Daniels. I'm not going to be able to verify the numbers
that Mr. Burns has, but let me tell you that really it's likely
that Mr. Burns is using a term ``employment'' that's different
from what's defined in the Social Security legislation as
employment. When we reimburse a State vocational rehabilitation
agency, we reimburse them according to our current statute. The
statute permits payment only when the individual has worked at
substantial gainful activity for 9 months. That's our
definition of successful work, and that's when we pay for
rehabilitation services.
The Rehabilitation Act of 1973, as amended, has a variety
of other types of employment that are also considered
legitimate closures--part-time employment, sheltered
employment, home-based employment, homemaker employment--that
do not meet our definition. So, basically, he's counting apples
and we're counting oranges. There's some overlap between those
two sets of figures, but the definition under the
Rehabilitation Act is broader because the act serves a broader
social service.
Mrs. Kennelly. Thank you, Doctor. Thank you for your
testimony.
Ms. Daniels. You're welcome.
Chairman Bunning. Mr. Johnson.
Mr. Johnson. Thank you, Mr. Chairman.
Thank you for being with us, Dr. Daniels.
What do you see as the greatest strengths and challenges to
your alternate participant program and how many individuals are
actually receiving services from a provider at this time?
Ms. Daniels. I think the greatest strength of the alternate
participant program is to teach us an early lesson--that there
are many results-oriented providers in the community that want
to work with our beneficiaries. Nearly 500 came forward when we
made the solicitation, and we have finished awarding contracts
to over 270 of those providers. So I think it was a great
lesson to learn that there are so many people interested in
working with our beneficiaries.
The program is very new. We are still signing up new
providers. It's taken us awhile to implement this provision,
the alternate providers, mainly because we used a method of
contracting that threw us some curve balls that we didn't quite
plan on. But we have gotten over those, and we are signing them
up at a faster clip now than we were a few months ago. So it's
too early to tell what the results will be, but considering
their eagerness and their interest, I think it's going to be
very, very good.
Now how many people have actually gone through the program
and finished? We have just started, and an individual must work
9 months before the provider can submit a claim to us. So we're
not far enough down this road to tell you how many people are
going to be working. When we receive claims from the providers,
we'll begin to know how many people have actually ended up in
employment. But no money will be spent from the coffers until
that outcome is achieved.
Mr. Johnson. How long have they been on a work program?
Ms. Daniels. We've been signing--Mr. Johnson?
Mr. Johnson. To date?
Ms. Daniels. We have signed up 270 providers.
Mr. Johnson. Yes, but you said none of them have been 9
months yet; is that true?
Ms. Daniels. None of them have been in 9 months, no.
Mr. Johnson. OK, and the process, as you indicated, was
complicated and cumbersome. We also heard the electronic
beneficiary and identification process wasn't working real
well. Do you want to comment on that?
Ms. Daniels. Well----
Mr. Johnson. And can we improve it?
Ms. Daniels. It certainly was a brandnew process to put up
a bulletin board of such scope. We have a contract manager
similar to that in Mr. Bunning's and Mrs. Kennelly's proposed
legislation. They call it a program manager. We now have that
program manager under contract. They have just taken over the
bulletin board, and we feel that they will be able to manage
this growing bulletin board very effectively. They have the
skills and the background to do it.
Mr. Johnson. Thank you, ma'am.
Ms. Daniels. You're welcome, Mr. Johnson.
Mr. Johnson. Thank you, Mr. Chairman.
Chairman Bunning. The gentleman from Missouri.
Mr. Hulshof. Thank you, Mr. Chairman.
Dr. Daniels, thanks for being here. I'm happy to report
that I'm cosponsoring this legislation, and I'm optimistic that
we can pass this bill in the House, but I'm also of the opinion
that it's going to take a great deal of effort to ensure that
this legislation is addressed in the Senate. Will the
administration support this legislation and help us with our
colleagues in the other body?
Ms. Daniels. Yesterday afternoon, I had a conversation with
Commissioner Apfel, and he puts return to work as one of his
highest priorities. I certainly can't tell you what he's going
to do tomorrow. I don't want to predict another human being's
behavior, but I'll tell you that he has expressed over and over
to me, and to the people who are in this audience that I know,
his commitment to return disability beneficiaries to work. I
think he's good for his commitments.
Mr. Hulshof. Let me ask about some of the concerns you've
suggested. A couple of our witnesses, if I read their testimony
correctly, suggest that the work incentives specialists who
specialize in assisting individuals to understand work
incentives--there's suggestion that these should not be SSA
employees and should instead be private individuals. I'd like
to hear your comment or reaction.
Ms. Daniels. Well, it is true, and I want to be honest with
you, that the work incentives are extraordinarily complicated,
but there are many individuals in SSA and many individuals in
the community--and I know a lot of them--who understand the
work incentives very well. So I think that I could envision
three scenarios. I can envision work incentive specialists
being SSA employees. I can envision them being community
support people under contract, and I can envision a
combination.
I think the most important thing here is having people who
know the work incentives inside and out, and who really care
about administering and getting this information across. I
don't think they come in only one size.
Mr. Hulshof. One of the other somewhat corresponding
issues--in your statement you raise a concern over the
provision requiring SSA to develop a demonstration project to
assess the effectiveness of reducing a disabled individual's
benefit amount due to earnings. And I recognize that there's a
real challenge there, but I know that you want flexibility to
conduct relevant issues and design demonstrations through
general demonstration authority, and yet haven't you had that
flexibility since 1980?
Ms. Daniels. Well, certainly we have had the flexibility to
design demonstrations off and on. There is an inherent problem
here in creating a demonstration that actually answers the
number one question, which is: What is the induced demand of
such an offset in the DI Program? How many more people would
become eligible for disability insurance? I think everybody
recognizes that it's better to have a ramp-off than a cliff. I
think everybody recognizes that. I think the question that has
always been difficult is: What will it cost? And because we
have to estimate the induced demand, and can't actually
describe it as a result of data, people have a lot of different
opinions about what it will cost.
A demonstration that actually answers how many people would
come on the rolls once you change the provisions is very hard
to run because you have to change the provisions in order to
find that out, and you have to make it so that people would
make wise decisions, based on a fairly stable set of
provisions. Doing that in a demonstration mode is very
challenging.
And I want to tell you that we will work very hard to do
whatever needs to be done, but it is a very challenging
question to answer in a demonstration project.
Mr. Hulshof. Let me ask you, as a final matter--thanks, Mr.
Chairman--that you mentioned demonstration project and
operations called Project RSVP to test the advantages and cost
effectiveness of contracting out certain administrative
functions. What are the specifics of the contract and what's
been your experience so far with this project?
Ms. Daniels. This is a fairly new approach. We're trying
this out. We have a contractor, Birch and Davis in Rockville,
Maryland, who has taken over running the bulletin board that
Mr. Johnson asked about. Birch and Davis has taken over the
recruitment of providers and is trying to increase the provider
pool. Birch and Davis is going to be running a hotline number,
an 800 number, to provide information to providers and
beneficiaries alike, as well as doing some outreach, and
handling and helping us process the claims when they come in.
So they will be a full-service center to help us keep the
machinery of these alternate providers running. From the
legislative language that I've read from Mr. Bunning and Ms.
Kennelly's bill and yours as well, it appears that you envision
such a contractor or contractors being involved. What we're
doing now is testing that idea, seeing how it works, and
working out the bugs.
Mr. Hulshof. Thanks, Dr. Daniels. Thank you, Mr. Chairman.
Chairman Bunning. Thank you for testimony, and we will
submit some written questions for you. We appreciate your being
here. Thank you.
Ms. Daniels. It's a pleasure to be here, Mr. Bunning.
Chairman Bunning. Testifying on the second panel today are
Tony Young, public policy associate, United Cerebral Palsy
Associations, Inc., and cochair, Consortium for Citizens with
Disabilities Task Force on Social Security Subcommittee on Work
Incentives; Earl Keller, Social Security disability
beneficiary, on behalf of the National Alliance for the
Mentally Ill; Quincy Abbot, president, The Arc of the United
States; Susan Webb, executive director, Arizona Bridge to
Independent Living.
Mr. Young, if you would begin, please.
STATEMENT OF TONY YOUNG, PUBLIC POLICY ASSOCIATE, UNITED
CEREBRAL PALSY ASSOCIATIONS, INC.; AND COCHAIR, CONSORTIUM FOR
CITIZENS WITH DISABILITIES TASK FORCE ON SOCIAL SECURITY,
SUBCOMMITTEE ON WORK INCENTIVES
Mr. Young. Thank you, Mr. Chairman. Good afternoon. I am
Tony Young, public policy associate with United Cerebral Palsy,
and a former SSDI beneficiary.
Chairman Bunning. Can you move your mike just a little
closer, please, so we can make sure it gets recorded? That's
it. There, that will really help.
Mr. Young. Maybe if I lean forward some, too. These
wheelchairs are wonderful things, but they're also very bulky.
Today I appear before you representing the Consortium for
Citizens with Disabilities Subcommittee on Work Incentives. CCD
is a coalition of almost 100 national disability organizations
working together to advocate for national public policy that
ensures self-determination, independence, empowerment,
integration, and inclusion of children and adults with
disabilities into all aspects of society.
CCD congratulates Chairman Bunning and Ranking Member
Kennelly, along with their staffs and the full membership of
the Subcommittee on Social Security, for their success in
crafting the Ticket to Work and Self-Sufficiency Act of 1998.
H.R. 3433 implements needed changes in Social Security
Administration disability programs right now, and sets the
stage for important future improvements that will enable SSDI
and SSI beneficiaries to work to the greatest extent of their
abilities.
It is important for SSA disability programs to begin the
process of evolving from their original purpose solely as early
retirement programs for injured workers. They must start moving
toward including a new purpose of supporting individuals with
disabilities in the work force. In this way, they are
transformed from a safety net into a trampoline--not only
catching people with disabilities as they fall out of work, but
also giving them a boost back into work when they are ready.
This benefits individuals by enabling them to remain in the
work force as wage earners. It benefits employers by adding
skilled workers to the labor pool. It benefits employment
service providers by enabling them to serve many more
participants. And it benefits taxpayers by assisting workers
with disabilities to begin or continue to pay taxes.
This bill does not immediately solve all of the barriers to
employment facing individuals on SSDI or SSI. No single piece
of legislation could. It does, however, meet three criteria
that are critically important as we undertake the
transformation of SSA's disability programs.
First, it does no harm. No one receiving SSDI or SSI will
be jeopardized by the passage of this bill.
Second, it moves us forward now. It extends health coverage
under Medicare for an additional 2 years after employment. It
provides a tax credit for the extraordinary expenses of working
with a disability. It establishes a corps of work incentive
specialists. It expands the choice of employment-service
providers to any public or private entity, and it requires an
advisory panel of beneficiaries, service providers, and
employers be created to advise SSA on these initiatives.
Third, it begins the research and development necessary to
achieve the ultimate goal of reshaping SSA's disability
programs. H.R. 3433 authorizes SSA to conduct employment
demonstrations, especially the critically important trial of a
sliding-scale reduction in SSDI benefits.
We acknowledge that this one bill cannot solve all the
barriers to work for SSI and DI beneficiaries. CCD is striving
to form a strategic partnership with the Subcommittee on Social
Security and other relevant House Subcommittees, the Senate
Committee on Finance, and SSA, and other agencies to further
the progress we have made together to transform the disability
programs.
The Congress and the administration have a historic
opportunity to meet the converging needs of SSDI and SSI
beneficiaries, service providers, employers, and taxpayers. The
Nation is watching our progress. CCD is ready to assist you to
achieve this important goal.
Thank you, Mr. Chairman. I'd be happy to answer any
questions you might have.
[The prepared statement follows:]
Statement of Tony Young, Public Policy Associate, United Cerebral Palsy
Associations, Inc.; and Cochair, Consortium for Citizens with
Disabilities Task Force on Social Security, Subcommittee on Work
Incentives
These Signatory Organizations Support This Statement in
Principle:
Based upon a preliminary examination of HR 3433, these
organizations are signatory to this statement. Additional
organizations may choose to sign on prior to the closing of the
record for the hearing on March 31, 1998.
Goodwill Industries International;
Inter-National Association of Business, Industry, and Labor;
National Alliance for the Mentally Ill;
National Association of Developmental Disabilities Councils;
NISH;
Paralyzed Veterans of America;
The Arc of the United States;
United Cerebral Palsy Associations, Inc.
Thank you, Mr. Chairman and distinguished Members of the
Subcommittee, for this opportunity to testify on the Ticket to
Work and Self-Sufficiency Act of 1998. I am Tony Young, a
Public Policy Associate with the United Cerebral Palsy
Associations, Inc., and a former SSDI beneficiary. Today I
appear before you representing the Consortium for Citizens with
Disabilities Subcommittee on Work Incentives. The Subcommittee
on Work Incentives consists of expert members in Social
Security and Employment issues. CCD is a coalition of almost
100 national disability organizations working together to
advocate for national public policy that ensures the self-
determination, independence, empowerment, integration and
inclusion of children and adults with disabilities into all
aspects of society.
CCD congratulates Chairman Bunning and Ranking Member
Kennelly, and the full membership of the Subcommittee on Social
Security, for their success in crafting the Ticket to Work and
Self-Sufficiency Act of 1998. This bill sets the stage for
important improvements in Social Security Administration (SSA)
disability programs that will enable SSDI and SSI beneficiaries
to work to the greatest extent of their abilities.
It is important for SSA disability programs to begin the
process of evolving from their original purpose as early
retirement programs for injured workers. They must start moving
toward including a new purpose of supporting individuals with
disabilities in the workforce. In this way, they are
transformed from a safety net into a trampoline; not only
catching people with disabilities as they fall out of work, but
also giving them a boost back into work when they are ready.
This benefits individuals by enabling them to remain in the
workforce as wage earners; it benefits employers by adding
skilled workers to the labor pool; it benefits employment
service providers by enabling them to serve many more
participants; and it benefits taxpayers by assisting workers
with disabilities to begin or continue to pay taxes.
This bill does not immediately solve all of the barriers to
employment facing individuals on SSDI or SSI. No single piece
of legislation could transform this complex program. It does,
however, meet three criteria that are critically important as
we undertake the transformation of SSA's disability programs.
First, it does no harm. No one receiving cash
assistance under SSDI or SSI will be jeopardized by the passage
of this bill.
Second, it moves us forward now. It extends health
coverage under Medicare for an additional two years after
employment begins; it provides a tax credit for the
extraordinary expenses of working with a disability, and it
expands the choice of employment service providers to any
public or private entity.
Third, it helps to place us on a path to achieve
the ultimate goal of reshaping SSA's disability programs to
meet the needs of SSDI and SSI beneficiaries in the 21st
century. It authorizes SSA to conduct employment
demonstrations, especially the critically important
demonstration of a sliding scale reduction in SSDI benefits.
In my testimony of June, 1997, I discussed reports that
demonstrate that there are five principal barriers to the
employment of individuals with significant disabilities who are
SSDI beneficiaries and SSI recipients (SSDI/SSI
beneficiaries).These barriers are:
1. The loss of health benefits;
2. The complexities of current work incentives;
3. Financial penalties of working;
4. Lack of choice in employment services and providers;
and,
5. Inadequate work opportunities.
I also discussed the legislative steps necessary to solve
these problems. These solutions are:
1. Extend Health Benefits;
2. Streamline Work Incentives;
3. Make Work Pay;
4. Enhance Consumer Choice of Services and Providers; and,
5. Help Employers to Employ Individuals with Significant
Disabilities.
CCD has reviewed the Ticket to Work and Self-Sufficiency
Act of 1998 (TTW&SSA98) in light of the testimony it presented
on these barriers and solutions. After a preliminary review and
analysis, the TTW&SSA98 receives a highly favorable grade. Also
as a result of this analysis, there are a few specific
recommendations for improvements made below. Due to the brief
period of time CCD has had to review this legislation, we will
offer a more in-depth analysis prior to the closing of the
record of the hearing on March 31, 1998.
Barriers and Solutions
Employment Barrier 1: Health Benefits.
Access to private health insurance is increasingly cited as
the key obstacle to employment, particularly in light of the
increase in part-time work, which rarely brings access to
health insurance. With underwriting practices and limits on
benefits acting as critical disincentives, many people with
disabilities must seek Social Security benefits in order to
gain access to public health insurance.
Recommended Solution 1: Extend Health Benefits.
Health coverage should be maintained for SSDI/SSI
beneficiaries going to work in three ways: 1) Continue Medicare
free until $15,000 of earned income, then with a buy-in at 10%
of earned income capped at the full Part A Medicare premium
amount; 2) Establish a Medicare-only buy-in similar to number
one above for individuals with disabilities who would be DI
eligible except for earning above SGA, capped at the full Part
A Medicare premium amount; and, 3) Create an optional state
Medicaid buy-in for working SSDI/SSI beneficiaries.
TTW&SSA98 Solution:
Extend premium free Medicare for Two Additional Years
(total six years premium free Medicare coverage before buy-in
at full Part A premium).
CCD Analysis.
This is a good beginning. However, because it does not
institute a sliding scale for premiums it only postpones the
onset of the expensive Medicare premium for two years. It also
does not allow a buy-in to Medicaid for critical services--
personal assistance and prescription medications--that are
vital to supporting people with disabilities who work, but that
are not covered by Medicare.
CCD Recommendation.
The bill should adopt the sliding scale Medicare program
and the State Medicaid ``Work Incentive Services Waiver''
proposed by the Work Incentives Improvement Act of 1998 soon to
be introduced in the Senate. If this is not possible, the
Congress must use the six years of premium free Medicare given
to disabled workers and should require HHS and HCFA to conduct
extensive research and demonstration during next six years to
determine how to continue to support disabled workers after
their premium free Medicare coverage ends.
Employment Barrier 2: Complexity of Work Incentives.
The SSDI and SSI programs both have work incentives that
are designed to assist beneficiaries and recipients to leave
the rolls by going to work. These work incentives have the
potential to be effective but they are complex and incomplete
and therefore are underutilized. In addition, they are not
coordinated for people who receive both SSDI and SSI. Despite
intense efforts by SSA and advocacy groups to publicize and
educate SSDI/SSI beneficiaries about these benefits, they are
used by only a small fraction of those eligible. They also are
very expensive to administer and too often result in benefit
overpayments that must be returned by the payees.
Recommended Solution 2: Streamline Work Incentives.
The work incentives must be simplified so that SSDI/SSI
beneficiaries can understand and utilize them, and so there is
a decrease in the expense of their administration. The goal
should be to modify them into easily understood and usable work
facilitators that encourage the transition from sole reliance
on public benefits to economic security primarily through
employment.
TTW&SSA98 Solution: Establish Work Incentives Specialists.
The Commissioner will establish a corps of trained,
accessible, and responsive work incentive specialists to
specialize in SSDI and SSI disability work incentives to
disseminate accurate information to disabled recipients.
CCD Analysis.
The effective use of SSA work incentives is dependent upon
1) the availability of knowledgeable, responsible staff inside
SSA that can make timely, accurate decisions regarding any
application to use work incentives; and, 2) the availability of
knowledgeable, responsible consultants outside SSA that can
offer timely, accurate information and analysis regarding any
application of work incentives. There are countless horror
stories citing massive overpayments, disrupted lives, and
dashed hopes resulting from the current haphazard approach SSA
uses to implement the work incentives.
CCD Recommendation.
There are three actions required to solve this problem. The
bill should mandate that a sufficient number of SSA employees
by knowledgeable of and responsible for handling work
incentives. The bill should also clearly state that the
external consultants must be work incentive specialists who are
employees of private, not-for-profit agencies or public
agencies other than SSA. The bill should also direct SSA to
contract with an appropriate vender to develop decision support
software that will analyze individual situations and provide
information on the impact work would have on net income for
that individual.
Employment Barrier 3: Financial Penalties.
Enabling individuals who have been unable to afford to enter or re-
enter the workforce due to the economic disincentives inherent in the
current system requires the redesign of the program. This should be
done in a way that facilitates former SSDI/SSI beneficiaries to earn an
income that enables them to survive. The current SSDI structure
punishes rather than rewards people with disabilities who attempt to
leave entitlement programs to work. The SSDI system eliminates
eligibility for both cash assistance and in-kind support (e.g., health
care) before the individual can earn a living wage. Whie the SSI
program has Sec. 1619, SSDI has no similar work incentives. This sudden
loss of support is known as the ``income cliff'' and represents a
significant disincentive to work.
Recommended Solution 3: Make Work Pay.
A combination of several financial mechanisms were recommended,
including declining cash assistance similar to the SSI Sec. 1619
program, disability expense related tax credits, and tax deductions
will enable individuals with significant disabilities to work. We also
recommended a change in the asset limitations for SSI recipients who
work to facilitate savings and investment. This recognizes that some
individuals with the most significant disabilities will need ongoing
support due to their limited earning capacities.
TTW&SSA98 Solution: Disabled Worker Tax Credit and Demonstration
Projects Providing for Reductions in Disability Insurance Benefits
Based on Earnings.
A tax credit in an amount equal to 50 percent of
impairment-related work expenses up to $10,000 will be provided to
disabled workers.
Demonstration projects for the purpose of evaluating a
program for SSDI recipients under which each $1 of benefits payable is
reduced for each $2 of such recipient's earnings that is above a level
to be determined by the Commissioner.
CCD Analysis.
The tax credit for impairment-related work expenses is available to
a wide range of workers with disabilities for expenses incurred on the
job. The demonstration is required to be conducted and must be of
sufficient scope, duration, and scale to permit a thorough evaluation
of the project to determine the: (1) effects, if any, of induced entry,
(2) extent to which the project is affected by the administration of
the Ticket to Work and Self-Sufficiency Program, and (3) savings that
accrue to the Trust Funds.
CCD Recommendation.
The tax credit should be targeted to those workers with
disabilities who are leaving SSDI or SSI, or reducing their reliance on
SSI, and should include items connected with ``preparation for, and
traveling to and from work, including the cost of a vehicle,
orientation and mobility services and Durable Medical Equipment.
Employment Barrier 4: Consumer Choice of Services and Providers.
People with disabilities who are SSDI beneficiaries or SSI
recipients have no choice in the providers of their services.
Consumers are assigned to a service provider, which by law must
be a state vocational rehabilitation agency, usually by type of
disability rather than type of services required. Consumers who
determine that they are not receiving appropriate or high
quality services generally have no recourse other than to
purchase services themselves from private vendors. Given the
cost of private services and the state of most consumer's
finances, this is an option very few can afford.
Recommended Solution 4: Enhance Consumer Choice of Services and
Providers.
CCD recommended consumer choice be implemented through
several components:
I. Consumers must be able to choose from among the many
thousands of public and private rehabilitation, employment
service, and related providers in the nation.
II. The payment system should encourage work by all SSDI/
SSI beneficiaries, regardless of their ultimate work capacity.
Payment should be made through a milestone approach.
III. A Commission with equal representation from consumers
and their self-selected representatives, providers, and
employers be appointed and charged with responsibility to
assist SSA in this endeavor.
IV. Advocacy services specifically designated to assist
SSA's beneficiaries to resolve disputes with providers should
be made available.
V. Management of the new program should be contracted to a
private sector firm on a competitive bid similar to the
arrangement in the current Alternate Participant program.
TTW&SSA98 Solution:
Consumer choice is offered to SSDI and SSI beneficiaries
through:
I. The Ticket to Work and Self-Sufficiency offered through
Individual Employment Plans and Employment Networks
II. Outcome Based and Milestone/Outcome Based Employment
Network Payment Systems
III. Ticket to Work and Self-Sufficiency Advisory Panel
IV. A method for resolving disputes between: recipients and
employment networks, and program managers and employment
networks.
V. Program Managers.
CCD Analysis.
The Ticket to Work program appears to meet the majority of
the criteria specified in CCD's testimony. The outcome based
and the milestone/outcome payment strategies both pay providers
40% of the average disability benefit for each month that a
recipient does not receive a benefit payment due to work
activity. Using the average monthly disability benefit, rather
than the individual monthly benefit will assist beneficiaries
with lesser work histories to obtain services by increasing the
potential payment available to them.
CCD Recommendation.
Modify that payment system for individuals on SSI to allow
providers to receive milestone/outcome payments based upon a
reduction in benefit payment in addition to when a beneficiary
does not receive a benefit payment due to work activity. This
would encourage providers to work with many individuals who can
work, but who are unlikely to ever have the capacity to earn
enough from wages alone to become self-sufficient. Congress
should also adopt a provision from the proposed Senate bill
that protects beneficiaries from unwarranted Continuing
Disability Reviews (CDRs) during the work attempt. These
include: work activities will not trigger a CDR; work
activities cannot be used as evidence that a disability has
ceased; termination of work activities does not presume an
inability to work.
Employment Barrier 5: Inadequate Work Opportunities.
Individuals with significant disabilities face competition
from many directions in their efforts to work. Individuals who
are leaving welfare, those who are graduating from schools and
colleges, and those who are dislocated due to corporate down-
sizing and economic restructuring all are competing for a
limited pool of jobs.
Recommended Solution 5: Help Employers to Employ Individuals
with Significant Disabilities.
The Committee should study the impact of an expansion of
the Work Opportunity Tax Credit to employers for hiring and
retaining former SSDI/SSI beneficiaries. It should also study
other ADA and disability related employment incentives already
available to employers.
TTW&SSA98 Solution: No provision for employer incentives.
CCD Analysis.
Given the lack of consensus on the efficacy of employer
incentives for hiring and promoting workers with disabilities
CCD understands the hesitancy of the Congress to direct scarce
resources into this area.
CCD Recommendation.
Congress should ask the General Accounting Office to study
the impact of an expansion of the Work Opportunity Tax Credit
to employers for hiring and retaining former SSDI/SSI
beneficiaries. It should also study other ADA and disability
related employment incentives already available to employers.
Chairman Bunning. Thank you very much, Mr. Young.
Mr. Keller.
STATEMENT OF EARL KELLER, SOCIAL SECURITY DISABILITY
BENEFICIARY, ON BEHALF OF THE NATIONAL ALLIANCE FOR THE
MENTALLY ILL
Mr. Keller. Yes, thank you, Chairman Bunning and
Representative Kennelly, and the Subcommittee, for holding this
hearing. My name is Earl Craig Keller. My age is 37. I live in
Rockville, Maryland. I first became mentally ill in 1982. I was
diagnosed and then rediagnosed in 1988 as having a
schizoaffective disorder. I graduated from college. I went back
to college and finished my degree in political science with a
minor in psychology, a B.A.
Schizoaffective disorder is basically a lot of paranoia
delusions, hallucinations, and some depression. So it's hard to
work, obviously.
I started receiving SSI and SSDI in 1987, and I received
Medicare in 1989. Ever since then, I've been stuck in the
system. What I mean by that is I can't earn over $500 a month.
Let me explain why.
My medication costs $1 a pill. I take three pills a day.
That's 90 pills a month. My psychiatrist costs $60 for 15
minutes to prescribe the medication. My therapy costs $100 for
50 minutes once a week, and I see my therapist once a week.
Currently, my Medicare and my Medicaid cover all the costs
of that. Medicare and the Medicaid cover the cost of the
therapy, and my Medicaid covers the cost of prescription drugs.
It only costs me $1 per prescription.
Many mentally ill people take more medication, more pills
than just one, however, and within those pills they take more
than one tablet. So you can see the cost is enormous. Newer
medications like Clozarol and also Zyprexa can be $2 and up per
pill. This does not take into account housing, food, and
socialization.
Concerning jobs, I've had over 25 jobs. I've had an
intermittent work history because I've been mentally ill. I've
been hospitalized 40 times over the last several years. I have
a work history that has been typically minimum-wage jobs,
although recently I received an $8-an-hour job in Rockville,
but I can't work over 15 hours a week due to the fact that I'd
be making $480, and I'm coming very close to that $500 limit.
I'm able to work; I want to work, and I will work. The point is
I can't work right now because the Social Security
Administration and the current $500 limit punishes me for
working.
Vocational rehabilitation, concerning vocational
rehabilitation, I was at vocational rehabilitation three times.
The first time they tested me and told me that the testing--
they couldn't do anything for me. The case manager suggested I
look through the Montgomery Journal together with him and
possibly get a job. So I had zero options. It didn't happen. I
didn't get a job. I didn't get training.
The second time I was with VR I got less. I didn't get the
testing. I didn't get anybody saying, Go through the paper. I
got absolutely nothing.
The third time I was with VR they said absolutely nothing
and they did absolutely nothing.
One of the programs I'm involved in is Threshold Services
in Rockville, Maryland. It's an excellent program. It's a model
program of psychosocial rehabilitation residential program. I'm
not in the residential part of it, but it's a very good
program. It's a model program for possibly in the future to be
a provider such as the bill suggests for employment. It's a
model program, and Kim Smith is the leader of the program
there, as well as other staffmembers, and they do an excellent
job. They treat people with mental illness as people, as human
beings, rather than just as objects, like some of the programs
I've been in in the past.
This bill would give me the opportunity to work more hours
and live a productive life. One aspect that needs to be added
to this bill is insurance to pay for prescriptions. The bill
would give me and others like me the opportunity to avoid VR
and go to a provider that will actually help me to get a job,
and will continue with me for 5 years. This is a very good
bill, and I support this bill.
Thank you, Chairman Bunning, Representative Kennelly, and
the Members of the Subcommittee for allowing me to speak. Do
you have any questions?
[The prepared statement follows:]
Statement of Earl Keller on Behalf of the National Alliance for the
Mentally Ill
Mr. Chairman, Representative Kennelly, my name is Earl
Keller. I am 37 years old and live in Rockville, Maryland. I am
pleased to have this opportunity to offer my views on H.R.
3433, the Ticket to Work and Self Sufficiency Act of 1998. As
an SSDI beneficiary myself, I am excited at the potential this
important piece of legislation offers in shifting the focus of
the current SSDI program and related employment systems away
from an inflexible ``one size fits all'' model, to a flexible
consumer-driven system that places beneficiaries in control of
their own future.
My Experience With SSDI and Vocational Rehabilitation
I was first diagnosed with schizo-affective disorder in
1988. Schizo-affective disorder is a serious brain disorder
that, while treatable, is very disabling. Like many people with
this rare brain disorder, I was originally erroneously
diagnosed with paranoid schizophrenia. This occurred in 1982.
In addition, I have also been treated for depression.
The illness I have has much in common with other severe
mental illnesses. The symptoms of schizo-affective disorder--
including delusions and hallucinations--are very disabling.
Like other severe mental illnesses schizo-affective disorder
is, by its very nature, intermittent and episodic. Medical
science has proven that schizo-affective disorder is a brain
disorder. It is a severe mental illness that is a disease of
the brain. It is not a result of a deficiency in character, nor
is it linked to bad parenting or other social factors.
More importantly, as advances in biomedical research have
occurred, we know that treatment works. Medications, for the
most part, are effective in controlling the symptoms that are
part of the disease in a way that allows me function at a high
level. At the same time, schizo-affective disorder does not
follow a constant path. As a result, I can at times be high
functioning. However, at other times, I can experience a break
that can leave me unable to work, and in some instances, has
required hospitalization--in my case, 40 separate times since
the early 1980s.
Despite the extreme disabling nature of schizo-affective
disorder and other severe mental illnesses, I can and want to
work. My own personal experience proves that work is possible.
Since 1983, I have had 25 different jobs, nearly all of which I
have found on my own. In addition, I have also earned a
bachelors degree in political science, with a minor in
psychology, in 1985. Despite this education and employment
experience, I still struggle to stay in the workforce.
My efforts are certainly complicated by my illness.
However, I also believe that my struggle is also made difficult
as a result of well intentioned government programs that are
both hostile to work, and unresponsive to people's real needs.
While a social safety net is certainly needed for people with
severe disabilities, this safety net should not unnecessarily
trap people in poverty by blocking part-time or intermittent
work. As my employment history demonstrates, people with severe
mental illnesses can find work on their own. However, my
experience also demonstrates that, in the absence of ongoing
supports and services, staying in a job is very difficult--
especially in cases where there has been a clinical change in
the course of treatment.
Mr. Chairman, millions of people like me who live with a
serious brain disorder are able to work and be productive,
taxpaying members of our communities. With access to effective
treatment through health care coverage, people with severe
mental illnesses who are on the SSI and SSDI rolls can move
toward greater independence.
Unfortunately, the current structure of the system,
including both the pervasive work disincentives in the SSDI
program, and the unresponsive nature of the state-federal
vocational rehabilitation program, make work a frequently
unachievable goal. Put simply, the current system is hostile
toward work for people who can and want to work, but whose
disability prevents them from moving rapidly and permanently to
full employment. More importantly, the system has the perverse
effect of trapping people in poverty. Allow me to explain.
The Existing SSDI Work Disincentives
Mr. Chairman, as you know, SSDI functions as an ``all or
nothing'' program. Once someone is able to prove that they are
too disabled to work, and they begin receiving cash assistance,
the program provides virtually no incentive to leave the rolls.
In fact, just the opposite is true. It provides very severe
penalties for beneficiaries who seek to move into the workforce
through limited or part-time employment. Once an SSDI
beneficiary begins earning more than $500 per month, they
``fall off a cliff'' that can compromise both access cash
assistance and medical coverage under Medicare.
In my case, this $500 limit has a profound impact on my
ability to work. I am now starting a new job as a telephone
interviewer. The job pays $8 an hour--well above many of the
minimum wage jobs I have had over the past decade or so.
However, because of the $500 SGA limit in the SSDI program, I
will be limited to 15 hours a week in order to avoid losing
eligibility for cash benefits, and more importantly, the health
care coverage that I must have in order to access treatment for
my illness. I believe that in the proper work environment and
with the right mix of supports and services, I could work more
hours, perhaps as many as 30 hours per week. Unfortunately,
anything above 15 hours is a massive step backwards for me,
risking both essential cash benefits and critical medical
coverage.
Mr. Chairman, I am not arguing for a system that would pay
cash benefits or extend Medicare coverage indefinitely. Such a
system would not serve the interests of taxpayers and would
fail to incentivize work and independence. At the same time,
the status quo is indefensible. SSDI needs to be changed in
order to allow beneficiaries a ``glide path'' rather than an
abrupt ``cliff'' off of cash benefits. The proposed ``2 for 1
offset'' demonstration contained in H.R. 3433 would help
achieve this end. If done correctly, this demonstration program
should prove what many people with disabilities and their
families already know, that extending and gradually phasing out
cash assistance in SSDI is a good deal for taxpayers and an
equitable way to help people move toward work.
Vocational Rehabilitation is Failing People with Severe Mental
Illnesses
Even in cases where government programs seek to help people
either return to work or develop skills to enter the workforce
for the first time, they fail to account for the unique needs
of people with serious brain disorders. The most glaring
example of this is the state-federal vocational rehabilitation
(VR) system. In my case, the three separate attempts of the VR
system to serve me have met with failure.
This is not a reflection of any lack attention on the part
of VR staff. Rather, it is a result of the basic structure of
VR being inconsistent with the employment and training needs of
people with severe mental illnesses. VR is directed almost
exclusively toward a single goal--case closure. For VR, the
process ends once a client is placed in a job for the required
time period and a file can be marked closed. This inflexible
goal fails to take into account the fact that illnesses such as
mine are episodic and intermittent. Moreover, for many people
with disabilities, this ``closure'' is only the beginning of
the process. Ongoing supports and services are oftentimes
critical to one's ability to stay in a job over the long-term.
The current VR system spends too much time testing and
assessing clients prior to employment, instead of actually
placing people in jobs and providing ongoing supports and
services that will help them stay employed, get of the rolls,
and (eventually) reach full independence. People with illnesses
such as schizo-affective disorder typically need assistance
that is both flexible and ongoing to help them live with their
disability in a way that will promote, rather than inhibit
work.
How H.R. 3433 Will Make a Difference in People's Lives
At the outset, I would like to make clear that this
legislation is not perfect. It does not fix every problem in
the current SSI and SSDI programs and it does not propose a
comprehensive solution to the massive shortcomings of the VR
system. No single legislative proposal could satisfy all of
these goals in a cost effective way. However, enactment of H.R.
3433 will begin the process of making the SSDI program more
equitable for beneficiaries who can and want to work. Passage
of this bill would also open up the system of rehabilitation,
employment, training and skills development and place people
with disabilities in control of their future.
By giving individuals a return to work ticket and placing
them in control of their own return to work plan, you will be
putting consumers in the driver's seat for the first time.
Providers will be forced to compete for business on the basis
of how well they meet the individual needs of consumers. State
VR agencies will no longer be in control of the resources that
are directed towards helping people with disabilities achieve
work and independence. Extended Medicare coverage (beyond the
current 39 month period) will help ensure that persons who move
toward full-time work will have the health security that is
essential to their staying in the workforce.
Perhaps the best way to demonstrate how this bill is a vast
improvement over current law is to look at my own personal
circumstances.
1. Consumer Empowerment Through a Ticket System
First, with a ticket to work, individuals such as myself
would be able to skip the entire testing and assessment process
within VR. By receiving a ticket directly, I would be able to
go directly to a provider that is part of an employment
network. This provider would be selected by me, on the basis of
their relative experience serving people with severe mental
illnesses and their record in placing, and more importantly
keeping, people in jobs in the local market. No longer would
consumers be forced to accept VR as the only game in town. You
should strongly resist any effort to remove from the bill the
provisions repealing a) priority referral by Social Security to
state VR agencies and b) benefit deductions for persons
refusing to accept VR services. If this system had been in
place for me, I would have been able to avoid three
unproductive and unpleasant encounters with the VR system.
Moreover, I would have been to go directly to a program such as
Threshold Services, Inc., the non-profit group in Rockville
that is providing me with the support I need to work.
2. The Employment Network Payment System
With regard to the payment of providers in the new
employment networks, the bill offers great potential for
extending services beyond the current 9 month limit that exists
in the VR system. Relying on milestones and outcomes as the
basis for payment of providers and extending payments for as
long as 60 months, you will be able ensure that providers will
not abandon consumers after only a few short months in a job.
As I noted earlier, severe mental illness poses a unique
challenge with respect to episodic and intermittent needs of
consumers. Basing payment on milestones and outcomes that are
linked to savings to the trust funds will, for the first time,
give a provider a reason to follow up with me to make sure that
I have the supports and services that I need, that treatment
for my illness is progressing, that my housing situation is
stable, that my transportation needs are being met, etc. In
structuring the payment system, I would urge that there not be
payment for an pre-employment milestones. This is necessary in
order to ensure that a new set of providers does not enter the
market to write employment plans, accept payment from SSA and
then quickly abandon consumers.
Likewise, protections should be added to ensure that
providers are not able to engage in any form of ``cherry
picking,'' risk selection, or ``creaming'' of consumers who may
appear (at first glance) more likely to be employed over a
sustained period of time. This is especially the case with
severe mental illness where the episodic nature of the illness
makes any accurate prediction of future prospects difficult.
3. Work Incentive Specialists
In my experience, one of the biggest frustration that
consumers face with SSI and SSDI is the Social Security
bureaucracy. When trying to get straight answers about your own
benefits and possible opportunities for work incentives,
consumers often find that SSA field offices and headquarters
staff give conflicting and confusing answers. No doubt, this
flows from the complexity of the programs, especially in the
case of PASS and 1619(a) and (b) for SSI beneficiaries.
However, this complexity does not excuse wrong or misleading
answers to basic questions and the (sometimes) complete lack of
effective counseling about what the real options are. Putting
work incentive specialists in SSA field offices will go a long
way toward helping consumers cope with this new program. More
importantly, these work incentive specialists should not be
employees of SSA in order to ensure that the advice they give
consumers is independent and free of the biases that we often
see in SSA field staff.
4. The ``2 for 1'' Demonstration
As I stated earlier, a ``2 for 1'' initiative would allow
me to increase my hours to as much as 30 hours a week in my new
job without having to go off the SSDI rolls altogether and, in
turn, lose access to Medicare. As a demonstration program it is
being put in place to test whether or not it would drain
resources from the trust funds and create an inducement for
people to enter the program who would not otherwise do so. In
structuring such a demonstration, I would urge that Congress
not limit the scope of this examination to the impact on the
trust funds alone (although I believe that a properly designed
program will render substantial trust fund savings). Instead
Congress and SSA should design a program that looks at both the
trust funds, the overall federal Treasury and the economy to
examine the added benefit of more people with disabilities
working. Some of these potential benefits to taxpayers include
payment of income taxes, payment of state and local taxes, and
a decline in subsidies for housing and other government
services.
5. Extended Medicare
As noted above, access to health benefits is a critical
prerequisite for a person with a disability who wants to enter
the workforce. If a person with a disability is uninsured, they
are highly unlikely to be able to get the health-related
services they need to stay working. While I strongly support
this provision in the bill, I also believe that it can be
improved by adding coverage for outpatient prescription drugs
for SSDI recipients with severe mental illnesses who elect to
return to work. Currently, I receive coverage for my
medications through Maryland medical assistance. However, my
eligibility for this program would be compromised once my
income rises. Some way must be found for SSDI beneficiaries
moving to work to get coverage for medications (which in the
case of the severe mental illness is the principal means of
treatment).
6. Disabled Worker Tax Credit
Providing a tax credit directly to people with disabilities
who move toward work is a great idea. Any such incentive in the
tax code should go directly to consumers. Under the bill, this
credit is limited to 50% of $10,000 in impairment related
expenses. I would urge that you consider expanding this
proposal to cover the costs of ``job coaches'' and forms of
supports as impairment related expenses. Like personal
attendant services and transportation, job coaches and other
targeted supports help people with severe mental illnesses stay
in the workforce once they have a job.
Mr. Chairman, thank you this opportunity to share my views
on this important policy initiative for people with severe
mental illnesses and their families.
Chairman Bunning. Thank you, Mr. Keller. We'll ask
questions after everybody is finished.
Mr. Keller. Thank you.
Chairman Bunning. Mr. Abbot.
STATEMENT OF QUINCY ABBOT, PRESIDENT, THE ARC OF THE UNITED
STATES, WEST HARTFORD, CONNECTICUT
Mr. Abbot. Thank you, Mr. Chairman and Members of the
Subcommittee, for this opportunity to testify on eliminating
the barriers to employment for Social Security disability
beneficiaries through H.R. 3433.
We appreciate the leadership of Chairman Bunning and
Representative Kennelly in taking a serious and long-overdue
look at the work incentive and barrier issues in the Social
Security disability programs. As you know, The Arc of the
United States has joined in support of your efforts for passage
of H.R. 3433, along with the Consortium for Citizens with
Disabilities Social Security Task Force and other disability
advocates across the country.
I am testifying in my capacity as president of The Arc of
the United States and also as a parent. My daughter, Becky, is
34 years old, has mental retardation, and is currently
competitively employed at CIGNA corporate offices in
Bloomfield, Connecticut. She operates a photocopy machine,
earns about $15,000 a year, and receives health coverage
through CIGNA. She does not currently receive SSI, SSDI, or
Medicare. She did receive SSI for a few years while training
for her job and currently receives some residential supports
through a Medicaid waiver. She also has section 8 housing
support.
Let me emphasize that Becky's situation is not typical for
people who have mental retardation severe enough to qualify
them for the SSI or SSDI Programs. As I note in my testimony
for the record, much of her success in becoming more
independent of benefits is due to favorable circumstances which
fell into place for her.
She does continue to need the residential supports
available to her through the Medicaid waiver and section 8
housing support. Even now, if circumstances changed and she
were unable to work, she would need to rely again on SSI and
would also probably qualify for title II disability benefits,
based on her status as my disabled adult child, and also from
her own work history.
On behalf of the 7 million Americans with mental
retardation, I want to thank Chairman Bunning and
Representative Kennelly for your bipartisan efforts to address
all the issues raised to you in this Subcommittee's hearing
last summer. We know there's still much work to be done, and we
pledge to work with you to help bring H.R. 3433 to enactment in
the 105th Congress.
The Arc's position statement on self-determination for
people with mental retardation states that people must control
their own lives, control their own destinies. ``Tickets to
Work'' will give them such control over getting a job and
getting a work opportunity.
Specifically, we commend you for including the following in
the bill:
``Tickets to Work'' to create for consumers a new
choice in providers of rehabilitation and other employment
support services.
Establishment of an advisory panel to advise the
Commissioner of SSA in implementing and refining the program
and designing the research and demonstration projects.
Establishment of a corps of trained, accessible,
and responsive work incentive specialists to assist
beneficiaries with disabilities.
Requirement for demonstration projects to test the
gradual decline in cash benefits as earnings increase.
Extension of the timeframe in which beneficiaries
can continue to receive Medicare coverage when they return to
work.
Creation of a disabled worker tax credit, which
will allow a worker with disabilities a credit of 50 percent of
impairment-related work expenses up to $10,000.
As you know from our testimony last summer, and through
your staff's work with us, The Arc believes it's imperative
that the gradual reduction in cash benefits as earnings
increase--otherwise known as the 2-for-1 proposal--be added to
the title II disability programs in a way similar to work
incentives in SSI. We believe this is critical for people,
including those with mental retardation, who tend to be low-
wage-earners or who will be able to work only intermittently.
We recognize the efforts of Chairman Bunning and
Representative Kennelly in attempting to incorporate this
approach in the work incentives bill. We commend you for
requiring SSA to test the 2-for-1 proposal in your
demonstration projects.
The Arc appreciates your dedicated work and the work of
your staffs in crafting this bipartisan bill. Our goal is to
make work incentives really work, to make them as sensitive as
possible to the different needs of people with different
strengths and limitations, and to have them incorporate the
need to potentially support some people over a lifetime.
We look forward to continued work with you toward enactment
of comprehensive work incentives legislation to help tax users
become taxpayers, like my daughter. Thank you.
[The prepared statement follows:]
Statement of Quincy Abbot, President, The Arc of the United States,
West Hartford, Connecticut
Thank you, Mr. Chairman and Members of the Subcommittee,
for this opportunity to testify on eliminating the barriers to
employment for Social Security disability beneficiaries through
H.R. 3433, The Ticket to Work and Self-Sufficiency Act of 1998.
We appreciate the leadership of Chairman Bunning and
Representative Kennelly in taking a serious and long overdue
look at the work incentive and barrier issues in the Social
Security disability programs. As you know, The Arc of the
United States has joined in support of your efforts for passage
of H.R. 3433 along with the Consortium for Citizens with
Disabilities and other disability advocates across the country.
I will use this opportunity to discuss key issues facing people
with mental retardation who want to work and the potential
impact of H.R. 3433 in addressing those issues.
I. H.R. 3433
I am testifying in my capacity as President of The Arc of
the United States and also as father of my daughter Becky. My
daughter is 34 years old, has mental retardation and is
currently competitively employed at CIGNA corporate offices in
West Hartford, Connecticut. She operates a photocopy machine,
earns about $15,000 per year, and receives health care coverage
through CIGNA. She does not currently receive SSI, SSDI, or
Medicare. She did receive SSI for a few years while training
for a job and currently receives some residential supports
through a Medicaid waiver. She also has Section 8 housing
support.
That said, let me emphasize that Becky's situation is not
typical for people who have mental retardation severe enough to
qualify them for the SSI or SSDI programs. I know that from my
years of experience in The Arc and through knowing my
daughter's friends who have mental retardation or other
developmental disabilities. My daughter's experiences are
instructive, however, for understanding various aspects of the
quest for job security by people with mental retardation. In
reviewing her story, it is easy to see those places where she
would have been left without support and without a job, had the
particular pieces of her life not fallen into place just right.
Even now, if circumstances changed and she was unable to work,
she would need to rely again on SSI and would also qualify for
Title II disability benefits based on her status as my disabled
adult child and also, probably, from her own recent work
history.
First of all, Becky is working at the corporate
offices of the insurance company from which I retired as Senior
Vice President of the Tax Department. After some vocational
assessment in a sheltered setting, she spent 3 years at CIGNA
in a supported employment enclave in the print shop, with a job
coach providing assistance to her and to the other workers in
her team with disabilities. Her productivity rate started at 50
percent and it took those 3 years to bring her production rate
up to 100 percent. She received SSI during those training
years. She also received private health coverage through my own
CIGNA policy since she was considered a disabled dependent at
21 (not typical coverage).
For some people with mental retardation, their production
rate will never reach 100 percent. For others, the years spent
reaching that level are not supported by an employer. For still
others, even with full-time employment, they will not be fully
covered by their employer's health insurance policy. Becky is
still receiving critical support services through Medicaid.
Some employers, of course, do not even offer health benefits.
At that point, she was put on the regular payroll
as a full-time employee. Many people with mental retardation
never are hired on as full-time employees.
Later, when the print shop operations moved to
another state, Becky was moved elsewhere in the corporate
offices to run a photocopier, where she continues to work. Many
employers do not have the capacity or interest in continuing
employment for their low wage employees in major corporate
restructuring or moves.
Becky's story is different than that of her friends. In the
second section of my testimony, I describe the typical scenario
for people with mental retardation when they do not have inside
corporate executives as their advocates, long term training
opportunities, job security, and health care coverage. I also
describe the complicated aspects of the disability programs
which create disincentives for the person with mental
retardation who wants to work despite the need for health
coverage and on-going, life-long supports, including income
supports, in time of need. This is the side of the story that
my daughter's friends, and so many others like them, face
nationwide. In a recent survey of waiting lists across the
country, The Arc documented over 64,000 people with mental
retardation waiting for daytime support services such as
vocational or employment support.
On behalf of 7 million Americans with mental retardation, I
want to thank Chairman Bunning and Representative Kennelly for
your bipartisan efforts to address all of the issues raised to
you in this Subcommittee's hearing last summer. We know that
there is still much work to be done and we pledge to work with
you to bring H.R.3433 to enactment in the 105th Congress.
Specifically, we commend you for including the following in the
bill:
Tickets to Work to create for consumers a new
choice in providers of rehabilitation and other employment
support services.
Establishment of an Advisory Panel to advise the
Commissioner of SSA implementing and refining the program and
designing the research and demonstration projects.
Establishment of a corps of trained, accessible,
and responsive work incentive specialists to assist
beneficiaries with disabilities.
Requirement for demonstration projects to test the
gradual decline in cash benefits as earnings increase.
Extension of the timeframe in which beneficiaries
can continue to receive Medicare coverage when they return to
work.
Creation of a ``disabled worker'' tax credit which
allows a worker with disabilities a credit of 50 percent of
impairment related work expenses up to $10,000.
As you know from our testimony last summer and from your
staff's work with us, The Arc believes that it is imperative
that the gradual reduction in cash benefits as earnings
increase (otherwise known as the ``2 for 1'' proposal) be added
to the Title II disability programs in a way similar to work
incentive provisions in SSI. We believe this is critical for
people, including people with mental retardation, who will tend
to be low wage earners (often without employer-sponsored health
coverage) or who will be able to work only intermittently.
We recognize the efforts of Chairman Bunning and
Representative Kennelly in attempting to incorporate this
approach in the work incentives bill. We commend you for
requiring SSA to test the ``2 for 1'' in demonstration
projects.
II. Background
This section of my testimony reviews some key points about
work incentives for people with mental retardation. While these
points were submitted to the Subcommittee last summer, I
resubmit them here for the record.
Title II and People with Mental Retardation
Many people with mental retardation receive ``Title II''
Social Security benefits as adult dependents of their parents
who have retired, become disabled, or died. To qualify in this
way for benefits based upon a parent's work history, the adult
``child'' must have been disabled during childhood. This group
of eligible adults disabled during childhood are often referred
to as ``DACs'' (disabled adult child).
In addition, a growing number of people with mental
retardation receive Title II disability insurance benefits as a
result of their own work history (quarters of coverage) and
disability.
Since the eligibility criteria and work incentive
provisions of the disability insurance program are applied to
all of these categories of adults, the term SSDI (Social
Security Disability Insurance) is often used in references to
encompass all of the Title II disability programs (even though
it is technically incorrect for encompassing all). It is
important that improvements in any of the work incentives be
applied to all people who receive Title II benefits on the
basis of disability, not just those who are technically in the
SSDI program.
The Lessons of Section 1619 and Title II Work Incentives
Following are highlights of a number of key issues
regarding work incentives for people with mental retardation,
based on the experiences of people with mental retardation as
reported to us over the years by themselves, their parents,
their employers, and their service providers.
People with mental retardation have a life-long
disability. Although most can work, those who are severely
disabled enough to qualify for SSDI or SSI benefits are likely
to need life-long support of some sort even if they are
working. That need for support will vary with the individual,
depending on circumstances including age, health, skill
development, severity of their disability, and family and
community support, to name a few.
Success for many people with mental retardation
must be measured in decreasing dependence (financial or
otherwise) and increasing productivity and community
participation; success should not be measured solely in terms
of elimination of benefits. The fact that many people continue
to use Section 1619 of the SSI program without ``moving off''
should not be viewed as failure. For the people with mental
retardation involved, they have increased their own financial
stability while reducing the amount of cash benefits paid out
of the general treasury.
Due to the nature of the disability and to the
nature of job opportunities traditionally open to people with
mental retardation, many will start as low-wage workers and
will remain at lower levels of income most of their lives,
often in jobs which do not provide health or other benefits.
Many will be the last hired, lowest paid, and the first to be
fired in any restructuring or downsizing. Even with the
additional support of the job coach in supported employment
situations, it can be very hard to find jobs which are an
appropriate match for the individual with mental retardation
and the employer. Sometimes, fitting in with untrained or
uninterested managers or co-workers can be an insurmountable
hurdle. In spite of the fact that people clearly want to work
and in spite of the Americans with Disabilities Act and the
Rehabilitation Act, it can be difficult to find jobs which
provide the right match for people with significant cognitive
limitations. It is even more difficult to find those jobs which
provide the long term stability and support needed by an
individual with significant impairment over a lifetime. Typical
seasonal jobs and other part time employment jobs do not
provide health or retirement benefits.
Therefore, the ``cash cliff'' in Title II (the
loss of all cash benefits after reaching the substantial
gainful activity (SGA) level of earnings for the 9 months of
the trial work period (TWP)) and the cost of continuing
Medicare are very real barriers to work. In the SSI program,
Sections 1619(a) and (b) allow for a gradual decline in cash
benefits as earned income increases beyond the SGA level and
for continued Medicaid coverage, even beyond the cash break-
even point, for as long as the person needs continued Medicaid
in order to continue working. The Social Security disability
program does not have similar work incentives. There, people
lose all cash after 9 months of trial work and Medicare is very
expensive for lower income earners when the extended period of
eligibility (EPE) is exhausted. It is important to note that,
when the Section 1619 program was made permanent in 1986, the
TWP and EPE were eliminated in SSI; with the gradual cash
offset and the availability of continued Medicaid, TWP and EPE
were no longer necessary.
In addition, there are very significant
complications for people who move from SSI Section 1619 work
incentives to the Title II disability programs and for those
who receive benefits from both Title II and SSI.
We strongly believe that a parallel program to
Section 1619 should be established in Title II, including
elimination of the confusing TWP and EPE.
In our experience, there is a very typical
scenario for people with mental retardation and their attempts
to work despite severe, life-long disability. Of course, there
are innumerable variations, but the basic scenario is repeated
over and over again across the country in family after family.
--First, the young person, often upon becoming 18 years
old, becomes eligible for SSI based on disability and low
income and resources. The individual is able to increase income
to the best of his/her ability using the Section 1619 program.
--Then the individual's parent retires or becomes disabled.
At that point, the individual becomes eligible to receive a
benefit equal to 50 percent of the parent's benefit. As you
know, an SSI beneficiary must apply for and accept all other
sources of income or benefits he/she is entitled to, because of
the nature of the SSI program as supplemental income.
--As a result of this increase in unearned income, the
individual may lose SSI completely OR may receive both SSI and
SSDI simultaneously. It is at this step that it becomes clear
that the work incentives in SSI and SSDI are not at all
coordinated.
--The next major change comes when the parent dies. For
parents, their greatest fear often is not for their own
futures, but for the future of their sons and daughters,
particularly when they have significant limitations in their
ability to anticipate and care for their own needs. At this
point, the individual becomes eligible for a Title II benefit
equal to 75 percent of what the parent's benefit was. Once
again, the individual may lose SSI altogether and move
completely into Title II, OR may continue to receive SSI and
SSDI simultaneously.
--Throughout all of this, the individual has not changed at
all. There may have been no change in job status, no change in
job or income, no promotion. Yet, the person, through no action
of his/her own, may become ineligible for basic safety net
support and is forced to choose between that critical support
or work which cannot meet his/her needs.
--The loss of SSI benefits and the loss of those work
incentives which make it possible to improve financial
stability, therefore, may also mean the loss of work and the
loss of an important factor in quality of life. The individual
with a significant impairment and the need for some level of
life-long support simply cannot afford to work at this point
unless potential income is high enough to skip over the cliffs
and canyons created by the loss of the Title II cash benefit
and medical coverage. For the individual whose income is likely
to start and remain low, including most people with mental
retardation, the loss of work is likely.
--For people with mental retardation, as for many of us,
loss of meaningful work also means loss of part of your
identity: your work is who you are. For those who have nothing
to do, or who are prevented from working due to the need for
on-going support, lives are wasted.
The movement between programs requires other
trade-offs also. In SSI, the Sec. 1619 work incentives
encourage work. However, a person cannot save meaningfully for
the future because of the limits on resources. While in SSDI,
the work incentives do not encourage work, so a person cannot
earn. However, there are no restrictions on savings for the
future. Both programs require that the individual give up one
or the other of these essential components for future financial
security, if not total financial independence. Families helping
a person with significant cognitive impairment, like mental
retardation, must be concerned for the future and the long-
term.
In designing a series of changes for Title II and/
or SSI, remember that, for people with mental retardation, work
is often for the first time and may require different
approaches than for people who are ``returning'' to work.
Finally, I would like to make a comment on SGA.
The substantial gainful activity level needs an increase and
should be indexed for inflation. Rep. Phil English has
introduced a bill which is long overdue. We urge the Committee
to address it as part of its work incentive improvement
efforts. However, caution will be necessary to ensure that it
works in the overall context of work incentives addressed here
this week.
The Arc appreciates the dedicated work of Chairman Bunning
and Representative Kennelly and their staffs in working out
this bipartisan bill. Our goal is to make work incentives
really work, to make them sensitive to the different needs of
people with different strengths and limitations, and to have
them incorporate the need to potentially support some people
over a lifetime. We look forward to continued work with you
toward enactment of comprehensive work incentives legislation
to help tax users become tax payers.
Chairman Bunning. Thank you, Mr. Abbot.
Ms. Webb.
STATEMENT OF SUSAN WEBB, NATIONAL COUNCIL ON INDEPENDENT LIVING
Ms. Webb. Mr. Chairman, Representative Kennelly, Members of
the Subcommittee, I sat before you in July of last year
representing the National Council on Independent Living. At
that time, on behalf of NCIL's membership, I brought to you a
proposal that represents what we believe is necessary to change
the Social Security work incentives, so that thousands upon
thousands of people with disabilities currently receiving
Social Security benefits can start or return to work.
Last week, you introduced the Ticket to Work and Self-
Sufficiency Act of 1998. Now, as the bill was only introduced
last week, our full membership has not yet had a chance to look
at it and analyze it and develop a formal position. Those will
be forthcoming from us as an organization and from our
individual members, as they deem appropriate.
Today, however, I sit before you with an initial
observation of the bill, and today I am excited and enthused
about the future of our members. You clearly heard what we said
last summer. Most notably, you heard us when we said a Band-aid
will not work, that comprehensive reform is essential. We
believe the legislation that you and your staff have crafted is
fair and contains many of the provisions that we asked from
you. We thank you.
We told you last July that consumer control is essential.
So you included a ticket to independence. We told you that
consumer choice is essential. So you included not only a
network of private providers, but you also preserved total
choice by ensuring the viability of the existing State agencies
to allow that total choice of whatever the consumer wants to
avail themselves of.
We told you that loss of health care coverage is a major
barrier to employment. So you included an additional 2 years of
Medicare coverage. We told you we needed quality assurance,
accurate information, informed consumers. We told you that the
2-for-1 offset was extremely important to us, and we told you
we needed a tax credit. Mr. Chairman, Representative Kennelly,
Members of the Subcommittee, you put it all in there, and we
thank you.
Now, unlike some of my colleagues here today, I kind of go
out on a limb a little bit. So I'm going to suggest that maybe
there are some things we can suggest to you today that might
actually even strengthen the bill even further, and so I'd like
to outline those very quickly for you now.
We know that there's still very much to be done, but, first
of all, we've been here before with disability-related
legislation, and we know that there are some things we need to
watch out for. One is that we really believe the bill should
include a date certain for the promulgation of the regulations.
We have seen over and over again that when law does not include
deadlines for the Federal agencies who are required to do the
regulations, they very often don't get them done on time, and
so we end up with a law that takes awhile to implement.
For example, that happened with the Rehabilitation Act of
1973. It happened with the Fair Housing Amendments Act. But
when the Americans with Disabilities Act was passed, Congress
included dates for the implementation of the regulations, and
guess what? It got done on time. So we encourage you to do
that.
Second, the Social Security Administration has told us on
numerous occasions that they are not in the employment
business, and that they support return-to-work services being
done by those who are in that business. The bill does add
significantly more responsibility onto the Commissioner's
shoulders. We believe a provision should be added to the
composition of the advisory panel that requires those appointed
to have subject matter expertise. Having been a presidential
appointee myself years ago, I know that very often these
appointments do represent political paybacks. So we're real
concerned that this advisory panel truly are people that do not
have to be educated, will be able to hit the ground running,
and assist the Commissioner in implementing this as far as
promulgation of the rules, as far as overseeing the quality
assurance program, deciding who the program and network
managers should be, designing an effective 2-for-1
demonstration project, and generally, being able to provide a
high level of expertise to assist the Commissioner in
implementation of this program.
Third, since the issue of cost has been a major
consideration throughout the drafting of this bill, we believe
the requirement that employment networks undertake an
employment evaluation as part of the development plan for each
individual consumer smacks of bureaucracy and wastefulness.
Those of us who are consumers looking for work, like every
other adult, can tell the difference between somebody who's
giving us a line and somebody who really wants to do a good
job.
Also, the outcome requirements to be paid that are included
in this bill I think also will go a long way to assure that the
people that are in this business are there to mean business and
actually assist us in getting a job. By incorporating a lot of
certifications, whether government or private, and requirements
for evaluations, self-directed consumers are only hurt by that.
There are several other recommendations that we have, and
we will bring those forward. We understand the markup is coming
next week, and so we will have a comprehensive list. In
general, though, I would like to say, Mr. Chairman, that I
thank you for inviting me back, and I applaud your commitment
to this effort. I know in my heart that with passage of this
bill, perhaps with a few amendments, many, many thousands of
people with disabilities who are not now working today will be
able to work and get out of poverty. Instead, we will move
productively toward economic self-determination.
Thank you.
[The prepared statement follows:]
Statement of Susan Webb, National Council on Independent Living
Mr. Chairman, Representative Kennelly, Members of the
Subcommittee, I sat before you in July of last year
representing the National Council on Independent Living (NCIL).
At that time, on behalf of NCIL's members, I brought to you a
proposal that represents what we believe is necessary to change
the Social Security Work Incentives so that thousands upon
thousands of persons with disabilities currently receiving
Social Security Disability Insurance (SSDI) and Supplemental
Security Income (SSI) can start or return to work. Last week
you introduced the ``Ticket to Work and Self-Sufficiency Act of
1998.''
Now as the bill was only introduced last week, our full
membership has not yet had the chance to analyze it and develop
a formal position and comments. Those will be forthcoming, we
expect, collectively from us as an organization and from
individual members as they deem appropriate. We will do our
part to ensure they have information about the bill as quickly
as possible and ask for their response immediately.
Today, however, I sit before you with an initial
observation of the bill. And today I am excited and enthused
about the future of our members. You clearly heard what we told
you. Most notably, you heard us when we said a Band-Aid will
not work--that comprehensive reform is essential. We believe
the legislation you and your staff have crafted is fair and
many of the provisions we asked for are included. We thank you.
We told you last July that consumer control is essential.
You included a ``Ticket to Independence.''
We told you consumer choice is essential. You included not
only a network of private providers but also preserved total
choice by ensuring the viability of the existing State agencies
in these reforms.
We told you loss of health care coverage is a major barrier
to employment. You included an additional two years of Medicare
coverage.
We told you we needed quality assurance in the provider
network and effective implementation by the Social Security
Administration. You included an Advisory Panel, a dispute
resolution process, and significant data collection so that we
can monitor the program's effectiveness and ``tweak'' it if
need be.
We told you we needed accurate information and informed
consumers. You included a trained cadre of specialists.
We told you we needed a ``2 for 1'' offset so that those
who needed to ease into the work force, or move in and out of
it, could be as self-sufficient as possible without falling
over the ``earnings cliff.'' You included a ``2 for 1''
demonstration that we are confident will prove unequivocally
that many more beneficiaries will reduce their dependency upon
SSDI than will be induced to enter it, resulting in a savings
to the Social Security Trust Fund.
We told you we needed a tax credit to recoup actual
expenses related to disability. You included a tax credit.
Mr. Chairman, Rep. Kennelly, Members of the Subcommittee,
we thank you.
We know, however, that there is still much to be done to
see this bill become law. In light of that, there are a few
recommendations I believe I can make at this time that will
further strengthen the bill and are consistent with NCIL's
mission:
1. The bill should include a date-certain deadline for
promulgation and implementation of all regulations.
Historically we have seen that not including a specific date
delays the regulations and subsequently delays implementation
of the Act (e.g., the Rehabilitation Act of 1973 and the Fair
Housing Amendments Act of 1988). Conversely, when specific
dates are included, such as was the case with the Americans
with Disabilities Act, the statute is implemented on time. We
recommend a deadline of one year from enactment.
2. The Social Security Administration has told us on
numerous occasions that they are not in the employment business
and that they support return-to-work services being done by
those who are in that business. The bill does add significantly
more responsibility onto the Commissioner's shoulders. We
believe a provision should be added to the composition of the
Advisory Panel that requires those appointed to have
demonstrated experience and expertise in employment and start/
return-to-work for Social Security beneficiaries. We also
believe the Panel should include 50% consumer representation.
The Panel, then, would share more responsibility for
promulgation of the implementing regulations, overseeing
quality assurance, deciding who the Program Manager(s) and
Employment Networks should be, designing an effective ``2 for
1'' demonstration project, and generally being able to provide
a high level of expertise to assist the Commissioner in
implementation of this program.
3. Since the issue of cost has been a major consideration
throughout the drafting of this bill, we believe the
requirement that Employment Networks undertake an employment
evaluation as part of the development of individual employment
plans, is a drain on resources that could be more cost-
effective and consumer-friendly by drawing upon our experience
with the Job Training Partnership Act and the Rehabilitation
Act. Historically we have seen that such a requirement is of
little or no use to many consumers who are self-directed. In
fact, it is frustrating and sometimes demeaning to people who
know what they want to do but are required to sit through
lengthy and costly assessments because the ``government
requires it.''
We understand and support requiring Networks to offer such
assessments to ensure that providers are giving beneficiaries
the greatest number of options for their careers. We believe
the way to address both sides of this issue is to add language
to the bill that is similar to a provision in the
Rehabilitation Act Amendments of 1992 allowing a consumer to
waive their right to such an evaluation. Suggested language:
``A beneficiary shall have the right to waive the employment
evaluation requirement. Each beneficiary shall be informed both
verbally and in writing of their right to waive the
evaluation.''
4. The ``2 for 1'' demonstration is of major interest to
our members. We are pleased that you have authorized the Social
Security Administration to include this element in the program,
even if it is only a demonstration project at this time.
However, the SSA has already been doing this with SSI
beneficiaries for some years now. Therefore, we believe that it
should not be an onerous administrative task for them to
assemble the necessary infrastructure to manage such a program
for SSDI beneficiaries. Because we believe this is such an
essential element in enabling beneficiaries to return to work,
we recommend that the demonstration project be national in
scope, have a specific implementation date and duration
included in the statute, and include a provision that the SSA
must notify all beneficiaries of its availability.
5. Several areas within the current bill include well-
intended provisions to ensure program integrity. We believe,
however, that some of them could be less bureaucratic to
encourage consumer control. For example, the bill requires the
Commissioner to develop selection criteria for Employment
Networks that includes some type of professional and government
certifications. We believe consumers have the ability to
determine whether providers of services are qualified and can
do a good job without bureaucratizing the provider network.
``Professsionalizing'' disability has historically not only
created increased and unnecessary costs, it has perpetuated a
``mystique'' around people with disabilities that we believe
has caused the stereotypes that employers have of us. Doctors'
releases, certified rehab plans, etc., serve only to stifle
creativity and innovation and separate us out as ``different''
from other adults seeking work.
Mr. Chairman, Members of the Subcommittee, I thank you for
inviting me back. I applaud your commitment to this effort. I
know in my heart that with passage of this bill, perhaps with a
few amendments, many, many beneficiaries will no longer be
trapped in poverty. Instead, they will move productively toward
economic self-determination.
Chairman Bunning. Thank you, Ms. Webb.
Let me ask anybody here on this panel to answer; you can
choose up sides and find out whoever wants to answer. As you
know, legislation passed by the House must be revenue-neutral.
We are waiting for CBO and Joint Tax to tell us what the score
on this bill will be; in other words, how much, if any, costs
are involved. Depending on what CBO tells us, either we are
going to have to find other ways to reduce benefits or we may
not be able to include all the provisions we would like to
include.
It would be helpful to hear from you regarding the
provisions you believe are the most important to include in
this bill. Which three provisions do you believe are the most
important to include? Mr. Young, would you like to start us
off?
Mr. Young. Well, clearly, from what we've heard over the
last couple of years from the consumers, the health coverage is
number one. No one is going to go back to work and give up
their vitally needed health coverage.
The second I think is the tax incentives. Folks just won't
go to work for the privilege of paying more out of their pocket
than they earn from the wages that they're going to be earning.
No business would run that way; no family could run that way;
certainly no individual can operate that way.
And then, clearly, the ticket to work, the access to the
services that the providers are going to help people with is a
critical piece of the legislation. Some folks would be able to
get back to work without the assistance, but many, many more
would benefit from access to the wide variety of providers that
the ticket offers.
Chairman Bunning. Thank you. Someone else?
Mr. Keller. I would say the health insurance is number one,
along with the actual ticket, number two, the ticket-to-work
program, and, number three, I would say the 2-for-1 option.
Chairman Bunning. Ms. Webb.
Ms. Webb. Mr. Chairman, I would agree that the ticket is
very important, as well as the health care extension. However,
I'd like to take a different approach, and that is that we have
current work incentives right now in many respects that could
be workable if they were administered better. I think one of
the provisions in this bill that I think doesn't cost anything
or very little that may get overlooked, and it worries me, is
the privatization aspect and the advisory panel. It is very,
very important that there be some other way to ensure that the
Social Security Administration manages this program
appropriately, or nothing is going to work.
Too many consumers receiving services don't have a clue of
what's available to them. If there is a provision in here that
is very strong, that requires that consumers are educated about
their options, this will work, and that piece has to be very
strong, and won't cost that much money.
Chairman Bunning. Mr. Abbot?
Mr. Abbot. I would guess that maybe there's going to be a
net savings and not net cost from this bill----
Chairman Bunning. Well, we hope that's----
Mr. Abbot [continuing]. Because----
Chairman Bunning. We hope that's the case, too.
Mr. Abbot [continuing]. I know personally a number of
people who are unable to work, beyond a certain point, to earn
money and pay taxes because of the barriers to employment. So I
would urge that when they look at the figures, they look at the
things outside of the box. It may take a little investment this
year that produces return next year, and it's not just the cost
in this bill; it's the savings from having additional revenues
coming in from other places.
Chairman Bunning. I think if Mrs. Kennelly and I were
scoring the bill, it would be all right--[Laughter.]--but since
CBO scores it, it's going to be a little different.
One other question: Ms. Webb has suggested compromise
language to allow the beneficiary the right to waive an
employment evaluation requirement. What are your reactions to
that?
Mr. Young. I would agree with that option for the consumer.
Mr. Keller. I do not understand. Can you explain more
completely, sir?
Chairman Bunning. Well, we have in the bill an employment
evaluation requirement. Ms. Webb suggests that we waive that
because she doesn't think, obviously, it's necessary.
Ms. Webb. And may I clarify a little bit?
Chairman Bunning. Go ahead.
Ms. Webb. I'm not suggesting that we waive the requirement
for the evaluation, but the evaluation should be offered by the
provider to the consumer, but as we did in the Rehabilitation
Act, the consumer has the option of waiving the evaluation and
saying, ``I don't need that.''
What we have today with, for example, the Job Training
Partnership Act is that many people are required to go through
expensive evaluation----
Chairman Bunning. I believe I said the beneficiary has the
option of waiving it.
Ms. Webb. I'm sorry, Mr. Chairman, I misunderstood you.
Chairman Bunning. That's OK.
Ms. Webb. Yes, that's correct.
Chairman Bunning. OK.
Mr. Keller. I would agree.
Chairman Bunning. OK.
Mr. Abbot. My feeling is that you should be able to waive
it. We spend I don't know how much time in evaluation and
training, which for many people with mental retardation is not
transferable into another situation. The best way to get them
on the job and working is to get them on the job and working
and provide the supports that they need to do the job there,
rather than forever and ever training and evaluation, which
doesn't get any place.
Chairman Bunning. Barbara.
Mrs. Kennelly. Thank you, Mr. Chairman.
Mr. Keller----
Mr. Keller. Yes?
Mrs. Kennelly [continuing]. Under the legislation, as you
know, you can choose the provider or rehabilitation service
which best fits your need. The bill offers an incentive for
providers to continue to support the individual by letting the
provider share in part of the savings that result. You
mentioned you have a nonprofit group in Rockville, Maryland,
that you have been using. Do you think it would make a
difference, this bill could make a difference to them, or do
you think that it's just that some agencies give better
assistance than others?
Mr. Keller. I believe the Threshold Services and
organizations like Threshold could be helped by this bill
because they would basically--I think the bill would help with
the 5 years for the individual, following the person for 5
years, and also I think it's very ingenious because it allows a
provider to get funding for 5 years, as opposed to not get
funding for 5 years, and also the fact that it's incentive
because the provider will want the individual, the disabled
individual, to keep the job for up to 5 years and beyond, to
follow through with us. I think it's a very good incentive for
providers to be helped and the consumer to be helped as well.
Do you understand?
Mrs. Kennelly. Yes.
Mr. Keller. OK.
Mrs. Kennelly. Thank you. Thank you, Mr. Chairman.
Chairman Bunning. Mr. Johnson.
Mr. Johnson. No questions, Mr. Chairman.
Chairman Bunning. No questions? Mr. Hulshof.
Mr. Hulshof. Thank you, Mr. Chairman.
Ms. Webb, let me kind of go back because I think when the
bill was drafted, the intent, of course, was to provide as much
program flexibility as possible, but at the same time
emphasizing the consumer protections. I notice in your
statement, you state that required individual employment plans
may not be a good idea. Help us find other ways. You talk about
trying to be less bureaucratic. What other suggestions might
you have to improve the bill?
Ms. Webb. Mr. Chairman, Representative Hulshof, we've been
through this with the Rehabilitation Act since 1973 of the
effect of bureaucratizing people with disabilities, and
unfortunately, with many of these laws we end up creating a
situation where people have no flexibility because of it, and
the way to resolve that is to recognize that people with
disabilities really are adult people that can make choices. I
think inherent in this bill that's different from others that
I've seen in the past is the incentive for the provider. They
will not get paid unless they produce, and that, in and of
itself, is enough to be sure that people are not going to be
doing needless evaluations just to do evaluations.
So leaving the flexibility in there for consumers to take
control of their own plan, and watching as a wary consumer
would, just as if I were buying a car, that is the way to
assure the quality. The outcome-based payment itself will
assure that quality, and the fact that we have choice. If we
don't like what we're getting, just as the gentleman here to my
right pointed out his experience, as long as we've got choice,
if we don't like what we're getting one place, we can go next
door. I think that that, in and of itself, the market-driven
aspect of it, will assure the quality that we're looking for,
and not pay money out of the trust fund that isn't earned.
Mr. Hulshof. I appreciate that. Thank you, Mr. Chairman.
Chairman Bunning. I want to thank you all for coming and
appearing as witnesses today, and I want to let you know that
we're going to submit some questions in writing to you, and we
really appreciate your returning them in writing.
[The following was subsequently received:]
Questions and Subsequent Answers from Mr. Young
1. You suggest creating an optional State Medicaid buy-in
for working SSI/SSDI beneficiaries. As Medicaid is under the
jurisdiction of the Commerce Committee, have you shared your
proposal with the Commerce staff, and what has been their
reaction?
CCD member organizations contacted staff of the Commerce
Committee several times regarding a Medicaid buy-in. None of
these contacts has resulted in any sign of interest on the part
of the Commerce Committee to pursue this issue.
2a. You recommend specific language be included in the tax
credit, that it should include items connected with
``preparation for, and traveling to and from work, including
the cost of a vehicle, orientation and mobility services and
durable medical equipment.'' Why do you believe it is important
to specifically mention these items in the law?
The tax credit language in HR 3433 only covers impairment
related work expenses (IRWEs) incurred on the job. However,
many times the IRWEs on the job are covered by the employer
under the reasonable accommodations provision of the Americans
with Disabilities Act. The disability related expenses of
preparing for and traveling to and from work often exceed that
which individuals with severe disabilities can afford and still
meet ordinary expences such as rent, utilities, insurance, etc.
These IRWEs are both the most critical for individuals with
severe disabilities to go to work, and the most often denied by
the IRS and SSA. Specifying these items in the law will prevent
any uncertainty among implementing agencies as to the full
intent of the Congress in regard to this provision.
2b. Follow-up: You recommend that the disabled worker tax
credit be confined to SSDI and SSI beneficiaries who are
attempting to leave the rolls. As you know, it is important
that we treat everyone fairly. Are you recommending that
individuals who are already working with severe disabilities
should be excluded from receiving this tax credit?
This suggestion of limiting the tax cut to those leaving
the rolls was an attempt to use DI and SSI status as a proxy
measure for severe disability. There are other methods,
including using the Disability Determination System, to qualify
individuals with severe disabilities for tax cuts (or medical
coverage). Targeting the tax cut to those leaving the rolls was
also intended as one example of strategies to control the cost
of an important work incentive while maximizing its impact.
Those individuals with severe disabilities who have the lowest
earnings and the highest expenses for work supports are the
logical target for tax relief that can help them enter and
remain in the workforce.
A tax cut that covers impairment related work expenses
related to preparing for, traveling to and from, and performing
work for individuals with severe disabilities who have limited
earnings is the best use of a limited funding.
3. While you support our provision to establish Work
Incentive Specialists, you believe that these individuals
should be employees of private, not-for-profit, or public
agencies other than SSA. Why? Shouldn't SSA employees be
responsible for their own work incentives?
Yes. SSA should employ workers who are knowledgeable of
work incentives and responsible for making timely and accurate
decisions on work incentives requests. However, beneficiaries
need access to independent expert advisors who can assist them
to make the best choice possible on an important decision. It
is critical that these advisors have the best interest of the
beneficiary at the center of their efforts. A complimentary
external group of expert advisors working in conjunction with
SSA staff would maximize the impact of these work incentives.
4. I'm curious about your request that we include a
provision to protect beneficiaries from unwarranted CDRs--these
include requiring that work activities will not trigger a CDR,
work activities cannot be used as evidence that a disability
has ceased, and that termination of work activities does not
presume an inability to work. Under current law, individuals
with disabilities will not have benefits terminated if they are
receiving rehabilitation services.
There are individuals, as you know, whose condition will
medically improve. Are you saying that work activity can never
be an indicator of medical improvement?
No, however, given the tenuous connection between work
activity and medical conditions that result in disability, it
is inadvisable for SSA to have the authority to conduct a
Continuing Disability Review (CDR) solely based upon work
activity. CCD strongly supports the use of CDR's at the
regularly scheduled 3, 5, or 7 year intervals as a necessary
mechanism for identifying beneficiaries who have medically
recovered. While beneficiaries in the Medical Improvement
Expected category may go to work because they have medically
recovered to the extent that they no longer meet the SIDI
definition of disability, beneficiaries in the Medical
Improvement Possible and Medical Improvement Not Expected will
rarely Medically recover to that extent. Yet, using the work
incentives offered by this bill, many in the MIP and MINE
categories will be able to work to some extent. Using work
activity alone to trigger a CDR is veiwed by many beneficiaries
as a not-so-veiled threat to the critical work supports and
safety net offered by the SSA disability programs. This
undermines the sense of confidence and security that is needed
for a successful work effort.
5. You recommend continuing Medicare free until an
individual has $15,000 of earned income. Once this level of
income is achieved, the individual would pay a premium equal to
10% of earned income, capped at the full Part A Medicare
premium amount. Have you discussed this proposal with the
Administration and received their views regarding how such a
buy-in would be administered or whether they would support such
a proposal?
CCD conducted informal discussions with the Administration
regarding their support for and the mechanics of a Medicare
buy-in. CCD believes that the current Medicare buy-in program
can be modified without undue hardship to manage the proposed
sliding-scale buy-in. We are eager to work with the Congress
and the Administration to effectively implement a Medicare buy-
in, should one be enacted.
6. You also recommend establishing a Medicare buy-in
similar to your first suggestion, but for individuals with
disabilities who would be eligible for disability except they
earn above the $500 per month limit. Has anyone obtained an
estiate regarding how much such a provision would cost?
A request for a cost estimate for this proposal has been
made to CBO by Senators Jeffords and Kennedy who have
introduced S. 1858, the Work Incentives Improvement Act of
1998. We do not believe this request has yet been answered.
Questions and Subsequent Answers from Mr. Abbot
1. We appreciate your sharing with us the experiences of
your daughter and the supports she has received from her
present employer. Becky has been fortunate in terms of her
employer, but we appreciate the fact that her situation may
well be unique.
You mention some of the changes that may happen to an
individual, through no fault of their own, for example that
they may become eligible for SSI, then, when a parent retires
or becomes disabled that are eligible to receive a benefit
equal to 50% of the parent's benefit so may lose their SSI
benefits and/or continue eligibility for both.
This happens again when one of the parent dies, and they
become eligible for 75% of the benefit. They then are forced to
choose between the basic safety net which provides critical
support or work and risk losing that basic safety net.
You summarize the key challenges of interfacing programs
based on need, such as SSI, with the basic insurances against
disability, death, or retirement provided by the Social
Security programs. I'm sure Arc has studied these circumstances
over the years ... do you have any particular suggestions which
we might keep in mind to address these important points as the
bill moves forward?
1. Regarding the key challenges of interfacing the SSI
program and Title II programs--While the SSI program is means-
tested and the Title II programs are insurance programs, there
are certain key ways in which they should be coordinated.
We believe that it will ultimately be necessary to create a
``2 for 1'' gradual decrease in cash benefits as earning
increase for the Title II program. When that is eventually
done, it will be important to ensure that other related aspects
of work efforts in Title II be coordinated with SSI. That
requires elimination of the Trial Work Period and Extended
Period of Eligibility and requires allowing earnings above the
substantial gainful activity level. Otherwise the complications
caused for a dual SSI/Title II beneficiary will create more
work disincentives. The TWP and EPE in SSI were eliminated when
Section 1619 was made permanent.
It would also be necessary for the order of ``2 for 1''
reductions to be clearly understood by dual beneficiaries.
Since SSI is means-tested, it would seem reasonable for the
reductions in SSI to occur before the reductions in Title II
benefits.
If the Title II programs were amended as described above,
we believe that it would simplify work incentives for people
who receive both benefits or for those who move from one
program to another. Although it is possible that a different
solution to the ``cash cliff'' problem in Title II could be
devised, we believe that success is more likely if the solution
is carefully crafted to address the needs of people who rely on
both programs: hence, our recommendation to create a ``Section
1619-type'' program in Title II.
We also believe that it is important to develop all
incremental steps toward the goal of simplified, coordinated
work incentives in a fashion that will ultimately complement
and facilitate that result. We believe that the provisions in
H.R. 3433 would complement and not hinder a future ``1619-
type'' approach, including a gradual reduction in cash
benefits.
2. You mention that it is important that improvements in
any of the work incentives be applied to all people who receive
Title II benefits on the basis of disability, not just those
who are technically in the SSDI program. Clearly that is our
intent. In your view, is this not the case? Is there something
in the bill we need to clarify?
2. Coverage of people with disabilities--Upon careful
review of H.R. 3433, we believe that you have, indeed, covered
all people with disabilities within the Title II programs. As
you can understand, since so many people with mental
retardation are actually eligible for Title II benefits as
``disabled adult child'' dependents or survivors, we simply
wanted to note for the record the importance of covering people
who do not fit technically in the category of ``disabled
workers.'' Thank you for attention to this issue.
Substantial Gainful Activity level--Finally, I urge you to
consider taking some steps toward improving the SGA level for
people who are not blind in both Title II and SSI. Since a
full-fledged ``2 for 1'' does not appear to be possible at this
time, it is particularly important to make at least some modest
improvements for lower-income earners now. We urge you to
consider including at full Committee mark-up a provision to (1)
increase the SGA level to accommodate the recent increases in
the minimum wage, and (2) direct the Commissioner to increase
the SGA level annually to account for inflation and to allow it
to gradually increase to the SGA level for people who are
blind. This gradual catching-up could be done by ``double-
indexing'' the SGA level each year. We would be happy to
explore this idea further with your staff.
Again, we appreciate all of your hard work and dedication
to passage of important work incentives legislation this year.
We look forward to continued work with you on H.R. 3433.
Chairman Bunning. Thank you very much.
Mr. Keller. Thank you, Chairman Bunning.
Mr. Abbot. Thank you.
Mr. Young. Thank you.
Ms. Webb. Thank you.
Chairman Bunning. Testifying on the third panel today are
Steven Shedlin, chair, Government Affairs Section, National
Association of Rehabilitation Professionals in the Private
Sector; Robert Burns, assistant State superintendent, Division
of Rehabilitation Services, Maryland State Department of
Education, on behalf of the Council of State Administrators of
Vocational Rehabilitation; Joe Miller, director, LifeSkills
Industries, and president, Kentucky Association of Community
and Employment Services, Bowling Green, Kentucky; Joe Mobley,
client, LifeSkills Industries, Bowling Green, Kentucky;
Francine Tishman, executive director, Edwin W. Martin, Jr.,
Career and Employment Institute, National Center for Disability
Services.
Mr. Shedlin, would you please begin.
STATEMENT OF STEVEN D. SHEDLIN, CHAIR, GOVERNMENT AFFAIRS
SECTION, NATIONAL ASSOCIATION OF REHABILITATION PROFESSIONALS
IN THE PRIVATE SECTOR
Mr. Shedlin. Thank you. Chairman Bunning, Ranking Minority
Member Kennelly, and Members of the Subcommittee, it is an
honor to sit here before you today. My name is Steve Shedlin,
and on behalf of the National Association of Rehabilitation
Professionals in the Private Sector, NARPPS, I want to thank
you for allowing me to testify on the Ticket to Work and Self-
Sufficiency Act of 1998, H.R. 3433.
As the chairperson of the NARPPS government Affairs
section, I'm here to extend our association's support for H.R.
3433, and provide an analysis of the legislation from the
perspective of private sector rehabilitation providers. I will
cite how the bill benefits not just Americans with disabilities
who receive SSI and SSDI payments, but all Americans, by virtue
of allowing more of us to benefit from the intrinsic value of
work, and by reducing the monetary support needed to assist
Social Security beneficiaries, by helping those individuals
return to productive and gainful activity, resulting in both
savings to the Disability Trust Fund and new revenue in the
form of payroll taxes.
I am particularly pleased with the provisions that allow
private sector vocational rehabilitation counselors and allied
professionals the ability to participate in the process of
helping SSI and SSDI recipients secure suitable gainful
employment.
I am a certified rehabilitation counselor who has worked in
the rehabilitation field for over 19 years, almost 17 of those
years as a private practitioner and businessowner in the
Washington, DC/Baltimore, Maryland area.
At prior hearings, you've had an opportunity to meet two of
my colleagues with NARPPS who gave you information about our
organization. So I will not go into great detail about us again
today.
However, briefly, NARPPS members, approximately 3,200 of
us, are located in nearly every State in the country. Our goal
is to assist an individual to reach the maximum level of
productive activity, most preferably being a return or an entry
to suitable gainful employment.
Needless to say, NARPPS welcomes the consumer having a
choice as to who will assist them with the provision of
rehabilitation services. We are confident that the more
professionals available to provide services, the greater the
amount of SSI and SSDI recipients who will be able to find and
keep employment.
To that end, we welcome the continued inclusion of State VR
agency participation, particularly those that opt to
participate as part of the employment network, who by
implication would be following strict, but reasonable criteria
set forth in the bill for members of an employment network.
We applaud the distinction of program managers and
employment networks. I would anticipate that NARPPS will have
members that will seek to become either a program manager or an
employment network position. While recognizing the distinction
that it is an ``either/or'' proposition, we are in favor of the
quality control that program managers offer to the program
itself.
NARPPS supports the criteria outlined in the bill for
employment networks as needing to demonstrate substantial
expertise and experience in the field of employment, vocational
rehabilitation, or other support services. NARPPS has published
standards and ethics which each NARPPS member pledges to abide
by, subject to peer review, as a condition of membership. As
our membership tends to consist of certified rehabilitation
counselors and nurses with advanced degrees, we welcome this
requirement and hope that selection to participate in the
employment network will look closely at applicants' background.
We applaud loudly the choice of employment network payment
plans. Some of our members, particularly those associated with
large companies, may opt for the outcome payment system.
However, as you have noted, this system would be untenable for
any of our membership who work for smaller companies or as sole
practitioners. The outcome milestone payment system will
potentially allow participation of virtually all of our
members, exposing the recipients to some very dedicated and
talented professions who work in small business settings.
NARPPS' preference would be that the program not be
implemented gradually at phase-in sites, but that the bold step
of full implementation be started immediately. However, we look
forward to eventual full implementation, and it is our hope
that if the program goes as well as we anticipate, that we will
see full implementation sooner than the 6-year period
identified in the bill.
NARPPS supports the creation of the advisory panel,
particularly the diversity of the panel as specified in the
bill. We believe the panel must have consumer representation,
as noted, as well as private employer participation. The
inclusion of peers, the providers themselves, on the panel is
also essential and greatly appreciated.
A desire to work is often not enough to make finding and,
more importantly, keeping a job possible. It goes without
saying that the success of the program is dependent upon making
it better to stop being an SSI or SSDI recipient than it is to
continue as a recipient. Many SSDI recipients have been out of
the labor market for years. SSI recipients have never had any
experience whatsoever in the labor market. The beneficiaries
may have experienced a catastrophic event or chronic illness
that has altered virtually every aspect of their lives.
Presently, there is a fear of attempting to return to work and
subsequently failing and then losing benefits that keeps many
recipients from even trying. The reductions in benefits based
on earnings, the extensions of Medicare coverage to SSDI
recipients, and the disabled worker tax credits are essential
ingredients to help make it practical to return to work.
Without these incentives, this program cannot be a success.
I am confident that the Ticket to Work and Self-Sufficiency
Program, particularly once it is fully implemented, will
combine altruism with practicality, and be a winning solution
for all Americans.
On behalf of NARPPS and myself, I want to thank you for the
opportunity to provide this testimony, and we remain available
to work further with the Subcommittee. I'd be happy to answer
questions at the appropriate time.
[The prepared statement follows:]
Statement of Steven D. Shedlin, Government Affairs Section Chair,
National Association of Rehabilitation Professionals in the Private
Sector (NARPPS)
Chairman Bunning, Ranking Minority Member Kennelly and
members of the Subcommittee, it is an honor to sit here before
you today. My name is Steve Shedlin, and on behalf of the
National Association of Rehabilitation Professionals in the
Private Sector, NARPPS, I want to thank you for allowing me to
testify on the ``Ticket to Work and Self-Sufficiency Act of
1998,'' H.R 3433. As the chairperson of the NARPPS Government
Affairs Section of NARPPS, I am here to extend our
association's support for H.R. 3433 and to provide an analysis
of the legislation from the perspective of private sector
rehabilitation providers. I will cite how the bill benefits not
just Americans with disabilities who receive SSI and SSDI
payments, but all Americans by virtue of allowing more of us to
benefit from the intrinsic value of work, and by reducing the
monetary support needed to assist Social Security beneficiaries
and helping those individuals return to productive and gainful
activity, resulting in both savings to the disability Trust
Fund and new revenue in the form of payroll taxes. I am
particularly pleased with the provisions that allow private
sector vocational rehabilitation counselors and allied
professionals the ability to participate in the process of
helping SSI and SSDI recipients secure suitable gainful
employment.
I am a certified rehabilitation counselor who has worked in
the rehabilitation field for over nineteen years, almost
seventeen of those years as a private case practitioner and
business owner in the Washington, D.C.-Baltimore area. At prior
hearings you have had an opportunity to meet two of my
colleagues with NARPPS who gave you information about our
organization, so I will not go into great detail about us again
today. However, briefly, NARPPS members, approximately 3,200 of
us, are located in nearly every state in the country. We are
private sector vocational rehabilitation counselors, nurses and
allied health professionals who may be solo practitioners, a
business owner, or a member of a regional or national
organization. Our referrals come from workers compensation
carriers, long term disability insurers, health insurers,
managed care companies, employers, attorneys and persons with
disabilities. Our goal is to assist an individual to reach
their maximum level of productive activity, most preferably
being a return, or an entry, to suitable gainful employment.
We welcome many of the key points of H.R. 3433 including:
The ticket to work and self-sufficiency.
State VR agency participation.
The employment networks.
The use of individual employment plans.
The employment network payment system.
The advisory panel.
The various incentives (i.e., $1/$2 offset,
extended Medicare coverage and the disabled worker tax credit)
making it viable for SSI and SSDI recipients to work.
Needless to say, NARPPS welcomes the consumer having a
choice as to who will assist them with the provision of
rehabilitation services. We are confident that the more
professionals available to provide services, the greater the
amount of SSI and SSDI recipients who will be able to find and
keep employment. To that end, we welcome the continued
inclusion of state VR agency participation, particularly those
that opt to participate as part of the employment network, who
by implication would be following strict, but reasonable
criteria set forth in the bill for members of an employment
network.
We applaud the distinction of program managers and
employment networks. I would anticipate that NARPPS will have
members that will seek to become either a program manager or an
employment network position, while recognizing the distinction
that it is an ``either/or'' proposition. We are in favor of the
quality control that program managers offer to the program
itself.
NARPPS supports the criteria outlined in the bill for
employment networks as needing to demonstrate substantial
expertise and experience in the field of employment, vocational
rehabilitation, or other support services. NARPPS has published
Standards and Ethics which each NARPPS member pledges to abide
by, subject to peer review, as a condition of membership. As
our membership tends to consist of certified rehabilitation
counselors and nurses with advanced degrees, we welcome this
requirement and hope that selection to participate in an
employment network will look closely at applicants'
backgrounds.
NARPPS unquestionably supports the inclusion of individual
employment plans providing for consumer ``ownership and
participation'' in their return to work, or entering work,
journey.
We applaud loudly the choice of employment network payment
plans. Some of our members, particularly those associated with
large companies may opt for the outcome payment system.
However, as you have noted, this system would be untenable for
any of our membership who work for smaller companies or are
sole practitioners. The outcome-milestone payment system will
potentially allow participation of virtually all of our
members, exposing the recipients to some very dedicated and
talented professionals who work in small business settings.
NARPPS preference would be that the program not be
implemented gradually at phase-in sites, but that the bold step
of full implementation be started immediately. However, we look
forward to eventual full implementation and it is our hope that
if the program goes as well as we anticipate, and that we will
see full implementation sooner than the six year period
identified in the bill.
NARPPS supports the creation of the Advisory Panel,
particularly the diversity of the panel as specified in the
bill. We believe that the panel must have consumer
representation, as noted, as well as private employer
participation. The inclusion of our peers, the providers
themselves, on the panel is also essential and greatly
appreciated. We look forward to the annual reports to the
President and Congress that the panel will provide as a method
of measuring and evaluating our progress.
NARPPS also looks forward to the establishment of the corps
of work incentive specialists. It is our belief that part of
the problem to date in assisting disabled recipients from
leaving the Social Security roles has been the lack of an
effective way to disseminate information to them. Awareness of
programs in and of itself should assist with a greater number
of recipients attempting to enter the labor market.
A desire to work is often not enough to make finding, and
more importantly keeping a job possible. It goes without saying
that the success of the program is dependent upon making it
better to stop being an SSI or SSDI recipient than it is to
continue as a recipient. Many SSDI recipients have been out of
the labor market for years. SSI recipients have never had any
experience whatsoever in the labor market. The beneficiaries
may have experienced a catastrophic event or chronic illness
that has altered virtually every aspect of their lives.
Presently there is a fear of attempting to return to work and
subsequently failing, and then losing benefits, that keeps many
recipients from even trying. The reduction in benefits based on
earnings, the extensions of Medicare coverage to SSDI
recipients and the disabled worker tax credits are essential
ingredients to help make it practicable to return to work.
Without these incentives, this program cannot be a success.
Throughout the years, studies have shown that there is an
intrinsic value to working, particularly in our culture as
Americans, that is a motivator even beyond the salary earned
for providing a service or a product. Today it is a necessity
that we look beyond purely altruistic measures and support
programs that are cost effective. I am confident that the
Ticket to Work and Self-Sufficiency Program, particularly once
it is fully implemented, will combine altruism with
practicality and be a winning solution for all Americans.
On behalf of NARPPS and myself, I want to thank you for the
opportunity to provide this testimony and we remain available
to work further with the Subcommittee. I would be happy to
answer questions at the appropriate time.
Chairman Bunning. Mr. Burns, please.
STATEMENT OF ROBERT BURNS, ASSISTANT STATE SUPERINTENDENT,
DIVISION OF REHABILITATION SERVICES, MARYLAND STATE DEPARTMENT
OF EDUCATION, BALTIMORE, MARYLAND; ON BEHALF OF THE COUNCIL OF
STATE ADMINISTRATORS OF VOCATIONAL REHABILITATION
Mr. Burns. Good afternoon, Mr. Chair, Mrs. Kennelly. It's a
pleasure. I'm Bob Burns, and I'm the State director of the
Rehabilitation Services Program in the State of Maryland, and
it's a pleasure----
Chairman Bunning. Mr. Burns, would you please bring the
mike a little closer, so we can hear you better? Thank you.
Mr. Burns. It's a pleasure to meet with the Subcommittee to
discuss this very important topic this afternoon. I've
presented written testimony on behalf of the Council of State
Administrators of Vocational Rehabilitation, CSAVR, for the
record.
CSAVR is 81 State officials who administer the Nation's
public rehabilitation program. We serve 1.2 million persons
with disabilities each year with approximately 40 percent of
those individuals SSI or SSDI recipients. In fiscal year 1995,
the last year that national data is available, the public
vocational rehabilitation returned to work over 200,000
individuals with disabilities and about 25 percent of those
individuals were Social Security beneficiaries.
I believe that the written comments speak very well to the
issues before us in returning SSI and SSDI beneficiaries to
work. This afternoon I will not read those comments, but I want
to speak really as a practitioner, someone in the field of
rehabilitation that works day-in and day-out with over 28,000
persons with disabilities each year in the State of Maryland,
and also administers the State's Disability Determination
Services Program that adjudicates and processes over 57,000
claims for Social Security each year.
I want to also talk as a service provider, someone who's
been in the field for 20 years, someone who's actually put
people with severe disabilities to work.
First of all, I need to commend, and I want to commend,
Chairman Bunning and Mrs. Kennelly for your leadership, and
Members of this Subcommittee for your leadership on taking on a
very difficult issue, but an extremely important issue. I
pledge to you my full support and participation as this
initiative goes forward.
There are some very, very positive features in the proposed
legislation, and let me speak to those first. The legislation
begins to address the real--the real--disincentives that exist
for Social Security beneficiaries to return to work. Those are
loss of medical benefits and loss of cash benefits. Unless we
are serious in addressing those issues in a very understandable
and doable fashion, any attempt to return beneficiaries of
Social Security to work will be significantly impeded.
The proposed bill has a project to look at offsetting cash
benefits with earnings, more or less, extending the 1619(a)
waiver to the DI Program. This is an excellent objective--it's
an excellent project. It must be done.
The bill also extends Medicare coverage 2 additional years
when a DI recipient returns to work. The recommendation of the
Council of State Administrators looks at it as recommending a
parallel to the 1619(b) waiver, where you continue to receive
Medicare benefits and also to broaden the array of services
covered under Medicare benefits. Again, these are excellent
features of the bill, and they begin to address the true
systemic issues in returning individuals with severe
disabilities to work.
We do, and I do, have some serious concerns about the bill,
and those involve the return to work or the voucher component.
The bill almost seems to discover this idea of vouchers. Since
1992 the public rehabilitation program has used informed client
choice. Not only does the individual get to choose their
service provider, but the individual gets to choose the
vocational objectives and employment goal.
The bill also discussed alternative providers, and again,
almost seems to discover that concept. I don't know of one
successful public rehabilitation program where our partnership
with alternate providers or community rehabilitation providers
is not strong. All State VR agencies must work in collaboration
with community providers to be successful. We must complement
each other's strengths. We cannot compete. We don't need
competition; we need synergy in terms of a return to work.
The bill fails to address the issue of timing of referrals.
This is critically important. People struggle for 2 years, up
to 3 years sometimes, just getting on the SSI/SSDI rolls, and
then as soon as they're allowed, they're referred for
rehabilitation. Really, at that point in time, it is not the
appropriate time to begin that return to work.
The testimony of CSAVR goes at many other issues and
recommendations. Essentially, we would ask the Subcommittee to
direct the Social Security Administration to work in
collaboration with the public VR program to use the existing
expertise and knowledge in place to address these issues, and
not building an untested service delivery approach.
Thank you, Mr. Chairman, very much.
[The prepared statement follows:]
Statement of Robert Burns, Assistant State Superintendent, Division of
Rehabilitation Services, Maryland State Department of Education,
Baltimore, Maryland; on Behalf of the Council of State Administrators
of Vocational Rehabilitation (CSAVR)
Chairman Bunning and distinguished Members of the
Subcommittee, it is a privilege to have the opportunity to
provide testimony on behalf of the Council of State
Administrators of Vocational Rehabilitation (CSAVR) regarding
the employment of Social Security Disability Program
beneficiaries.
The CSAVR is composed of 81 state officials who administer
the Public Vocational Rehabilitation Program in the 50 states,
the District of Columbia and the territories. This program, as
authorized by the Rehabilitation Act of 1973, as amended,
provides Vocational Rehabilitation services to beneficiaries
under the various Social Security Disability Programs and has
provided these services since the inception of the Social
Security Disability Insurance (SSDI) and Supplemental Security
Income (SSI) programs.
Our goal today is to relate the previous recommendations
made by the CSAVR in a White Paper titled ``Vocational
Rehabilitation and Social Security'' (June, 1997) relative to
reform of the Social Security Disability Programs to the
``Ticket to Work and Self-Sufficiency Act of 1998''.
The CSAVR believes that the recommendations made in the
White Paper are as valid today as they were last June, and can
be implemented without spending additional time and fiscal
resources on the development of a new administrative structure,
such as would be necessary if the ``Ticket to Work and Self-
Sufficiency Act of 1998'' were passed as it stands today. It
would be more cost effective and advantageous for beneficiaries
if the CSAVR could work with the Social Security Administration
and Members of the Congress to build on an already existing and
effective program of Vocational Rehabilitation for Social
Security Disability Program beneficiaries.
The CSAVR is proud of the history and the achievement of
the Public Vocational Rehabilitation Program in annually
assisting thousands of beneficiaries of the Social Security
Disability Programs to prepare for, enter, and maintain
employment. Of the 1.2 million people served annually through
the Public Vocational Rehabilitation Program, approximately 40
percent are estimated to receive SSDI and/or SSI benefits at
the time they enter or during the Vocational Rehabilitation
process. In Fiscal Year 1995, data from the Rehabilitation
Services Administration shows that 209,848 individuals entered
employment as a result of their efforts with the Public
Vocational Rehabilitation Program. Of these individuals,
52,753, or 25 percent, were SSI and/or SSDI recipients. The
level of partnership with consumers, families, and other public
and private rehabilitation programs exhibited in the delivery
of services through the Public VR Program is exemplary and this
partnership has brought about the success of the Program.
We have had the opportunity to review a Discussion Draft of
the ``Ticket to Work and Self-Sufficiency Act of 1998,'' and
although the draft we have access to may not be a current
reflection of the goals of the proposed Act, we would like to
submit the following for consideration.
During the past several decades of working with
beneficiaries of the Social Security Disability Programs, two
primary reasons why beneficiaries do not enter employment at
the level of Substantial Gainful Activity (SGA) continue to
resonate: the fear of loss of cash benefits, and the fear of
loss of medical benefits. There have been Demonstration
Projects, General Accounting Office Reports, and Reports
directly from the Social Security Administration supporting
these issues. A recent Longitudinal Study conducted by the
Research Triangle Institute clearly demonstrates that these
issues are keeping beneficiaries from working. In delineating
the reasons why Public Vocational Rehabilitation consumers did
not go to work, this study cited three major areas of
difference between beneficiaries and non-beneficiaries were:
fear of losing medical benefits, fear that the beneficiaries
would not be able to get back on benefits if they were to lose
their job, and fear that earnings from employment would not
equal the amount received from benefits.
It is interesting to note that many of the more recent
legislative proposals targeted at SSA system redesign have
centered around a competitive private-sector referral model,
opening up referrals of SSA Disability Program beneficiaries to
alternate providers. It should be noted that the CSAVR has seen
no actual data or substantive evidence to support the basis for
these proposals, namely that access and choice are limited in
the current system. The CSAVR strongly believes that it is the
disincentives around the loss of cash and medical benefits, not
choice of service providers, that has been the primary cause
for the low rate of benefits termination resulting from
employment. It is clear that changes in the SSA benefit
structure must be made regardless of who provides
rehabilitation services.
Tax credits have also been included in some recent
legislative proposals. The ``Ticket to Work and Self-
Sufficiency Act of 1998,'' specifically, offers a tax credit in
an amount equal to 50 percent of impairment-related work
expenses up to $10,000 for disabled workers. However, there is
no evidence to suggest that a tax credit would alleviate the
fears of losing cash and medical benefits.
Loss of Medical Insurance
One of the primary issues keeping beneficiaries from
employment is the lack of availability of continued eligibility
for Medicare and Medicaid. This medical coverage helps with the
costs of treatment, medication, and other necessary services
that enable individuals with significant impairments to enter
and maintain employment. There is broad agreement on these
issues and we need to continue to work on various modifications
to the Medicare and Medicaid structures in order to enable
persons with disabilities to continue to have access to medical
and rehabilitation treatments.
In a summary of the Act, a plan is included to phase-in an
extension of Medicare coverage for two additional years beyond
current law for SSDI beneficiaries who return to work. While
this phased-in extension is encouraging, it does not appear
that the scope of the legislation will be sufficient to
alleviate the fears of beneficiaries faced with the loss of
medical coverage.
Our recommendations around medical insurance, provided to
the Subcommittee in the form of the White Paper titled
``Vocational Rehabilitation and Social Security'' (June, 1997),
are as follows:
Protection of medical coverage for SSDI
beneficiaries similar to the SSI 1619a and 1619b programs;
Immediate Medicare coverage (elimination of the 24
month waiting period);
In any proposed medical insurance package, include
provisions to cover personal attendant care services and
prescription medications necessary to maintain employment
Loss of Cash Benefits
The issue of loss of cash benefits affects both SSDI and
SSI beneficiaries, but the disincentives are greater for SSDI
recipients, where benefits awarded are often equal to or exceed
the value of past or potential earnings, particularly when
medical benefits are considered. There is no gradual phase-down
of benefits when SSDI beneficiaries attempt work return, as is
available to SSI recipients. This ``all or nothing'' approach
to employment and public insurance for persons with
disabilities, young or old, does not work, and often results in
the under-employment of persons receiving SSDI benefits. The
gradual phase-down of benefits based on earnings, as available
to SSI recipients, is widely held as a stronger work incentive
than the trial work period.
Review of the Discussion Draft does show that the bill
attempts to address the issue around loss of cash benefits. The
legislation includes a $1 for every $2 earnings offset, which
more closely parallels the provisions of the SSI Program.
However, there is little information surrounding additional
provisions of this offset approach. In theory, this is the type
of systemic change the CSAVR would welcome, as it eliminates
one of the strongest disincentives to employment for Social
Security Disability Program beneficiaries. Again, without the
specific provisions, it is difficult to assess the impact on
Public Vocational Rehabilitation consumers, or beneficiaries in
general.
In addition to the two primary disincentives outlined
above, there are other barriers to employment for Social
Security Disability Program beneficiaries. Two of these issues
are the timing of referrals, and the complexity of the
Disability Program.
Timing of Referrals
Referral from SSA to State VR Agencies occurs at the point
of award/denial of Social Security Disability Program benefits,
despite data that this is the time least likely to result in
engagement by the individual in a process resulting in
employment. Currently, the Disability Determination Service
(DDS) refers 10 to15 percent of their applicants to the Public
Vocational Rehabilitation Program at the time of disability
determination, immediately following the completion of a
complex process to prove their inability to work at the SGA
level. As a result, only a very small percentage of the people
referred actually follow through and apply for Vocational
Rehabilitation services. An evaluation is necessary to
determine the optimal time for referral of disability
applicants or beneficiaries, and a process needs to be
developed to capture these referrals. The Discussion Draft of
the ``Ticket to Work and Self-Sufficiency Act of 1998'' does
not address the issue of timing of referrals. It is CSAVR's
understanding that the current law which authorized priority
referral of recipients by the Social Security Administration to
the Public Vocational Rehabilitation Program will be repealed.
There is, however, no discussion of the replacement for such a
system.
The Social Security Administration needs to take the
opportunity at every contact with a beneficiary or potential
beneficiary to reinforce and promote employment. Data from the
Rehabilitation Services Administration (911 Data, Fiscal Year
1995) demonstrates that approximately 28 percent of all
beneficiaries in the Public Vocational Rehabilitation Program
come into the program as self-referrals, 14 percent are
referred by Community Mental Health Centers, and approximately
11 percent are referred by other individuals. The Social
Security Administration needs, in its system redesign, to
promote partnerships, not only at a national level, but also at
the District Office level. Social Security District Offices
need to be partnering with local Public Vocational
Rehabilitation offices to ensure the highest quality,
employment focused services for beneficiaries.
Complexity
In a Report titled ``Defining a Work Employment Strategy
for People With Disabilities (September, 1994), the Social
Security Administration acknowledged that ``the complexity of
the system makes it difficult for people with disabilities to
understand, and makes it complex for SSA to administer.'' The
Discussion Draft includes a provision for the development of
Work Incentive Specialists to specialize in title II and title
XVI disability work incentives. However; this does not address
the core issue of complexity.
Summary
The CSAVR is pleased to have the opportunity to testify on
issues pertaining to the employment of Social Security
Disability Program beneficiaries. Over the past several years,
the Public Vocational Rehabilitation Program and the Social
Security Administration have taken strides toward the
development of a partnership designed to maximize employment
opportunities for beneficiaries.
The CSAVR has been trying to develop a collaborative
relationship with the Social Security Administration, and
together with the Rehabilitation Services Administration has
been attempting to improve the current reimbursement system,
and there has been some progress in this area. If we were able
to develop a streamlined reimbursement system, this would
increase the amount of fiscal resources available to the Public
Vocational Rehabilitation Program for use in maximizing
employment outcomes for Social Security Disability Program
beneficiaries. For the first time in many years, Social
Security has begun the process of evaluating the reimbursement
program, and eliminating some of their capacity issues in
claims processing.
It is the CSAVR's belief that, once the current
reimbursement program is functioning at an optimal level, the
nation will have a clearer picture of the efficacy of the
Public Vocational Rehabilitation Program and its ability to
return beneficiaries to competitive, integrated employment
settings consistent with the beneficiary's choice. Although the
legislative proposal provides the option for choosing either
participation in the employment network or continuation under
the current reimbursement system, there is no demonstration of
the need for a new system. The Public Vocational Rehabilitation
Program serves approximately a half million beneficiaries
annually, and as mentioned earlier, 25 percent of all
successful rehabilitation closures in the Public Program are
beneficiaries. The data from the Rehabilitation Services
Administration shows that approximately 73% of these closures,
who represent severely disabled individuals, are in competitive
employment. These figures demonstrate that the Public
Vocational Rehabilitation Program is an open system. These
beneficiaries are able to access our services and enter into
employment. The problem is that they are not willing to risk
the loss of cash and medical benefits by returning to work at
the level of Substantial Gainful Activity. They choose to limit
their hours, and continue to keep their cash and medical
benefits. Work becomes an adjunct to benefits, rather than a
replacement.
We strongly believe that the Public Vocational
Rehabilitation Program has much to offer in terms of history
and experience supporting individuals with disabilities in
their return to work efforts, and we would like to work with
the Social Security Administration and members of Congress to
build on this history. Based on our experience, we have made
some recommendations for Social Security Disability Program
reform. To address the concerns of the Public Vocational
Rehabilitation Program in their efforts to maximize employment
outcomes for Social Security Disability beneficiaries, we would
like to see most, if not all, of the following elements in any
legislation:
Implementation of a sliding scale system for
reduced cash benefits for SSDI beneficiaries;
Protection of medical coverage for SSDI
beneficiaries similar to the SSI 1619a and 1619b programs;
Provision of immediate Medicare coverage;
Inclusion in any medical insurance package of
provisions for personal attendant care services and
prescription medications necessary to maintain employment;
Implementation of an unlimited extended period of
eligibility, to ensure that an individual would not have to go
through a new eligibility determination for disability benefits
as long as their medical condition remained;
Simplification and full explanation of existing
work incentives;
Assignment of responsibility for development and
approval of PASS Plans to Public Vocational Rehabilitation
Counselors.
Further recommendations to promote employment outcomes for
Social Security Disability Program beneficiaries include:
Accurate and timely exchange of information
between the Social Security Administration and the Public
Vocational Rehabilitation Program regarding SSI-SSDI status of
persons served by the Public Vocational Rehabilitation Program;
Evaluation of the significant impact similar
benefits have in service delivery to beneficiaries at no cost
to the Social Security Administration;
Provision of more timely reimbursement for
successful cases so funds can be reinvested in Vocational
Rehabilitation Services.
The CSAVR would like to commend Chairman Bunning and the
Subcommittee for their consideration of ways to redesign the
Social Security Disability Programs to maximize employment
opportunities for beneficiaries. The Public Vocational
Rehabilitation Program has been working with beneficiaries
since the inception of the Social Security Disability Programs.
The Public Vocational Rehabilitation Program provides a
comprehensive array of services, partnering with private non-
profit and for-profit organizations to provide individualized
services to persons with disabilities. We believe that choice
of service providers, as well as choice in many other areas
such as employment goal, objectives and measures of success, is
afforded to each consumer in the Public Vocational
Rehabilitation Program.
We would like to stress, however, that the voucher system
is an unnecessary step in reform. The development of a new
system, based on the assumption that the current system does
not work is futile. There is no evidence to suggest that
changes to the service delivery system will increase employment
outcomes for Social Security Disability Program beneficiaries.
All of the evidence supports the need to fix the disincentives,
to remove the restraints keeping beneficiaries on the
Disability rolls. It is our strong belief that it is the
disincentives inherent within the Social Security Disability
Programs, not the service delivery system, that is keeping
beneficiaries from employment at levels of Substantial Gainful
Activity. These disincentives need to be addressed before
implementing unproven, costly service delivery models. If
systemic disincentives are addressed, a newly streamlined
Public Vocational Rehabilitation Program that utilizes an
existing Public/Private service delivery system is poised to
address the return to work effort for SSDI/SSI beneficiaries.
Chairman Bunning. Thank you.
Welcome, Mr. Miller and Mr. Mobley. We're glad to have you
from Bowling Green.
STATEMENT OF JOE MILLER, DIRECTOR, LIFESKILLS INDUSTRIES, AND
PRESIDENT, KENTUCKY ASSOCIATION OF COMMUNITY AND EMPLOYMENT
SERVICES; ON BEHALF OF THE AMERICAN CONGRESS OF COMMUNITY
SUPPORT AND EMPLOYMENT SERVICES
Mr. Miller. Thank you. Mr. Chairman, Congresswoman
Kennelly, and honorable Members of the Subcommittee, thank you
for the opportunity to present testimony before you today. My
name is Joe Miller. I am the director of LifeSkills Industries,
an employment-service provider that assists people with
disabilities, with jobs skills training, support, and
placement. My employees and I are dedicated to helping people
with disabilities achieve their greatest potential.
I am also the president of the Kentucky Association of
Community Employment Services. I'm here today to present
testimony on behalf of the American Congress of Community
Support and Employment Services. ACCSES is a national
organization that represents more than 700 facilities like
mine.
Unfortunately, Mr. Chairman, our efforts to help people
with disabilities achieve their greatest potential are hampered
by Federal laws. I have included in my written testimony
statistics about how bad the system is. Out of 4.2 million
persons with disabilities receiving SSDI, only one-third of 1
percent find and keep the jobs that earn them more than $500 a
month.
The Federal Government would save $3 billion for every
percentage point of people on SSA's disability rolls placed in
gainful employment. If the percentage of employed individuals
were increased from one-third of 1 percent to just 10 percent,
the government would save almost $27 billion.
The Ticket to Work and Self-Sufficiency Act includes two
provisions that would substantially improve the ability of
employment service providers to place people with disabilities
in good jobs. The first provision would open up a system that
requires people with disabilities to go through their State
vocational rehabilitation agency in order to find employment.
However, only 1 out of 500 people with disabilities ever get
counseling from the VR. Your bill would allow people with
disabilities to access appropriate services and supports
without having to wait and hope for VRs to act.
The second critical provision provides benchmark payments.
Benchmarks would pay set fees to providers for meeting certain
goals. Without these payments, the financial risk of providing
services for people with disabilities would be too high for
most of the Nation's employment service providers. SSA has one
program that allows a few people with disabilities to directly
access private employment service providers.
Providers like LifeSkills who participate are paid a
portion of the savings that accrue to SSA if the job placement
is successful. About 270 providers have contracted to
participate. Yet, as of March 1, only 22 individuals with
disabilities have entered the program. Of those individuals,
nine have been placed. Now that's a good ratio. However, the
fact that there are only 22 enrollees in this program indicates
that many providers can't take on the risk involved in training
and placing individuals with disabilities, then waiting a long
period of time to be paid, if at all, for their services.
I have the pleasure of being here with Joe Mobley.
LifeSkills is helping him through SSA's special program. We are
aware of the financial risk involved in helping Joe, but we
believe with our support Joe will be able to leave SSA's rolls
and become a tax paying citizen. I'm happy to introduce you to
Joe, and Joe will tell you his story.
Thank you again for providing me the opportunity to
testify, and thank you for this legislation.
[The prepared statement follows:]
Statement of Joe Miller, Director, LifeSkills Industries, and
President, The Kentucky Association of Community and Employment
Services; on Behalf of the American Congress of Community Support and
Employment Services
Mr. Chairman, Congresswoman Kennelly and Honorable Members
of the Committee:
Thank you for the opportunity to present testimony before
you today. My name is Joe Miller. I am the Director of
LifeSkills Industries, an employment service provider that
assists people with disabilities with job skills training,
support and placement. My employees and I are dedicated to
helping people with disabilities achieve their greatest
potential. Every year, we work with hundreds of disabled
individuals, many of whom we help to place in good jobs. I am
also the President of the Kentucky Association of Community and
Employment Services. KACES represents providers like LifeSkills
across the Commonwealth of Kentucky.
I am here today to present testimony on behalf of the
American Congress of Community Supports and Employment
Services. ACCSES is a national organization that represents
more than 700 facilities like mine. ACCSES and KACES do not and
have never received grants, contracts or other support from the
federal government. LifeSkills Industries of Bowling Green, is
currently receiving a $60,000 grant through the Job Training
Partnership Act and has not received any other federal grants
or contracts in the past two years. Every year, ACCSES members
assist thousands of individuals with disabilities in their
efforts to find employment.
Unfortunately, Mr. Chairman, our efforts to help place
people with disabilities in meaningful employment are hampered
by federal laws. I have included in my written testimony
statistics that demonstrate the short comings in the current
system. Out of 4.2 million persons with disabilities receiving
Social Security Disability Insurance, only one third of one
percent find and keep jobs that earn them more than $500 a
month.
For most people, working may be just a matter of waking up
in the morning, fixing breakfast, getting dressed, and driving
to work. For many people with disabilities, the act of going to
work is a far more complicated affair. Many people with
disabilities need assistance to fix breakfast or get dressed.
People with mobility or cognitive impairments need assistance
getting to work. And at work, more assistance may be needed. A
person with blindness may need assistive technology to read e-
mail messages, an individual with mental retardation may need a
job coach, a person with a spinal cord injury may need wide
doorways for a wheel chair.
In 1973 and 1990, Congress passed and the President signed
legislation that made it the policy of the federal government
to assist people with disabilities to become full fledged
citizens of the United States. Through section 504 of the
Rehabilitation Act and the Americans with Disabilities Act,
Congress has declared that people with disabilities should be
provided with equal access, equal rights and equal opportunity.
And while Congress and the administration have assisted people
with disabilities to overcome barriers faced in private
industry and society, Congress and the Administration have not
adequately addressed serious barriers to employment that
continue to exist within the federal government. The process of
change is beginning however. Just a few days ago, President
Clinton signed an executive order mandating that the Executive
Department implement measures to encourage people with
disabilities to return to work, and today we are discussing
legislation that will go even further.
Ninety-five percent of federal dollars targeted to people
with disabilities encourage dependence, not independence. When
it was first created, the Social Security Agency's programs for
people with disabilities were crafted with the belief that
people with disabilities would be forever dependent. Like
retirees, it was felt that people with disabilities would never
return to work. The people who put the Social Security Agency's
disability programs together could not have considered new
technologies, medical breakthroughs and advances in providing
rehabilitation services for people with disabilities. And so, a
system of dependency was instituted that created significant
barriers to employment for people with disabilities.
For a lot of people with disabilities, all the new
technologies, breakthroughs, and advances in the world cannot
help them go back to work. And this is not because of their
disabilities--it is because of the system. LifeSkills recently
began working with a disabled individual. She wanted to work
and we thought we could help her. We found an entry level job
for her where she earned $6 an hour, but then we figured out
that after her trial work period, her earnings would actually
go down--substantially.
Virginia Commonwealth University studied the problem of the
earnings cliff faced by Social Security Disability Insurance
(SSDI) recipients and found that people on SSDI earning $500
had a monthly net income (including benefits) of about $1,000.
But when SSDI recipients earned $750 a month, their monthly net
income actually went down to $500. Another earnings cliff
exists at about $1,500 a month when government sponsored health
insurance benefits are cut off. At that point people with
disabilities are often forced to purchase, at considerable
expense, their own health insurance, if it is available to them
at all.
The U.S. General Accounting Office found that the federal
government would save $3 billion dollars for every percentage
point of people on the Social Security Administration's
disability rolls who are placed in gainful employment. If the
percentage of employed disabled individuals was increased from
one third of a percent to just ten percent, the federal
government would save almost $27 billion.
The Ticket to Work and Self-Sufficiency Act of 1998 is a
good first step in resolving some of the most significant
barriers faced by persons with disabilities in their efforts to
return to work. The most recent information suggests that the
nationwide unemployment rate for persons with disabilities is
close to 70%. The national unemployment rate for all residents
is approximately 4.6%, the lowest it has been in the past 30
years. Of those individuals with disabilities who are
unemployed, fully one third would like to find employment. Yet
the system we now have prevents this. As I stated earlier,
people with disabilities face earnings cliffs. They also face
the prospect of loosing their government sponsored health
insurance coverage which, for many, is absolutely necessary for
their survival.
The Ticket to Work and Self-Sufficiency Act addresses both
the earnings cliff and the loss of government sponsored health
insurance. The ``two for one'' concept included in this
legislation addresses the earnings cliff problem, however, this
is just the first step. That provision must, in the future, be
applied to all citizens with disabilities and not just those
permitted to enter through a mandated demonstration program.
The two year extension of Medicare benefits will also help
people with disabilities in their efforts to return to work,
however, further health care security measures must be
instituted, otherwise many people with disabilities will still
hesitate to leave the Social Security Administration rolls.
Beyond the earnings cliff and loss of health care insurance
is the lack of access to rehabilitation services, as well as
the lack of access to job training, support and placement
services. Of the 6.6 million persons with disabilities
receiving assistance from the Social Security Administration
only one out of every twelve or thirteen individuals (or 8%)
are referred to State Vocational Rehabilitation Agencies. Of
the individuals fortunate enough to be referred, only one out
of sixteen individuals (or 0.48% of the total) are actually
seen by their State V.R. Agency. In the end, only one out of
500 disabled individuals receive counseling from their State
V.R. Agency and only one third of one percent (0.33%) of
individuals receiving SSDI are ever able to leave the Social
Security Disability rolls due to work. Congress should not
accept numbers like this.
Mr. Chairman and Representative Kennelly, your legislation,
the Ticket to Work and Self-Sufficiency Act, includes two
provisions that would substantially improve the ability of
employment service providers to place people with disabilities
in meaningful employment. The first provision would open up the
system. Currently, people with disabilities must go through
their State Vocational Rehabilitation Agency in order to find
employment. In short, they have no choices or options. They do
not have the ability to access appropriate rehabilitation
services or community supports from a provider that they
believe will best suit their needs.
There is no ``one size fits all'' solution to helping
people with disabilities. Individuals who are blind require a
different set of services than an individual who has mental
retardation or a spinal cord injury. Private employment service
providers, because they have a wealth of experience and
knowledge and have developed programs specifically tailored to
different disability groups are best able to support people
with disabilities in their efforts to find employment and
achieve more independent lives. Mr. Chairman, you have said
``The payment process is designed to ensure that as many
providers as possible are available to serve consumers'' and
Ranking Member Kennelly, you have said ``People could choose
the provider most able to assist them effectively in returning
to work.'' Your legislation would do exactly that.
As I mentioned earlier, only one out of five hundred people
with disabilities receives counseling from their State V.R.
Agency. These are truly staggering and dismal odds. Your bill
would provide people with disabilities with the ability--the
choice--to access appropriate services and supports without
waiting for their State V.R. Agency to provide counseling or a
referral. That is critical if your legislation is to succeed.
The second critical provision would provide milestone
payments to facilities that cannot afford to bear financial
risks. Almost all employment service and community support
providers are not-for-profits. We operate on very slim margins
and often require charitable donations to make up for budget
shortfalls. Milestones would pay set fees to providers for
meeting certain employment goals for people with disabilities.
Though your legislation leaves it to the Social Security
Administration to determine when milestone payments are to be
made, I expect, for example, that a payment would be made for
the drafting of an employment plan. Without milestone payments,
the financial risk of serving people with disabilities would be
too high for most of the nation's employment service
providers--they are simply too small and run on such slim
margins. The most severely disabled individuals who require
costly services would, in particular, not be served by risk
averse employment service providers. The danger of never
receiving payment for services provided to the hardest to place
people with disabilities is too great for most providers.
If clients should never reach nine months of substantial
gainful activity, providers will not be compensated at all.
People with disabilities, and particularly those with severe
disabilities, are at a far greater risk than the non-disabled
population for medical complications, secondary conditions and
even violence. ACCSES is involved in federal efforts to prevent
these occurrences because these events can diminish, slow or
end a person's ability to return to work.
The Social Security Administration crafted the Alternate
Participant Program to allow a few people with disabilities to
directly access private employment service providers. Clients
are able to contract with providers without waiting for their
State V.R. Agency to provide counseling or a referral.
Providers, like my facility, who participate are paid a portion
of the savings that accrue to the Social Security
Administration if the job placement is successful. Success is
met if the consumer earns more than the Substantial Gainful
Activity income level for more than nine months. About 250
providers have contracted to participate in this program, yet
as of March 1, only 22 individuals with disabilities have
entered the program. Of those individuals, nine have been
placed--that's a good ratio when you consider that only 0.33%
of SSDI enrollees leave the Social Security Administration's
rolls due to employment. However, the grand total of 22
enrollees in this program indicates that many providers cannot
take on the risk involved in training and placing individuals
with disabilities, then waiting a long period of time to
receive compensation for their services.
I have the pleasure of working with a young man that
LifeSkills is helping through the Alternate Participant
Program. His name is Joe Mobley. Joe has diabetes and digestive
failure. LifeSkills is aware of the financial risk we bear in
order to help Joe, but we believe that, with our support, Joe
will be able to leave the Social Security Administration's
rolls and become a taxpaying citizen. Like Joe, we hope that
his progress through our programs is not impeded by medical
complications and that he is able to reach his dream of having
a good job.
Joe and all people with disabilities should benefit from
our nation's commitment to ensure that people with disabilities
are made equal. We are not asking for a new hand out. Believe
it or not, many people with disabilities would like to be tax
paying citizens. Joe wants to take pride in his job and in his
participation as an equal and contributing member of our
society--just as I take pride in what I do and you take pride
in what you do. Congress can and must change the old system of
dependency to allow people with disabilities to become
independent.
Thank you again for providing me the opportunity to testify
before this Subcommittee. I would particularly like to thank
Chairman Bunning and Representative Kennelly for their ground
breaking legislation. I urge all the members of this
subcommittee and Congress to support passage of this
legislation.
Statistics on the Employment of People with Disabilities
(1) Unemployment rate for persons with disabilities in the
United States (1986 and 1994): 67%
(2) Current unemployment rate for all individuals in the
United States: 4.6%
(3) Percentage of federal funding for persons with
disabilities targeted for supporting dependancy: 95%
(4) Number of persons with disabilities (PWD) receiving
Social Security Disability Insurance in 1997: 4.2 million
(5) Number of persons with disabilities receiving SSDI who
were working in Sept 1997: 318,728
(6) As a percentage of total case load: 6.1%
(7) Percentage of people with disabilities earning over
$500 after 12 month SSDI trial and grace periods: 0.33%
(8) Approximate monthly net income of an SSDI recipient
with earnings of $500: $1,000
(9) Approximate monthly net income of an SSDI recipient
after trial and grace periods with earnings of $750: $500
(10) Number of Persons with Disabilities receiving
Supplemental Security Income: 3.1 million
(11) Number of Persons with Disabilities receiving SSI who
were working in March 1997: ``A few''
(12) Percentage of persons with disabilities receiving
support from SSA who are referred to state V.R.s: 8% (13) Ratio
of persons with disabilities referred by SSA to state V.R.s to
number of referrals actually seen: 16:1
(14) Chances that a person with a disability on SSI or SSDI
will see the state VR for return to work counseling: 1 in 500
(15) Chances that a person with a disability on SSI or SSDI
would like to return to work: 1 in 3
(16) Total number of persons with disabilities receiving
assistance from SSA (accounting for overlap): 6.6 million
(17) Weekly SSI and SSDI disbursements made by SSA to
persons with disabilities: $1.21 Billion (18) Lifetime savings
to SSA in SSDI and SSI disbursements for each 1% (66,000) of
PWD returned to work: $3 billion
(19) Number of SSI and SSDI beneficiaries in 1989: 5.5
million; In 1997: 9 million. Percentage increase: 64%
(20) SSI and SSDI disbursements in 1989: $34.4 billion; In
1997: $62.9 billion. Percentage increase: 83%
1, 3 ``Achieving Independence: The Challenge for the 21st
Century,'' National Council on Disability, July 26, 1996.
2 February 1998--U.S. Department of Labor, Bureau of Labor
Statistics.
4, 10, 11, 12, 15, 16, 17, 18: ``Social Security: Disability
Programs Lag in Promoting Return to Work,'' March 17, 1997, U.S.
General Accounting Office.
5, 6: ``Quarterly Report on SSI Disabled Workers and Work Incentive
Provisions,'' September 1997, SSA, Office of Research, Evaluation and
Statistics.
7 ``Removing Barriers to Work: Action Proposals for the 105th
Congress and beyond,'' National Council on Disability, September 24,
1997. (data from April 1996 analysis by the SSA Office of Disability
for individuals under 59)
8, 9: Employment Support Institute, Virginia Commonwealth
University. Study cited in ``Social Security Disability: Improving
Return-to-Work Outcomes Important, but Trade-Offs and Challenges
Exist,'' September 1997, U.S. General Accounting Office.
13, 14, 19, 20: Fallavollita, B., & Bordelon, B., ``Social Security
Disability Programs Lag in Promoting Return to Work,'' National
Association of Rehabilitation Professionals in the Private Sector
Journal, October 1997.
Chairman Bunning. Mr. Mobley, would you like to speak?
STATEMENT OF JOE MOBLEY, CLIENT, LIFESKILLS INDUSTRIES
Mr. Mobley. Mr. Chairman, Congresswoman Kennelly, and
honorable Members of the Subcommittee----
Chairman Bunning. Please move the microphone closer, so we
get it recorded. Thank you.
Mr. Mobley. My name is Joe Mobley. It is an honor for me to
be here to present testimony. It makes me proud to be an
American citizen.
For most people, working may be just a matter of waking up
in the morning, fixing breakfast, getting dressed, and driving
to work. But for many people with disabilities, including
myself, it is more complicated than that. Many of us need
assistance to fix breakfast, get dressed, go to work--things
people take for granted.
And the system makes it even harder for people with
disabilities to go to work. Seventy percent of us are
unemployed. I'm one of the lucky ones. SSA has contracted with
LifeSkills to join the alternate participant program. I am one
of the 22 people with disabilities in the entire country who
has been given the chance to find a good job due to the
program. I have Susan Daniels at SSA and LifeSkills to thank
for that.
Joe Miller and I know that there is a financial risk
involved in helping me. LifeSkills found a job for one
participant in this program who had to quit because she would
have lost more benefits than the money she was making. Even
though Joe's staff worked with her and helped her find a job,
LifeSkills won't get paid for that. LifeSkills may not get paid
for me either, even if something like a medical complication
happens.
There are a lot of people like me in this country. We want
to be employed. We want to take pride in our jobs, but my VR
didn't help me, and if it weren't for the alternate participant
program and Joe taking a chance on me, I wouldn't be here
telling you about how bad the system is.
People like me shouldn't have to wait for VR to provide
counseling. We should be allowed to go to a private facility
and get the support we need to go to work, and providers like
Joe shouldn't have to take a big risk to help people with
disabilities find employment.
Mr. Chairman and Congresswoman Kennelly, I want to thank
you for recognizing this problem. I urge the other Members of
this Subcommittee to support your bill, and so that people with
disabilities have the opportunity to take pride in their work,
just like you do.
Thank you.
[The prepared statement follows:]
Statement of Joe Mobley, Client, Lifeskills Industries
Mr. Chairman, Congresswoman Kennelly and Honorable Members
of the Committee:
My name is Joe Mobley. It is an honor for me to be here to
present testimony. It makes me proud to be an American citizen.
For most people, working may be just a matter of waking up
in the morning, fixing breakfast, getting dressed, and driving
to work. But, for many people with disabilities, including
myself, it's more complicated than that. Many of us need
assistance to fix breakfast, get dressed, go to work--things
most people take for granted.
And the system makes it even harder for people with
disabilities to go to work. Seventy percent of us are
unemployed! I'm one of the lucky ones. SSA contracted with
Lifeskills to join the Alternate Participant Program. I am one
of only 22 people with disabilities in the entire country who
has been given a chance to find a good job through this
program.
I have Susan Daniels at SSA and LifeSkills to thank for
that. But, Joe Miller and I know that there is a financial risk
involved in helping me.
LifeSkills found a job for one participant in this program
who had to quit because she would have lost more benefits than
the money she was making. Even though Joe's staff worked with
her and helped her find a job, LifeSkills won't get paid for
that. LifeSkills may not get paid for me either if something
like a medical complication happens.
There are a lot of people like me in this country. We want
to be employed. We want to take pride in our jobs. But my V.R.
didn't help me and if it weren't for the Alternate Participant
Program and Joe taking a chance on me, I wouldn't be here
telling you about how bad the system is--I'd be living how bad
the system is.
People like me shouldn't have to wait for their V.R. to
provide counseling. We should be allowed to go to a private
facility and get the supports we need to go to work. And
providers like Joe shouldn't have to take a big risk to help
people with disabilities find employment.
Mr. Chairman and Congresswoman Kennelly, I want to thank
you for recognizing this problem. I urge the other members of
this Committee to support your bill so that people with
disabilities have an opportunity to take pride in their work--
just like you do.
Chairman Bunning. Thank you very much.
Ms. Tishman.
STATEMENT OF FRANCINE M. TISHMAN, EXECUTIVE DIRECTOR, EDWIN W.
MARTIN, JR. CAREER AND EMPLOYMENT INSTITUTE, NATIONAL CENTER
FOR DISABILITY SERVICES; AND MEMBER, BOARD OF DIRECTORS, INTER-
NATIONAL ASSOCIATION OF BUSINESS, INDUSTRY, AND REHABILITATION
(INABIR)
Ms. Tishman. Thank you. Good afternoon, Mr. Chairman and
Members of the Subcommittee. My name is Francine Tishman, and
I'm the executive director of the Career and Employment
Institute, a division of the National Center for Disability
Services, located in Long Island, New York.
National Center is dedicated to empowering children and
adults with disabilities to fulfill their academic and
professional potential through education, training, and
employment. I am here today as a representative of my own
organization and as a member of the board of directors of
INABIR, the Inter-National Association of Business, Industry,
and Rehabilitation, which is comprised of more than 100
Projects with Industry programs across the country.
I want to thank you, Congressman Bunning and Representative
Kennelly, and other Members of the Subcommittee, for your
efforts over the last several years to create increased
opportunities and incentives that will facilitate employment
among SSDI and SSI recipients. Your bill addresses the most
significant obstacles that confront SSA recipients with
disabilities and providers of placement services.
Statistics continue to demonstrate the devastating reality
for 16.9 million persons with disabilities who have stated
their desire to work. Of that number, only 4.5 million are
employed, leaving almost 11.5 million without employment and
dependent on benefit programs. Under the current system, less
than one-half of 1 percent of all SSA recipients with
disabilities become employed each year and leave the rolls.
National Center has more than 30 years of experience in
placing persons with disabilities into competitive employment.
Over those years, I estimate that we have assisted more than
10,000 persons to achieve employment, but during those years we
have been, and continued to be, most challenged by persons who
are Social Security recipients. Of the total number of people
we serve each year, approximately 25 percent are recipients of
Social Security benefits.
My organization and PWIs across the country have the desire
to assist recipients to go to work. The major difficulties
under the current system are: Receiving direct SSA referrals,
reimbursement under the current system, which is not a fiscally
sound proposition for most of the Nation's nonprofit
organizations, and finally, the authority remains within the
State VR system to retain a case for 4 months before referring
it to an alternate provider.
Projects with Industry programs have an outstanding record
of success. In citing recent statistics, in just 1 year, 11,000
persons were placed into full- and part-time competitive jobs.
Collectively, they earned over $112 million, paid almost $16
million in taxes, and saved SSA programs a little more than $15
million.
The local economies across the country were stimulated at a
rate of $3 for every dollar that SSA recipients earned. Or
better stated, that represents almost $340 million each year
going into local economies.
We know that PWIs can play a significant role in assisting
SSA beneficiaries to become employed because we recognize that
both job seekers with disabilities and employers are our
customers. SSA recipients have not been specifically targeted
as a service population by PWIs and by other providers, due to
the referral and reimbursement constraints under the current
system. Projects with Industry transcend the traditional model
of vocational service delivery systems by creating and
maintaining strong partnerships with the business community in
order to enhance and expand job opportunities in the primary
labor market.
Projects with Industry is perhaps the single most
accountable program supported by the Federal Government through
the Department of Education Rehabilitation Services
Administration. PWIs must meet rigorous standards and
indicators and are among the most creative in developing
strategies to recruit and serve individuals with severe
disabilities.
Our center operates PWI placement programs in conjunction
with Centers for Independent Living in seven cities. Centers
for Independent Living provide other support such as housing
and transportation assisting, peer counseling, and independent
living skills in order to enhance employment potential. Our PWI
expertise in working with the business community, along with
the strong consumer focus service delivery of Independent
Living Centers, are catalysts in overcoming the barriers to
employment independence.
The bill clearly reflects the respect for the individual,
as well as the concern about its realistic implementation. SSA
recipients seeking employment will clearly have independence
and authority and the resources needed to achieve their
employment goals.
While creating opportunities, the bill also targets long-
overdue reform of significant work disincentives. Extended
Medicare coverage, task credits for disability-related work
expenses, and the gradual reduction of benefits are all
necessary tools to achieve the Subcommittee's goals.
From the provider perspective, we are especially pleased
that the bill includes an earn-as-you-serve system that will
now enable more alternate providers to bring their expertise
and talents to addressing our country's significant
unemployment rate among SSDI and SSI recipients.
I cannot conclude my remarks without expressing some
concerns about the time it will take to fully implement the
provisions of the bill, and to stress to you that recipient
disincentives must be eliminated simultaneously with the
initiation of provider incentives.
My final words congratulate you all and your staff for
addressing these major obstacles and for demonstrating your
understanding of what needs to be done to help people with
disabilities on SSI and SSDI who want to work get to work. I am
certain that the expansion of the provider pool made possible
by this bill will have a direct and immediate impact on the
level of employment and the strength of our economy.
The National Center and Projects with Industry across the
country are eager to support you and to assist the Social
Security Administration in implementing this outcome-oriented
program. Thank you.
[The prepared statement follows:]
Statement of Francine M. Tishman, Executive Director, Edwin W. Martin,
Jr. Career and Employment Institute, National Center for Disability
Services; and Member, Board of Directors, the Inter-National
Association of Business, Industry, and Rehabilitation (INABIR)
Good afternoon Mr. Chairman and members of the
Subcommittee. My name is Francine Tishman and I am the
Executive Director of the Career and Employment Institute, a
division of the National Center for Disability Services located
in Long Island, New York. NCDS is dedicated to empowering
children and adults with disabilities to fulfill their academic
and professional potential through education, training and
employment. I am here today as a representative of my own
organization and as a member of the Board of Directors of the
Inter-National Association of Business, Industry and
Rehabilitation (I-NABIR) comprised of more than 100 Projects
With Industry Programs across the country.
I want to thank you, Congressman Bunning, Congresswoman
Kennelly and other members of the Subcommittee for your efforts
over the last several years to create increased opportunities
and incentives that will facilitate employment among SSDI and
SSI recipients. Your Bill addresses the most significant
obstacles that confront SSA recipients with disabilities and
providers of placement services.
Statistics continue to demonstrate the devastating reality
for 16.9 million persons with disabilities who have stated
their desire to work. Of that number, only 4.5 million are
employed, leaving almost 11 million without employment and
dependent on benefit programs. Under the current system, less
than one half of one percent of all SSA recipients with
disabilities become employed each year and leave the roles.
Our organization has more than thirty years of experience
in placing persons with disabilities into competitive
employment. Over those years, I estimate that we have assisted
more than 10,000 persons with disabilities to achieve
employment. But during those years we have been, and continue
to be, most challenged by persons who are Social Security
recipients. Of the total number we serve each year,
approximately 25% are recipients of Social Security benefits.
My organization and PWI's across the country have the desire to
assist SSDI/SSI recipients to go to work. The major
difficulties under the current system are:
Impossibility of receiving direct SSA referrals
Reimbursement under the current system is not a
fiscally sound proposition for most of the nation's non-profit
providers
Authority remains with State VR to retain the case
for 4 months before referring to an alternate provider.
Projects With Industry programs have an outstanding record
of success. In citing recent statistics, in one year, 11,000
persons with disabilities were placed into full and part-time
competitive jobs. Collectively they earned $112,200,000; paid
$15,708,000 in taxes; and saved SSA programs $15,246,000. Local
economies were stimulated at a rate of $3 for each $1 earned--
or better stated $336,600,000/yr.
We know that PWI's can play a significant role in assisting
SSA beneficiaries to become employed because we recognize that
both job seekers with disabilities and employers are our
customers. SSA recipients have not been specifically targeted
as a service population by PWI's and by other providers due to
the referral and reimbursement constraints under the current
system.
Projects With Industry transcends the traditional model of
vocational service delivery systems by creating and maintaining
strong partnerships with the business community in order to
enhance and expand job opportunities in the primary labor
market. Projects With Industry is perhaps the single-most
accountable program supported by the federal government (U.S.
Department of Education, Rehabilitation Services
Administration). PWI's must meet rigorous standards and
indicators and are among the most creative in developing
strategies to recruit and serve individuals with severe
disabilities.
NCDS operates placement programs in conjunction with
Centers for Independent Living which provide other supports
such as housing and transportation assistance, peer counseling
and independent living skills training in order to enhance
employment potential. Our PWI expertise in working with the
business community along with the strong consumer focussed
service delivery system of independent living centers are
catalysts in overcoming the barriers to employment and
independence.
The Bill clearly reflects respect for the individual as
well as the concern about its realistic implementation. SSA
recipients seeking employment will clearly have independence
and the authority and the resources needed to achieve their
employment goals. While creating opportunities, the Bill also
targets long overdue reform of significant work disincentives.
Extended Medicare coverage, tax credits for disability related
work expenses and the gradual reduction of benefits are all
necessary tools to achieve the Subcommittee's goals.
From the provider perspective, we are especially pleased
that the Bill includes an ``earn as you serve'' or milestone
reimbursement system that will now enable more alternate
providers to bring their expertise and talents to addressing
our country's significant unemployment rate among SSDI/SSI
recipients.
I cannot conclude my remarks without expressing some
concerns about the time it will take to fully implement the
provisions of the Bill. Recipient disincentives must be
eliminated simultaneously with the initiation of provider
incentives. I cannot stress strongly enough that the success of
this new initiative is dependent upon the effectiveness of its
implementation strategies.
My final words congratulate you all and your staff for
addressing these major obstacles and for demonstrating your
understanding of what needs to be done to help people with
disabilities on SSDI and SSI who want to work . . . get to
work. I am certain that the expansion of the provider pool made
possible by this Bill will have a direct and immediate impact
on the level of employment and the strength of our economy.
Thank you.
Chairman Bunning. Thank you, Ms. Tishman.
I will start out. Mr. Miller, you mentioned that there are
many risks involved in providing services to people with
disabilities under the alternative participant program. Since
LifeSkills is participating in this program, can you tell us
why you are helping Mr. Mobley and other consumers, in spite of
the risk?
Mr. Miller. We feel that we are large enough to accept some
of that risk. We're also very confident that the people that we
work with who have disabilities are able to work in the
community and that we can be successful in placing them.
Chairman Bunning. All right. There are plenty of other
questions. Let me get back to general questions for the whole
panel.
As you may know, and most of you already have said
something about this, our bill allows for the employment
network to choose between two reimbursement systems--one being
based on outcomes only, and the other being based on achieving
milestones and outcomes. We define outcomes as no longer being
eligible for cash benefits. We do leave it up to the
Commissioner, with advice from the advisory panel, to set up
this milestone payment process.
What advice would you give us, and give the Commissioner,
as to how to set up the milestone payment plan? Anyone?
Mr. Shedlin. Well, NARPPS has taken the position that there
can be several different milestones. One could be at the
implementation of an individualized rehabilitation plan.
Another could be at the point where the individual actually
returns to work, and then at the actual outcome that you would
utilize in the outcome-based plan. We'd look at those three
spots as making it feasible for all rehabilitation counselors
in the private sector, large or small, to be able to
participate in this program.
Chairman Bunning. Anyone else?
Mr. Miller. I believe the same three elements: When one
signs to a plan, when one begins work, and at the successful
conclusion.
Ms. Tishman. I would agree, except to say that in
delivering individualized services, those milestones will occur
over different time periods in people's lives. But, basically,
something that does not rely necessarily just on venture
capital of nonprofit organizations, of which we have none to
contribute, would really bring more people into our systems,
and obviously, we have been delivering outcomes for many, many
years, would allow us to bring these services to individuals
right now that we're not targeting, and for that reason.
Mr. Burns. Mr. Chairman, if I could just respond to that
question----
Chairman Bunning. Go ahead.
Mr. Burns. Currently, as you're aware, the public VR agency
operates under--we're reimbursed after the individual
terminates benefits, after they meet the substantial gainful;
that's kind of the playingfield that we've operated under now.
We in Maryland do work with community providers and are
implementing a system that develops milestones in terms of
payment relative to job development, job placement, and
followup, as one of the other speakers commented. That seems
like a very doable and workable approach.
The only thing I would caution the Subcommittee on, that
there have been--public VR agencies have experienced major
problems in receiving reimbursement from Social Security under
the current system, when the individual goes off of benefits.
So any system that would have to be implemented, the critical
feature is the capacity for Social Security to monitor,
reimburse, and is doable, and we found that the current system
results in some problems.
Chairman Bunning. Thank you.
Barbara.
Mrs. Kennelly. Ms. Tishman, you mention that the State has
the case for 4 months before it can be referred. In your
experience, does the State refer or does the nonprofit have to
go after the case? How does it work?
Ms. Tishman. Well, since we're not out recruiting for
individuals--they're referred to us--and we don't know at what
point within that 4 months or after that 4 months they're
referred to us, if they're coming through the regular VR
system. They are not referred to us specifically as an
individual who is on a Social Security benefit program. That's
just incidental information and data that we gather about the
individual as they come to us.
Mrs. Kennelly. One of our earlier witnesses said that
there's a lack of information about the benefits available to
individuals. Do you think that they know after 4 months they
can go to another agency?
Ms. Tishman. I really couldn't attest to that. I'm not
certain about that. I would think it was more in the hands of
the VR counselor as opposed to the individual who's seeking the
service.
Mrs. Kennelly. Thank you.
Mr. Burns, I asked about your figures earlier, and I was
wondering if you wanted to take the opportunity to explain the
difference between your 53,000 figure and the 8,000
beneficiaries which SSA reimburses?
Mr. Burns. Yes, Mrs. Kennelly, and Susan Daniels, I think,
began to answer that question. The 210,000 figure are the total
number of individuals that we returned to employment. Again,
that's in a broader rehabilitation program that includes both
SSA beneficiaries and just persons with disabilities not
receiving Social Security. As I stated in my testimony, about
25 percent of the 210,000 individuals, or just over 52,000
individuals that we rehabilitated, were beneficiaries of Social
Security.
And you heard some consumers speak to what occurs--is that
consumers will take part-time employment, so that they do not
hit the substantial gainful threshold, and that, I mention in
my testimony, is a very, very real issue--the critical issue of
why it is not working to the degree that we all want it to
work--you want it to work; the public VR agencies want it to
work, and consumers want--are the economic disincentives around
health care and cash benefits. Those are the critical issues
that need to be addressed to have a successful return-to-work
program.
Mrs. Kennelly. Thank you, Mr. Burns. Thank you, Mr.
Chairman.
Chairman Bunning. That's why we have it in our bill. That's
why there are two alternative programs that you and the private
rehabers will be able to work with. So we're not leaving you
out of the loop at all.
Mr. Burns. The only concern, Chairman Bunning, on that is,
again, you're setting up a two-track system, where my
experience, as both a practitioner, a rehab counselor, and as
an administrator, it works best when we collaborate. It's when
we work together as a public VR agency and community
rehabilitation providers----
Chairman Bunning. Are you telling me, then, that you could
do the job by yourself if we took and made these disincentives
disappear?
Mr. Burns. I'm saying that is the major problem for return-
to-work for SSA beneficiaries. We would never do any
rehabilitation by ourselves. We work in collaboration with
community providers. Again, they have a certain expertise.
They've talked about their linkages with business, their
placement abilities, their flexibility. But public VR agencies
also have certain capacities to link-in and fund other services
that are not typically provided by community rehabilitation
programs.
Chairman Bunning. Almost every consumer that has testified
here has testified that health care, extension of health care
coverage, is number one.
Mr. Burns. I would agree. Health care, number one; cash
benefits, number two.
Chairman Bunning. We want to thank you all. It's impossible
for some of the Members of the Subcommittee, obviously, to be
here today. Therefore, we may be submitting additional
questions in writing for you to answer for the record.
[The following was subsequently received:]
Questions and Subsequent Answers from Mr. Shedlin
1. We thank you for your testimony and your many positive
comments about this legislation. Your organization represents
3,200 member groups. Do you see real interest by your
membership in terms of enrolling in the program as either an
employment network or a program manager?
1. The members of NARPPS unquestionably have an interest in
enrolling in the program. A majority of our larger members will
choose to enroll in the program as program managers and our
smaller members (which comprise the largest part of our
membership) will most likely select to become an employment
network. The interest of our members has been demonstrated by
the large number of providers who completed the RFP for the
Alternate Participant program (although mostly our larger
members due to the lack of milestone payments) and by the
active involvement of our membership and the NARPPS Board in
working with the Subcommittee staff regarding the introduction
of this bill and our hope for the bill to be enacted into law.
2. You may have heard Ms. Webb suggest that the legislation
should not require the Commissioner of Social Security to
develop selection criteria for employment networks, including
professional and government certifications. What are your views
on this suggestion?
2. My understanding of Ms. Webb's comments regarding the
selection criteria for an employment network was her opinion
that the consumer could decide on their own who is or is not a
capable provider. It is the NARPPS position that well educated,
certified and experienced professionals should be selected for
the employment network but we take no position as to whom
should develop the selection criteria. We agree with Ms. Webb
that consumers are capable of making their own choice of
providers from the providers designated as an employment
network.
3. As you may know, our bill allows for the employment
network to choose between two reimbursement systems, one being
based on outcomes only, and the other being based on achieving
milestones and outcomes. We define outcomes as no longer being
eligible for cash benefits. We do leave it up to the
Commissioner, with advice from the Advisory Panel, to set up
this milestone payment process. What advise would you give the
Commissioner as to how to set up the milestone payment plan?
3. NARPPS would advise the Commissioner that milestone
payments be provided to the employment network at the time that
a return to work plan has been developed by the recipient and
the provider, at the initial job placement, and that final
payment should be made when the recipient is no longer eligible
for cash benefits.
4. I understand that the State Vocational Rehabilitation
(VR) agencies receive priority referral of SSDI and SSI
beneficiaries for services. Last year, SSA implemented an
Alternate Participant program that allows private sector
providers to serve SSDI and SSI beneficiaries who have been
turned down by the State VR agencies. While this program seems
to be a move in the right direction, I've heard there have been
difficulties. Can you describe your experiences with the
Alternate Participant program?
Follow-up: Are their lessons learned that we should address
in this legislation?
4. The Alternate Participant program is definitely a step
in the right direction. Missing from the program is the option
of milestone payments to providers, which effectively precludes
all but the largest private companies from participating and
thus limiting the amount of qualified providers available to
recipients. Also missing from the programs are incentives such
as tax credits and extended health benefits for the recipient.
As H.R. 3433 addresses these issues, NARPPS believes that when
enacted and fully implemented, it will serve as a significantly
more effective program than the Alternate Participant program.
The lesson to be learned, as NARPPS sees it, is for
consumer choice, consumer incentives and broadening the section
of qualified professionals available to assist the recipients
in finding gainful employment.
Questions and Subsequent Answers from Mr. Burns
1. Is it true that State Vocational Rehabilitation (VR)
agencies define successful rehabilitation as the beneficiary
working and earning over $500 a month for 9 months?
Follow-up: Most people would define successful
rehabilitation as getting a job, maintaining that job, and
ultimately coming off the Social Security rolls. The bill's
payment system rewards providers in such a way that the
provider will continue providing employment supports well after
9 months of earning over $500 a month. In fact, the bill
rewards providers up to 5 years as long as the individual is
off the rolls because of work activity. Do State VR agencies
continue working with beneficiaries after they have been
reimbursed for an individual?
The definition of a ``successful rehabilitation'' in the
national public VR program is defined by federal law and
regulation, not by state agencies. According to federal
regulations (Section 361.56) promulgated by the U.S. Department
of Education the following requirements must be met in order to
claim a successful employment outcome: (a) The provision of
services under the individual's IWRP has contributed to the
achievement of the employment outcome; (b) The employment
outcome is consistent with the individual's strengths,
resources, priorities, concerns, abilities, capabilities,
interests, and informed choice; (c) The employment outcome is
in the most integrated setting possible, consistent with the
individual's informed choice; (d) The individual has maintained
the employment outcome for a period of at least 90 days; (e) At
the end of the appropriate period under paragraph (d) of this
section, the individual and the rehabilitation counselor or
coordinator consider the employment outcome to be satisfactory
and agree that the individual is performing well on the job.
State VR agencies also participate in the Social Security
reimbursement program for our clients who are Title II and
Title XVI beneficiaries. In those instances, success is defined
and determined by Social Security law and regulations which is
the maintenance of employment that leads to the termination of
Social Security benefits.
Finally, state VR agencies can and do provide
rehabilitation services to individuals after they have
terminated Social Security benefits. The agency can provide
those service under a ``post-employment'' option or can open a
new service case if the individual is requesting a new and
substantive Individualized Written Rehabilitation Program
(IWRP).
2. You say that State VR agencies serve approximately a
half million beneficiaries per year. Yet, in 1996, State VR
agencies were reimbursed for only a little over 6,000
beneficiaries. I think that equates to about a 1% success rate.
Recognizing that fear of losing health care benefits and cash
benefits contribute to beneficiaries' reluctance to work, what
are the keys to success, in your experience, that do enable an
individual to work for beyond the 9-month trial work period?
The critical element in a successful return to work program
is the availability of work incentives that are effective,
flexible, and do not result in a loss of a benefit until the
individual with a disability can afford to or can accommodate
the loss of the benefit. The current Social Security law and
regulations do not provide effective, flexible, or non-punitive
work incentives.
Legislation, to be effective, must eliminate the so-called
``earnings cliff'' and other powerful disincentives that exist
in the current law. True work incentives would permit a
graduated loss of benefits, both health care and cash, to
assure that SSA beneficiaries only lose benefits after they
have achieved an adequate level of self-sufficiency. In
addition, work incentives should be flexible to permit the
individual to return to a beneficiary status expeditiously if
the employment situation fails.
Social Security law, regulations, and policy maintain a
bias of ``all or nothing.'' In SSA's view, the individual is
either totally disabled or they are not disabled. This is a
very significant shortcoming of the Social Security program;
its failure to support the fact that persons with very severe
disabilities can work, but may require an accommodation in
order to do so. The accommodation that is required is a program
of work incentives that is effective, understandable, and non-
punitive.
An example of this bias within Social Security is the data
presented by SSA that state VR agencies in 1996 were reimbursed
for only a little over 6,000 beneficiaries. This figure greatly
underestimates the number of beneficiaries that went to work as
a result of VR services because it does not include individuals
that use the existing, albeit ineffective, work incentives that
are currently available (e.g., 1619 A and B waivers, PASS) or
individuals that deliberately keep their earnings under the SGA
so they do not fall off the ``cliff'' in terms of the loss of
benefits on which they are dependent. Over and above the 6,000
beneficiaries reimbursed annually by SSA, an additional forty
thousand (40,000) plus SSI/DI beneficiaries go to work each
year as a result of the work of the public VR program. The
disincentives which exist in current SSA law encourage these
individuals to limit or leave their work in order to retain
benefits.
Additionally, the record should reflect the following:
16,000 represents the number of claims SSA is able
to process, not the number of claims eligible for reimbursement
VR agencies have increased the number of claims
submitted for reimbursement by 21.5% since FY 96
VR agencies have increased the number of claims
submitted for reimbursement by 40% since FY 96
3. You mention that currently, the State Disability
Determination Services refer 10 to 15% of their applicants. Why
is this percentage so low? Have VR agencies and State DDSs
worked together in the past to see how they could increase the
referral rate? In fact, don't the majority of State DDSs report
directly to the State VR Director?
The core issue is not the percentage of applicants referred
or the referral rate. Both of those measures could be
substantially increased and not impact the number of
beneficiaries that go to work. The core issue is when
individuals are referred for vocational rehabilitation services
and who is referred. Traditionally both those issues (when and
who) have been controlled by Social Security through its
program operations manual system (POMS) under which state DDS
agencies are required to operate. Although a number of state
DDS agencies report to the State VR Director, Social Security
has maintained very strong operational control, at a policy
level, regarding all elements of administration.
Clearly, the time the individual is most receptive to
participate in vocational rehabilitation services is not after
struggling with the SSA system for 1, 2, or 3 years, and
finally being determined as ``totally and permanently''
disabled from working.
Additionally, SSA needs to reexamine its POMS guidelines
regarding appropriate referrals to VR. Nationally, 65-70% of
SSI and SSDI claims are denied. It is not unusual or
unexpected, therefore, to see state DDS agencies making
significantly more referrals of ``denied'' claimants than
``allowed'' beneficiaries. By weighting the referral pool to
state VR services of ``denied'' claimants, the current system
fails to get what should be the targeted group (allowed
beneficiaries) efficiently into the service delivery system.
4. You suggest an evaluation is necessary to determine the
optimal time for a referral for rehabilitation services. How
would you see such an evaluation working? Under this
legislation, the individual receives the ticket once they are
allowed benefits and upon a CDR. They then decide when to
choose to use the ticket. Isn't the consumer in the best
position to decide when it is best for them to take advantage
of the ticket?
As a practical matter, at present 40% of SSI/DI
beneficiaries served by the Public Vocational Rehabilitation
program are walk-in or self referrals. In contrast, only 4% of
SSI/DI beneficiaries known to the Public VR program were
referred by SSA or the state DDS agency. The reality is that
beneficiaries are already exercising their choice of when and
how to participate in a rehabilitation program. This again
illustrates that the underlying barrier to an effective SSA
return to work program is the availability of effective,
flexible, and non-punitive work incentives.
We would recommend that SSA utilize a pilot program to
study the success rate of making referrals to state VR services
at an earlier point than when the claim is fully adjudicated
(which is the current SSA policy). There is a widely held
belief that if the referral of appropriate individuals for VR
services was done earlier in the process, rather than at time
of final decision, the success rate in attaining SGA would be
increased. Under a pilot program, in instances of a ``presumed
determination'' (PD) of eligibility for benefits by the SSA
worker at time of application, an individual would be referred
immediately by the local SSA office for state VR services. The
pilot would examine the success rates for attaining SGA for
referrals from the pilot versus ``end-of-process'' referrals.
5. You make what I consider a good recommendation--that SSA
take the opportunity at every contact with a beneficiary to
reinforce and promote employment. Can you provide more specific
information on how SSA should go about promoting employment?
Through a systematic process analysis, SSA should determine
the ``critical junctures'' that its staff and organization
interact with claimants, beneficiaries, and the general public
to determine when and how information on employment and VR
services is presented. The information can be as discreet as
public service announcements (PSAs) relative to persons with
severe disabilities working, to very specific information on
the VR process and resources for a claimant or beneficiary to
consider.
There are significant potential benefits of a very
aggressive and sustained public information and outreach
approach that emphasizes disability benefits as a dynamic and
flexible system rather than a permanent lifelong benefit for
all beneficiaries. First, it begins to frame a national policy
debate around the issue of disability and employment, i.e.,
that the concepts are not mutually exclusive and in fact the
expectation is that persons with disabilities work and have
meaningful careers. Secondly, the approach would begin to
change the Social Security law which also sees and supports
disability as a permanent inability to work thereby
``creating'' a permanent barrier to employment.
Questions and Subsequent Answers from Mr. Miller
1. Mr. Miller, you mention that the two year extension of
Medicare benefits will help, however you also say that further
health care security measures must be instituted. What measures
are you referring to?
Question one concerning further health care security
measures:
There needs to be an allowable buy-in to either Medicare or
Medicaid, depending upon the need, to provide wrap around
coverage. The ability to have needed services not otherwise
covered under an employers insurance program would enable those
individuals who have that need to remain employed and
productive. Personal attendant services would be an example of
this need. Mr. Chairman as you are aware the fear of losing
health care benefits and the inability to obtain affordable
medical insurance is one of the major deterrents to people
leaving the SSI/SSDI system. Individuals fear the difficulty in
reinstating Medicare/Medicaid, when a medical problem reoccurs
and they lose their job and their health insurance.
2. As you may know, our bill allows for the employment
network to choose between two reimbursement systems, one being
based on outcomes only, and the other being based on achieving
milestones and outcomes. We define outcomes as no longer being
eligible for cash benefits. We do leave it up to the
Commissioner, with advice from the Advisory Panel, to set up
this milestone payment process. What advise would you give the
Commissioner as to how to set up the milestone payment plan?
Question two as to how to set up the milestone payment
plan:
I think most of us realize that besides reaching SGA there
are two other defining points or milestones. The first would be
the actual signing of the individualized employment plan. This
is a moment of success because the individual and the provider
have developed and agreed to a path or plan that results in the
individual becoming as independent and self sufficient as
possible. The next milestone would be the employment date for
the job that is developed and expected to lead to SGA. Once SGA
is achieved the current proposal that there would be a payment
for each month the individual does not receive a benefit
payment due to work activity for up to 60 months should be
maintained. It should not be expected for Providers to assume
all the financial risk. There is a substantial benefit
available not only in a reduction of the monetary cost of SSI/
SSDI, but also to society and the economy as a whole. It has
been my experience that endeavors that can be undertaken as a
win-win situation for everyone involved will have the greatest
chance of success.
3. I understand that the State Vocational Rehabilitation
(VR) agencies receive priority referral of SSDI and SSI
beneficiaries for services. Last year, SSA implemented an
Alternate Participant program that allows private sector
providers to serve SSDI and SSI beneficiaries who have been
turned down by the State VR agencies. While this program seems
to be a move in the right direction, I've heard thare have been
difficulties. Can you describe your experiences with the
Alternate Participant program?
Follow-up: Are their lessons learned that we should address
in this legislation?
Question three, experiences with the Alternate Participant
program:
The actual process to become an Alternate Participant is
very lengthy and difficult to understand and complete.
A real fear from the beneficiaries of losing medical
benefits if they go to work.
Local SSA offices need to be more familiar with the
Alternate Participant program and be able to answer questions
concerning a particular case as it pertains to the program.
Preliminary information as to the benefits being received
by the beneficiary needs to be available. Beneficiaries are not
always sure of the mix of benefits they are receiving.
The information on the bulletin board needs to be more user
friendly. The format for referrals is such that the alternate
participant must each month wade through a sea of numbers to
see if anyone has been taken off or added.
Some individuals are referred who are already receiving VR
services.
SSA Publication No. 05-10050, How Social Security Can Help
With Vocational Rehabilitation, has wording under Refusal to
Accept Rehabilitation Services that scares people into thinking
they are going to lose their benefits, even if they are not
able to participate.
Lessons learned that could be addressed in this
legislation:
As we are all aware, the benefit of going to work has to
outweigh the benefit of continuing to receive SSI/SSDI. The $1
reduction for each $2 earned along with extended medical
coverage is the right direction.
The Alternate Participants should not be required to assume
all the risk. If that remains the case then the number of
individuals under the Alternate Participant program will
continue to be small.
Informing and educating beneficiaries as to the services
available. It is important that SSI/SSDI beneficiaries
understand and believe that the system can help them and that
there are choices available to provide those services.
Questions and Subsequent Answers from Ms. Tishman
1. You mention that Project With Industries recently, in
one year, placed 11,000 persons with disabilities into full and
part-time jobs. Of these how many were SSDI beneficiaries and
how many were SSI beneficiaries?
Follow-up: Do you forsee Project With Industries programs
being interested in becoming employment networks?
Follow-up: What are the unique needs of SSI and SSDI
beneficiaries based on your experience?
1. Number of SSDI and/or SSI recipients who receive
Projects With Industry Services:
The Rehabilitation Services Administration initially
required PWI's to determine whether recipients of PWI services
were receiving SSDI or SSI when they were placed into
employment. At that time (early 1990's) PWI's reported that
approximately 2,420 (22%) of the 11,000 persons placed in one
year had been receiving SSDI or SSI. RSA no longer requires
this information to be tracked. However, our national PWI
organization, I-NABIR, reports that those PWI's who do continue
to track this information report that the percentages have
remained about the same. I would assume that, based on the
reporting relationship between RSA, the State VR programs and
PWI's, that these numbers were included in those reported to
your committee by CSAVR. My organization, the Career and
Employment Institute, continues to track this information and
during the last project year, 170 or 27%, of all persons we
placed were SSI/SSDI recipients.
Projects With Industry programs are extremely interested in
becoming employment networks. PWI programs have clearly
demonstrated their ability to achieve successful outcomes with
SSDI and SSI recipients. PWI's have a very strong partnership
with the business community through their business advisory
councils, which have lead to meaningful employment for tens of
thousands of persons with disabilities. PWI's also encompass a
wide spectrum of providers including organized labor, trade
associations and foundations, community colleges, for-profit
providers and community rehabilitation programs. The Career and
Employment Institute for instance, is utilizing centers for
independent living as placement assistance sites. Our PWI
expertise in working with business along with the strong
consumer focussed service delivery system of independent living
centers are catalysts in overcoming the barriers to employment
and independence. In serving SSI and SSDI recipients we are
most challenged by concern regarding their medical coverage and
anticipated accompanying work related expenses. Most
individuals would be more amenable to job pursuits if they had
a better understanding of the benefit system.
2. You mention your concern that about the time it will
take to fully implement the provisions of the bill. How quickly
a ramp-up time do you believe is realistic?
2. Ramp-up time.
The immediate elimination of the four-month period during
which state VR has the ``right of first refusal'' would
certainly expedite the process. The determination of milestone
and outcome payments by SSA should be completed within 9-12
months in order to quickly expand the service delivery pool
available through alternate providers, PWI's and CARF
accredited programs.
3. I couldn't agree with you more that the success of the
Program will depend on the effectiveness of the implementation
strategies. We set up an Advisory Panel, made up of consumers,
providers, and employers to advise SSA on how best to proceed,
to ensure effective implementation. We are interested in any
feedback you might have regarding how to optimize the
effectiveness of the Advisory Panel. Do you have any
suggestions at this time?
3. Advisory Panel Effectiveness.
While I agree with the composition of the Panel, I do feel
that each member must be knowledgeable about the issues and the
systems regarding employment incentives and disincentives. The
process should be accessible to the community with specified
reporting timeframes to Congress. Utilization of the Internet
will create opportunities for increased involvement and
dissemination.
4. As you may know, our bill allows for the employment
network to choose between two reimbursement systems, one being
based on outcomes only, and the other being based on achieving
milestones and outcomes. We define outcomes as no longer being
eligible for cash benefits. We do leave it up to the
Commissioner, with advice from the Advisory Panel, to set up
this milestone payment process. What advise would you give the
Commissioner as to how to set up the milestone payment plan?
4. Milestone payment process.
I would recommend milestone payment at the following
intervals:
After the development of the employment plan;
Upon initial placement on the job;
Upon nine months of employment; and,
Based on monthly savings to the fund over a 60-
month period.
5. I understand that the State Vocational Rehabilitation
(VR) agencies receive priority referral of SSDI and SSI
beneficiaries for services. Last year, SSA implemented an
Alternate Participant program that allows private sector
providers to serve SSDI and SSI beneficiaries who have been
turned down by the State VR agencies. While this program seems
to be a move in the right direction, I've heard there have been
difficulties. Can you describe your experiences with the
Alternate Participant program?
Follow-up: Are their lessons learned that we should address
in this legislation?
5. Problems with the current Alternate Provider program.
SSDI and SSI recipients should be given the opportunity to
choose their provider at the beginning of the process. Under
the current system, applicants must wait four months while VR
determines whether or not they will serve the individual before
referring on to another provider.
The current Alternative Provider system assumes that
organizations have the ``venture capital'' available to sustain
the cost of service provision until people achieve nine months
of employment; after which, providers will be reimbursed the
actual cost of service. There is no provision to cover costs
for persons who are not successful in achieving or retaining
employment for whatever reason. SSDI and SSI recipients usually
have serious and multiple barriers to employment. Success is
not only impossible; it's an unrealistic expectation for any
group. In the current system, state VR agencies use monies
under the Rehabilitation Act to fund the services to SSDI/SSI
recipients. In essence, VR is receiving funding from RSA and
SSA for the same individual, but at different points in the
service delivery.
Chairman Bunning. I would like to thank all of the
witnesses today who have shared with the Subcommittee their
comments on the Ticket to Work and Self-Sufficiency Act of
1998. We appreciate hearing your views, and will examine each
one of your recommendations as we move this legislation
forward. For those interested, we hope to mark this bill in the
Full Committee sometime next week.
The Subcommittee will stand adjourned.
[Whereupon, at 4:36 p.m., the hearing was adjourned subject
to the call of the Chair.]
[Submissions for the record follow:]
Statement of Dr. Robert S. Rudney, Chairman, EXCEL! Networking Group,
Inc.
Mr. Chairman and Members of the Subcommittee,
As Chairman of the EXCEL! Networking Group, I strongly
endorse the ``Ticket to Work and Self-Sufficiency Act of
1998.'' EXCEL! is a nonprofit, Washington-area self-help group
focusing on competitive employment and career development. Run
entirely by and for people with disabilities, EXCEL! seeks to
enhance their self-determination and advancement through its
educational, training, mentoring, and outreach programs.
Many of EXCEL!'s members are Social Security Disability
recipients who are seeking to return to work. These members
have expressed their acute dissatisfaction with the arcane
regulations governing conditions for return to work, with the
inability of many Social Security Administration employees to
explain clearly these regulations, and with the incompetence of
state vocational rehabilitation counselors to assist and advise
them in their job searches.
EXCEL! was explicitly established to empower people with
disabilities by making them responsible for program design and
implementation and thus overcoming the passivity and dependency
traits so prevalent among clients of the vocational
rehabilitation system. In the process, EXCEL! explicitly
welcomes cooperative arrangements and partnerships with
employers, counselors, and training organizations outside the
rather insular disability community.
The 1997 United Way Fairfax-Falls Church State of the
Community Report; Partners in Progress cited EXCEL! in a
special article for its efforts at developing partnerships with
the business community. EXCEL! is actively involved in the
Potomac Knowledgeway Project's Abilities Team, which seeks to
ensure that people with disabilities are full members of the
on-line community. The Potomac Knowledgeway Project is a
coalition of high-tech companies and institutions working to
make the Greater Washington region a global leader in the
digital age. EXCEL! also participates in regular meetings of
Project SAVE, a networking organization for corporate human
resources professionals. In addition, EXCEL! is working closely
with Integrated Disability Resources, a Kemper Insurance
subsidiary, that is introducing innovative ``return to work''
programs to assist its disability claimants. For 1998, EXCEL!
intends to focus on building additional bridges to the
corporate sector, in part through a June 10th Washington
conference, ``No More Crutches: New Approaches to Employment
Counseling of Persons with Disabilities.''
EXCEL!'s training efforts focus in three areas:
personal accountability and goal-setting;
On September 19-20, 1997, EXCEL! co-sponsored an intensive
workshop on ``Crafting and Achieving a Life Vision,'' led by
Lee Bussard of the Pacific Institute (Seattle). Bussard (who
was born with cerebral palsy) has been instrumental in
developing the Pacific Institute's award-winning Investment in
Independence curriculum that teaches effective thinking skills
and affirmation techniques to people with disabilities.
Incorporating much of this curriculum, the EXCEL!workshop
provided valuable tools for building self-esteem and self-
efficacy and for sustaining personal growth and career success.
Six support sessions following the workshop reinforced
Bussard's motivational teachings. EXCEL! seeks to incorporate
this curriculum into its 1998-99 training program.
job search strategies and techniques
In November 1997, EXCEL! contracted with Morris Associates,
a prominent Washington career counseling firm, to provide
comprehensive workshop strategy sessions on career assessment,
resums, interviewing, employment resources, and networking,
followed by support meetings designed to keep participants' job
searches on track. EXCEL! also maintains a productive mentoring
partnership with the Washington Chapter of the International
Association of Career Management professionals. In 1998, EXCEL!
will work together with the Five O'Clock Club, a nationally
recognized job search strategy group run by professional career
counselors, to assist EXCEL! members in their job searches.
computer skills acquisition.
EXCEL! is arranging computer classes with three
professional organizations: the Support Center of Washington, a
training organization serving the local nonprofit community;
HandsNet, a nonprofit providing hands-on Internet instruction;
and the CURE Network, a self-help group of people with
disabilities dedicated to bringing the benefits of information
technology to the disability community. These three training
organizations offer EXCEL! participants a large degree of
flexibility and choice in pursuing instruction in computer
applications best-suited to their career objectives.
In summary, the EXCEL! program is a vivid example of the
useful contributions that persons with disabilities themselves
can bring to the networks of private service agencies
envisioned under the proposed legislation. While ``client
choice'' is key to assuring more responsive services, ``client
participation'' is critical to developing creative and
successful strategies for persons with disabilities to attain
rewarding competitive employment.
For further information, please contact: Dr. Robert Rudney,
Chairman, EXCEL! Networking Group, Inc.
Testimony of the Mental Health Liaison Group, Employment and Income
Security Committee
The Mental Health Liaison Group's (MHLG) Employment and
Income Security Committee focuses on the employment issues of
persons with mental illnesses, including vocational
rehabilitation, the federal social security and disability
programs, and disability programs in the private sector. The
Committee consists of members of the Mental Health Liaison
Group, a coalition that represents the views of mental health
consumers and providers to Congress and the federal government.
Persons with mental illness are the fastest growing
population on the Supplemental Security Income (SSI) program
and the Social Security Disability Insurance (SSDI) program.
People with mental illness make up the single largest
population on the SSI and SSDI rolls. They come on the rolls
earlier than people with other disabilities, and they remain
dependent on SSI and SSDI longer than individuals with other
types of disabilities. Consequently, the reforms considered
today will have a great bearing on persons with mental illness.
Despite numerous efforts in the past to reform the existing
federal-state public vocational rehabilitation program, the
existing public VR program simply does not meet the needs of
people with disabilities who are on SSI or SSDI. Its time-
limited, short-term approach to rehabilitation ignores the
episodic nature of mental illness and the likely intermittent
nature of employment that most people with severe and
persistent mental illness will face. Further, the public VR
system lacks the resources necessary to provide the long-term
employment supports needed by most people with mental
illnesses. Although most state VR agencies have attempted to
accommodate the vocational needs of persons with mental
illnesses, the structure of public VR program severely limits
this effort.
The Social Security Administration currently refers social
security beneficiaries to the state VR agency. It is then up to
the VR agency to provide the appropriate VR services or find a
provider that can meet those needs. This approach must change.
Several reports indicate that a mere six to ten thousand social
security beneficiaries leave the rolls through work each year.
A person on the SSI/SSDI rolls is more likely to die on the
rolls as a beneficiary than return to work. Clearly a new
approach is needed.
To be successful this new approach must:
Take into account the episodic nature of mental
illnesses and the likely intermittent employment patterns of
most people with mental illnesses,
Empower consumers to allow them to choose the
provider that will do the best job for them,
Provide fair and timely reimbursement to providers
when successful outcomes are achieved, and
Ensure that health care is available as the
individual begins their work effort, in short it must end the
current system that punishes people for trying to work.
H.R. 3433, The Ticket to Work and Self-Sufficiency Act of
1998, introduced last week by Congressman Jim Bunning (R-KY)
and Congresswoman Barbara Kennelly (D-CT), is a tremendous
improvement over current law. It will help vastly greater
numbers of people with mental illness move from dependence on
government benefits to independence through work. Here's why:
Empowers consumers
Giving beneficiaries a Ticket they can take to ANY provider
at ANY time gives consumers the choice they need to seek and
receive services from the provider who can best meet their
needs. H.R. 3433 ends the automatic referral to the state VR
agency and ends state VR's right of first refusal to serve any
beneficiary under the current Alternate Provider Program.
Establishes a Fair and Timely Reimbursement:
The current SSA Alternate Provider Program ``end loads''
the reimbursement to providers. Under current law, providers
receive no payment from SSA until a beneficiary is no longer
receiving Social Security cash benefits. This is unfair for
three reasons. First, the vocational rehabilitation effort for
persons with the most severe disabilities, including those with
a mental illness, means that it may take months or years before
an individual returns to work and then works their way off of
benefits. End loading the payment forces the VR provider to
weigh the ongoing costs of a long-term rehabilitation against a
payment that may only occur years down the road, forcing
providers to prognosticate the vocational capability of the
consumer, something that is absolutely impossible to do when
considering a person with a mental illness.
Second, by ``end loading'' the payment, smaller providers
that can not capitalize the long term costs of rehabilitation
are severely disadvantaged. Only large, well-financed providers
can afford to participate. Thus, smaller providers like
psychosocial rehabilitation agencies and consumer-run agencies,
as well as the people they serve, are treated unfairly.
Third, the one-point-in-time reimbursement in the Alternate
Provider Program provides no incentive to the provider to make
sure the individual remains employed. Instead, like with the
current public VR program, the consumer's case is ``closed''
when the payment is received. This is a serious flaw given the
episodic nature of mental illness.
H.R. 3433 will put an end to all three of these problems
through the establishment of a ``milestone'' reimbursement
system. Milestone reimbursements will allow providers to
receive ``installment'' payments when the individual goes back
to work and subsequently reduces their dependence on cash
benefits. Furthermore, spreading the milestone payments over a
60 month period will help ensure that consumers receive the
long-term employment supports they need to stay on the job. The
milestone system is a critical component of this legislation
and key to the success of the Ticket-to-Work concept.
In fact, Congress should repeal outright, on a state-by-
state basis, the Alternate Provider Program when the Ticket
Program becomes available in a state. Providers currently
participating in the Alternate Provider Program could be
grandfathered into the new pool of providers under the Ticket
proposal.
Extends Health Care:
Consumers on SSDI and SSI openly admit that just the fear
of the potential loss of health care benefits either stops them
from working altogether or severely limits their work efforts.
H.R. 3433 extends Medicare for two years, substantially
reducing this fear.
Establishes a Disabled Worker Tax Credit:
This credit will benefit consumers by allowing them to
account for the extraordinary expenses that many people with
disabilities face when they return to work.
Starts the Effort to End the SSDI ``Cash Cliff'':
The abrupt and total loss of cash benefits and the
consequences that has for health care coverage when a
beneficiary goes to work is a severe obstacle to work. Again,
consumers openly admit that the fear of suddenly losing
benefits is a major barrier to work. We know that thousands of
people with mental illness on the SSDI cash rolls could work
more if the ``cash cliff'' were replaced by a graduated income
offset like that in SSI. H.R. 3433 begins the process of
eliminating the ``cash cliff'' by requiring the Social Security
Administration to conduct cash offset demonstration projects.
The legislation leaves some important issues to be
resolved. Already noted is the fate of the Alternate Provider
Program. Another important issue is how providers will ``sign
up'' to be providers to persons with Tickets to Work. Under the
current Alternate Provider Program, providers must complete a
300+ page document called an RFP that has simply overwhelmed
smaller providers who lack the expertise and staffing to
complete such a document. The new Ticket system must be simpler
if consumer choice is to be maximized. Thousands of providers
sent ``Letters of Intent to Participate'' in SSA's Alternate
Provider Program. Only slightly more than 200 have been
accepted, and only a handful of persons have been served.
Replicating these dismal results in the Ticket proposal would
be tragic. The MHLG Employment and Income Security Committee
believes that these issues, though critical, can be resolved
simply and easily, and we will work with Congressman Bunning
and Congresswomen Kennelly to achieve that goal.
To the great credit of Congressman Bunning and
Congresswoman Kennelly, H.R. 3433 does much more than simply
establish new programs or end currently ineffective ones. It
starts the long-delayed transformation of the nation's
disability benefit program from one of being a cash-welfare
benefit distribution system that demands total and permanent
dependence to one where employment and work are supported and
where independence is encouraged and favored.
Mental Health Liaison Group Employment and Income Security Committee
Members
International Association of Psychosocial Rehabilitation
Services
Judge David L. Bazelon Center for Mental Health Law
National Alliance for the Mentally Ill
National Association of Social Workers
National Council for Community Behavioral Healthcare
National Mental Health Association
Minnesota Consortium for Citizens with Disabilities
March 15, 1998
The Honorable Jim Bunning, Chair
Subcommittee on Social Security of the Committee on Ways and Means
United States House of Representatives
B-316 Rayburn House Office Building
Washington, D.C. 20515
Dear Congressman Bunning:
The Minnesota Consortium for Citizens with Disabilities (MN CCD) is
grateful for this opportunity to provide a written statement to your
committee on the ``Ticket to Work and Self-Sufficiency Act of 1998.''
The Consortium is a broad-based coalition of organizations representing
persons with a wide variety of disabilities. A listing of MN CCD
members is attached.
We strongly support your committee's efforts to remove barriers to
employment faced by persons with disabilities. In particular, the
provision for tax credits and the requirement that the Social Security
Administration test a gradual offset of Social Security Disability
Insurance (SSDI) benefits are both important steps forward.
We are pleased that the committee recognizes the fear of losing
health care coverage as one of the primary barriers confronting persons
with disabilities who wish to work. The Act's extension of Medicare
benefits will provide help for some, but does not get to the root of
the problem. Neither employer-based health insurance, nor Medicare
cover personal assistance services, nor do they offer comprehensive
coverage of special medications, equipment, supplies and other long
term supports commonly needed by persons with disabilities. Because
such coverage is only offered by Medicaid, many individuals have no
choice, but to rely on Medicaid, even if they have access to Medicare.
To remain eligible for Medicaid under existing policies, they have no
choice but to limit or forego employment, even if they are well
qualified and highly motivated to work.
The existing SSI 1619(b) program provides continued Medicaid
coverage for some individuals with disabilities as an incentive to
work. Unfortunately, persons on SSDI and many others with disabilities
do not qualify for SSI 1619(b), even though they have prior work
history and would be good candidates for successful employment, given
the proper long term health care supports.
The Minnesota House and Senate recently passed the attached
resolution urging Congress to remove Medicaid policy barriers to
employment. The resolution calls for legislation giving states the
option to allow working persons with disabilities to receive continued
Medicaid coverage to address unmet health needs when they become
employed.
Everyone would benefit from legislation removing Medicaid barriers
to employment:
Individuals with disabilities would gain opportunities to use their
skills and become self-sufficient. They would no longer be forced into
poverty to have their long term health needs met.
Employers would gain an expanded pool of qualified, motivated
candidates for positions that are difficult to fill in a shrinking
labor market. Employers would not be expected to pick up any more
health care costs than they would for non-disabled employees.
Taxpayers would benefit as working people with disabilities reduced
or eliminated their dependence on public programs, including Medicaid,
SSI, SSDI, Medicare, Food Stamps, subsidized housing, and a variety of
other federal, state and local programs. Tax revenues would increase as
more people with disabilities became taxpayers themselves.
While we understand that issues pertaining to Medicaid fall under
the jurisdiction of the Commerce Committee, substantial savings to
Social Security and Medicare could be gained if people with
disabilities were no longer faced with the very real fear of losing
long term health supports that are only covered by Medicaid.
Thank you again for initiating this legislation to remove barriers
to employment of persons with disabilities. We hope your committee will
take further leadership in promoting legislation to remove the
significant disincentives to employment created by existing Medicaid
policies.
If you have any questions, please don't hesitate to contact us. We
deeply appreciate this opportunity to comment.
Sincerely,
Anita Boucher, Chair
MN CCD Work Incentives Committee
Attachments
cc: Congressman Jim Ramstad
Congressman Martin Sabo
SF2699, as passed by MN Senate on 2/24/98 and by MN House on 3/10/98
A Resolution Memorializing the Congress of the United States to Remove
Medicaid Policy Barriers to Employment for People with Disabilities.
WHEREAS, seventy-four percent of working-age adults with
severe disabilities are unemployed; and
WHEREAS, many people with disabilities are highly dependent
on local, state, and federal assistance for support and
survival, particularly for necessary health care; and
WHEREAS, a 1995 Lou Harris poll reported that two-thirds of
unemployed people with disabilities are eager to work; and
WHEREAS, advances in technology, the civil rights
protections of the Americans with Disabilities Act, and the
current labor shortage are opening up many new employment
opportunities for people with disabilities; and
WHEREAS, current government policies, particularly those
relating to Medicaid, discourage people with disabilities from
working; and
WHEREAS, existing Medicaid work incentives are flawed and
are completely unavailable to people with disabilities who do
not qualify for the SSI 1619(b) program; and
WHEREAS, removing policy barriers to employment would
enable more people with disabilities to reduce their dependence
on Social Security, Medicaid, Medicare, subsidized housing,
food stamps, and other state, local, and federal government
programs; and
WHEREAS, becoming employed allows individuals with
disabilities to contribute to society by becoming taxpayers
themselves; and
WHEREAS, employer-based health care and government
programs, such as Medicare, Minnesota Comprehensive Health
Association, and MinnesotaCare, do not typically cover long-
term supports needed by people with disabilities; NOW,
THEREFORE,
BE IT RESOLVED by the Legislature of the State of Minnesota
that it urges the Congress of the United States to adopt
Medicaid buy-in legislation that would allow people with
permanent disabilities to retain Medicaid coverage to address
unmet health needs when they become employed.
BE IT FURTHER RESOLVED that such Medicaid buy-in
legislation should require individuals to take advantage of
employer-based health coverage, if available and affordable,
and should further require individuals to purchase needed
Medicaid coverage on a sliding fee scale, based on their
ability to pay.
BE IT FURTHER RESOLVED that the Secretary of State of the
State of Minnesota is directed to prepare copies of this
memorial and transmit them to the President and the Secretary
of the United States Senate, the Speaker and the Clerk of the
United States House of Representatives, and Minnesota's
Senators and Representatives in Congress.
Minnesota Consortium for Citizens with Disabilities
The Minnesota Consortium for Citizens with Disabilities (MN
CCD) is a broad-based coalition of organizations of persons
with disabilities, providers and advocates, dedicated to
improving the lives of persons with disabilities. We address
public policy issues that affect people with disabilities by
collaborating with others, advocating, educating, influencing
change, and creating awareness for understanding. The Minnesota
Consortium for Citizens with Disabilities includes:
Access Press
Accessible Space, Inc.
Advocating Change Together
Alliance for the Mentally Ill of Minnesota
Alliance Health Care
Arc Minnesota
Arc of Anoka and Ramsey Counties
Arc of Hennepin County
Arc Olmsted County
Association of Residential Resources in Minnesota
Becklund Home Health Care, Inc.
Brain Injury Association of Minnesota
Courage Center
Epilepsy Foundation of Minnesota
Executive Assistants
Fairview Multiple Sclerosis Achievement Center
Flaten, Kris, Consumer
Fraser Community Services
Gillette Children's Specialty Healthcare
Goodwill/Easter Seal of Minnesota
Independence Crossroads
Johnson, Cindy, Parent/Advocate
Lutheran Social Service of Minnesota
Mental Health Association of Minnesota
Mental Health Consumer/Survivor Network
Metro Work Center, Inc.
Metropolitan Center for Independent Living
MN Assn. of Community Mental Health Programs, Inc.
MN Assn. of Community Rehabilitation Organizations (MACRO)
Minnesota Disability Law Center
Minnesota Governor's Council on Developmental Disabilities
Minnesota Habilitation Coalition
Minnesota State Council on Disability
National Multiple Sclerosis Society-MN Chapter
Parenting Resource Center
Southeast Minnesota Center for Independent Living-UHHC, Inc.
Sister Kenny Institute
Slattery, Jamie, Consumer
Southern Minnesota Independent Living Enterprises and Services
Southwestern Center for Independent Living
St. Paul Rehabilitation Center
STAR Program
Tasks Unlimited
The Disability Institute
Tourette Syndrome Association, MN Chapter
United Cerebral Palsy of Central Minnesota
United Cerebral Palsy of MN
(Please note: This is only a partial listing. MN CCD
membership continues to grow.)
Statement of Paralyzed Veterans of America
Paralyzed Veterans of America applauds the efforts of
Congressman Jim Bunning and Congresswoman Barbara Kennelly to
refashion the Social Security disability insurance system so
that beneficiaries can participate more fully as productive
members of our society. By introducing the Ticket to Work and
Self-Sufficiency Act of 1998, these Congressional leaders have
taken a bipartisan step toward enactment of a law that removes
the major barriers to work that now confront recipients of
federal disability insurance.
Because 78 percent of PVA members receive either Social
Security disability insurance [SSDI] or supplemental security
income [SSI], PVA has identified certain principles to which we
believe any reform legislation should conform. Foremost is the
need to assure that individuals who leave the rolls to attempt
working should retain access to health care coverage. Right
now, SSDI recipients who go back to work can remain covered by
Medicare for free for up to 39 months, with a buy-in provision
after that. However, if their job carries no health insurance
coverage and they cannot afford to pay the full Medicare
premium, they risk being uninsured when that time expires. By
extending Medicare coverage for an additional two years beyond
current law, the Bunning-Kennelly bill takes a step in the
right direction. Ultimately, because employer-provided
insurance is so often inadequate or nonexistent, PVA would like
to see affordable Medicare coverage made available indefinitely
to beneficiaries returning to work, along with ancillary health
care benefits not covered by Medicare, such as personal
assistant services.
Second, PVA believes that SSDI and SSI recipients must have
the freedom and opportunity to select the services they need to
attain career and employment goals. By giving beneficiaries
``tickets'' to buy vocational rehabilitation, employment and
other support services from an expanded network of providers,
this bill provides the kind of consumer choice that will
improve the current system through increased competition.
Third, we applaud the requirement that the SSA Commissioner
conduct demonstration projects examining the merits of phasing
out DI cash benefits as income rises so that beneficiaries no
longer face the ``income cliff'' when they reach $500 a month
in earnings. Too many SSDI beneficiaries feel compelled to keep
their earnings below this ``substantial gainful activity
level'' [SGA] in order to preserve their limited benefits and
access to Medicare. This is a tragic waste of human potential.
Absent a phasing out of benefits, PVA would prefer that the SGA
limit, which has not been increased since 1990, be made
consistent for all people with disabilities and indexed for
inflation. However, we recognize that fiscal realities make the
demonstration project the approach most likely to succeed in
finding an answer to this difficult question.
PVA has also called for tax incentives to assist SSI and
SSDI recipients with work-related expenses. It is heartening
that the sponsors of this bill have included a disabled worker
tax credit that would be available to all participants in the
program and that could be used to offset an array of expenses
from assistive technology to personal assistant services. Too
often, beneficiaries find that the costs of returning to work
outweigh the benefits. This will go a long way toward ``making
work pay.''
PVA finds many positive elements in the Ticket to Work and
Self-Sufficiency Act and looks forward to working with this
subcommittee and others in Congress to strengthen its value for
SSI and SSDI recipients. We commend Chairman Bunning and
Congresswoman Kennelly for initiating this process and offer
our commitment in transforming federal disability programs from
barriers to work to bridges to opportunity.
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