[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
THE SOCIAL SECURITY ADMINISTRATION'S
EMPLOYMENT SUPPORT PROGRAMS
FOR DISABILITY BENEFICIARIES
=======================================================================
HEARING
before the
SUBCOMMITTEE ON SOCIAL SECURITY
of the
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
MAY 19, 2009
__________
Serial No. 111-21
__________
Printed for the use of the Committee on Ways and Means
----------
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COMMITTEE ON WAYS AND MEANS
CHARLES B. RANGEL, New York, Chairman
FORTNEY PETE STARK, California DAVE CAMP, Michigan
SANDER M. LEVIN, Michigan WALLY HERGER, California
JIM MCDERMOTT, Washington SAM JOHNSON, Texas
JOHN LEWIS, Georgia KEVIN BRADY, Texas
RICHARD E. NEAL, Massachusetts PAUL RYAN, Wisconsin
MICHAEL R. MCNULTY, New York ERIC CANTOR, Virginia
JOHN S. TANNER, Tennessee JOHN LINDER, Georgia
XAVIER BECERRA, California DEVIN NUNES, California
LLOYD DOGGETT, Texas PATRICK J. TIBERI, Ohio
EARL POMEROY, North Dakota GINNY BROWN-WAITE, Florida
MIKE THOMPSON, California GEOFF DAVIS, Kentucky
JOHN B. LARSON, Connecticut DAVID G. REICHERT, Washington
EARL BLUMENAUER, Oregon CHARLES W. BOUSTANY, JR.,
RON KIND, Wisconsin Louisiana
BILL PASCRELL JR., New Jersey DEAN HELLER, Nevada
SHELLEY BERKLEY, Nevada PETER J. ROSKAM, Illinois
JOSEPH CROWLEY, New York
CHRIS VAN HOLLEN, Maryland
KENDRICK MEEK, Florida
ALLYSON Y. SCHWARTZ, Pennsylvania
ARTUR DAVIS, Alabama
DANNY K. DAVIS, Illinois
BOB ETHERIDGE, North Carolina
LINDA T. SANCHEZ, California
BRIAN HIGGINS, New York
JOHN A. YARMUTH, Kentucky
Janice Mays, Chief Counsel and Staff Director
Jon Traub, Minority Staff Director
______
Subcommittee on Social Security
JOHN S. TANNER, Tennessee, Chairman
EARL POMEROY, North Dakota SAM JOHNSON, Texas, Ranking Member
ALLYSON Y. SCHWARTZ, Pennsylvania KEVIN BRADY, Texas
XAVIER BECERRA, California PATRICK J. TIBERI, Ohio
LLOYD DOGGETT, Texas GINNY BROWN-WAITE, Florida
RON KIND, Wisconsin DAVID G. REICHERT, Washington
JOSEPH CROWLEY, New York
LINDA T. SANCHEZ, California
JOHN A. YARMUTH, Kentucky
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 May 12, 2009, announcing the hearing................. 2
WITNESSES
Bobbie Christensen, Ticket to Work program Participant, Mesa,
Arizona........................................................ 10
Robin Clark, Ticket to Work program Participant, Largo, Florida.. 6
Sue Suter, Associate Commissioner for Employment Support
Programs, Social Security Administration....................... 13
Cheryl Bates-Harris, Senior Disability Advocacy Specialist,
National Disability Rights Network, on behalf of the Consortium
for Citizens with Disabilities Employment and Training Task
Force and Social Security Task Force........................... 21
Susan Webb, President and Co-founder, National Employment Network
Association, Avondale, Arizona................................. 29
Thomas P. Golden, President, National Association of Benefits and
Work Incentives Specialists.................................... 34
Bruce Growick, Associate Professor of Rehabilitation Services,
The Ohio State University College of Education, Columbus, Ohio. 41
John Kregel, Center Associate Director and Director of Research,
Virginia Commonwealth University, Rehabilitation Research and
Training Center on Workplace Supports and Job Retention,
Richmond, Virginia............................................. 44
SUBMISSIONS FOR THE RECORD
American Network of Community Options and Resources, statement... 60
Austin Area Mental Health Consumer, statement.................... 64
Barbara Barbin, letter........................................... 65
Brenda Peterson, statement....................................... 65
Council of State Administrators of Vocational Rehabilitation,
statement...................................................... 66
Diana Bell, statement............................................ 69
Don C. Kandlbinder, statement.................................... 70
Don Fitch, Center for Career Freedom, statement.................. 70
Francoise Frigola, statement..................................... 72
Health and Disability Advocates, statement....................... 72
Joann Barnes, statement.......................................... 76
Joe Hennen, statement............................................ 76
Joe Ramirez-Forcier, Positive Resource Center, statement......... 79
John M. Connelly and Joseph Dunn, Ohio Rehabilitation Services
Commission, statement.......................................... 79
John Riley, statement............................................ 81
Kenneth McGill, statement........................................ 82
Laura L. Dawson, statement....................................... 83
Linda Landry, statement.......................................... 85
Marion Moore, statement.......................................... 89
Paralyzed Veterans of America, statement......................... 90
Paula Vieillet, Employment Options, statement.................... 91
Peter Kierpiec, statement........................................ 93
Randall Bosin, statement......................................... 95
Robert Wittmer, statement........................................ 96
Stephen J. Mitchell, Unum and Lara Heal, statement............... 96
Victor Quibas, statement......................................... 99
THE SOCIAL SECURITY ADMINISTRATION'S
EMPLOYMENT SUPPORT PROGRAMS
FOR DISABILITY BENEFICIARIES
----------
TUESDAY, MAY 19, 2009
U.S. House of Representatives,
Committee on Ways and Means,
Subcommittee on Social Security,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:03 p.m., in
Room 1100, Longworth House Office Building, Hon. John S. Tanner
(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
May 12, 2009
Congressman Tanner Announces a Hearing on
the Social Security Administration's Employment
Support Programs for Disability Beneficiaries
Congressman John S. Tanner (D-TN), Chairman, Subcommittee on Social
Security, today announced a hearing on the Social Security
Administration's (SSA's) employment support programs for disability
beneficiaries, including the Ticket to Work program. The hearing will
take place on Tuesday, May 19, 2009, in the main Committee hearing
room, 1100 Longworth House Office Building, beginning at 2:00 p.m.
In view of the limited time available to hear witnesses, oral
testimony at this hearing will be from invited witnesses only. However,
any individual or organization not scheduled for an oral appearance may
submit a written statement for consideration by the Committee and for
inclusion in the printed record of the hearing.
BACKGROUND:
The Social Security disability program provides essential income
security for millions of Americans who are unable to work due to
significant disabilities or disabling illnesses. However, SSA also has
an array of policies and programs designed to facilitate the employment
efforts of those beneficiaries who are able to attempt to work despite
their impairments.
SSA's employment support programs have a number of components. For
decades, the Social Security Act has included work incentive policies
that are designed to allow beneficiaries to test their capacity to
sustain work, and to provide a transition period between benefit
receipt and employment.
In 1999, Congress passed Public Law 106-170, the Ticket to Work and
Work Incentives Improvement Act (Ticket to Work Act), with the goal of
further strengthening employment supports for Social Security
disability beneficiaries. This legislation established a number of new
programs and policies.
A central component of the legislation was the Ticket to Work and
Self-Sufficiency program (Ticket to Work program), a program to expand
choice in vocational rehabilitation providers. Under this program, SSA
provides eligible beneficiaries with a ``ticket'' that can be used to
obtain employment services from a provider participating in the
program. These providers are referred to as Employment Networks (ENs),
and they include State Vocational Rehabilitation agencies as well as
other private and public (non-Federal) providers of employment support
services. Participation in the Ticket to Work program is voluntary for
the beneficiary and for the provider, and payments to ENs are tied to
employment outcomes.
The Ticket to Work program was fully implemented nationwide in
2004, but the participation rate for both ENs and beneficiaries was
lower than expected for the first several years after implementation.
To improve the program and increase participation, SSA issued new
regulations effective July 2008, and has significantly increased
outreach and marketing. The results of the Ticket program have been
closely monitored by an external evaluator, and a rigorous evaluation
of the revised program is ongoing.
The Ticket to Work Act also authorized two programs now known as
the Work Incentive Planning and Assistance (WIPA) program and the
Protection and Advocacy for Beneficiaries of Social Security (PABSS)
program. Under the WIPA program, SSA funds community-based
organizations to assist beneficiaries in understanding SSA's complex
work incentives policies and the effect of working on their benefits.
Under the PABSS program, SSA funds protection and advocacy systems to
provide advocacy services to help beneficiaries secure, maintain, or
regain employment. The authorization for both programs will expire on
September 30, 2009.
SSA is also developing or conducting several demonstration projects
to test new work incentive policies for Social Security disability
beneficiaries, including a sliding scale benefit reduction. However,
because SSA's demonstration authority for disability insurance
beneficiaries expired in December 2005, SSA can continue demonstrations
already initiated, but cannot begin new projects. Reports issued by the
Government Accountability Office in 2004 and 2008 raised concerns about
SSA's management of its demonstration projects and made recommendations
for ways to strengthen their planning and implementation.
In addition, an April 2009 report by the SSA Inspector General
found that SSA was not acting quickly enough to terminate the benefits
of disability beneficiaries who lose eligibility because they have
returned to work. This has been a longstanding concern. Past testimony
before the Subcommittee has reported that former beneficiaries have
been overpaid tens of thousands of dollars due to SSA's delays in
terminating benefits, even if beneficiaries have informed the Agency
that they are working. The threat of receiving large overpayments which
must later be repaid can be a significant work disincentive for
disability beneficiaries. In addition, the failure to terminate
benefits in a timely way increases costs to the Social Security Trust
Fund, as overpaid funds may not be completely recovered.
In announcing the hearing, Chairman Tanner said, ``Social Security
beneficiaries who strive to return to work despite severe disabilities
face many barriers. In 1999, Congress passed the Ticket to Work Act to
make their path easier. We look forward to learning more about how
Social Security's employment support programs are working and how we
can make them even more efficient and effective. We will also examine
the continued payment of benefits to individuals who have returned to
work, the hardships these overpayments create for the individual, and
the negative effect such payments have on the Social Security system.''
FOCUS OF THE HEARING:
This hearing will assess the impact of SSA's recent efforts to
improve the Ticket to Work program. The hearing will also examine the
implementation and effectiveness of the WIPA and PABSS programs, delays
in processing reports of earnings
by disability beneficiaries, and SSA's plan to strengthen its demonstrat
ion authority.
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noted above.
Chairman TANNER. If we could come to order, I just got a
buzzer. The best laid plans of mice and men. We are going to
have three votes in about 15 to 30 minutes. So we will try to
go ahead and get started so we can--probably have to suspend
for a few minutes, if you will allow that.
But I thank all of you for being here, to the Social
Security Subcommittee hearing today, which will focus on
employment support programs for disability beneficiaries, the
results thereof. We want to talk about the implementation of
the marketing efforts that SSA has undertaken to help people
get back into the workforce who so desire and who are able to
accomplish that fact. And we also want to touch on the
continuing disability review procedures.
I want to thank our Ranking Member, Mr. Johnson, and other
Members of the Subcommittee who are here today, and talk just a
minute about the programs here, the Ticket to Work Act that was
adopted by Congress in 1999 to try to help people who were on
disability gain gainful employment in the workforce, should
they be able to do so. And it was disappointing, in the least,
in that it failed to--in the initial stages--to attract the
kind of significant participation from both the employment
services providers and beneficiaries.
And so, last year the Social Security Administration issued
some changes that show some promise. And we want to focus on
those today and see if there are other things that we can do,
as a Subcommittee, to help with this program. We are going to
focus in that regard on the PABSS and WIPA programs that
provide advocacy and personalized assistance with work
incentives to help beneficiaries who want to go back into the
workforce.
These programs--the authorization of these programs, will
expire at the end of this fiscal year, and we want to use this
hearing as a groundwork to see what we need to do in that
regard, and we also want to look at the overpayment situation
from beneficiaries who have returned to the workforce, yet
still are receiving disability benefits. They are a burden on
those people who so receive, and of course it results in
inadequate funding to the Social Security Administration.
We have some very stimulating testimony to hear today. And
with that, I would like to turn it over to Mr. Johnson for any
comments you might have. Mr. Johnson.
Mr. JOHNSON. Thank you, Mr. Chairman. Looks like you
misjudged that vote.
Chairman TANNER. I know it.
Mr. JOHNSON. Or they did. As the Chairman indicated, this
Act was implemented in 1999. What we wanted to do was try to
get people back to work. And thanks to many, Social Security
assembled, piece by piece, a new ticket to work, to issue
tickets and pay for services available to over 10 million
people receiving benefits. They've worked to educate those
receiving benefits and the public about the program, recruited
new service providers, known as employment networks, and
developed and implemented new program rules.
By September of 2004, when the program was fully phased in,
over 11 million tickets had been issued and all State
vocational rehabilitation agencies and 1,300 employment
networks were enrolled in the program. Unfortunately, these
achievements were followed by serious setbacks. Congress
anticipated the new programs would need to be adjusted, and
provided the commissioner the authority to make the fixes along
the way.
But Social Security's ability to find problems and
implement solutions has been slow. For example, new program
regulations initially proposed in 2005 were met with broad
praise, but took more than 3 years before finally being put
into place. Even molasses would be embarrassed if it moved that
slow.
[Laughter.]
Mr. JOHNSON. This delay took the wind out of the sails of
the Ticket program. Employment networks withdrew, recruitment
of new networks stalled, and concerns that the program wasn't
working spread.
In addition, real choice of service and who provides the
service has barely materialized. As of December 2005, less than
one-half of the 1,300 employment networks had accepted a ticket
to provide services, and 88 percent of the tickets used were
assigned to State vocational rehabilitation agencies under the
traditional system in place before the program was created.
Most importantly, in a report issued last summer, Social
Security's Office of the Inspector General found that in fiscal
year 2005 Social Security made a payment for services resulting
in work for 3,800 of the 10 million who had received a ticket,
or less than one-tenth of 1 percent. The report concluded that
``implementation of the Ticket program did not appear to
increase the percentage of disabled beneficiaries who returned
to work, nor realize the outcomes and savings envisioned by the
Congress.''
Put simply, we were spending money and not getting any
results. Last week, we learned Social Security's looming
insolvency is worse. And in just 11 years, there won't be
enough payroll tax to pay full disability benefits. At the same
time, the American people face unacceptable delays when they
visit or contact a local Social Security office, call the 800
number or wait over 16 months for a decision on their
disability appeal before an administrative law judge.
Now, more than ever, how every taxpayer dollar is spent
matters. Programs that don't achieve results must be fixed, or
they ought to end. Fortunately, we are beginning to see
promising signs of success in the Ticket program, since new
regulations were implemented last summer. And our witnesses on
the first panel will remind us of the positive impact the
Ticket program can have when it works.
The question we need to answer today is, can we get the
Ticket program to achieve the results Congress and the
taxpayers expect, and those with disabilities deserve? Thank
you, Mr. Chairman.
Chairman TANNER. Thank you, Mr. Johnson. The Chairman would
ask unanimous consent that all Members who wish to insert an
opening statement in the record be allowed to do so without
objection.
And what I think we can do--we have 15 minutes, and we have
these two witnesses, Ms. Clark and Ms. Christensen. I would ask
you, if you could, to hold your oral testimony to 5 minutes. We
will, of course, accept--without objection, any statements you
may wish to put into the record will be happily received. But I
think that we can have their testimony before we have to go
vote, and then we can move swiftly when we get through voting
to come back and reconvene.
So, Ms. Clark, we are delighted to have you here today, and
you are recognized.
STATEMENT OF ROBIN CLARK, TICKET TO WORK PROGRAM PARTICIPANT,
LARGO, FLORIDA
Ms. CLARK. All right. Thank you, Mr. Chairman, and Members
of the Subcommittee. Like you said, my name is Robin Clark, and
I am a participant of the Ticket to Work program. And thank you
for inviting me here today.
I remember panic, anxiety, fear, and the realization that
my nursing career was over. In the middle of a night shift
working with a mother about to give birth, the doctor was
present, the baby's head was beginning to crown, and then came
flashes of memory: The feeling of terror, physically sick,
unable to breathe, panic, and the intense need to escape.
I excused myself from the room, walked to the nurse's desk,
requested another nurse be sent to assist in the delivery.
There must have been something in my voice or my manner. I only
remember knowing that a nurse went into the room. Knowing that
my patient was cared for, I walked outside and rapidly
progressed from shaking to crying to sobbing. I have no memory
of how I got home that night. The last night I worked as a
labor and delivery nurse was on October 27, 1998.
I am a registered nurse, and also have a bachelor's degree
in education. As a registered nurse, I was trained to care for
others. Somewhere along the line, I forgot to care for myself.
That night was a culmination of years of developing physical
and emotional stresses that I never dealt with, trying to
continue to do a job that I was really unable to do at that
point.
I had multiple diagnoses of depression, anxiety panic
disorder, post-traumatic stress disorder. And, at that time,
due to medication and other issues, my weight had escalated to
425 pounds. I am sure I don't have to review all the list of
back and other medical conditions and co-morbidities that went
along with that. I couldn't stand for more than 5 minutes, I
couldn't walk. I couldn't do basic household chores to care for
my family, shop, or anything like that, not to mention panic-
anxiety attacks when I went out in public.
Suicide for me often seemed to be the only option. My
mind's image of my life at that time is best described as a
long, deep black hole with sporadic tree branches. I was
falling at a rapid rate of descent. I was dying. Initially,
just free-falling, and then, with help, I reached out and
grabbed onto a branch, stopping the fall.
I remember thinking, somewhere along the line, as I did
start to feel better, that I did still have a brain, and that I
was capable of learning. I had proved that before. In June
2002, I received a letter from Social Security Administration,
informing me of this new program, the Ticket to Work. My
ticket--originally, I was contacted with a confirmation letter
and never heard from the Agency again.
Then, in 2003 I was notified that my ticket had been
reassigned. At that point, I contacted Paula Vieillet at
Employment Options, and made an appointment to work with her. I
was embarrassed when I made that appointment because here I
was, with two degrees, a supportive husband and a family. Why
am I in this situation? I shouldn't be here.
I worked with Paula, and learned to write resumes. You
would think, as a professional, I would have been better at
writing resumes, but no, I wasn't, because after I got my first
nursing job, I never interviewed for another job, because
recruiters came to me. I had a specialty certification, and I
was known in my community as a good nurse.
My first job attempt was in July 2002, as a home health
nurse, but I was unable to stand long enough to do the more
complex treatments. I worked with Paula, who was very
encouraging. The techniques that she had which helped was she
had a book that she wrote, which was teaching people in their
rights in the job, in the Americans with Disabilities Act, that
I didn't have to disclose my disability, but that I had to
define and redefine what--a job I was able to do. She taught me
on interview skills. She coached me on techniques such as, you
know, making the followup phone calls afterward, guidelines for
dressing.
Most of all, what I received from Paula was if I didn't get
a job offer I still had worth as a person, realizing that, with
each job, I was gaining, you know, new skills.
I had taken a position with a substance abuse treatment
facility doing utilization management. It was low-paying for
what nurse salaries go, but again, I wanted to work. The stairs
there were an issue. There was supposed to be an elevator, but
there was no elevator that ever worked. Eventually, I did end
up leaving that position because they also eliminated the
utilization management department.
Then, in February 2005, I started working for a company
that did computer Medicaid in-patient reviews. That was
something I could do. I progressed from there. Today I am 200
pounds lighter, and I work as a nurse, doing telephonic medical
case management for Medicaid and Medicare members, which is
interesting. Lots of times, when my members are ready to return
to work--I have plenty that are on disability--I try to refer
them to vocational rehab and a Ticket to Work program.
I would like to thank you for this opportunity to tell my
story, as this month I have been off of cash benefits for 5
years. I received the cash benefits for 5 years. I have been
off for 5 years. And this month I graduate from the Ticket to
Work program. Thank you.
[The prepared statement of Ms. Clark follows:]
Prepared Statement of Robin Clark,
Ticket to Work Program Participant, Largo, Florida
Mr. Chairman and Members of the Subcommittee, my name is Robin
Clark. I am a participant in the Ticket to Work program. Thank you for
inviting me here today.
I remember panic, anxiety, fear, and the realization my nursing
career was over. I was in the middle of a night shift working with a
mother about to give birth, the doctor was present, the baby's head was
beginning to crown, and then came the flashes of memory: The feeling of
terror, physically sick, unable to breathe, panic, and the intense need
to escape. I excused myself from the room, walked to the nurse's desk,
requested another nurse be sent to assist in the delivery. There must
have been something in my voice or my manner, I only remember knowing a
nurse went into the room. Knowing my patient was cared for I walked
outside and rapidly progressed from shaking, to crying, to sobbing. I
have no memory of how I got home that night, as much of my life at that
time is overshadowed by the illness. The last night I worked as a labor
and delivery nurse was October 27, 1998.
I am a registered nurse and also have a bachelor's degree in
education. As a registered nurse, I was trained to care for others.
Somewhere, I forgot to care for me. That last night culminated in years
of treatment for depression and multiple physical conditions. I was
hospitalized for depression, unable to find medication with side
effects with which I could live or work. They affected my memory. I had
tremors, headaches, body aches, visual changes and over a 5 year period
I gained 125 pounds. It was no longer fair to my family, my co-workers
nor my patients to ignore. So in 1998 I took a medical leave from my
job and in March 1999 filed a claim for Social Security disability
benefits.
I was diagnosed with clinical depression, anxiety/panic disorder,
post traumatic stress disorder and my weight had reached 425 pounds. My
many co-morbidity's included sleep apnea, a fatty liver, elevated liver
enzymes, diabetes, severe degenerative disc disease, facet syndrome,
bone spurs in both thoracic and lumbar regions, spondylolisthesis and
spinal stenosis. Translation . . . physically there was constant pain;
I could not stand for more than 5 minutes at a time, shortness of
breath, could not shop for even the basics, most all daily activities
had to be adapted to sitting down. This by the way is how I had
continued to work as long as I did in a highly physical job, adapting
and choosing assignments when I could. I had trouble walking to the
mail box. I became housebound, retreating into a deep depression. I had
worked since the age of 14 years, that is what you do, you work. I had
worked as a nurse since 1979, 19 years. At that point I think I was in
bed for 6 months, paralyzed by pain and depression, rapidly becoming
agoraphobic. If I would try to attend a normal event like go to a
school open house, I could not. If physically I was able to get into
the building, I would have to leave when an anxiety attack would take
over. Suicide often seemed to be my only option. My minds image of my
life at that time is best described as a long, deep, black hole with
sporadic tree branches--I was falling at a rapid rate of descent, I was
dying. Initially just free falling. Then, with help--I reached out and
grabbed onto a branch. Stopping the fall.
Medications, psychologist, psychiatrist, medical doctors, priest,
family and prayer, all lifesaving tools. I began to feel better. I
remembered I had a brain and was capable of learning. Just because the
body could not work in familiar nursing or education positions, I began
to think about exploring my options. First I got involved with a
volunteer position at church and assisted in the opening of a pregnancy
crisis center.
In June 2002 I received a letter from the Social Security
Administration informing me of this new program called the Ticket to
Work. I was assigned to an agency that other than a confirmation letter
never met with me. In March 2003 I was notified my ``Ticket'' had been
reassigned. I contacted Paula Vieillet at Employment Options making an
appointment to meet. She explained the program and encouraged me to
work with her. I was embarrassed as here I was with two degrees, a
supportive husband and family. I should not be in this situation.
Working with Paula involved learning to write resumes. I had
minimal experience with resumes because after I got my first nursing
job I never applied for other jobs, the recruiters came to me. I had a
specialty certification and colleagues in my community knew I was a
good nurse. My first job attempt, July 2002, was as a home health nurse
but I was unable to stand long enough to do the more complex treatments
and left after 2 months. In June 2003, I interviewed and received a
position at a substance abuse treatment facility doing utilization
management chart reviews. A major barrier to this job was my office was
on the second floor and the elevator was always broken. The pay was low
as nursing salaries go, $14 per hour, and as it became more difficult
to climb the stairs, thankfully, the company eliminated the utilization
management department.
Paula was very encouraging as we continued exploring the job
market. I was looking at case management positions, a job title with
many interpretations and surprisingly difficult to get a position in
without ``experience.'' Paula worked with me on interview skills, post
interview techniques, guidelines for dressing and most of all if I did
not receive a job offer to realize--I still had worth as a person. The
encouragement and support provided along the way perhaps was the most
useful to myself: Realizing with each job I was gaining new skills.
In February 2005, I went to work for a company doing inpatient
medical reviews for the State of Florida Medicaid program. This was a
computer-based company, this I could do! I used my 20-plus years of
nursing knowledge while developing more skills. I became proficient in
the company's computer program and processes. When awarded a new
commercial contract a manager requested I join her case management
team. I had worked for 2 years when I received a diagnosis of cancer
which required I take a medical leave for surgery and radiation
therapy. One of my fears was how will this effect my ability to
continue working. I did return and, after being back for a few months,
was recruited by a larger company with a large and developing case
management department. The money was $12,000 more a year with equal
benefits. A difficult decision, as I felt a certain amount of loyalty
to a company that had given me my first real opportunity at re-entry
into the workforce. However, the professional opportunity was one I
needed to explore.
Today, I am 200 pounds lighter, I work as a nurse doing telephonic
complex medical case management with Medicaid and Medicare members and
plan to take the national exam for certification in case management
this year. I have been in my current position for 18 months, serve on
the Policy and Procedure committee, orient new nurses, requested to be
in the first group implementing a new computer program and recently was
asked if I would be interested in applying for a management position
within our case management department. I do continue to suffer from
chronic pain and continue to have physical limitations but have
progressed to where I can now walk for 30 minutes, in fact I can walk a
mile. I can do grocery shopping, housework and actually can go to the
mall. I volunteer at my church and I am the catechist for the youth
group. Recently I was able to go to Washington State to help my
daughter and her husband with the birth of their second child. Three
years ago this would not have been possible, 10 years ago unthinkable.
The Ticket to Work program offered me a way back to work, a way
back to my life. Not losing benefits while trying to find the correct
job helped me make the attempts, as the loss of benefits was a real
concern. My case worker with Social Security, Ms. Fitchpatrick, was
another great resource, answering my questions and confirming the
details about this program. In my current position I occasionally have
the opportunity to recommend the Ticket To Work program to my Medicare
members on SSDI when exploring their readiness for re-entering the
workforce. An offer of choice, an offer of hope.
Thank you for this opportunity to tell my story as this month my
ticket expires.
Chairman TANNER. Thank you, Ms. Clark. May I apologize in
advance, Ms. Christensen? We don't have time. We have to go
vote. They have this unreasonable expectation that, no matter
what you are doing, you are supposed to come vote.
So, if you will allow, we will go vote, and we should be
back within maybe 20, 25 minutes, hopefully. We will stand in
recess.
[Recess.]
Chairman TANNER. If we might come back to order, the good
news is those were the last votes of the day, so we won't
impose that on the witnesses or our guests today.
So, Ms. Clark, thank you very much for your testimony.
And, Ms. Christensen, you are recognized.
STATEMENT OF BOBBIE CHRISTENSEN, TICKET TO WORK PROGRAM
PARTICIPANT, MESA, ARIZONA
Ms. CHRISTENSEN. Thank you for inviting me today, Mr.
Chairman. My name is Bobbie Christensen. I was born with
Cerebral Palsy. Cerebral Palsy, as you can tell, affects me
specifically in my speech and it slows down all my physical
movements. It affects everybody who has Cerebral Palsy in
different ways.
I have been a Ticket to Work consumer for about 6 years. I
moved to Arizona from Colorado because I fell in love with my
fiance, at that time, and he, unfortunately, passed away in a
motor vehicle accident in December of 2001. That caused me to
go through some major depression at that point. And the job I
had at that point I lost because of the depression I was in.
About 6 months after that, my parents came down to assist
me and help me figure out what I wanted to do. And I decided
that I liked Arizona, and I wanted to stay there. So I decided
to pull myself up by my bootstraps and get an apartment.
And, from that point, I called Arizona Bridge to
Independent Living, asked them if they had a bus trainer. The
first thing I did was get bus-trained, so I could get around.
The second thing I did was contact Susan Webb at Arizona Bridge
to Independent Living, employment division. She then assisted
me in several interviews. About, I would say, a year into the
process, she helped me get an interview with the State of
Arizona. They also helped me prepare with the test to become a
program evaluator. I eventually landed the job. I have been
there for about 6 years now.
But about the third year into that process I was having
some physical issues because of my Cerebral Palsy. And without
the Ticket to Work program, I would not be able to afford the
medical that I would need to continue to work. That is very
important, even now, to still remain in my position, because
without the attendant care that I receive now, I would not be
able to work a full-time job.
So--and my goal is to stay off of State assistance, as long
as I can. And hopefully that will be forever.
Access is a very important part of the whole entire
program. And because of that, we need to keep this system
going. And hopefully, a lot more people will be willing to do
the program. Thank you very much.
Currently, I am married to a wonderful gentleman who was
actually my bus trainer when I got bus-trained. And I am fully
able to support myself on my job. Thanks to Susan and thanks to
the Ticket to Work program, I have been off Social Security
disability assistance also since 2001.
So thank you very much for giving me this opportunity. And
if you have any questions, please ask.
[The prepared statement of Ms. Christensen follows:]
Prepared Statement of Bobbie Christensen,
Ticket to Work Program Participant, Mesa, Arizona
Mr. Chairman, Members of the Subcommittee, my name is Bobbi
Christensen. I am a participant in the Ticket to Work program. Thank
you for inviting me here today.
I was born with Cerebral Palsy. Each person with CP has different
challenges. For me, my muscle movements are slow, including my speech,
so it takes me longer to do things. It is fair to say, however, that my
physical limitations are pretty significant. But having my disability
since birth, it is just a part of who I am. I just do what needs to be
done, including working.
I worked as a clerical assistant in the Sheriff's Office in Boulder
County, CO for 8 years. During that time I also attended Front Range
Community College. I earned an Associates Degree as a Paralegal
Assistant and another in Computer Science.
I met a wonderful man, fell in love, and we decided to get married.
He worked in Arizona so I moved there to be with him. Life seemed
perfect until my fiance was killed in a car accident. I was so
depressed I lost my job and became homeless.
After 2 years I contacted the local Center for Independent Living,
Arizona Bridge to Independent Living. I told them I needed help with
learning the bus system and finding a job. It turns out that ABIL is an
employment network under the Ticket to Work program.
I have participated in the Ticket to Work program for 6 years. ABIL
helped me with job searching. They had a relationship with the Human
Resource Manager for the State of Arizona Department of Economic
Security. DES was hiring about 100 Eligibility Interviewers at the
time. ABIL helped me with the rather complicated application process,
including providing me with a book to study in preparation for an exam
I needed to pass to be considered for the job.
Just as important as helping me get the job in the first place is
the availability of post-employment services. There have been several
occasions when I needed help with accommodations, including a transfer
from one office to another and evaluating my work station to identify
solutions to some of the problems I was having with the way things were
arranged.
In addition to direct employment services, it is a real advantage
that I can keep my State health care coverage (called AHCCCS in
Arizona). I need attendant care, and even though I have great insurance
coverage for medical, it doesn't provide the attendant care. Without
that I would not be able to work.
Life is good for me again. Along the way, I met and married my best
friend, Scott. We have been married for 4 years.
My original intent for returning to work after 2 years of
depression was because I had no one else to depend on for support. What
I discovered, however, is that returning to work actually helped pull
me out of the depression. The Ticket to Work program gave me that
opportunity.
I really hope many other people with disabilities can find their
way to this program and achieve the success in their life that I have
in mine.
Once again, thank you for the opportunity to share my story. I'd be
happy to answer any questions.
Chairman TANNER. Well, thank you very much, Ms.
Christensen, and also Ms. Clark. Your testimony is truly
inspiring, and gives, I think, hope to those who may wish to
join the Ticket program in the future. And we certainly
appreciate you being here and telling us of the benefits that
the program has afforded you, and hopefully thousands of others
in the future, as we try to help those people who are capable
of working and who desire to work to do so. It is truly an
inspirational story that you both have, and we thank you for
sharing it with us.
Mr. Johnson, do you have a question?
Mr. JOHNSON. No, thank you, Mr. Chairman. I just want to
echo what has been said. Thank you both for your testimony. It
was moving. We appreciate you all working the system for us--
for America, really. Thank you.
Chairman TANNER. Mr. Pomeroy is recognized.
Mr. POMEROY. Thank you, Mr. Chairman. I want to join my
colleague, Congressman Johnson, in saying what an inspirational
panel. Each of you, thank you very much for your testimony.
It strikes me that the worst thing we can do, in the effort
to try and help people, is to essentially force them away from
their inclinations toward independence, force them to work on
being dependant and disabled in order to continue to receive
essential security.
I believe we have, in some instances, inadvertently crushed
the spirit out of people to make certain their benefits weren't
jeopardized. You want to have some--I think any one of us, we
want to dwell on why we can't move forward? You know, we could
pretty well convince ourselves we can't move forward. And the
Ticket to Work changes all that dynamic.
And so, we have people with the heart and the guts that you
have shown, each of you outstanding witnesses. You can reach
independence, and we are going to help you every step of the
way. And everybody is better off, at the end of it.
I am disappointed with the numbers, ultimately, that we
have been able to reach through this program. I don't think we
have--I had much bigger hopes for this program. And I don't
quite understand why it has not been more of a tool for people
getting back to work. And I will be--and that is part of my own
education that I need to achieve.
But, bottom line, your testimonies let me know that, for
those who want to, and are determined, you have a program that
can help get you independence without sacrificing everything as
you take the first steps down that road. So, congratulations.
And thank you, Mr. Chairman. I yield back.
Chairman TANNER. Ms. Brown-Waite, you are recognized.
Ms. BROWN-WAITE. Thank you very much, Mr. Chairman.
I read your testimony last night. I had some constituents
here, so I wasn't actually here for your presentation. But
certainly you two are perfect examples of why we need to have
this program up and operating, and operating well. And my
district is just a little bit north of Largo, Ms. Clark. I
don't go down that far, but I call that the wealthy district.
But it's a beautiful, beautiful area.
And I am so delighted that, as a nurse, you were able to
return, not to the traditional nursing duties, but other
necessary nursing work. My youngest daughter is a nurse, and I
have often wondered if anything happened to her, how she could
transition into something like this. Thankfully, you are a
great role model, and I really appreciate the fact that you
have the--what they call the old-fashioned work ethic, and my
hat is off to both of you.
Thank you, Mr. Chairman.
Chairman TANNER. Thank you. Mr. Yarmuth, do you care to be
recognized?
Mr. YARMUTH. Thank you, Mr. Chairman. All I can say is that
I congratulate you on your successes, and thank you for sharing
your stories with us. I can't think of a more compelling case
for this program than you both have made.
And I would also just reflect for a second that this is one
example of a number of programs across government where we
actually have a very, very cost-effective program that returns
many, many times its investment back to society and, of course,
in this case, provides an incredibly important human benefit,
as well.
So, I commend you both, again, for your successes, and
thank you for being here. Thank you, Mr. Chairman.
Chairman TANNER. Well, thank you both very much. I think
you can tell from the comments of the Members that your
testimony has been both inspirational and effective. Thank you
for being here. We now will excuse you all. We have a second
panel. So, thank you so much.
Our second panel will be Ms. Sue Suter, from SSA; Ms.
Cheryl Bates-Harris, on behalf of the Consortium for Citizens
with Disabilities; Ms. Susan Webb, National Employment Network
Association; Thomas P. Golden, President, National Association
of Benefits and Work Incentives Specialists; Dr. Bruce Growick,
the Ohio State University, Columbus, Ohio; and Dr. John Kregel,
Virginia Commonwealth University in Richmond.
If you all could please take your seats, I have a statement
for the record here that Mr. Astrue, the Commissioner of Social
Security, has asked me to provide. And that is a commendation
for Sue Suter for her public service.
[Applause.]
Chairman TANNER. She has been a dedicated advocate for
people, it says, for decades. But as young as she looks, that
has to be a typo. But she has been--significantly contributed
to the Ticket to Work program and Social Security's efforts to
expand its return to work initiatives, as well as many other
endeavors. So thank you very much for your service, Ms. Suter.
And without any other interventions, Ms. Suter, I have you
first on our list to be recognized. Thank you for being here,
and congratulations on your commendation.
STATEMENT OF SUE SUTER, ASSOCIATE COMMISSIONER FOR EMPLOYMENT
SUPPORT PROGRAMS, SOCIAL SECURITY ADMINISTRATION
Ms. SUTER. And thank you for taking the time to do that.
That was very nice.
Mr. Chairman and Members of the Subcommittee, my name is
Sue Suter, and I am the Associate Commissioner for Social
Security's Office of Employment Support Programs. I have spent
much of my life working with individuals with disabilities to
obtain and retain meaningful work, and I thank you for the
opportunity to discuss our efforts to assist beneficiaries
returning to work.
Encouraging beneficiaries to return to work has been a part
of our disability program since its beginning. Both Title I and
Title XVI of the Social Security Act include comprehensive work
incentive policies designed to foster return to work. Thanks in
large part to the Subcommittee's leadership, Congress passed
the Ticket to Work and Work Incentives Improvement Act of 1999.
Today I will discuss several programs established by the Ticket
Act and briefly discuss the effect of work on benefits.
Congress established the Ticket program to expand the
universe of service providers, and to provide beneficiaries
choices in obtaining the services and supports they need to
find, enter, and maintain employment. Beneficiaries' employment
networks and State Vocational Rehabilitation (VR) agencies
voluntarily participate in the program.
Under the Ticket program, we issue a ticket to
beneficiaries who then have the option of using the ticket to
obtain services from an employment network or EN, or from a
State VR agency. Upon agreement with the beneficiary, the EN
may supply various employment support services. When the
beneficiary achieves certain work outcomes, we pay the
provider.
Our early experience showed that the Ticket program did not
meet our expectations. In response, we published several
revised regulations that we believed would significantly
enhance access to, and choice of services for beneficiaries
which would, in turn, improve the likelihood that the
beneficiary would return to work. These regulations became
effective last July.
Specifically, the revised regulations increase payment
rates to ENs, providing an incentive necessary to increase
their participation, and allowing more people to use EN
services. The regulations also encourage better coordination of
services provided by State VR agencies and ENs.
I am pleased to say that in the 11 months since the new
rules became effective, early data show promising trends in the
number of new EN contracts, the number of people using ENs, and
the number of individuals entering the workforce.
The Ticket Act also created two grant programs to
supplement the assistance available at our field offices, and
to help our beneficiaries understand the work incentive rules--
Work Incentive Planning and Assistance (WIPA), and Protection
and Advocacy for Beneficiaries of Social Security (PABSS)
grants. Through our grants to organizations with ties to the
disability community at the local level, these programs provide
an alternative to the help available at our local field
offices. This help includes disseminating information on Social
Security work incentives, and providing advice on VR and other
employment services.
Unless Congress re-authorizes these programs, funding for
the WIPA program will end on March 31, 2010, and funding for
the PABSS program will end on November 30, 2009.
The Ticket Act also granted Social Security authority to
conduct demonstration projects to test how certain changes in
the program would affect beneficiary work activity. Our
authority to initiate projects under this provision ended in
December 2005.
However, we have several projects initiated prior to that
date now underway. We expect these demonstration projects to
yield valuable insight on factors such as providing enhanced
rehabilitation services, and health care to individuals with
disabilities.
Finally, I would like to discuss the relationship between
our return-to-work efforts and our continuing disability review
process. To help protect the long-term health of the disability
program, we strive to pay disability benefits only to eligible
persons.
Toward the end, we periodically conduct continuing
disability reviews to determine whether an individual still
qualifies for disability benefits. We initiate a work CDR when
a beneficiary voluntarily reports he or she is working, when a
third party reports a beneficiary is working, or when wages are
posted to an earnings record. Beneficiaries who demonstrate an
ability to work, in spite of their medical impairment, may no
longer continue to qualify for benefits.
We may delay completing some work CDRs because of competing
high-priority workloads, or the complexity of our work
incentive rules. We fully understand the confusion and the
hardship that overpayments can cause, and we are exploring
policy changes that can reduce overpayments.
In closing, we are taking a number of steps aimed at
fostering return to work. The ticket program started slowly,
but our new regulations have given new life to the program. We
are on the right path to reducing those barriers within our
control, so that every beneficiary can realize his or her
fullest potential. With your support, we will continue to
improve the service that we provide.
Thank you, and I would be happy to answer any questions
that you may have.
[The prepared statement of Ms. Suter follows:]
Prepared Statement of Sue Suter, Associate Commissioner
for Employment Support Programs, Social Security Administration
Mr. Chairman and Members of the Subcommittee:
Thank you for the opportunity to discuss our efforts to help
beneficiaries with disabilities return to work. We have been committed
to encouraging beneficiaries to return to work since the disability
program \1\ began more than 50 years ago. Thanks in large part to this
Subcommittee's leadership, Congress expressed its bipartisan support
for expanding these efforts by passing the Ticket to Work and Work
Incentives Improvement Act of 1999 (Ticket Act). Among other
provisions, this legislation established the Ticket to Work program
(Ticket program), created two programs to help beneficiaries understand
the work incentive rules, and authorized us to test the effect of
certain changes in the disability program on beneficiaries' work
activity.
---------------------------------------------------------------------------
\1\ The Social Security Disability program began more than 50 years
ago and the Supplemental Security Income program began more than 35
years ago. In this testimony, ``disability program'' refers to both
programs.
---------------------------------------------------------------------------
We serve a diverse population of beneficiaries with disabilities
through the Social Security Disability Insurance (SSDI) and the
Supplemental Security Income (SSI) programs. SSDI and SSI beneficiaries
represent a wide range of age groups and have different impairments,
levels of education, work experience, and capacities for working.
Assisting beneficiaries to return to work has been challenging, and
helping these beneficiaries take advantage of employment opportunities
remains one of our highest priorities.
Today, I will update the Subcommittee on the Ticket program,
discuss the demonstration projects currently underway, and briefly
discuss one of our program integrity measures. We believe recent
changes to the Ticket program ensure that all beneficiaries have the
opportunity to engage in productive work.
The Ticket to Work Program
The Ticket program is an important part of the Social Security
Act's comprehensive set of work incentive policies designed to help
beneficiaries with disabilities return to work. Other examples of work
incentives include the Trial Work Period, which allows SSDI
beneficiaries to test their work abilities for 9 months, and Expedited
Reinstatement, which enables us to quickly reinstate benefits to
beneficiaries who are unable to sustain their return to work. Our Red
Book (which can be accessed online at http://www.socialsecurity.gov/
redbook/) provides basic explanations for all of our work incentives.
Prior to the Ticket program, State Vocational Rehabilitation (VR)
agencies were the primary entities that provided return-to-work
services at no cost to beneficiaries. We would reimburse the State VR
agency's costs if a beneficiary it served engaged in substantial
gainful activity (SGA) for 9 consecutive months. (SGA is significant
work normally done for pay or profit. For example, if a non-blind
beneficiary earns above $980 in a month this year, we consider that
beneficiary to be engaged in SGA. We adjust the SGA dollar amount every
year.)
The Ticket Act represented an historic milestone. It was the first
time Congress explicitly recognized that while many people receiving
disability benefits from Social Security want to work and could become
able to work, they face a number of significant barriers that prevent
them from reaching their employment goals. Congress established the
Ticket program to expand the universe of service providers and to
provide beneficiaries choices beyond the State VR agencies in obtaining
the services and supports they need to find, enter, and maintain
employment.
We do not expect the Ticket program to help every beneficiary
return to full-time employment. However, even if the Ticket program
were to help only a small number of beneficiaries return to work full-
time, Congress noted that it could generate enormous savings. In 1999,
Congress noted in the Ticket Act's findings that, if the number of
beneficiaries who returned to full-time employment increased by only
one-half of 1 percent, there would be $3.5 billion in savings to the
Social Security Trust Funds and the general fund of the Treasury.\2\
---------------------------------------------------------------------------
\2\ We are evaluating the Ticket program's potential savings and
will have a report later this year.
---------------------------------------------------------------------------
Ticket Program Overview
Under our current Ticket program rules, an SSDI or SSI beneficiary
receives a Ticket to Work (Ticket) if he or she is at least 18 years
old and younger than 65. We enter into contracts with Employment
Networks (EN), which are qualified State, local, or private
organizations that offer employment support services. We also contract
with State VR agencies acting as ENs. We have also been working closely
with the Department of Labor to expand the involvement of workforce
investment boards and One-Stop Career Centers in becoming ENs.
Beneficiaries, ENs, and State VR agencies voluntarily participate
in the Ticket program. A beneficiary who receives a Ticket may choose
to assign it to any EN or to the State VR agency. An EN may decide
whether to accept a Ticket from the beneficiary. Once a beneficiary
assigns a Ticket to an EN, the EN may supply various employment support
services to assist the beneficiary in obtaining, regaining, or
maintaining self-supporting employment. Providers may supply these
services directly or by entering into agreements with other
organizations or persons to supply the appropriate services. The
beneficiary receives the services at no charge.
We pay ENs based on their success in assisting beneficiaries secure
and maintain employment. An EN may elect to receive these payments
under one of two systems. Under the Outcome Payment System (Outcome
System), an EN receives a payment for each month in which a beneficiary
it serves does not receive cash benefits due to work or earnings--up to
60 months for SSI beneficiaries and up to 36 months for SSDI
beneficiaries. Under the Outcome-Milestone Payment System (Milestone
System), an EN receives a payment when a beneficiary it serves reaches
one or more milestones toward self-supporting employment. The EN will
also receive reduced outcome payments for each month--up to 60 months
for SSI beneficiaries and up to 36 months for SSDI beneficiaries--that
a beneficiary does not receive cash benefits because of work or
earnings. An EN can receive up to 22 milestone payments for SSI
beneficiaries and up to 15 milestone payments for SSDI beneficiaries.
Ticket Program Regulations
On December 28, 2001, we published our initial regulations
implementing the Ticket program. Under those regulations, an EN outcome
payment was worth only 40 percent of an average SSDI or SSI benefit. An
EN that opted to receive payments under the Milestone System was
limited to four milestone payments. Furthermore, an EN would receive
these milestone payments only when a beneficiary it served engaged in
SGA.
We rolled out the Ticket program in phases; the implementation
began in February 2002 and ended in September 2004. Early experience
showed that the Ticket program did not meet expectations. The program
did not increase beneficiary choice or increase work outcomes as much
as we would have liked. Through our conversations with members of the
advocacy community and the evaluations carried out for us by our
contractor, Mathematica, we learned that the program had not developed
the vibrant market of ENs envisioned by Congress. In fact, by 2005,
very few ENs were accepting Tickets.
Experience revealed that our initial Ticket regulations contributed
to this problem. The regulations set the EN milestone and outcome
payment amounts too low and set the bar for receiving those payments
too high. This unattractive combination discouraged service providers
from becoming ENs. As a result, beneficiaries in many areas did not
have an EN to provide them with services, and the overwhelming majority
of beneficiaries with disabilities receiving services received them
from traditional State VR agencies.
To address these concerns, we published new Ticket program
regulations on May 20, 2008. These rules became effective on July 21,
2008, and made several key changes to the Ticket program. We created a
more attractive EN payment structure. The 2008 regulations increased
the value of outcome payments (they are now worth 67 percent of an
average SSDI or SSI benefit) and increased the value of milestone
payments (increasing the total payout under the Milestone System
relative to the Outcome System). The new Ticket regulations increased
the number of milestone payments an EN can receive from 4 for serving
any Ticket beneficiary to 15 for SSDI beneficiaries and 22 for SSI
beneficiaries. The regulations also allow an EN to receive the first 4
milestone payments when a beneficiary it serves earns $700 in a month,
which is below the SGA level. We expect this payment structure will
entice more service providers to become ENs.
In addition, experience showed that many beneficiaries wanted to
ease their way back into the workforce via part-time work. However,
since the previous EN payment structure based payments on attainment of
SGA, ENs were reluctant to accept Tickets from beneficiaries seeking
part-time employment. The current EN payment threshold removes previous
disincentives to serve these beneficiaries.
We also increased available services by permitting State VR
agencies to work collaboratively with ENs in an arrangement known as
Partnership Plus. This ``team'' approach allows State VR agencies to
provide training and job placement services and then refer
beneficiaries to ENs, who can offer job retention supports. This
initiative increases the likelihood that beneficiaries will keep
working and leave the rolls. In addition, the new regulations
abbreviated the process for the One-Stop Career Centers to become ENs.
Prior to publishing the new Ticket program regulations, we
identified three key indicators to assess the degree to which the new
regulations addressed the concerns we had heard. We measure success by:
(1) the number of new EN contracts, (2) the number of beneficiaries
accessing EN services, and (3) the number of beneficiaries entering the
workforce. In the 11 months since the new rules became effective, our
early data show a promising trend for these indicators. Compared to the
11 months preceding the new Ticket rule's publication, the number of
new EN contracts has increased from 5 to 34 per month. At the end of
last month, there were over 1,300 ENs. Furthermore, the number of
beneficiaries assigning their Tickets has increased from 332 per month
to 867, and the number of job starts has increased by 83 percent. So
far, it looks like the new regulations have truly hit the mark.
Ticket Program Outreach Activities
In addition to revising our regulations, we have recruited more
ENs. Through our marketing contractor, Cherry Engineering Support
Services, Inc. (CESSI), we are contacting ENs that have gone 6 months
without taking a Ticket to determine whether we can resolve any
problems. CESSI also holds State and regional ``Ticket Express''
conferences to recruit new ENs and share best practices. With CESSI's
support, we have also increased our conference attendance, EN training,
and frequency of webinars to recruit ENs.
We have extended outreach activity to beneficiaries. For example,
we created the Work Incentive Seminar (WISE) event to encourage
beneficiaries to attempt to work. WISE events educate beneficiaries and
their families about work incentives. Employers, ENs, State VR
agencies, Protection and Advocacy agencies, and other employment
support providers attending these events share information with
beneficiaries about available services and employment opportunities in
their communities. In 2008, we conducted 111 WISE events, and these
events have been well attended. Working with the Department of Labor,
40 State workforce investment entities have become ENs, and they
provide return-to-work services in 119 One-Stop Career Centers. In
addition, approximately 300 new organizations are in the process of
becoming ENs.
We strive to give beneficiaries with disabilities the robust return
to work services they need and deserve. We are optimistic that the new
Ticket rules, coupled with our expanded outreach activities, will
foster the level of beneficiary work activity we envisioned when
Congress passed the Ticket Act.
WIPA and PABSS
The Ticket Act created two programs to supplement the assistance
available at our field offices and help beneficiaries understand the
work incentive rules. The two programs provide grants to organizations
with ties to the disability community at the local level. All SSDI and
SSI beneficiaries may use these services.
Work Incentives Planning and Assistance (WIPA)
WIPA grantees help beneficiaries with disabilities understand our
work incentives and their effect on disability benefits. Specifically,
WIPA grantees provide benefit planning and assistance, job placement,
and career development. By working with a WIPA grantee, our
beneficiaries can make informed choices about work. WIPA grantees also
conduct the WISE events.
We currently have 104 community-based cooperative agreements that
ensure the availability of WIPA in all 50 States, the District of
Columbia, and U.S. Territories.
Protection and Advocacy for Beneficiaries of Social Security (PABSS)
The PABSS is a network of Protection and Advocacy projects in all
50 States, the District of Columbia, U.S. territories, and the tribal
entities. This network represents the Nation's largest provider of
legal-based advocacy services for persons with disabilities. The 57
PABSS advise beneficiaries about obtaining vocational rehabilitation
and employment services. They provide advocacy and services
beneficiaries may need to secure, maintain, or return to gainful
employment.
For example, PABSS projects have helped beneficiaries regain
employment. In one case, a beneficiary with epilepsy lost his job as a
cashier after suffering an on-the-job seizure. He filed a charge of
discrimination with the Equal Employment Opportunity Commission (EEOC)
and sought representation from PABSS for the EEOC mediation. The PABSS
appeared at the mediation and was able to negotiate a settlement that
allowed the beneficiary to return to his job.
Expiring Grant Authority
The Ticket Act initially authorized appropriations for these grants
for each fiscal year (FY) through FY 2004. The Social Security
Protection Act of 2004 extended this authorization through the end of
the current fiscal year. Unless we receive reauthorization, funding for
the WIPA program will end on March 31, 2010, and funding for the PABSS
program will end on November 30, 2009.
Both the WIPA and PABSS programs provide services to beneficiaries
seeking to return to work or maintain their current employment. If
after a review of these programs a decision is made to pursue
reauthorization, we will work with Congress to reauthorize funding.
Disability Demonstration Projects
The Ticket Act authorized us to test how certain statutory changes
to the disability program would affect beneficiary work activity.
Pursuant to this authority, we initiated four demonstration projects--
the Benefit Offset National Demonstration (BOND), the Mental Health
Treatment Study (MHTS), the Accelerated Benefits Demonstration (AB),
and the Youth Transition Demonstration (YTD). Each project has distinct
test objectives. The following sections provide a brief overview of our
progress in each project.
Benefit Offset National Demonstration
Because SSDI beneficiaries lose all of their cash benefits for any
month in which they engage in SGA after the trial work period, they are
often reluctant to attempt to work. The BOND project tests the effects
of replacing this ``cash cliff'' with a benefit offset that reduces
SSDI benefits $1 for every $2 a beneficiary earns above the SGA
threshold. This benefit offset takes effect after the beneficiary
completes the trial work period and subsequent 3-month grace period. We
also offer certain BOND participants enhanced work incentives
counseling. Based on data from this project, we will estimate the
effect of the benefit offset and counseling on beneficiary work
activity.
This demonstration consists of two phases. In the first phase,
which lasted from August 2005 to December 2008, we conducted a four-
State pilot. We used our experience with the pilot to strengthen the
design for the BOND. The pilot also helped us design and build a stand-
alone agency system that partially automated the benefit offset
calculations and notices, which currently have many manual elements and
are very labor-intensive. We have also received some preliminary
findings for this pilot and expect to complete a final evaluation
report this June.
In the second phase, we will conduct a more expansive demonstration
in sites across the Nation. We awarded a design contract for this phase
of the BOND to Abt Associates in 2004. We approved the design in
September 2008, and we will award an implementation and evaluation
contract for this project no later than September 2009.
Mental Health Treatment Study
About 27 percent of all SSDI beneficiaries have severe mental
illness. Many persons with mental illness respond well to treatment and
want to work. The MHTS tests the effectiveness of providing medical
care and employment supports to a sample of SSDI beneficiaries with
schizophrenia or affective disorders who have expressed a desire to
work. Testing began in October 2006 and will continue through July
2010.
For the most recent reporting period, treatment group participants
had an employment rate of about 40 percent, compared to an employment
rate of only 22 percent for control group participants. This difference
may result from the specific types of supports the MHTS provides
(psychiatric nurse-care coordinator, case worker, and a supported
employment specialist) and the manner in which the MHTS integrates
those supports.
Through the MHTS, we have helped many beneficiaries return to work;
in any given quarter of a year, about 400 participants work. For
example, some MHTS participants with schizophrenia talk back to the
voices they hear. One of our study sites has an ongoing relationship
with a sports arena. The sports arena hires these participants, and the
arena's noise masks any conversations the participants have with these
voices. Thus, the MHTS has placed these participants in employment
situations where they can succeed. In other situations, we purchase
items that enable participants to return to work, such as dentures and
glasses.
We will analyze the demonstration's results and plan to submit our
final report by January 2011.
Accelerated Benefits Demonstration
Under current rules, most SSDI beneficiaries have a 24-month
waiting period after the date of entitlement before they are eligible
for Medicare. This project tests the effect of providing immediate
health care to newly-entitled SSDI beneficiaries. Specifically, the
project tests whether providing medical benefits sooner will result in
better health and return to work outcomes for beneficiaries. Since the
start of this project in October 2007, we have enrolled about 2,000
beneficiaries in one of three study groups: A control group, a group
that receives a medical benefits package, and a group that receives the
medical benefits package and comprehensive support services. We will
complete this project in November 2010.
To date, project data show that a little over 85 percent of the
beneficiaries contacted for inclusion in the project were ineligible
for the project because they already had some type of health insurance
coverage. Participants in the study have embraced the additional
supports offered in this project. We have found that many beneficiaries
in the third study group are using the employment counseling,
behavioral support program, and medical care management offered as part
of this demonstration. However, it is too early to tell whether using
these services translates into improvements in health and employment
and reduced dependence on SSDI benefits.
We plan to submit a final report on this project by January 2011.
Youth Transition Demonstration
The YTD seeks to identify effective and efficient methods for
assisting youths to transition from school to work and become self-
sufficient. This project identifies services, implements service
interventions, and tests modified SSI income and resource exclusions
(referred to as waivers) that lead to better education and employment
outcomes for youth with disabilities. The YTD serves youths between the
ages of 14 and 25 who receive SSI or SSDI (including child's insurance
benefits based on disability) or who are at heightened risk of becoming
eligible for those benefits. This study will produce the first
empirical evaluation of the effects of enhanced youth transition
programs and modified SSI work incentives on disabled youth.
We began the YTD in September 2003 with seven projects. At present
eight YTD projects are underway in New York (two sites), California,
Colorado, Florida, Maryland, Mississippi, and West Virginia. The last
YTD project will in end in spring 2012.
As of January 2009, 503 of the 2,028 YTD participants (25 percent)
had full- or part-time employment. Most of the YTD participants are
students. By comparison, in December 2007, only about 11 percent of all
SSI beneficiaries aged 18 through 21 were working. The nature of the
YTD participants' work varies widely and some participants hold only
short-term or summer work.
Early data from the projects show that the interventions and the
YTD waivers help participants gain experience in both work-related
activities and paid employment, increase earnings, improve attitudes
and expectations about the future, and achieve greater engagement in
education (for those projects with a focus on educational activities).
Among the beneficiaries helped by this project is a young artist
enrolled in the Mississippi Model Youth Transition Innovation (MYTI)
project. She has intellectual disabilities, but with the help of a
specialized savings account allowed under the YTD and counseling she
has received from MYTI, she is on her way to establishing a successful
business.
We plan to complete a comprehensive final report on this project by
2014.
New Disability Demonstration Authority
We believe that the projects we have in place will yield
information Congress can use when it considers certain statutory
changes. We want to test other disability program modifications and
have several new ideas for demonstration projects.
However, our authority to initiate demonstration projects for SSDI
beneficiaries expired on December 17, 2005. Therefore, we would need
authority to start new projects and would like to work with you toward
that goal. To start this process, we will develop and present to
Congress and other stakeholders a detailed plan for how we would use
this authority if reinstated.
Continuing Disability Reviews (CDRs)
To help protect the long-term health of the disability program, we
strive to pay disability benefits only to eligible persons. Toward that
end, we periodically conduct continuing disability reviews (CDR) on
beneficiaries with disabilities to determine whether they still qualify
for disability benefits. These reviews come in two types--medical CDRs
and work CDRs.
Medical CDRs
We conduct medical CDRs on a periodic basis to ensure that only
those who have a disabling condition under our rules continue to
receive benefits. We use two methods to conduct these CDRs. We send
some cases to the disability determination services (DDS) for a full
medical review; others may be completed using the mailer process. The
mailer process includes a profiling system that uses data from our
records to determine the likelihood of medical improvement and the
individuals' responses to a mailer questionnaire.
We send most cases profiled as having a high likelihood of medical
improvement to the DDSs for a full medical review and no mailer is
sent. In addition, if a beneficiary's responses to our mailer
questionnaire indicate medical improvement, we send the case for a full
medical review. Otherwise, based on the mailer response, we may decide
not to initiate a full medical review, and we schedule the case for a
future CDR. We also conduct medical reviews when we receive a voluntary
or third-party report of medical improvement.
We will not initiate a medical CDR on a beneficiary who is using a
Ticket. Furthermore, if a beneficiary has received SSDI benefits for at
least 24 months, we will not initiate a medical CDR solely on the basis
of his or her work activity.
Historically, we have realized program savings of $10 for every $1
we spend on medical CDRs. In FY 2008, we processed 240,000 full medical
CDRs, an increase of about 50,000 over FY 2007. The FY 2009
appropriation provides an upward adjustment to the discretionary caps
to fund program integrity activities such as CDRs. At this level, we
will be able to process 329,000 full medical CDRs this year, an
increase of 89,000 compared to FY 2008. For FY 2010, the President's
Budget requests $359 million to conduct medical and work CDRs, which is
part of a larger request of $758 million for program integrity
activities at the Agency.
Work CDRs
We initiate a work CDR when a beneficiary voluntarily reports he or
she is working, when a third-party reports a beneficiary is working, or
when wages are posted to a beneficiary's earnings record. Because the
work CDR process intersects with our return-to-work efforts, I would
like to briefly explain our process and how we address the overpayments
that can result.
To process work CDRs, we use a centralized national database called
eWORK. This automated system collects the necessary work information,
prepares the necessary forms and notices, and generates receipts for
work reports. A separate system, the Continuing Disability Review
Enforcement Operation (CDREO), alerts us to possible unreported work
activity by a beneficiary. The CDREO alerts approximately 522,000 cases
annually for possible work CDRs. We review and process all work reports
we receive. From 2006 to 2008, we processed an estimated 174,000 work
CDRs annually in our field offices. At present, there are approximately
62,000 work CDRs pending in field offices.
While most work CDR overpayments occur because we do not receive a
timely report of work activity, some overpayments occur because we do
not process the related work CDRs timely. Delays in processing these
cases may occur for several reasons. First, we have concentrated on
high-priority workloads, such as processing retirement and disability
claims. Consequently, we have delayed acting on work reports and CDREO
alerts. The current recession and the aging population have caused an
overall increase in our workloads, thereby exacerbating this situation.
Finally, our work incentive rules, which affect how we treat a
beneficiary's earnings, are complex. Therefore, these work CDRs may
take more time to process correctly.
We know that the potential of an overpayment may discourage some
beneficiaries from working. We are committed to reducing the likelihood
of overpayments, and we are collaborating with all stakeholders to
develop proposals to ensure that beneficiaries who report their
earnings timely will not be penalized for our delays in processing
their work CDRs.
Conclusion
We are firmly committed to assisting beneficiaries with
disabilities who want to return to work. The Ticket program started
slowly, but our new regulations have given new life to the program.
Since the new rules became effective, we have seen increases in new EN
contracts, in Ticket assignments, and in beneficiary work activity. We
will continue to monitor the program and consider any advice we receive
from beneficiaries, service providers, and Congress to make sure the
program continues to meet the needs of our beneficiaries.
We have embraced a comprehensive approach to helping beneficiaries
return to work. We are on the right path to reducing those barriers
within our control so that every beneficiary can realize his or her
fullest potential.
Thank you again for your support and interest in this matter.
Chairman TANNER. Thank you very much, Ms. Suter.
Ms. Bates-Harris, you are recognized, please.
STATEMENT OF CHERYL BATES-HARRIS, SENIOR DISABILITY ADVOCACY
SPECIALIST, NATIONAL DISABILITY RIGHTS NETWORK, ON BEHALF OF
THE CONSORTIUM FOR CITIZENS WITH DISABILITIES EMPLOYMENT AND
TRAINING TASK FORCE AND SOCIAL SECURITY TASK FORCE
Ms. BATES-HARRIS. Thank you, Chairman Tanner, and Members
of the Subcommittee, for holding this important hearing today.
I am Cochair of the Consortium for Citizens with Disabilities
Employment and Training Task Force, and an active member of the
Social Security Task Force. CCD is a coalition of national
consumer, advocacy, provider, and professional organizations
working on behalf of the 54 million American children and
adults with disabilities and their families.
The Ticket to Work and Work Incentives Improvement Act was
created a decade ago to reduce barriers to work for Social
Security Title II and Title XVI beneficiaries. TWWIIA was not a
perfect program at its inception, but Social Security has put
significant effort to improve the program. Some of those
improvements include creating incentives to encourage service
providers to become employment networks, including one-stop
centers, acknowledging that return to work is an incremental
process, and that self sufficiency often begins with part-time
employment. They recognized that education and training of work
incentives is vital to the employment of people with
disabilities, and have made strides to better coordinate
services and supports, and to collaborate rather than compete
with the State Vocational Rehabilitation agencies.
In addition, the increased payment system, as a result, has
allowed more ENs--has made ENs more readily accessible, and
willing to provide services to both SSI and SSDI beneficiaries.
While these are very positive trends, there is still more
work to be done. And CCD is concerned that the level of
attention on work incentives seems to have waned at the Agency.
For example, there is the continued delay of the required
benefit offset demonstration. This project has been in the
planning process since TWWIIA's inception, and is not scheduled
for implementation until 2010. The very purpose of this project
has been tested in a four-State study on the subject, and the
effects of the employment outcomes have been demonstrated,
that--when benefits are reduced to reflect employment,
beneficiaries can successfully work their way off benefits.
This analysis already exists in the SSI program, and has
shown itself to be a powerful work incentive. If properly
implemented, the results of this study could prevent
beneficiaries from experiencing an abrupt dropoff in benefits
when employment earnings reach the substantial gainful
activity. We believe the results from this demonstration do not
require an additional long, drawn-out evaluation, but rather,
that policy changes could be implemented based on the evidence
already gained.
As you know, work incentives already exist in both
programs. But the success of these incentives to the Ticket to
Work rest heavily on the ability of SSA to record and track
wages and make prompt adjustments to benefits level, thereby
reducing overpayments.
I think I am going to skip some of the statements around
overpayments. We just believe that it is important to recognize
that there is no standardized way of filing or tracking wage
information. Social Security does not require a specific report
format--it can be made in writing, by calling an 800 number, or
by reporting in person, and staff are not always sure what to
do with the complex work rules. Until such time as Social
Security addresses this issue, overpayments will continue.
I want to address some of the expiring provisions in TWWIIA
in my time remaining. The work incentive planning and
assistance program grants provide benefits planning services to
SSDI and SSI beneficiaries about work incentives and services
for finding, maintaining, and advancing an employment. Trained
staff are skillful at helping beneficiaries understand what
will happen to their benefits when they gain employment. This
is a vitally important program that has been flat-funded since
its inception, and it needs to continue with an increase in
appropriations.
The protection and advocacy for beneficiaries of Social
Security is another crucial program for ensuring TWWIIA's
success, by protecting the rights of beneficiaries who
transition to work. With a presence in every State, territory,
and the District of Columbia, they provide advice and legal and
administrative advocacy to remedy complaints of beneficiaries,
ranging from things to overpayments to workplace
discrimination.
Recent incidents, such as that of Henry's Turkey Service,
demonstrate the need for the PABSS program to be expanded, not
cut back. Despite the demand for services, the program receives
a modest $7 million, and has been flat-funded.
We believe that the PABSS program should also be able to
address and monitor representative payees who may have a
conflict of interest in serving those beneficiaries.
I am way over my time. There are a number of other
provisions in TWWIIA that are important--or provisions outside
of the jurisdiction of this Committee but part of the larger
discussion. They are well documented in my written testimony.
And, although I have tried to keep this testimony short to 5
minutes, I request that you enter the full testimony into the
record.
Thank you for extending me this opportunity to testify
before you.
[The prepared statement of Ms. Bates-Harris follows:]
Prepared Statement of Cheryl Bates-Harris,
Senior Disability Advocacy Specialist, National Disability Rights
Network,
on behalf of the Consortium for Citizens with Disabilities Employment
and Training Task Force and Social Security Task Force
I would like to thank Chairman Tanner, Ranking Member Johnson and
Members of the Subcommittee for inviting me to testify at today's
hearing on the Social Security Administration's (SSA) employment
support programs for beneficiaries with disabilities. The focus of this
hearing is extremely important to people with disabilities as they seek
to return to work or work for the first time.
I am a Senior Disability Advocacy Specialist for the National
Disability Rights Network (NDRN), but I am here today in my capacity as
a Cochair of the Consortium for Citizens with Disabilities (CCD)
Employment and Training Task Force as well as an active member of the
Social Security Task Force. CCD is a working coalition of national
consumer, advocacy, provider, and professional organizations working
together on behalf of the 54 million children and adults with
disabilities and their families living in the United States. The two
CCD Task Forces (hereinafter ``CCD'') focus on disability policy issues
in employment programs and services for people with disabilities as
well as the Title II disability programs (for beneficiaries with
disabilities in the Old Age, Survivors, and Disability Insurance
programs) and the Title XVI Supplemental Security Income (SSI) program.
Also, as a former member of the Ticket to Work and Work Incentives
Advisory Panel, I have considerable experience with the Ticket to Work
and Work Incentive Improvement Act including the Ticket to Work and
Self Sufficiency program.
Roughly 10 years ago, the Ticket to Work and Work Incentives
Improvement Act (TWWIIA) was signed into law as P.L. 106-170. Its
intent was to reduce barriers to work for Social Security Title II and
Title XVI beneficiaries with disabilities by offering greater choice in
vocational rehabilitation and employment services providers, to assure
ongoing access to affordable health care coverage, and to assure access
to benefits planning services and legal advocacy, if needed, to protect
the rights of the individuals with disabilities.
The original Ticket to Work regulations became effective January
28, 2002, before the first Tickets had been released. It quickly became
evident that the regulations were insufficient to support the true
purposes of expanding choice in vocational providers and supports. In
September 2005 and August 2007, the Social Security Administration
(SSA) issued Notices of Proposed Rule Making (NPRM) which proposed
changes to the Ticket regulations. Revised regulations were issued
effective July 2008. We want to recognize and commend SSA for the
revised Ticket regulations which aimed to improve the Employment
Network (EN) payment systems and provided greater financial incentives
and flexibility for ENs. This action encouraged service providers and
other entities to become ENs by making the Ticket program more
appealing financially. ENs now earn milestones earlier in the
employment process and are reimbursed at a higher rate based on
beneficiary attainment of specific earnings targets (such as placement
with earnings at $335.00 month, Trial Work Period earnings of $670.00
month, and SGA earnings at $940.00 a month) even if cash benefits are
never reduced to zero.
The changes encourage beneficiary participation by recognizing that
return to work is an incremental process and self-sufficiency often
begins with part-time employment. In addition, individuals with
disabilities--regardless of whether they are receiving Supplemental
Security Income (Title XVI) or disability benefits (Title II) can now
expect to receive similar levels of service from providers because the
outcome payments and milestone payments are about the same for both
programs. Moreover, the payment system no longer requires a higher
level of earnings for the Title XVI beneficiary, which had discouraged
ENs from serving those individuals under the old regulations.
The regulations also encourage better coordination of services and
supports available to beneficiaries and include incentives for ENs to
partner with, rather than compete with, State Vocational Rehabilitation
(VR) agencies. This is reflected in the simplified and improved
definition of ``using a ticket'' which means that individual has
assigned a ticket to an EN or a State VR agency that has elected to
provide services to that individual as an EN. The regulations also
streamlined the related requirement for measuring ``timely progress
toward self-supporting employment'' by allowing a beneficiary to
complete either a work requirement or to obtain educational/vocational
credit which will assuredly improve their employment potential through
the acquisition of skills and training.
Indeed, SSA was ``listening, learning, and responding'' as SSA
stated in its ``messaging'' during the March 2008 Ticket to Work
Partners Summit. A recent SSA report shared with the Protection and
Advocacy Systems (P&As) indicates that since the revised regulations
became effective on July 21, 2008, the number of new service providers
signing up to become ENs has increased from an average of 5 a month to
an average of 34, and as a result SSA reports higher return to work
rates as ENs are more readily accessible and more willing to provide
services.\1\
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\1\ Ticket Trends--May 19, 2009 Hearing.
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While these are positive trends, there is still more that needs to
be done.
From a broader policy perspective, CCD is concerned that the level
of attention at the Agency on work incentives seems to have waned. The
Cochairs of both of these CCD Task Forces met with SSA legislative and
policy staff in March of 2008 to discuss ways to simplify the work
incentives for SSI and SSDI beneficiaries. Since then there has been no
followup or further discussion on this issue. In a recent long term
plan issued by SSA, only one paragraph contained any mention of work
incentives, and that statement failed to recognize SSA's own role in
the number of overpayments, as well as structural contributions (such
as retrospective accounting in SSI). We recognize SSA's need to focus
on reducing the disability claims backlog, but believe that more must
be done to assist those who want to try to work.
Benefit Offset Demonstration
Long before TWWIIA, SSA was required to initiate a national
demonstration to test alternate methods of treating work activity in
the Social Security Disability Insurance (SSDI) program through a
benefit offset project. The purpose of the Benefit Offset demonstration
was to determine the effect of employment outcomes including wages,
benefits, hours worked, and job retention when a financial offset in
benefit payment is applied reducing Title II disability benefit
payments by only 1 dollar for each 2 dollars earned. This work
incentive already exists in the SSI program and enables a beneficiary
to successfully and gradually work their way off benefits and move
toward self sufficiency by decreasing benefit payments as earnings
increase. This encourages work but does not penalize the individual or
force them to give up a full benefit amount when they are working their
way back to full employment.
Despite years of planning and design, the Benefit Offset National
Demonstration (BOND) is not scheduled for implementation until FY 2010.
Prior to this national implementation, SSA conducted a four-State pilot
demonstration, which began in August 2005. The results have not been
shared publicly. This long overdue project will allow beneficiaries to
face a gradual reduction in their benefits eliminating the abrupt loss
of cash benefits in the Title II disability programs when the
beneficiary works and has earnings over the Substantial Gainful
Activity (SGA) level which is currently $940.00 a month. If properly
conducted and implemented, the strategies developed for this project
could serve as a powerful incentive and should considerably reduce
barriers to work for SSDI beneficiaries by allowing them to maintain or
increase their employment, earnings and financial independence. CCD
believes it is imperative that this project not languish any longer but
instead move forward with full deliberation and intent. In addition SSA
should be required to report the results of their findings to the
public in a timely manner.
Overpayments
As you know, the SSI and SSDI programs include numerous work
incentives which allow beneficiaries to work and test their ability to
become self-sufficient. The success of these work incentives, as well
as that of the Ticket to Work program, rests heavily on the ability of
SSA to record and track wages and make prompt adjustments to benefit
levels when working beneficiaries report earnings, thereby reducing
overpayments. According to an SSA Office of Inspector General report
dated April 2006, income or earnings from work activity was the most
significant reason for overpayments. These overpayments were said to be
much larger and spanned longer periods of time than the overpayments
identified by SSA's normal processes of Continuing Disability Reviews
(CDRs) and data matches to detect deaths, prisoners, fugitives, and
other issues that impact eligibility.\2\
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\2\ Congressional Response Report--Overpayments in the Social
Security Administration's disability programs, A-01-04-24065, April
2006.
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Overpayments have been a huge concern for many years and are
recognized as a tremendous disincentive for beneficiaries to try work.
Many beneficiaries do the right thing: They report their work in person
or to the 800 number and are told that SSA will let them know if
anything is a problem. At best SSA takes a month or two to process the
report, which causes overpayments that the beneficiary is obligated to
repay. However, SSA very often fails to process the earnings reports
and adjust the payments for months or even years. Beneficiaries
reasonably assume that SSA is paying them the correct amount. When SSA
finally gets around to processing the earnings reports, the beneficiary
is hit with a demand to repay overpayments that often amount to
thousands of dollars. This can be devastating for someone whose sole or
primary source of income is their benefit payment (currently a maximum
of $674 per month for SSI beneficiaries).
In one reported case, the New York Protection and Advocacy for
Beneficiaries of Social Security (PABSS) reported that a client file
clearly showed timely wage reporting by the beneficiary, yet he still
received an overpayment notice of almost $64,000. The overpayment
occurred because the beneficiary was a dual SSI/SSDI recipient. When he
reported his monthly earnings to SSA; the SSI benefits were adjusted
but the SSDI benefits were not adjusted until several years later.
Furthermore, while PABSS was assisting with the client with the SSDI
waiver request, SSA was initially refusing to look at the information
contained in his separate SSI file.
Only when PABSS insisted did they retrieve his SSI file and finally gran
t the waiver.
CCD and the disability community continue to struggle with the
inability of SSA to record and appropriately adjust benefits in a
timely manner. SSA does not require earned income reports to be made in
any specific way; they can be made in writing, by calling the 800
number, or by stopping in to report at an SSA field office. There is no
particular form to complete or file, and until the Social Security
Protection Act of 2004 was implemented, there was no official record
for the beneficiary to use that proved the report was made. In
addition, there appears to be no effective internal system for
recording the income which beneficiaries report. And despite the
development of internal electronic tools such as eWorks,\3\ this
program is not used consistently across the country. In addition, SSA
does not seem to realize that people do not understand the terms of art
used by the Agency when making SGA determinations and staff are not
always clear in their explanations or do not have the time necessary to
explain them well enough. Therefore, important wage deductions such as
Impairment Related Work Expenses (IRWEs), Blind Work Expenses,
Subsidies and Special Conditions do not get reported or considered.
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\3\ In December 2004, SSA finished its national rollout of eWork,
an interactive web-based application system that monitors the work flow
of Social Security field staff and tracks reported earnings of Social
Security Disability Insurance beneficiaries.
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In terms of overpayment issues, field office staff seem to have a
single rule: ``You worked; you are at fault for the overpayment.'' The
staff is very reluctant to apply the other work incentive rules, like
IRWEs or special conditions after wage reporting has occurred, and
rarely are these questions asked during the submission of this type of
wage information.
SSA clearly needs to improve its processing of work and earning
reports. Most individuals who receive these benefits are overwhelmingly
low income and do not have the income cushions to deal with unreliable
application of the work rules. Some at SSA seem to have a cavalier
attitude about overpayments (considering them low interest loans), not
understanding the financial and emotional effect of a large overpayment
on someone who is low income and who thought s/he was doing a good
thing by going to work.
Many claimants do not understand the differences between SSI or
Title II disability benefits and many do not know which is which even
though they may get both. These concurrent beneficiaries will not know
to report work activity separately to the Claims Representatives
assigned to each of the benefit programs. As a result, concurrent
beneficiaries are doubly impacted with overpayments over time. The SSI
file and Title II disability file are separately maintained and
information within the office is not communicated across programs. SSA
staff who are assigned to only one benefit program (SSI or Title II
disability) should understand that claimants will not know to
separately report work and they should make sure that the work report
gets to all the right places, including the payment processing center,
and that it is acted on in a timely fashion.
Expiring TWWIIA Provisions
There are several expiring or expired provisions contained within
TWWIIA that are critical to facilitating the participation of those on
Title II and/or Title XVI in the workforce. The failure to extend these
programs could undermine the long-term impact of the law in improving
employment opportunities for this population of people with
disabilities. Two such programs include the Work Incentive Planning and
Assistance (WIPA), and the Protection and Advocacy for Beneficiaries of
Social Security (PABSS).
Work Incentive Planning and Assistance (WIPA) Program--The Social
Security Administration has long been committed to the WIPA program and
issued a Request for Proposal inviting application for these programs
in May of 2000, with a second round of application in the fall of 2006.
WIPA grants to nonprofits and other agencies fund outreach, education
and benefits planning services to Title II Disability and SSI
beneficiaries about work incentives and services for finding,
maintaining and advancing in employment.
WIPA grantees inform beneficiaries of the impact that employment
will have on their disability income and medical coverage, and address
many of the real fears that individuals have about going to work,
including the risk of losing health coverage. These grants have
consistently demonstrated their effectiveness in explaining work rules
and stressing the important information that people need to know before
going back to work. Relevant pamphlets and the ``Red Book'' are not
enough to help individuals understand the confusing work rules. People
often need more than one explanation and need to see the rules applied
to the facts of their cases. Trained WIPA staff is skillful at making
sure that beneficiaries know what will happen to their benefits when
they go to work.
WIPA programs have been flat funded at $23 million since their
inception and are struggling to maintain their high level of service.
In addition, these grants will terminate 6 months into FY 2010 unless
renewed by Congress. Increased appropriations are needed to continue
and expand this very important program.
The Protection and Advocacy for Beneficiaries of Social Security
(PABSS)--This program was created in TTWWIIA to protect the rights of
beneficiaries as they attempt to go to work and was the last programs
within TWWIIA to be fully implemented. It is the responsibility of the
PABSS programs to provide information, advice, and remedy to complaints
of beneficiaries utilizing their options to explore work. This work is
consistent with the mission of P&As, created by Congress in the 1970's
to protect individuals with disabilities from abuse, neglect, and
discrimination based on disability. With a presence in every State and
U.S. territory, and the District of Columbia, the Protection and
Advocacy (P&A) systems offer an advocacy and legal voice to individuals
with disabilities as they venture into the workforce.
The PABSS program assigns an extensive set of duties to the P&A
agency. In addition to resolving work related overpayments and
assisting individuals to access the services and supports they need to
work, this program assures that legal protections are given to
beneficiaries in the difficult economic climate where discrimination
against people with disabilities may increase. Using the powerful tools
afforded by the recent passage of the ADA Amendments of 2009, PABSS
helps people with disabilities maintain employment, enforces the
nondiscrimination provisions of the ADA, works for the provision of
reasonable accommodations, and seeks to protect other basic employment
rights that are important to the employment of people with
disabilities. In addition, P&As have worked tirelessly with community
partners to improve the employment rate of people with disabilities
thereby changing the quality of life for many people with disabilities.
An increase needs to be authorized for the program to be able to
continue, let alone thrive. The static funding of $7 million annually
since its inception has resulted in staff cutbacks across programs and
has clearly strained the ability to serve all eligible clients. Given
the recently uncovered abuses with Henry's Turkey Service in Atilissa,
Iowa, (see story at http://www.desmoinesregister.com/
article/20090208/NEWS/902080344), Congress should consider expanding
the jurisdiction of the P&A program into other SSA areas such as
monitoring organizational representative payees to assure adequate
protection and advocacy services are available to this vulnerable
population.
TTWWIIA Health Care Work Incentives
The Ticket to Work and Work Incentive Improvement Act included
several key provisions to ensure that workers with disabilities are
able to access crucial health care supports. We urge you to ensure that
these critical health programs are maintained and strengthened. Three
of these provisions are the Medicaid Infrastructure Grants (MIG), the
Medicaid Buy-in for Workers with Disabilities, and the Demonstration to
Maintain Independence and Employment (DMIE). As the findings of the Act
state: ``For individuals with disabilities, the fear of losing health
care and related services is one of the greatest barriers keeping the
individuals from maximizing their employment, earning potential, and
independence'' (Section 2a(5)). These provisions are critical to
ensuring the success of other programs within the Act. Therefore, CCD
encourages this Committee to collaborate with your colleagues on the
Health Subcommittee as well as the Energy and Commerce Committee to
strengthen and maintain these critical health programs.
Medicaid Infrastructure Grants--These grants were authorized from
2001-2011 by section 203 of the TTWWIIA and are administered by the
Centers for Medicare and Medicaid Services. These grants provide States
with flexible funds to enhance State infrastructure that supports
workers with disabilities. Due to the MIGs, over two-thirds of States
have implemented Medicaid buy-ins, redesigned Medicaid waivers and
personal care programs to ensure that individuals can go to work, and
improved coordination between Social Security, WIPAs, Medicaid and
related agencies. In 2009, 42 States and the District of Columbia
received these grant funds.
Medicaid Buy-in--The Medicaid buy-in provides Medicaid coverage to
people with disabilities who would be receiving SSI but for their
earnings from employment. Many of these individuals need services
beyond what private insurance covers, or they would be unable to
acquire coverage on the individual market. Over 40 States have created
a Medicaid buy-in under TWWIIA or under the earlier buy-in created
under the 1997 Balanced Budget Act and are experiencing positive fiscal
returns. An analysis in Kansas demonstrated that Medicaid buy-in
participants increased the taxes paid to the State and Federal
Government, increased premiums paid to the Medicaid program, and
decreased their medical costs.\4\
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\4\ http://www.workinghealthy.org/publications/policybriefs/
WHPolicyBriefno12.pdf.
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Scott's Story--One success story thanks to the Medicaid buy-in
comes from Minnesota Work Incentives Connection. Scott was in college
when he had a car accident, which left him with a severe spinal cord
injury. Despite his injury, Scott continued his studies. Having a
disability increased Scott's desire to help others, so he pursued a
graduate degree in biomedical engineering. When he was offered a job at
a medical device firm, Scott contacted the Minnesota Work Incentives
Connection. He was willing to give up his Social Security cash
benefits, but was concerned about health coverage. Like most insurance,
his employer's health plan did not cover the daily personal care
assistance Scott needed, nor could he afford to pay out of pocket for
those services, despite earning a decent salary. For people with
injuries like Scott's, personal care assistance alone can easily cost
over $3,000 per month.
Scott's Benefits Specialist told him about the Medical Assistance
for Employed Persons with Disabilities (MA-EPD) program, which allows
him to maintain Medical Assistance (Medicaid) for services his
insurance doesn't cover. Scott doesn't mind paying a monthly premium,
based on his income. He says, ``Despite the opportunities that my
degree has opened up to me, I am fairly certain that I would not be
working in my current capacity if it were not for MA-EPD. MA-EPD allows
me to participate, to compete, to excel on the same stage as those I
consider as peers, regardless of the obstacles my disability
presents.''
Demonstration to Maintain Independence and Employment (DMIE)--the
DMIE program provides preventive care to individuals with serious
medical conditions that have not yet reached a level of severity to
qualify them for Social Security disability benefits. Examples of
individuals who have benefited from the DMIE include persons with
mental illness, AIDS, and diabetes.
DMIE Successes--Using a rigorous experimental model, including a
control and treatment group, the State of Minnesota found that only 4%
of the intervention group applied for Social Security while 15% of the
control group reported applying for benefits.\5\ Another example of
DMIE success comes from Texas. Janie is a home health aide. She has
diabetes, epilepsy, Hepatitis C, hypertension, chronic depression,
anxiety disorder, and suffers from debilitating headaches. Janie's case
manager obtained Working Well (a private insurance program) vision,
dental and medical services for her. The case manager also provided
employment counseling and medical education. Janie has been able to
start and maintain a diabetic diet. Her symptoms have greatly improved
and she is now earning significantly more as she is able to increase
her work hours.
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\5\ Stay Well, Stay Working: Policy Brief, The Lewin Group, March
2009.
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The MIGs, the Medicaid buy-in, and the DMIE provide invaluable
supports that enable individuals with disabilities to obtain and
maintain employment. Yet Congress has undermined the ability of many of
these health care work incentives to have an impact on the broader
population of people with disabilities either through specific action
or through inattention. For example, despite the positive results
evidenced by DMIE, Congress rescinded the unspent funds for the program
in the 2009 omnibus budget bill because the authority for the
demonstration ends in FY 2009. What Congress may not have recognized is
that CMS delayed issuing an application for funding which resulted in
unspent program money which CCD believes should be carried over and
continued.
The Medicaid buy-in has several lingering policy concerns that have
weakened its effectiveness and should be addressed during Ticket
reauthorization. These issues include, but are not limited to, how to
define if a person is `employed' and the inability of individuals to
participate in a buy-in beyond their 65th birthday.
Section 201 (a)(2)(B) of Title II offers a definition of employment
for individuals with medically improved disabilities who are eligible
for the Medicaid buy-in in which they must be working at least 40 hours
per month and earning at least the applicable minimum wage. A similar
definition of employment exists under Section 204 of Title II for
workers with potentially severe disabilities. Unfortunately, some
States have been reluctant to undertake a buy-in program over confusion
as to how to define employment. Thus, Congress may wish to clarify this
for the future.
Sec. 201 (a)(1)(C) allows participation in the Medicaid buy-in for
those ``at least 16 years of age but less than 65 years of age''
despite the increase in normal retirement age beyond age 65. Thus,
someone can be using the buy-in to work until he/she retires at
``normal retirement age'' but then is confronted by the loss of the
resource/asset limit suspensions when they reach age 65. This anomaly
needs to be corrected.
Finally, because the buy-ins are State options, this has created a
patchwork of access across the country. Either States should be
required to establish Medicaid buy-in programs or deemed Medicaid
eligibility should be provided to Title II beneficiaries up to the
current buy-in earnings levels.
SSA and Work Incentives
The Ticket to Work program and other provisions of TTWWIIA are only
one part of a larger discussion needed concerning barriers to
employment for Social Security disability beneficiaries. Many other
policies within the Social Security Disability and Supplemental
Security Income programs serve as disincentives to workforce
participation for people receiving these benefits. Broader system
changes--beyond TTWWIIA--are needed to address these impediments--as
outlined in the CCD Social Security Task Force's Statement of
Principles: Social Security Disability Program Work Incentives and
Related Issues. (See--http://www.c-c-d.org/task_forces/social_sec/CCD-
Principles-and-Recom-29-08.pdf.) These include:
The elimination of the 24-month waiting period for Medicare--Good
health is essential to a successful return to work. Failure to have
access to health coverage undermines the person's ability to stabilize
his or her condition and to attempt a return to work when that is
appropriate.
Allowing permanent premium-free access to Medicare for
beneficiaries who work--Social Security disability beneficiaries who
have lifelong conditions should retain lifetime access to Medicare.
Once someone goes beyond the premium-free Part A coverage provided
under TTWWIIA, a working person with a disability can buy-in to
Medicare but at significant expense. Providing continued attachment to
Medicare for working beneficiaries would ensure ongoing eligibility for
health care. Some beneficiaries, based on their earnings, should have
the ability to obtain this coverage through a buy-in program.
Elimination of the Medicare ``homebound'' rule--Current Medicare
policy for durable medical equipment (DME) restricts its use to ``in
the home,'' meaning that people on Title II disability benefits cannot
obtain the devices and technology they need for independent living or
risk violating the law if they use their DME to go to work. We are
pleased to see that the Senate Finance Committee has included several
possible options for phasing out the 24-month Medicare disability
waiting period in its May 14 description of policy options for
expanding health care coverage.
Increasing Medicaid asset and resource limits--SSI assets/resource
limits have increased only minimally since 1974. As a result, working
people with disabilities who rely on that program for critical services
and supports cannot earn and save like most Americans.
Modifying ``deemed'' SSI eligibility to protect Medicaid for
certain working people who transition to Title II--The deeming of SSI
eligibility is important to avoid creating an unintended disincentive
to work, especially for younger individuals who receive Disabled Adult
Child or DAC benefits. Current law creates a constraint against
attempting to work because it only provides protection when the sole
reason a person's income exceeds the SSI level is the Title II benefit
increase. Thus, working and having any earnings will automatically make
the person ineligible for the deemed SSI status that protects his or
her Medicaid. This is especially ironic, because if s/he had been
solely an SSI recipient, the person would be able to benefit from the
1619(a) and (b) work incentives. This can be fixed by providing that
SSI deemed status will continue so long as the person's only other
reason for ineligibility is earnings from work.
These are but a few of the recommendations in the CCD principles
and recommendations paper. We urge you to consider improvements, as
outlined in the paper, to assist people with disabilities to work.
Thank you again for extending me the opportunity to testify before
you. I look forward to working with the Subcommittee on these important
issues for people with disabilities.
On Behalf Of:
ACCSES
American Network of Community Options and Resources
APSE--The Employment Network
Association of University Centers on Disabilities
Bazelon Center for Mental Health Law
Community Access National Network (TIICANN)
Council of State Administrators of Vocational Rehabilitation
Easter Seals
Epilepsy Foundation of America
Inter-National Association of Business, Industry and
Rehabilitation
National Council on Independent Living
National Disability Rights Network
National Organization of Social Security Claimants'
Representatives
National Rehabilitation Association
National Spinal Cord Injury Association
Paralyzed Veterans of America
The Arc of the United States
The Epilepsy Foundation
United Cerebral Palsy
United Spinal Association
World Institute on Disability
Chairman TANNER. Thank you very much. We were not going to
be insistent on the 5-minute rule, because we were interested
in what you have to say. And all of your testimonies will, in
their entirety, be inserted into the record.
Ms. Webb, the Chair is pleased to yield the floor to you.
STATEMENT OF SUSAN WEBB, PRESIDENT AND CO-FOUNDER, NATIONAL
EMPLOYMENT NETWORK ASSOCIATION, AVONDALE, ARIZONA
Ms. WEBB. Thank you, Mr. Chairman. My name is Susan Webb,
and I am here today on behalf of the National Employment
Network Association, or NENA. NENA is a membership association
that provides technical assistance and training to employment
networks around the country.
Our comments today revolve around three particular topics:
The new Ticket to Work regulations that took effect in July of
2008; marketing the program to beneficiaries; and the statutory
requirements to validate earnings in order to get paid is a
problem, so we want to talk about that.
Our written testimony also contains additional information
and comments about capitalization of ENs and the utility of the
work opportunity tax credit.
First, the Ticket program is innovative, in that it pays
for outcomes, not services. This is a significant departure in
methodology from most employment services providers who chose
to sign up for the program as employment networks.
Social Security developed the original payment structure to
maintain fiscal integrity, and not being overly generous. But
they also tried to design a structure that would encourage
employment networks to participate, and to be able to cover our
costs of delivering services.
Unfortunately, without any data to draw upon at the time,
the original regulations in place until July of 2008 proved to
be inadequate. NENA believes this is the reason why most of the
more than 1,400 ENs who originally signed up either left the
program or accepted few tickets.
After 3 years of rulemaking, SSA published new regs that
took effect in July of 2008. This is well past the time period
analyzed in the Inspector General's August 2008 report, making
that report an outdated snapshot of the Ticket program's
current methodology.
The new rules primarily changed the payment structure, so
that ENs could more effectively participate in the program. SSA
started making payments under the new rules in November of
2008. Without exception, our members told us that the new rules
are a vast improvement over the original rules. We expect that
once new and prospective ENs see the data from the new rules,
there will be significantly more ENs participating in the
program, and thus accepting new tickets.
To give you a snapshot of the difference, and why the new
rules will likely help ENs participate, let me give you my own
agency's experience as an example. ABIL Employment Services in
Phoenix began taking tickets as a stand-alone program when the
tickets were first mailed in February of 2002.
Under the old rules, through November of 2008 our ticket
revenues were more than $865,000. When you look at the data,
that is a significant portion of the total payouts in one
little EN in Phoenix, Arizona.
The kicker, though, is that on the surface that looks like
a pretty good return, except that we spent $1.7 million to get
that $865,000. That's $2.03 we spent for every $1 we returned.
Not very many ENs have the resources to do that. And, of
course, it begs the question, ``Why should they?''
In contrast, thus far under the new rules, that statistic
has completely turned around. Since December of 2008, for the
first time, we consistently brought in enough revenue under the
new rules to more than cover our cost. As a result, we now plan
to expand the program by hiring more staff and conducting more
beneficiary marketing.
In addition, we are budgeting to provide more services to
beneficiaries. And we believe these are exactly the kind of
program enhancements that SSA wanted, and that will stimulate
interest, not only on the part of ENs, but also on the part of
beneficiaries.
The beneficiary marketing--we understand that SSA really
has very limited resources to do much marketing. We hope that
will change under the new rules, however, because of the
expanded payments that will be generated--NENA is working with
States to develop State employment network chapters that will
pool their resources to help us market directly to
beneficiaries in our local community.
So, we believe that with more partnership between the
program manager for recruitment and outreach, the work
incentive planning and assistance, and NENA, we could
significantly improve beneficiary awareness and the benefits of
the Ticket program. It is indeed a new day. And with aggressive
beneficiary marketing, we think that we can turn this around
and make more people participate.
My final comments will have to do with earnings validation.
I don't think that Congress intended, when this program began,
that we would be chasing after pay stubs for 5 years. But,
unfortunately, that is what we are doing. The Agency has done a
yeoman's job of trying to develop less onerous ways to collect
earnings data. But, unfortunately, it appears that many
different stakeholders have looked at very many different ways
to possibly collect earnings data, and nothing seems to be
working.
It is because of the language in the statute that says,
``Due to work or earnings''--that is at section--oh, it is in
my written testimony. It is actually in several places
throughout. But we recommend that the statute be amended to
remove the ``Because of work or earnings'' language. Ticket
stakeholders, as I said, have discussed the issue. And we
believe that, at last blush, that is the only way that we are
going to eliminate this onerous requirement to collect pay
stubs.
Mr. Chairman, Members of the Subcommittee, it is a new day.
We look forward to another 5 years of the Ticket to Work
program. And with program enhancements to marketing, to help us
remove that language regarding validation of pay stubs, and
with the new payment structure that SSA has put into place, we
believe that this will be effective and will help millions of
people--not hundreds of thousands, but millions--to return to
work.
I would be happy to answer any questions that you might
have.
[The prepared statement of Ms. Webb follows:]
Prepared Statement of Susan Webb, President and Co-founder,
National Employment Network Association, Avondale, Arizona
Mr. Chairman, Members of the Subcommittee, my name is Susan Webb. I
am here today on behalf of the National Employment Network Association
(NENA). NENA is a membership association providing training, technical
assistance and program updates to Employment Networks (EN) nationally
who provide employment services under the Ticket to Work and Self-
Sufficiency program. Five of the largest, most active private ENs sit
on NENA's Board of Directors.
Our oral comments today cover three key areas: (1) the new TTW
regulations that took effect in July 2008; (2) marketing the program to
beneficiaries; and (3) the statutory requirements to validate earnings
in order to get paid. Our written testimony contains additional
comments regarding EN capitalization and utility of the work
opportunity tax credit (WOTC).
I. New Ticket Regulations
First, the Ticket program is innovative in that it pays for
outcomes, not services. This is a significant departure in methodology
for most employment service providers who chose to sign up for the
program as ENs. SSA developed the original payment structure to
maintain fiscal integrity in not being overly generous; but they also
tried to design a structure that would encourage ENs to participate and
be able to cover our costs of delivering service. Unfortunately,
without any data to draw upon, the original regulations in place until
July of 2008 proved to be inadequate. NENA believes this is the reason
why most of the more than 1,400 ENs who originally signed up either
left the program or accepted few tickets.
After 3 years of rulemaking, SSA published new regulations that
took effect in July 2008. This is well past the time period analyzed in
the Inspector General's August 2008 report, making that report an
outdated snapshot of the Ticket program's current methodology. The new
rules primarily changed the payment structure so that ENs could more
effectively participate in the program. SSA started making payments
under the new rules in November 2008. Without exception our members
told us the new rules are a vast improvement over the original rules.
We expect that once new and prospective ENs see the data from the new
rules, there will be significantly more ENs participating in the
program and accepting new tickets.
To give you a snapshot of the difference and why the new rules will
likely help ENs participate, let me give you my own agency's experience
as an example. ABIL Employment Services in Phoenix, Arizona began
taking tickets as a stand-alone program when the first tickets were
mailed in February 2002. Under the old rules, through November 2008 our
ticket revenues were more than $865,000. On the surface, when you look
at the total payouts during that time for all ENs, we received a
significant percentage of the total. However, our expenses to operate
the program during that time were $1.76 million! In other words, we
invested $2.03 for every $1 in revenue we received. Few organizations
have the resources to operate such a program, and it begs the question:
Why would we do so?
In contrast, thus far under the new rules, that statistic has
completely turned around. Since December 2008, for the first time, we
consistently brought in enough revenue under the new rules to more than
cover our costs. As a result, we now plan to expand the program by
hiring more staff and conducting more beneficiary marketing. In
addition, we are budgeting to provide more services to beneficiaries,
such as short-term job training and paying for licenses and other
expenses to help beneficiaries get a job and keep it. We believe these
are exactly the kind of program enhancements SSA desired to stimulate
with the new Ticket program rules, and the rules are working for us at
ABIL.
II. Beneficiary Marketing
No matter how good the new rules prove to be, beneficiary marketing
is a critical component of program success. NENA recognizes that SSA
faces priorities that place significant demand on its resources, most
notably reducing the backlog of initial claims and completing mandated
continuing disability reviews. This resource demand is not likely to
subside any time soon.
Some of the new initiatives SSA plans to implement such as more
targeted mailings will help. In addition, the valuable contributions of
the Work Incentive Planning and Assistance contractors cannot be
overestimated.
NENA believes the new rules will create revenues that ENs can use
to conduct marketing locally. NENA plans to help ENs develop
Association chapters in their States. These chapters can encourage
their EN members to pool resources to develop and distribute marketing
materials to ticket users most likely to succeed in the program. The
mailings can be targeted using the beneficiary list currently available
on CD. These consortia of ENs can build upon the targeted information
being developed by SSA's Program Manager for Recruitment and Outreach
(PMRO).
Although NENA would very much like to see SSA devote more resources
to beneficiary marketing, we understand that is not likely. We believe
more collaboration between the PMRO, WIPAs and NENA could significantly
improve beneficiary awareness of the benefits of the Ticket program.
III. Earnings Validation
In addition to the promise of the new rules and collaborative,
aggressive beneficiary marketing, we believe there is one other area in
particular that could significantly help the Ticket program succeed. In
Section 1148(h)(2)(B) and other sections throughout the statute that
discuss payments to ENs, the language says, ``. . . payments to an
employment network . . . for each month . . . for which benefits . . .
are not payable . . . because of work or earnings.'' [emphasis added].
This language has been interpreted by SSA to mean that an EN cannot
be paid without collecting earnings data in the form of a pay stub or
other equally valid document. This interpretation has proven to be a
tremendous burden to ENs and SSA field office staff. One major goal of
the program is to ensure that beneficiaries have access to continued
services after they go to work with the intent that such services will
help them achieve self-support and they can end their use of cash
benefits. One of the key provisions of the Ticket program is this
follow-on support for 3-5 years after the beneficiary actually achieves
an earnings level that is sufficient to end their dependence on cash
benefits. An unintended consequence of this language is that it
requires an EN to chase down pay stubs for up to 60 months after the
individual leaves cash benefits. Otherwise, we forgo timely payments.
SSA has implemented some helpful procedures to ease this burden.
However, we still wait months for payment unless we can collect pay
stubs.
In our experience, once a beneficiary starts working, we want them
to be as independent as possible. The requirement to collect pay stubs
from them is often annoying, especially after they have been working
for an extended period of time. Even though we tell them about this
requirement upfront, we are completely at their mercy to get paid in a
timely manner.
NENA recommends that the statute be amended to remove the ``. . .
because of work or earnings'' language. Ticket stakeholders have
discussed this issue since first implementation of the statute. Several
alternatives to this problem have been discussed and rejected for
various reasons as unworkable.
There are reasons a beneficiary might cease using cash benefits
other than because of work. But NENA believes that the potential
overpayments to ENs would be minimal, especially in light of the
tremendous administrative burden this provision has demonstrated itself
to be. It is a burden not only to ENs, but also to SSA field office
staff, who are struggling to meet SSA goals despite staff attrition and
tight budgets. Overpayment to ENs is a simple problem and easily
solved; since ENs are contractors, overpayments can easily be recovered
with the next month's billing.
We wholeheartedly ask the Subcommittee to seriously review this
language. We believe you will agree with us that this is an onerous
requirement that should be eliminated.
Mr. Chairman, Members of the Subcommittee, thank you for the
opportunity to address you today. I would be happy to answer any
questions you have.
IV. Work Opportunity Tax Credit
The Work Opportunity Tax Credit (WOTC) allows employers to claim a
tax credit up to $2,400 during the first year of employment for hiring
workers from certain disadvantaged groups. Ticket program participants
are one of the groups for which the employer may take the credit. About
one-third of our members who responded to our survey said they find the
WOTC useful as an incentive for employers to hire our Ticket
participants.
NENA recommends that the WOTC be evaluated at its next
reauthorization to consider increasing it to attract the interest of
more employers. The WOTC and the amount of the credit was established
in 1996. Using the Consumer Price Index Calculator found at
www.bls.gov/data/inflation_calculator.htm, if the credit had been
increased each year consistent with inflation, the rate would currently
be $3,250. We recommend increasing it to that level and indexing it
each year from there.
V. Capitalization
NENA supports the outcome-based design of the Ticket program.
However, it can take several months to appreciably start up a program
during which an EN will not realize revenues. It can be quite costly
and difficult from a cashflow perspective for ENs to capitalize their
program. Consequently, many ENs start out very small and only add the
program to serve consumers already served by their other programs. ENs
need capital to take a larger number of tickets, especially from
ticketholders who are not otherwise already engaged through other
services. Lack of capital is likely another reason ENs have accepted
such a small number of tickets.
One of the key objectives of the Ticket program is to widen the net
of available providers and services. Many of the ENs who responded to
our survey are working through their State Vocational Rehabilitation
agency instead of going it alone. In some ways, that defeats the
purpose of expanding the availability of services other than the VR
system. This is further exacerbated by the fact that VR agencies around
the country are suffering under budget cuts, which reduces the
availability of VR services.
NENA has been advocating to bring in the Community Development
Financial Institutions (CDFI) managed by the Department of Treasury.
NENA is poised to develop a template business plan that ENs can
customize for their organization and take to their local CDFI.
Concurrently, NENA is advocating on a State-by-State basis to bring the
local CDFIs on board to understand the Ticket to Work program with an
eye toward infusing capital and financial technical assistance to ENs
so they may use loans and grants to buffer them through the lengthy
startup phases of their development.
We believe that through the local NENA chapters discussed earlier,
ENs can build collaborative efforts to approach their local CDFIs for
the seed capital they need. We ask that the Social Security
Subcommittee would notify the Department of Treasury to add Ticket
program ENs to the list of programs that CDFIs consider funding. This
will greatly assist ENs in working with CDFIs on the local level.
Chairman TANNER. Thank you very much, Ms. Webb. We may well
have some followup questions on your suggestions later on. So
thank you for raising those.
Mr. Golden, you are recognized, sir.
STATEMENT OF THOMAS P. GOLDEN, PRESIDENT, NATIONAL ASSOCIATION
OF BENEFITS AND WORK INCENTIVES SPECIALISTS
Mr. GOLDEN. Thank you, Chairman Tanner, Ranking Member
Johnson, and Members, thank you for inviting me to testify
today on behalf of the National Association for Benefits and
Work Incentives Specialists, a national association composed of
many and varied professionals providing assistance to
individuals who receive disability benefits and public
entitlements.
With the passage of the Ticket to Work and Work Incentives
Improvement Act came a promise to millions of Americans with
disabilities who receive SSI and SSDI, that they would have
access to the critical supports that they need to realize the
American dream: The ability to work and earn wages and not have
the path to employment blocked by policy barriers and risks
associated with losing critical health care coverage.
Over a decade later, while we have minimized some obstacles
in employment, this critical piece of legislation, as you had
expressed earlier, has yet to fully recognize its potential.
Today I would like to share with you our perceptions of
successes to date, challenges for the future, and specific
recommendations for your consideration to re-establish a new
course that ensures not just achieving, but exceeding the
original intentions and purpose of the Act.
Specifically, my testimony is going to fall into four
categories: Implementation of the Ticket to Work program; work
CDRs, backlogs and overpayments; reauthorization of the work
incentives outreach provision of the law; and SSA's
demonstration authority.
While prior to the release of the recent Ticket to Work
regulation changes the outlook for the program seemed bleak, as
you have heard from testimony from Sue Suter, there has been a
new program released, and we have seen increased numbers of ENs
engaged in the program, increased numbers of ENs actively
participating, and increased numbers of payments to employment
networks for successful outcomes.
WIPA and PABSS, along with the area work incentive
coordinators employed by SSA and other return-to-work partners
have played a critical role in supporting these outcomes
through a variety of strategic outreach events, including work
incentive seminars, or WISE. These types of high-touch outreach
events provide opportunities to educate community partners, and
hold great promise for the continued success of the program.
While we are hopeful that the new regulations and increased
recruitment and marketing activities will continue to expand
the universe of providers currently available under the
program, we feel strongly that a national education campaign to
increase beneficiary information regarding the program is very
much needed. The ongoing need to educate beneficiaries,
parents, and other stakeholders about the program and the
opportunity that it provides is critical.
Another challenge needing to be addressed is the extent to
which the adequacy of incentives population, or the AOI
population, in the original legislation is participating in the
Ticket to Work program. While the new regulations and payment
scheme for the program recognize and value beneficiaries who
work part-time, there is no convincing data to date to
substantiate that individuals requiring high-cost
accommodations, beneficiaries who require long-term supports,
or individuals earning sub-minimum wage are able to participate
in the program.
Therefore, we offer two recommendations for the
Subcommittee's consideration to improve the Ticket to Work
program.
First, Congress should require SSA to conduct a general
education campaign for beneficiaries, and allocate additional
resources to WIPA for increased educational and outreach
activities to support the program in recognizing its full
potential.
Second, Congress should require SSA to conduct a second
adequacy of incentives study to gauge participation of this
population in the program. This could be accomplished by
modifying reporting requirements for ENs, and asking them to
identify when a beneficiary is part of one of the four targeted
groups.
In regard to work CDRs, backlogs, and overpayment, NABWIS
applauds Congress' allocation of personnel resources to SSA to
aid them in addressing the issue of work CDRs, backlogs, and
overpayments. But there is where we stop. This one area has
done more to undermine the marketing of work incentives than
any other single thing. NABWIS members, regardless of setting
and location, are experiencing overpayments resulting from CDR
backlogs and weak SSA operations in documenting earnings.
We need to have resources allocated to SSA in the form of
AWICs and WILs, because they play a critical role in
adjudicating work issues on behalf of the Social Security
Administration. Because the work CDRs are rarely done on a
timely basis, even when beneficiaries report wages timely, the
quality of the results can be greatly diminished.
Also, the notices that are sent out are becoming poorer and
poorer in quality, often not explaining the basis for
decisions, as required by the regulations. Addressing the issue
requires SSA to prepare and assign adequate personnel with
knowledge of work and employment supports to process these
critical work claims.
Therefore, we would like to recommend that SSA expand the
current AWIC and WIL corps of work incentives specialists that
are outlined in the work incentive outreach provision of the
law by 50 percent to increase resources for adjudicating these
work claims.
In regard to reauthorization of the work incentive planning
and assistance programs, as well as the PABSS program, I
presented information in my testimony that showed clear and
convincing evidence of the positive outcome of that provision
of the law.
Most unfortunate, though, is recognizing that over the past
two decades we continue to see a decrease in work incentive
utilizations, specifically the IRWE, the PASS, the blind work
expense, as well as other work incentive programs, despite our
best efforts at providing more information. That speaks to a
potential that possibly those work incentives aren't actually
work incentives at all. While they may work for a very small
portion of the population, they don't seem to be allowing
individuals the necessary resources that they need to be able
to start down that path to employment.
We can't report to you on SSDI work incentives, because
SSDI does not make that data public regarding the number of
work incentives that are utilized under that program.
Therefore, to close very quickly, we would like to
recommend that Congress think, as they look at reauthorizing
this piece of legislation, that they clearly set out a much
more clear set of performance standards and indicators for the
WIPA program, the PABSS, as well as the AWICs, as well as
require a data management system that can be integrated with
SSA administrative data to report attainment and progress
toward specific employment goals, as well as to be able to
begin to report on SSDI work incentive utilization, and just
not the work incentives under the SSI program.
I do have some additional thoughts regarding SSA
demonstrations that are included in my testimony, and
appreciate your consideration of those. Thank you.
[The prepared statement of Mr. Golden follows:]
Prepared Statement of Thomas P. Golden, President,
National Association of Benefits and Work Incentives Specialists
I. Introduction
Chairman Tanner and Members of the Subcommittee, thank you for
inviting me to testify today on behalf of the National Association for
Benefits and Work Incentives Specialists (NABWIS). I am both honored
and proud to be here as the current President of the NABWIS--a national
association composed of many and varied professionals providing
assistance to individuals who receive disability benefits and public
entitlements. In communities all across America, hundreds of benefits
and work incentives specialists are trained to provide information and
indepth analysis to individuals currently receiving benefits so that
those individuals can make informed choices about employment. Some
practitioners are funded by the Social Security Administration, some of
us work for State agencies, while others work in community
rehabilitation programs--all committed to seeing that people with
disabilities get the highest quality information available to support
choices regarding work and increased economic self-sufficiency. The
profession of benefits and work incentives planning and assistance is a
growing field--taking its place as a critical employment support
service for individuals who receive disability benefits. I am extremely
grateful for this Subcommittee's support and assistance in, among other
things, efforts to increase employment support, and ensure that the
Ticket to Work Act realizes its full potential.
II. Background
With the passage of the Ticket to Work and Work Incentives
Improvement Act came a promise to millions of Americans with
disabilities who receive Supple-
mental Security Income (SSI) and Social Security Disability Insurance
(SSDI) that they would have access to the critical supports they need
to realize the American dream--the ability to work and earn wages and
not have the path to employment blocked by policy barriers and risks
associated with losing critical health care coverage. Over a decade
later, while we have minimized some obstacles to employment resulting
in increased employment participation and created some new health care
options, the vision cast on December 17, 1999 and potential of this
critical piece of legislation has yet to be fully recognized.
Today, I would like to share with you our perceptions of successes
to date, challenges for the future, and specific recommendations for
your consideration to reestablish a course that ensures not just
achieving but exceeding the original intentions and purpose of the Act.
A critical part for resetting that course is the ongoing commitment of
this Subcommittee to continue to identify and remove obstacles to
employment for beneficiaries who want to work while at the same time
encouraging and supporting the SSA to continue the culture shift within
their work environment to become focused on return-to-work.
Specifically, we will address the overall implementation of the Ticket
to Work and Self-Sufficiency program; Work CDRs, backlogs and
overpayments; reauthorization of the work incentives outreach provision
of the law; and, SSA's demonstration authority.
III. The Implementation of the Ticket to Work and Self-Sufficiency
Program
As mentioned earlier, Congress hoped that the creation of the
Ticket program would: Stimulate private sector providers and employers
to participate; engender competition, and; empower beneficiaries with
more choices and greater involvement in the employment and
rehabilitation process. While in 2004, with the release of the Ticket
to Work and Work Incentives Advisory Panel's report, ``The Crisis in EN
Participation,'' the outlook seemed bleak for the Ticket to Work
program, SSA's promulgation of new regulations, increased focus on
marketing and recruitment and alignment of the WIPA, PABSS and AWIC
efforts to strategically support employment outcomes heralded a new
beginning for the program.
As you will hear in other testimony today, implementation of the
new Ticket to Work program has increased the number of ENs engaged in
the program, the number of ENs actively participating, the number of
payments to ENs for successful outcomes, and increased numbers of
beneficiaries achieving successful work outcomes. WIPA, PABSS, AWICs
and other return to work partners have played a critical role in
supporting these outcomes through a variety of strategic outreach
events, including Work Incentives Seminars (WISE). These types of high-
touch outreach events provide opportunities to educate community
partners and hold great promise for the continued success of the
program.
While we are hopeful that the new regulations and increased
recruitment and marketing activities will continue to expand the
universe of providers available under the program, a national education
campaign to increase beneficiary information regarding the program is
needed. Beneficiaries need to hear information about return to work
from more than just one sector, and more than one time to consider
employment options. The ongoing need to educate beneficiaries, parents
and other stakeholders is critical. They need to hear the information
several times from knowledgeable people who provide accurate
information. Individuals who do not understand or trust the information
will not choose to work. The programs in the work incentives outreach
provision of the law are tasked with huge responsibilities to support
successful outcomes under the Ticket to Work program. Another challenge
needing to be addressed is the extent to which the Adequacy of
Incentives (AOI) population in the original legislation is
participating in the Ticket to Work program. While the new regulations
and payment scheme for the program recognize and value beneficiaries
who work part-time, there is no convincing data to substantiate that
individuals requiring high cost accommodations, beneficiaries who
require long-term supports or individuals earning sub-minimum wage are
participating in the program. While SSA has used administrative data to
attempt to identify these potential populations, the experience of
disability is not homogenous and specific disability categories are not
representative of the AOI populations. We offer two recommendations for
the Subcommittee's consideration. Congress should require SSA to
conduct a general education campaign for beneficiaries and allocate
additional resources to WIPA for increased educational and outreach
activities to support the program in recognizing its full potential.
Congress should require SSA to conduct a subsequent AOI study to gauge
participation in the program. This could be accomplished by modifying
reporting requirements for ENs and asking them to identify when a
beneficiary is part of one of the four targeted populations.
IV. Work CDRs, Backlogs and Overpayments
NABWIS applauds Congress' allocation of personnel resources to the
SSA to aid them in addressing the issue of work CDRs, backlogs and
overpayments. Beyond that though, this is the one area that has done
more to undermine the marketing of work incentives than any other
single thing. NABWIS members, regardless of setting and location, are
experiencing overpayments resulting from CDR backlogs and weak SSA
operations in documenting earnings. One of the most critical work
support roles that SSA can engage in is the timely input of wages and
processing decisions based on that information. SSA has had pockets of
excellence in addressing these operations issues. In New York State, as
part of the State Partnership Initiative from 1999-2005 interventions
under this research demonstration almost eliminated the occurrence of
overpayments. A key to the success of this part of that intervention
was adequately trained and allocated personnel within the SSA office to
process work claims. AWIC and WIL personnel play a critical and vital
role in adjudicating work issues. Because the work CDRs are rarely done
on a timely basis, even when beneficiaries report wages timely, the
quality of the results can be greatly diminished. Also, the notices
that get sent out are becoming of poorer and poorer quality, often not
explaining the basis for decisions as required by the regulations. A
huge process finding from the $1 for $2 benefit Offset Pilot was the
number of overpayments and inappropriate suspension of benefits that
were the result of delays in development of the Trial Work Period
(TWP). The inability of SSA to manage the TWP in a timely manner is
itself an additional work disincentive. The TWP is an ineffective work
incentive that is costly for SSA to administer. Addressing this issue
requires SSA to prepare and assign adequate personnel with knowledge of
work and employment supports to process work claims. This investment of
personnel, while costly at first will prove advantageous in the long
run as work claims are processed in effective and proactive ways. We
recommend that: SSA expand the current AWIC and WIL corps of work
incentive specialists by 50% to increase resources for adjudicating
work claims and increasing contact and outreach within local
communities.
V. Reauthorization of the Work Incentives Outreach Provision of the
Ticket to Work Act
Since the passage of the Ticket to Work Act, extensive work
incentives training and dissemination efforts have been implemented
nationally as a result of the work incentives outreach provision of the
law which included three important dimensions: Development of a corps
of work incentive specialists within the SSA; a national network of
benefits and work incentives planning and assistance practitioners,
and; protection and advocacy services and supports for beneficiaries of
Social Security. Generally, the purpose of the work incentive outreach
provision of the law was to increase the availability of work incentive
information to disability beneficiaries to support informed choice
regarding work. While clearly there was a well-documented need for
knowledge dissemination about work incentive provisions, an underlying
assumption of many in the disability community leading up to the
passage of the Act was that increased knowledge would translate into
individual beneficiary change as well as organizational practice
change. Yet, research on organizational change suggests that knowledge
transfer alone is often not sufficient to bring about behavioral
changes in individuals and/or organizations. Similarly, research shows
that knowledge-based training programs may be weak interventions for
bringing about organizational change; the barriers to changing
individual and organizational practice may not be based in insufficient
knowledge. Rather, barriers to change may lie more in elements of
individual and organizational culture that subtly contradict the aims
of the intended change.
There are many successes along the road to implementation of this
provision of the law that should be celebrated.
A customer satisfaction survey conducted by the SSA in 2004 of a
random sampling of 1,764 beneficiaries having accessed benefits
planning, assistance and outreach services found that: 89 percent of
respondents rated the counseling they received as ``good,'' 94 percent
felt the information they received was correct and 21 percent began
working subsequent to having received benefits counseling. While the
survey also found that only 43 percent of respondents stated that the
benefits counselor contacted someone on their behalf to move them into
employment, SSA developed an action plan to realign the national
network reinforcing their role as an essential support leading to
employment and strategically conducting outreach to populations of
beneficiaries with an expressed interest in work.
From the establishment of the original BPAO initiative to the
current Work Incentives Planning and Assistance (WIPA) network we have
seen increasing numbers of individuals returning to work under the SSI
program and participating in the 1619(b) provision (from 6.7% in 1999
to 7.9% in 2007 with an approximate 7% increase in 1619(b)
participation rates).
Research from the State of Vermont showed a 102% increase in
earnings after an enrollment in benefits and work incentives counseling
for beneficiaries who chose to work. The study also documented that in
the year following enrollment in benefits and work incentives
counseling that participants brought in an additional $800,000 in
additional earnings and raised their employment rates from 35-50%. The
study's conclusions highlight that enrollees earned on average $1,400
more after enrolling in benefits counseling services. Similar empirical
results have been found in other States like New York, Minnesota,
Wisconsin, Connecticut and others although average costs for services
varies based on level of intensity, credentials and level of
preparation of personnel and other variables.
The SSA has successfully established an internal corps of work
incentive specialists through the Area Work Incentive Coordinators
(AWICs) and Work Incentive Liaisons (WILS) that have become integral
change agents not only within the SSA but also on a regional and
Statewide level.
While we celebrate the successes of this provision to date, the
future holds many challenges.
While the network of work incentives practitioners have contributed
to increased employment outcomes for beneficiaries, we have seen no
improvement in work incentive utilization. In 1995, 10,322 SSI
recipients were using the PASS as a work incentive. By 2000, only 1,382
SSI recipients were using the PASS.\1\ While the number of SSI
recipients using a PASS increased to 1,582 in 2005 through the BPA&O
years, since implementation of the WIPA initiative the number of PASS
has declined to 1,515 in 2007. Use of an IRWE as a work incentive
continues on a steady decline as well from 9,940 SSI recipients in 1995
to 5,161 in 2007. Use of BWE as a work incentive has shown more than a
50% reduction in utilization from 4,433 SSI recipients in 1995 to 2,142
SSI recipients in 2007. This data might suggest the existence of a
knowing/doing gap on several fronts. First, potentially the knowledge
gained from work incentive training programs may not be translating
into ``doing'' or assisting the beneficiary into putting an action plan
into place that results in work incentive utilization or employment.
Further, it recognizes that the choice to work lies in the hand of the
beneficiary and there may be other obstacles out of the control of the
profession that come to bear on the beneficiary's final decision.
Finally, it may provide strong evidence that the current package of
work incentives continue to be too complicated and may not provide
adequate enough incentives to make work pay. Regardless of the reason,
this does not augur well, and holds significant implications for the
ongoing evolution of public policy--with an emphasis not only on
knowledge-based learning objectives but also behavioral and
performance-based objectives as well.
---------------------------------------------------------------------------
\1\ During the spring of 1996 SSA completely redesigned the way in
which the PASS incentive was administered in response to a report
issued by the GAO. This drastically reduced the number of PASS in the
United States.
---------------------------------------------------------------------------
Recipients of cooperative agreements under the WIPA program, as
well as PABSS, have operated on the same or reduced levels of funding
now for more than 8 years, meaning that resources/staffing is going
down when the demand for work is going up. At the same time, SSA has
not conducted research or required a rigorous data management system to
document costs of services under either program to substantiate the
need for increased allocations. Data clearly substantiates that both
projects can have a positive impact on employment outcomes if funding
is increased substantially.
The current AWIC and WIL networks are spread too thin and while
having a positive impact on a larger regional and Statewide level,
cannot make a meaningful contribution at the local level where it is
needed most.
The lack of performance benchmarks for the work incentives outreach
provision of the Act make it difficult to gauge the effectiveness of
work conducted to date. The Ticket to Work and Work Incentives Advisory
Panel in their report entitled ``Update, Simplify and Educate: A
National Call to Optimize Work Incentives'' called for establishment of
clear performance objectives and standards for these networks although
to date no action has been taken to build in accountability measures.
Unfortunately, we were not able to present data on the return to
work and work incentive utilization rates of SSDI beneficiaries as SSA
does not produce annual statistical supplements of this information.
The Ticket to Work and Work Incentives Advisory Panel in both their
Final Report and Work Incentive Utilization Report provided clear
guidance to the SSA as to the need for this information, format and
frequency with which it should be reported although to date the SSA has
yet to respond to this critical guidance.
To continue to broaden the impact of this provision, we strongly
recommend action in the following areas:
Require the SSA to conduct a demonstration to simplify the existing
array of work incentives that exist and improve consistency across the
SSI and SSDI programs.
Expand the current allocation of resources for both the WIPA and
PABSS by 25% with an annual cost of living adjustment to ensure that
the existing workforce and effort are maintained at adequate levels.
Subsequently, require the SSA to conduct a cost/benefit analysis to
determine per beneficiary costs to provide a formula for future
allocations.
Expand the resources available to the SSA to increase the number of
AWIC/WIL 50% to increase impact at the local level.
Identify a clear set of performance standards and indicators for
the three facets of the work incentives outreach provision and a
national data management system that can be integrated with SSA
administrative data to report attainment and progress toward these
benchmarks.
Require the SSA to collect and annually distribute a statistical
supplement/update on the return to work and work incentive utilization
rates of SSDI beneficiaries.
VI. SSA's Demonstration Authority
The Benefit Offset Demonstration. Under the Ticket to Work Act, SSA
was required to conduct a national demo of a $1 for $2 offset for the
SSDI program to address the issue of the substantial gainful activity
cliff. Until very recently there have been no research data to support
the assumption that beneficiaries would increase their employment if an
offset were available. However, in 2008, data from the four pilot
projects in Connecticut, Utah, Vermont and Wisconsin established by the
Social Security Administration (SSA) have begun to provide clear
evidence that a gradual offset of SSDI benefits would result in
increased earnings. Originally, the State pilots were established as an
implementation test, to inform a much larger national demonstration
planned to start in 2009 and be completed in 2015. However, the pilots
were each implemented with a rigorous experimental research design and
have each begun to produce outcome data. To date, the results from the
States appear to support a gradual offset as policy for the SSDI
program.
Based on the experiences and results from these States, a policy
change could accomplish several important goals: Increase the
employment levels of SSDI beneficiaries; increase the economic well-
being and self-sufficiency of SSDI beneficiaries; generate cost savings
or at minimum be cost neutral to the Trust Fund; simplify the
administration of the SSDI program.
While the four pilot States are producing very promising data to
reinforce the need for significant policy change, it has been over a
decade and the national demonstration has still not happened. At this
rate, even if the demo occurs, there will not be results until 2017.
The four State pilots have already produced data indicating an offset
would result in increased earnings rates for beneficiaries. While the
numbers are small, the pilots were conducted using random assignment
experimental design. In addition, the SSA Advisory Council in an April
2009 policy brief, has proposed SSA look to modeling and simulation to
evaluate the possible impact of a $1 for $2 instead of doing a lengthy
demo that may not yield results that are useful in terms of
policymaking. They support the implementation of an SSI like offset for
DI beneficiaries will ``do much to encourage work by SSDI
beneficiaries.'' There is concern that the large scale of the demo
(across 10 sites) and the inevitable implementation challenges that SSA
and the sites will experience will result in a false negative result.
For example, if SSA ramps up the demo without sufficient resources on
the ground (benefits counseling and other supports), the first couple
of years of the demo will be lost because folks simply won't understand
it. Also, if there are implementation issues with administration of the
offset beneficiaries will be unwilling to risk participation for fear
of errors.
Based on the results to date and to accomplish the intended goals
of Congress, the following broad policy changes are recommended:
A $1 reduction (offset) of SSDI cash benefits for every $2 in
employment earnings.
Elimination of the ``Trial Work Period'' and ``Extended Period of
Eligibility.''
Continued attachment to the SSDI program for beneficiaries.
These proposed policy changes would bring the work rules of the
SSDI program into alignment with other broad State and Federal program
initiatives launched under the umbrella of the 1999 Ticket to Work and
Work Incentives Improvement Act. Most importantly, this change will
provide beneficiaries with significant disabilities the opportunity to
try to return to work without risking everything in the process.
SSA Demonstration Authority. It is critical that SSA be provided
ongoing authority to demonstrate program innovations that promote
return to work and test new approaches to establishing disability
standards. While SSA has executed their authority in the past, it has
only been as directed by Congress. It is critical that this
Subcommittee identify demonstration priorities for the next 10 years
that contribute to innovations that result in reduction of the
disability rolls and promote increased employment outcomes. Beyond
rolling out the policy recommendations above pertaining to the $1 for
$2 offset under the DI program, Congress should direct SSA to conduct
additional demonstrations that include:
Creating, piloting and evaluating new work incentives that
streamline, simplify and bring consistency between both the SSI and DI
program.
Creating, piloting and evaluating a new disability standard leading
to a voluntary and elective short-term employment support benefit.
These recommendations are consistent with past recommendations put
forth by the Ticket to Work and Work Incentives Advisory Panel in their
final report.
VII. Conclusion
I would like to thank you again for the privilege and opportunity
to appear before you today, and to thank the SSA and its staff for
their hard work, vision and commitment to ensuring that disability
beneficiaries have access to the critical employment supports they need
to realize the American dream. I would be happy to answer any questions
you might have.
Respectfully submitted,
Thomas P. Golden, President
National Association of Benefits and Work Incentives
Specialists
Cc: NABWIS Board of Directors
Chairman TANNER. Thank you. As all of you know, your
statement in its entirety is in the record, and that staff is
already looking at some of the suggestions. So, thank you for
your testimony.
Dr. Growick, you have the floor, please.
STATEMENT OF BRUCE GROWICK, ASSOCIATE PROFESSOR OF
REHABILITATION SERVICES, THE OHIO STATE UNIVERSITY COLLEGE OF
EDUCATION, COLUMBUS, OHIO
Mr. GROWICK. Yes. Thank you, Chairman, and Members of the
Subcommittee. I certainly do appreciate being here. My name is
Bruce Growick, and I am on faculty at Ohio State University,
where I train rehabilitation professionals at the master's
level, those individuals who work both in the public and
private sector to return individuals with disabilities back to
work.
For those of you who are perhaps not familiar with the
Ticket program, since it does have a rather strong legacy, and
having been dated back to the 1980s with initial demonstration
projects, I do have two scholarly papers that I have authored
that are going to be included in the record, and I strongly
encourage you to take a look at them if you are not familiar
with the Ticket.
One is entitled, ``The Political Implications of the
Ticket,'' which outlines the quid pro quos of the basic aspects
of the Ticket that were important, in terms of it initially
getting passed.
The second article, which was published afterward, is
entitled, ``The Unintended Consequences of an Imperfect Law.''
And in that article what I try to do is outline what the
current shortcomings of the Ticket are.
And what I am here to do today is to share with you my
disappointment with the Ticket. I was involved in the Ticket as
early as the 1980s, when Social Security Administration first
developed demonstration projects showing that rehab counselors
in the private sector, as they do in other disability venues,
such as workers compensation, long-term disability, and
personal injury cases, help individuals with disabilities
return to work.
With those demonstration projects, it became clear that the
existing sole provider of rehabilitation services, namely the
State Federal system, should not be the only provider of
rehabilitation services, return-to-work services. So, what the
Ticket did, in part, was provide an opportunity for private
providers, called the ENs, to become part of the equation in
helping the over 10 million Social Security beneficiaries
return to work.
Unfortunately, that has not been the case. The number of
ENs that are participants in the Ticket to Work program is very
small, if not totally negligible. Individuals that I train at
the master's level at the university are clearly not interested
in entering into this venue to provide services for individuals
who sorely need them.
The Ticket to Work program has not increased the number of
beneficiaries that have returned to work. Initially, in the
preamble of the law, it talks about the State Federal rehab
system returning less than one-half of 1 percent of
beneficiaries back to work. And that has continued to be the
case. The Ticket program has not had an appreciable and
positive impact on the number of individuals who are receiving
Social Security benefits.
In my remarks I would like to make three suggestions, in
terms of ways in which perhaps this can be improved. First of
all, the Social Security Administration convened a committee of
which I was a part a couple of years ago called, The Adequacy
of Incentives. That committee focused on the beneficiaries and
incentives that would increase the number of beneficiaries who
might be interested in the program.
What I would like to suggest to the Committee is that you
convene, through the Social Security Administration, a similar
committee to focus on the ENs, the providers, the providers of
the other half of the equation here, those individuals, other
than that State Federal rehab system that can return
individuals with disabilities back to work. It is crucial that
you make the Ticket program as inviting and as friendly to
providers as you do to beneficiaries.
Second of all, regarding the WIPA program and the PABSS
program, I would like to see some goals and milestones attached
to those programs that are related to the return to work. The
purpose those provisions are in the Ticket is to help
beneficiaries understand the Ticket program and return to work.
If those milestones or goals are not included, then perhaps the
WIPA program and the PABSS program can be decoupled from the
Ticket program.
And then, lastly, as a creative suggestion, I would like to
see the State Federal VR system focus on individuals who are
applicants to the Social Security disability system, and not
necessarily beneficiaries. If one separates out the service
providers between public and private, in terms of who is
disabled under Social Security and who isn't, I think we can
accomplish a lot more.
Thank you very much for the opportunity to provide these
comments. I would be happy to answer any questions that you
might have.
[The prepared statement of Mr. Growick follows:]
Prepared Statement of Bruce Growick,
Associate Professor of Rehabilitation Services,
The Ohio State University College of Education, Columbus, Ohio
Employment Support Programs for Disability Beneficiaries
(1) Biographical Statement
Faculty member at Ohio State University in Vocational
Rehabilitation Services since 1982.
Former State Director of the Vocational Rehabilitation
Division of the Bureau of Worker's Compensation in Ohio (1989-1990).
Past National President of the Association of
Rehabilitation Professionals (1994-1995).
Presidential Appointee to the U.S. Access Board (2002-
2006).
Practicing vocational rehabilitation professional with
SSA, Ohio Workers' Compensation, Ohio Police and Firemen Disability
Fund, and civil courts (1992-present).
(2) Involvement with the `Ticket'
As President of the Association of Rehab Professionals
in the Private Sector (which has 3,200 members nationally and 38 State
Chapters) in 1995, I was asked to represent vocational rehab
professionals in disability determination and management in various
settings, such as workers' compensation, personal injury, Social
Security, and pension funds.
Participated in the negotiations for the passage of the
Bill during the 1990s, and attended the Bill signing ceremony in 12/
1999.
Conducted for the SSA a national survey of ENs in 2002
on their interest in providing services under the `Ticket' program.
Participated in the Adequacy of Incentives (AOI)
committee of SSA that developed the most recent rule changes in the
`Ticket.'
Has presented numerous times to the `Ticket' Advisory
Panel on the role and functions of ENs in the `Ticket' program.
As a Commissioner for VR in Ohio, I have continued to
promote the advantages of the `Ticket' for RTWs, such as suggesting the
use of Federal stimulus money for the development of ENs.
(3) The Basic Premise of the `Ticket' (Insert for the Record: Growick,
Bruce (2001). ``The Political Implications of TTW-WIIA.''
Rehabilitation Education. 15(1), 89-93.)
The GAO has repeatedly reported in the 1990s that many
SSA disability beneficiaries are not receiving RTW services under the
model of RSA as the sole provider of VR services.
Other indemnity systems, such as Workers' Compensation
and Long-Term Disability, use independent rehabilitation professionals
(i.e., the private-sector) to return beneficiaries to work and save
Trust Fund money.
The SSA in Demonstration Projects in the late 1980s and
early 1990s substantiated the fact that 12-15% of the SSA beneficiaries
would be feasible for RTW services with 5-8% actually returning to work
and saving the Trust Fund money.
`Consumer Choice' or `Fair Trade' in the delivery of VR
services to SSA disability beneficiaries should be paramount.
According to a national study by the GAO, the major
obstacle or disincentive for SSA disability beneficiaries to RTW is
health care, and NOT monthly cash payments.
The basic `quid pro quo' of the `Ticket' is the
provision of health care coverage to RTW beneficiaries, in return for
the use of the private sector for those RTW services.
(4) Why the `Ticket' is Currently Not Working (Insert for the Record:
Growick, Bruce (2003). ``The Ticket to Work: The unintentional
consequences of an imperfect law.'' Rehabilitation
Professional. 12(3), 18-21.)
The eventual rules and regulations covering the `Ticket'
were not provider (EN) friendly, such as the enrollment process, the
fee schedule including milestone and annuity payments, the inability to
review cases before contact, and the overall lack of cooperation of SSA
as the regulatory body for the `Ticket' program.
Even though the `Ticket' program was not meant for
everyone, as the SSA demo projects indicated, the guidelines developed
for the program tried to be too inclusive. All disabilities and
functional limitations, i.e., potential barriers to employment, are not
the same.
The State-Federal VR System continues to monopolize the
delivery of VR services to SSA beneficiaries, and is still not willing
to relinquish its role as sole provider of rehab services; it is `all
about the money.'
(5) Where Are We Now and What Should Be Done
SSA still needs to function more like a private
insurance company, and less like a public bureaucracy if possible.
VR services, after disability determination, should be
delivered by the private sector under the `Ticket' where competition
among providers makes it more effective and efficient.
WIPA and P&A services, although worthy services, should
not be tied to the `Ticket' program.
With looming health care changes, it is imperative to
reexamine the basic `quid pro quo' of the `Ticket.'
The State-Federal system of VR should concentrate mostly
on RTW services for pre-SSA disability cases.
Different VR paradigms exist across the country for
different indemnity systems with the same goal: Reduced Trust Fund
payments, and more RTWs.
(6) Summary
Vocational rehabilitation is a necessary element of the
SSA disability program which is good for both SSA Trust Fund and
beneficiaries when done `right.'
The rules and regulations for the `Ticket' program
should be evaluated and reformulated for their willingness to
incorporate ENs into the service delivery system, just like the
incentives were.
The WIPA and P&A programs, although laudatory, should be
decoupled from the `Ticket' program.
Greater synergy should be developed between SSA and RSA
in the delivery of VR services to applicants for, rather than
beneficiaries of SSA disability (i.e., an early intervention program).
Thank you for the opportunity to present these observations and
suggestions to you, and I am pleased to respond to any questions that
the Subcommittee Members may have.
Chairman TANNER. Thank you very much. A most interesting
presentation, and we will follow up.
Dr. Kregel, you have the floor.
STATEMENT OF JOHN KREGEL, CENTER ASSOCIATE DIRECTOR AND
DIRECTOR OF RESEARCH, VIRGINIA COMMONWEALTH UNIVERSITY,
REHABILITATION RESEARCH AND TRAINING CENTER ON WORKPLACE
SUPPORTS AND JOB RETENTION, RICHMOND, VIRGINIA
Mr. KREGEL. Mr. Chairman, thank you very much for this
opportunity. I will focus my comments today on SSA's employment
programs, particularly the WIPA program.
First, I would like to say that, while we, as a country,
spend over $100 billion per year on our disability benefit
programs, SSA spends far less than $1 billion on our efforts to
return beneficiaries to work. The programs that you have heard
about today, funded under the Ticket legislation, represent
SSA's only effort to assist beneficiaries to work their way
back off benefits.
These programs should be carefully designed, stringently
monitored, and continuously evaluated. The parts of the
programs that are not working should be fixed or eliminated.
The parts that are working successfully should be maintained
and expanded.
Let me now turn my attention to one of these programs, the
Work Incentive Planning and Assistance, or WIPA, program. The
WIPA program is a large, SSA-operated employment program which
has provided assistance to over 350,000 SSA beneficiaries since
its inception. The WIPA program is not focused on helping
individuals remain on benefits, express complaints or concerns
to SSA, or solve every beneficiary payment problem. It has a
clear, concise mission: Assist the 2 million current
beneficiaries who today are working or actively seeking
employment, to ultimately work their way off of SSA cash
benefits.
Let me provide you an example based on these data. The
Center for Independent Living of Middle Tennessee work
incentive planning and assistance program serves 40 counties in
western and central Tennessee, an area that contains more than
150 WIPA-eligible adults with disabilities receiving SSI and/or
SSDI. Best estimates indicate that there are 15,000
beneficiaries residing in these counties who have engaged in
employment, or actively sought employment during the past 12
months alone. These individuals should be the focus of SSA's
return-to-work efforts.
The CIL in middle Tennessee is recognized as one of the
best WIPA projects in the country. It's a highly productive
program, staffed by outstanding CWICs. The project has provided
intensive WIPA services to over 1,200 beneficiaries since its
inception in 2006 alone. The situation is equally challenging,
and full of opportunities in each of the districts represented
by your colleagues on the Committee.
My written testimony documents only a few of the remarkable
case studies that are occurring daily across the country,
illustrating how beneficiaries are obtaining employment for the
first time, returning to employment after a lengthy absence, or
working their way off benefits with the assistance of a CWIC, a
community work incentive coordinator.
But WIPAs are overwhelmed and extremely frustrated at their
inability to meet the needs of all the beneficiaries requesting
their services. Their meager funding--the program has been
flat-funded since its inception in 2000--makes it difficult for
them to provide effective and timely services. Wait lists for
WIPA services in many of your districts are reaching 30 days.
This flies in the face of everything we know about providing
employment services, which should be provided to the
individuals at precisely the moment where they have made a
serious commitment to obtain or return to employment.
An additional 1,000 CWICs could work tomorrow to
significantly improve the current lack of program capacity.
Since current evidence indicates that WIPA services such as
those provided by Easter Seals of Greater Northwest Texas can
increase the rate of beneficiaries working their way off
benefits to three times over the national average, this type of
increase would ultimately result in savings to both the Trust
Fund and the general fund.
Also, additional CWICs are required to prevent or
ameliorate the effects of overpayments. The overpayment problem
may be difficult for you to grasp, Mr. Chairman. It seems
illogical, because it is illogical. The system isn't designed
to pay beneficiaries the proper amount of benefits. It is
designed to pay them too much, and then demand that they pay it
back, even though the individual is trying to work, reduce or
eliminate the need for disability benefits, and has complied
with all program rules for timely reporting.
Overpayments are built into our system. They are
demoralizing to working beneficiaries, and frequently result in
the individual disengaging from the workforce. With funding for
an additional 200 CWICs, the WIPA program can significantly
ameliorate the impact of overpayments on individuals and their
families, and help to ensure that the problem doesn't lead to
individuals abandoning their employment efforts altogether.
Finally, additional resources to the WIPA program would
increase services to underserved populations. There are
subgroups of the beneficiary population, as has been pointed
out, that are not adequately served by the WIPA program at the
present time. Foremost among these are transition-aged youth
leaving secondary special education programs and veterans who
receive disability compensation or disability pension benefits
under VA, as well as Social Security benefits. An additional
200 to 400 CWIC positions would enable the WIPA program to
seriously meet this unmet need.
Mr. Chairman, thank you very much for your opportunity, and
I look forward to responding to any questions you may have.
[The prepared statement of Mr. Kregel follows:]
Prepared Statement of John Kregel, Center Associate Director
and Director of Research, Virginia Commonwealth University,
Rehabilitation Research and Training Center on
Workplace Supports and Job Retention, Richmond, Virginia
Work Incentives Planning and Assistance (WIPA) is an integral part
of SSA strategy to promote employment among SSA beneficiaries, reduce
dependence on SSI and SSDI cash benefits, reduce the number of
burdensome overpayments and other post entitlement problems experienced
by beneficiaries engaged in employment, and decrease Trust Fund and
general fund expenditures by reducing cash payments to beneficiaries.
Authorized by Section 121 of the Ticket to Work and Work Incentive
Improvement Act of 1999, 104 WIPA projects are providing services to
SSA beneficiaries in all 50 States and territories. Collectively, the
104 projects employ over 400 Community Work Incentive Coordinators
(CWICs), many of whom are themselves individuals with disabilities, and
have served over 350,000 individuals since the program's inception in
2000.
The mission of the WIPA program is to provide timely and accurate
information to beneficiaries on SSA's work incentives and other Federal
efforts to remove regulatory and programmatic barriers to employment
for persons with disabilities. To achieve this purpose, the program
uses a highly skilled and rigorously trained cadre of CWICs to provide
individual counseling to beneficiaries seeking employment and intensive
followup services to ensure that the beneficiaries are using the work
incentives appropriately, that they have been connected to employment
service programs in their community, and that they are communicating
their work activities to the Social Security Administration. CWICs in
local WIPA programs work with individual beneficiaries to explain the
myriad of regulations, provisions, work incentives and special programs
that complicate an individual's decision to enter or reenter the
workforce.
The questions posed to benefits specialists by beneficiaries are
basic and straightforward. What will happen to my benefit check if I
return to work? I want to start my own business--is this possible if I
receive SSA benefits? I am currently working and got a letter from SSA
indicating that I have been overpaid and have to pay back money--can
you help me? I want to start a new career--where should I begin? As
simple and basic as these questions are, their answers are often
complex and highly individualized. Even more frustrating to
beneficiaries is the overwhelming amount of confusing and inconsistent
information they often receive from SSA field offices, Employment
Networks, Vocational Rehabilitation and other agencies involved in the
employment process. This sea of misinformation makes employment seem a
perilous and terrifying undertaking and lessens the resolve of many
beneficiaries to pursue their career goals.
The WIPA program is designed to fill this information void by
providing beneficiaries access to complete, individualized information
from a trained professional in a confidential setting apart from SSA.
SSA field office staffs, overwhelmed with processing current disability
claims, are simply unable to provide this level of intensive services.
Armed with an understanding of the impact of employment on their
benefits, beneficiaries can confidently pursue employment options,
maintain health care coverage, and obtain necessary employment supports
and services. With the help of benefits planning and assistance,
beneficiaries can take charge of their own careers without the constant
worry that the application of an unknown rule or a mistake by a Federal
caseworker will jeopardize their ability to pay for their basic needs
or treat their health conditions.
It's about trust. If beneficiaries are to accept personal
responsibility for their careers and their economic self-sufficiency,
they have to be able to trust the information they receive and the
service providers that assist them. If beneficiaries are told that
employment will affect their benefits in a certain manner, they have to
be able to trust and act on that information. If individuals with
diabetes, epilepsy or a psychiatric disability are told that they will
still have access to health care coverage even though they no longer
receive a cash benefit from SSA, they must be able to depend on this
information, as erroneous information may literally put them in a
potentially life-threatening situation. If an individual complies with
all SSA regulations and reporting requirements and SSA fails to
accurately apply the reported information to the individual's case, the
resulting overpayment can have a catastrophic and disheartening effect
on even the most courageous and patient beneficiary. Viewed from this
perspective, the WIPA program is the most basic of all employment
services. For example:
Staff from the Center for Independent Living--Middle
Tennessee report talking to many individuals who have received
conflicting and often inaccurate information from the Vocational
Rehabilitation agency, SSA field offices, and Employment Networks. This
confusion increases fear and causes concerns among beneficiaries
bravely attempting to return to work.
In eastern Pennsylvania, WIPA project staff members
describe a number of consumers who have stopped working while on
benefits because of substantial overpayment situations, many of which
occur even though the beneficiaries have maintained meticulous earnings
records and are accurately following SSA wage reporting procedures.
In Kentucky, staff from the Center for Accessible Living
report that beneficiaries have responded positively to the simple fact
that accommodations such as sign language interpreters are provided by
the WIPA project upon requests. Many beneficiaries have noted they have
not been provided accommodations at the SSA office even when requested.
In California, most beneficiaries contacting the Familia
Unida WIPA project have language and cultural barriers that affect
their communication with SSA. Most of these individuals are afraid to
call the SSA office and are not clear about the information they have
received.
This testimony contains four sections. The first section discusses
the need for WIPA services and summarizes current program outcomes. The
second section describes the job of the CWICs and illustrates their
role in promoting employment among SSA beneficiaries. The third section
summarizes some of the major accomplishments of the WIPA initiative.
Finally, the fourth section recommends additional resources to maintain
and enhance the program.
The Need for WIPA Services
The WIPA program is a large, SSA operated employment support
program, which has provided assistance to over 300,000 SSA
beneficiaries who are currently employed or interested in pursuing
employment since its inception in 2000. The WIPA program is not focused
on helping individuals remain on benefits, express complaints or
concerns to SSA, or solve every beneficiary concern. It has a clear,
concise mission--assist the over 1 million current beneficiaries who
desire to work to obtain employment and pursue their careers,
ultimately working their way off SSA cash payments.
The overwhelming need for the program is clearly documented in the
results of the National Beneficiary Survey (NBS), conducted by
Mathematica Policy Research under contract from SSA. The NBS is the
most methodologically rigorous and precise estimate of the employment
aspirations and activities of SSA beneficiaries currently available to
policymakers. The most recent administration of the survey, in 2006,
found that 44% of beneficiaries reported that their personal goals
include getting a job, getting a better job, or moving up in a job and/
or that they see themselves working for pay sometime in the next 5
years.
The survey discovered that not only are SSA beneficiaries setting
employment goals for themselves, they are also taking direct, concrete
actions to achieve these goals. Many beneficiaries had engaged in
employment, vocational training, or job-seeking activities over the
past year. In real terms, the NBS found 2 million SSA beneficiaries who
are working or actively seeking. These individuals should be the focus
of SSA's employment and return to work efforts. In short, the NBS
reaffirms what beneficiaries and advocates have repeatedly articulated
to Congress over the recent past--that they desire lives of
productivity over idleness, self-sufficiency over poverty, independence
over dependence, and that they can achieve these goals if provided the
right services and supports.
Estimating the Need for WIPA Services--The NBS results described
above indicated that large numbers of beneficiaries are currently
employed or pursuing employment. Even if the reported expectations tend
to be overly optimistic, the findings imply that large numbers of
beneficiaries (over 4 million) are interested in employment and they
might benefit from employment services or policies designed to promote
employment. Of those individuals, 52% had engaged in recent work
activities (worked in previous year, working or actively seeking work
at interview, participated in vocational training). Extrapolating these
figures to individual States or localities, it can be conservatively
estimated that approximately 20% of all working age SSA beneficiaries
could benefit from WIPA services, either immediately or in the near
future.
WIPA Participant Characteristics--WIPA projects serve a group of
individuals who are seriously pursuing careers. Overwhelmingly,
beneficiaries served are between the ages of 22 and 59. Youth were not
significantly represented among WIPA participants, with less than 5% of
beneficiaries reported to be under the age of 22. Males (49.8%) and
females (50.2%) were equally represented among total participants. The
program serves individuals with a broad variety of both physical and
mental disabilities throughout its 5-year implementation. The most
commonly indicated disabilities were mental and emotional disorders and
system diseases, which jointly accounted for over half of WIPA
participants.
Nearly 90% of all individuals who contact a WIPA project are either
employed, actively seeking employment, or interested in obtaining
employment in the near future. Less than 1% of individuals contacting
WIPAs are in the process of terminating employment or reducing their
work hours. The services and supports provided by WIPA programs to
assist beneficiaries to achieve these goals will be illustrated later
in this testimony.
The Role of CWICs in the WIPA Program
The foundation of the WIPA program is the national cadre of highly
skilled and rigorously trained Community Work Incentive Coordinators
(CWICs). CWICs complete a demanding preparation and certification
program and participate in an intensive program of ongoing technical
assistance and training. These dedicated professionals are using their
knowledge, skill, and personal experience to assist other persons with
disabilities to navigate the maze of SSA work incentives and
regulations to obtain employment and maximize their economic self-
sufficiency. CWICs are not peer counselors or trained volunteers. They
are a group of highly trained professionals dealing with extremely
technical information in a way that makes sense to beneficiaries and
allows them to pursue their career goals.
All WIPA project personnel (CWICs) providing direct services to
beneficiaries are required to successfully complete a highly
challenging training and certification process. The CWIC Initial
Certification process consists of four components. The amounts of time
CWICs devote to these components are summarized in the table below.
Component 1--First, CWICs participate in a 32-hour Face-to-Face
Training Class. The training class addresses each of the 20 training
competencies found in the National Training Curriculum. Sixteen Initial
Training classes have been conducted over the past 16 months.
Component 2--CWICs engage in extensive self-study activities to
prepare for and complete the required CWIC certification assessments.
Self-study activities include review of the National Training
Curriculum, review of other resource documents, and study calls
moderated by the NTC trainers. Data reported by CWICs completing the
certification process revealed that on average they spent approximately
30 hours completing the self-study and activities.
Component 3--CWICs are required to complete six competency-based
assessments that address each of the major training modules of the
National Training Curriculum. Assessments are conducted entirely online
using the Blackboard Learning System and consist of objective test
items, essay responses, and case studies. CWICs reported spending
approximately 20 hours completing the six assessments. Approximately
30% of all initially certified CWICs receive additional support from
NTC staff during the early stages of service delivery. Based on a
recommendation from NTC or OESP staff, a CWIC may be required to submit
a prescribed number of individual beneficiary reports to VCU technical
experts prior to sharing the reports with beneficiaries. This ensures
that the information provided by initially trained CWICs is complete
and accurate.
Component 4--Finally, CWICs completing the certification process
are enrolled in the NTC Supplemental Training and Technical Assistance
Activities. The activities include face-to-face and online training,
and individual, State, and regional technical assistance. The NTC
estimates that CWICs receive approximately 60 hours of technical
assistance in the first year post certification and participate in an
additional 25 hours of supplemental training events.
Number of CWICs Certified--Between December 2007 and May 2009, a
total of 572 individuals have been formerly certified as Community Work
Incentive Coordinators (CWICs). Approximately 50 of these individuals
are professionals working in SSA demonstration projects or other local
partners. To date, 87% of individuals attempting to become certified as
CWICs have successfully completed the process. At the present time,
between 400 and 450 individuals are providing services across the 104
projects.
The Typical CWIC--The ``typical'' CWIC has a college degree, is
employed by a public agency (VR, University, etc.) and has been
employed as a CWIC for over 3 years. One-third of the time, he or she
will be a person with a disability, including many individuals who have
previously received SSA benefits and have worked their way off the SSA
rolls.
The ``typical'' CWIC participates in 160 hours of training and
technical assistance activities during his or her first year of
employment. After the first year, the CWIC receives 85 hours of
training and technical assistance each year.
The ``typical'' CWIC serves multiple counties or large sections of
metropolitan areas. In some instances, such as North Dakota, a single
CWIC may serve virtually an entire State. Typically, from 30,000-50,000
SSA beneficiaries will reside in an individual CWIC's catchment area.
Many of the beneficiaries in the catchment area are gravely ill or
possess significant health related disabilities that preclude their
ability to work at the present time. However, as discussed above, at
least 40% of beneficiaries report that their personal goals include
getting a job, advancing in their careers, or working for pay sometime
in the next 5 years.
Based on these data, the ``typical'' CWIC will serve a catchment
area that contains 12,000-20,000 beneficiaries who are currently
employed or who will be seeking employment in the near or intermediate
future. Of those, approximately 5,000 had engaged in recent work
activities (worked in previous year, currently working or actively
seeking employment). These beneficiaries are the target population for
WIPA projects--beneficiaries who are employed or actively seeking
employment whose ongoing employment, health care, and benefit status
may be jeopardized without complete and accurate information on the
effects of employment on their SSA benefits.
The ``typical'' CWIC maintains a wait list for services. Most CWICs
are overwhelmed by the number of beneficiaries seeking their services.
Wait periods are generally from 15 to 20 days, with many projects now
reporting that wait time for services has reached 30 days from initial
contact. These long waits are very unfortunate, since the best time to
encourage a beneficiary to seek employment is immediately when he or
she has indicated a desire to seek employment or when employment is
imminent.
Illustrations of the Accomplishments of Individual WIPA Projects--
All over the country, WIPA project staff members are providing services
and supports to beneficiaries who are attempting to enter the workforce
for the first time, reenter employment after a long period of
disengagement, improve the financial situation of themselves and their
families, pursue employment training or education that will lead to
meaningful and rewarding employment and eliminate their dependence on
SSA cash benefits. Examples of services provided by WIPA projects are
provided below.
Center for Independent Living of Middle Tennessee
The Center for Independent Living of Middle Tennessee (CIL-MT) Work
Incentives Planning and Assistance (WIPA) program serves 44 counties in
western and central Tennessee. This area includes Nashville and
Memphis--two of the most populous areas in the State. The project
covers a WIPA service area that contains more than 150,000 WIPA
eligible adults with disabilities receiving SSI and/or SSDI (nearly
three-fourths of the State's disability beneficiaries).
Five full-time CWICs provide WIPA services across the 44 counties.
Three of the five CWICs have been with the project since the inception
of the program 8 years ago. Based on data from the National Beneficiary
Survey, the National BPAO database, and the perceptions of the project,
there are an estimated 60,000 individuals in the counties served by the
project who are interested in obtaining employment, including 25,000
who have engaged in employment or actively sought employment during the
past 12 months.
The CIL-MT is a highly productive program staffed by outstanding
CWICs. The project has provided intensive WIPA services to 1,224
beneficiaries since the inception of the WIPA contract in 2006. Two of
literally hundreds of success stories documenting the delivery of
quality services by the project are provided below.
In Shelby County, CWIC Hope Johnson worked with Shawn, a 39-year-
old woman who is visually impaired who came to the WIPA program in 2007
after being referred by her VR Counselor. Shawn was a concurrent
beneficiary. The CWIC assessed her situation and found that she was a
good candidate for a PASS, a very powerful, although complex, SSA work
incentive. Her goal was to be a massage therapist. She needed assistive
technology and training before she was ready for school. She began
Orientation and Mobility training, plus Braille and computer classes.
After completing her training at Clovernook Center for the Blind
and Visually Impaired, her VR Counselor agreed to pay for tuition,
books, some supplies, some assistive technology, and transportation for
her to attend school. However, VR was not able to pay for the Braille
Writer that she would need. In addition, there were many other school-
related expenses, such as a school application fee, massage supplies,
massage table, uniforms, required background check, licensure exam, and
CPR certification.
Ms. Johnson helped Shawn write her PASS and gather all of the
needed documentation regarding expenses and steps to reach her goal.
The PASS was approved in February 2008 and Shawn received the funds
necessary to start massage therapy classes the very same month. Shawn
has now completed her classes, passed her licensure exam, and started
working as a massage therapist in Memphis. She uses her own Braille
Writer to keep up with appointments. Shawn utilized community
resources, such as VR and Clovernook, to get her schooling and
equipment. The PASS was a great SSA work incentive for Shawn to use in
order to receive all of the items, supports and equipment she needed in
order to be successfully employed.
In Tipton County, Ms. Johnson worked with Cindy, a 27-year-old,
visually impaired woman from Millington, TN, who contacted the WIPA
program in 2007 after receiving confusing information in the mail from
Social Security. Her father had recently retired, making her eligible
for Childhood Disability Benefits (a special type of SSDI benefit for
adults disabled as children). The SSA letter stated that her SSI check
would be stopping and SSDI would start. Ms. Johnson explained the
ramifications of ``switching'' from one disability program to another.
Since she was currently working full-time, she had many questions about
the work rules under the SSDI program, Medicare, and TennCare coverage.
Cindy and her CWIC gathered earnings information and disability-
related work expenses to report to SSA. They tracked her Trial Work
Period and the CWIC assisted her with the SSA work review. Because
Cindy had so many work and disability-related expenses, her SSDI check
continued past the Trial Work Period even though her gross earnings
exceeded the Blind SGA (earnings) level. That was only due to the
CWIC's help in documenting Impairment-Related Work Expenses (IRWE).
Otherwise, Cindy's SSDI check would have stopped. The CWIC has
continued to assist Cindy with questions regarding her health insurance
and properly reporting earnings information to SSA. She has received
two raises in the past couple of years and has contacted the WIPA
program as needed.
Easter Seals of North Texas
The WIPA program of Easter Seals North Texas serves individuals
receiving Social Security Disability and/or Supplemental Security
Income benefits in 19 counties in the North Texas area. Each
beneficiary we meet receives an individualized Benefits Summary which
summarizes the work incentives discussed and an action list. This
action list acts as a catalyst for taking those needed steps to enter
employment. It is the goal of the WIPA project to not only educate
beneficiaries but to guide them to take the steps necessary to obtain
and maintain employment.
Over the past 3 years, the project's 5 CWICs have provided
intensive, long-term work incentives support to 1,302 beneficiaries. Of
these 1,302 consumers, 184 are employed, with 52 working at or above
the current SGA level of $980 a month. Sustaining this level of income
will mean that approximately 3.5% of the individuals provided more
intensive WIPA services will eventually become self-sufficient. This
success rate is more than 3 times the national benchmark rate of 1% of
all SSA disability beneficiaries.
The project employs four full-time CWICs, with one serving as both
a CWIC and the Project Director, and one part-time CWIC. The project
serves a 19 county area in North Texas, some parts of which are rural.
Out of the five staff members, three of them have significant
disabilities. Two of them were once on the Social Security benefit
rolls but have now worked to the point where they are not. One staff
member was a client under the BPAO program and now is employed as a
full-time CWIC covering three counties. The Project Director, Ms. Cindy
Herzog stated recently,
Over the history of both BPAO and WIPA, we have been able to
see thousands of beneficiaries and many have entered into
employment. We have seen clients who have never worked before,
enter into employment for the first time, breaking that cycle
of dependence on benefits. The program as a whole has been a
great success and we look forward to increasing the numbers of
beneficiaries who leave the rolls completely, one case at a
time. This is a challenging but fulfilling line of work. We
have the opportunity and privilege to present and create
positive change for individuals living with disabilities.
The Need for Expanded WIPA Services
The WIPA projects provide encouragement and direct assistance to
SSA beneficiaries seeking to obtain employment for the first time or
improve their employment situation. The SSA rules and regulations
regarding beneficiaries are complex and often overwhelming for
beneficiaries. WIPA projects can directly support beneficiaries who
otherwise may be unnecessarily apprehensive of pursuing their career
goals due to fears that employment may lead to a loss of health care
and other benefits. Every day CWICs are assisting beneficiaries to take
the first step toward employment.
Unfortunately, the national WIPA initiative lacks sufficient
capacity to adequately meet current and future demand. The number of
beneficiaries requesting services has continually overwhelmed a large
number of local programs. The problem is particularly acute for WIPA
programs in rural areas where extensive travel requirements reduce
potential service time.
The WIPA capacity problem is exacerbated by the fact the program
has been flat-funded since its inception in 2000, without any inflation
increase over the past 7 years. In addition, when SSA wisely increased
the minimum amount of funding for WIPA projects from $50,000 to
$100,000 in 2005, the funding level of a number of WIPA projects,
particularly in SSA Region IV, actually declined.
WIPA projects struggle to find the resources to provide long-term
followup services to beneficiaries. In most projects, CWICs are doing
an outstanding job of providing initial advisement services to
beneficiaries. However, the demands on their time make it difficult for
them to provide proactive followup services to beneficiaries weeks or
months after their initial contact with the beneficiary. Lack of
ongoing followup services reduces the ability of CWICs to assist
beneficiaries to access and benefit from needed employment services,
decrease the number of individuals experiencing an overpayment, and
assist the beneficiaries in career advancement activities.
Youth are currently not significantly represented in the population
served by the program. Less than 6 percent of beneficiaries receiving
services from the prior BPAO program were under the age of 22. The
challenges faced by transition-aged beneficiaries are unique, and
specific work incentives have been developed to assist them in their
employment efforts. Future BPAO outreach activities should focus on
contacting and serving adolescents and young adults.
The WIPA projects assist many other entities to provide employment
services and supports. Across the country, WIPAs are coordinating their
efforts with Workforce Development Centers, Vocational Rehabilitation
agencies, mental health centers, community rehabilitation programs,
secondary schools and institutions of higher education, veterans
service centers and employment service organizations. These
partnerships, which have expanded dramatically over the past several
years, enable the WIPA projects to more effectively assist
beneficiaries to pursue their employment goals.
Many State Vocational Rehabilitation agencies refer most if not all
SSA beneficiaries applying for services to WIPA projects prior to
initiating services. The WIPA program has contributed significantly to
the ability of vocational rehabilitation to better meet the needs of
beneficiaries. Similarly, many Employment Networks and mental health
centers request the services of WIPAs prior to delivering services. The
WIPA program is critical to efforts to promote employment outcomes and
economic self-sufficiency among beneficiaries.
An example of the assistance provided to other employment programs
is the SSA/Vocational Rehabilitation reimbursement program, in which
SSA reimburses individual State Vocational Rehabilitation agencies for
serving SSA beneficiaries who meet specific employment goals, returned
over $124 million to State VR agencies in FY 08. When serving SSA
beneficiaries, many VR agencies require the beneficiary to seek the
services of a WIPA prior to initiating employment services. As a
result, WIPA projects play a critical role in the successful employment
outcomes of literally thousands of these beneficiaries, even though the
WIPA projects receive absolutely none of the reimbursement funds
generated in part by their services.
The WIPA program is vital to SSA's efforts to reduce and eliminate
the chronic problem of overpayments. The vast number of overpayments
currently facing beneficiaries in every State creates a second
``disability backlog'' for them and SSA. The overpayment backlog has
many causes and very few solutions. Among the causes are the
unnecessarily complex SSA rules that don't even measure earnings across
the SSI and SSDI programs in a consistent way and a lack of automation
in wage reporting systems makes it very difficult for beneficiaries to
comply with wage reporting rules. Even SSA's attempts at further
automating the system have significant limitations. For example, the
recently initiated telephone reporting system has significant
potential, but currently cannot be used by beneficiaries who are taking
advantage of the work incentive provisions that SSA has encouraged them
to use.
At the core of the problem is the lack of resources currently
devoted to addressing this issue. Responsibility for processes that
could eliminate or ameliorate the overpayment problem is currently
spread across teleservice centers, program service centers, and field
offices. WIPA projects can work with beneficiaries to accurately report
their earnings and minimize the impact of overpayments on their
personal and family finances. This is a function that cannot be
performed by SSA field offices but is vital to any realistic SSA
employment initiative.
Today literally hundreds of SSA beneficiaries are in overpayment
status. Frustratingly, SSA continues to devote extensive resources to
an intractable administrative problem that continually gets worse and
worse. The fear and reality of overpayments actually causes many
beneficiaries to reduce and curtail their employment efforts. Many
others experience extreme financial hardship as they and their families
are forced to repay monies they erroneously received, even though they
complied with every reporting deadline in a timely and accurate manner.
Continuing and expanding the WIPA program will greatly assist in a
reduction of the overpayment backlog and lessen the impact of
overpayments in beneficiaries and their families.
Over time, the WIPA program can literally ``pay for itself.'' The
WIPA program should be judged on two outcomes. The first is increased
beneficiary use of specific SSA work incentives. The second is
increased employment participation and reduced receipt of disability
benefits by program participants. When a CWIC works with a beneficiary
to overcome their fears of employment and increased earnings on their
benefits, he or she is not only contributing to the employment success
of the beneficiary, but also the employment service program (VR, DOL,
EN, etc.) that assists the beneficiary. When a State VR agency or EN
requires some or all referrals to receive WIPA services prior to
initiating a support plan, and then receives SSA reimbursement for
specific beneficiary employment outcomes, the ``credit'' for these
outcomes should fall not only to the employment agency, but also to the
WIPA program. Over time, the implementation of a more sophisticated
program to evaluate the outcomes of WIPA activities can clearly
document the cost-effectiveness of the program.
An example from the State of Kentucky illustrates the extent to
which WIPA projects are working to create significant savings for
Congress and SSA. In Louisville, the Center for Accessible Living, Inc.
provides services to 70 counties, including Jefferson and Fayette--the
two most populous counties in the State of Kentucky. Four CWICs serve
this large project area that includes 175,000 WIPA eligible SSA
beneficiaries, an average of 42,000 per individual CWIC.
The lone CWIC serving Jefferson County (Louisville) responded over
600 referrals for WIPA services over the past 2 years. Referrals could
be much higher and additional resources are needed to address current
demand. However, with only one staff member serving a county with over
35,000 beneficiaries, very little outreach activity actually occurs.
Over the past 2 years, this single CWIC has assisted 14 beneficiaries
to work their way off SSA cash benefits, saving Social Security over
$130,000 per year. These savings will increase exponentially over time
as additional beneficiaries no longer receive cash benefits.
The Need for Additional WIPA Resources
The current WIPA program has been highly successful. It has
increased the employment participation and self-sufficiency of hundreds
of thousands of individuals and has assisted other employment service
agencies to more effectively meet the needs of beneficiaries. However,
the program simply doesn't have the resources necessary to respond to
the current and future demand for services. With additional resources,
the program can serve a larger number of beneficiaries, reduce the
number of beneficiaries negatively impacted by the overpayment backlog,
and continue to generate additional program savings.
The WIPA project is currently staffed by approximately 450 CWICs
nationwide. The number of CWIC positions should be significantly
expanded. Based on all currently available data and the results of a
current program capacity workgroup, it is recommended that funding be
provided to support an additional 1,600-1,800 CWICs. This increase
could be easily absorbed into the existing service delivery network and
would have the following benefits.
Additional WIPA resources would allow the program to
expand the number of beneficiaries supported in their employment
efforts and reduce the current wait time for services (1,000 CWICs).
Additional WIPA resources would allow programs to provide
more intensive long-term services to beneficiaries, improving
employment retention and reducing beneficiary dependence on SSA cash
benefits (200 CWICs).
Additional WIPA resources would allow the program to
conduct more directed outreach efforts to currently underserved
populations, such as transition-age youth and veterans (200-400 CWICs).
Chairman TANNER. Well, let me thank the panel for a most
informative--and I might say thorough--examination of the
topics under discussion today. I have one question I want to
follow up with Ms. Webb on, and some other--we have other
questions, as well.
But by the way, I noticed that you are going to get your
law degree here shortly.
Ms. WEBB. Yes, 3 weeks.
Chairman TANNER. When my great-grandmother--who lived to be
101--was 100 years of age, I went to see her on her birthday.
And she said, ``Son, what are you doing now?'' And I said,
``Well, Grandmother, I am in law school.'' And she went, ``That
is a mighty poor calling.''
[Laughter.]
Chairman TANNER. I think that we both will share that law
degree, and it is all right. I want to congratulate you on
that.
Getting back to the subject at hand, could you tell us a
little more, or expand on the problem that you are having with
collecting pay stubs, and how that is negatively impacting the
situation?
Ms. WEBB. It creates a real problem. First of all, when we
provide services to a beneficiary, and they go back to work,
they really are achieving independence, and they don't want to
hear from us anymore. Even in my EN, we pay them a stipend to
give us the pay stubs, and at some point they want to feel like
adults and just be left alone.
And, in the beginning, when they are obligated--when they
are still on benefits and they are using their trial work
period, for example, they are still obligated to report their
earnings to SSA. There is no problem there. But once they leave
the benefit rolls because they are working, we need to leave
them alone. And for an EN to be calling them every month just
to get paid--because we need those pay stubs, is irritating to
them. In some cases, it can lead to identifying a disability to
an employer when, in fact, the employer didn't know there was a
disability.
And for us to have to chase down those pay stubs, we
sometimes will wait months and months beyond the time that we
were really eligible for the payment in order to get paid. That
is particularly demoralizing for a new EN who is trying to get
their cash flow going, and it's taking them 6 months or longer
to get paid, when they know somebody is working.
As I mentioned in my testimony, the Agency has done a great
deal to try and put some other things in place, like using the
unemployment insurance data from the States. That still means
we're 5 to 8 months behind in getting the data.
We have talked about the IRS being able to report earnings
data to Social Security more than annually. The fact is,
employers don't report earnings on an individual employee
basis, except on an annual basis to the IRS. So that doesn't
bode well as a solution.
The solution really is that when someone leaves the cash
rolls, then we can assume that they're working. There are some
conditions under which they might not be: They might be in
prison, and they might be dead. But I would think that if
Social Security stopped paying them benefits because of either
of those conditions, then they would know that. And the
opposite is not true. When the person is working, they don't
know that.
The other benefit of this is once a person is off of
benefits and we are still in touch with them, we can get that
data, in some cases. But in our experience, in our agency, it's
about 50 percent of the time. That creates a terrible cash flow
problem for ENs, especially the smaller ones.
Does that answer your question, Mr. Chairman?
Chairman TANNER. Yes. We want to try to see what we can do
on that. Ms. Suter, do you have a reaction to this?
Ms. SUTER. Yes. I agree with Susan's points. We have done a
number of things to simplify collecting data. Last fall, we
started an auto-pay, where an EN has to just give us the name
of the person, and then we look at the earnings records, in
order to pay the EN. So the only information the EN has to
provide is the name of the person. But, as Susan said, we have
to wait until we get those records to verify that.
With some ENs, we look at paying when the EN certifies that
that person is working, and signs a document saying that, and
then, if the person is not working, we reconcile that at the
end of the year. So we have tried to make it as easy and
responsive to ENs as possible, and we are happy to continue to
look at ways to simplify it.
Chairman TANNER. I will stop here. Mr. Johnson, you are
recognized.
Mr. JOHNSON. Thank you, Mr. Chairman. Thank you all for
your testimony. Ms. Suter, before we get to the topic of the
hearing, numerous press accounts last week talked about dead
people receiving economic recovery checks. Can you explain to
me how 8,000 of those checks were mailed, and how you are
recovering them?
Ms. SUTER. We have made mistakes in those cases, and that
is hard to explain. That is not in my jurisdiction in the
Agency. But we have made mistakes. We are looking at that. We
obviously do not want to do that. And I would be happy to look
at that and provide you more information----
Mr. JOHNSON. I would appreciate if you would provide the
Committee with that information.
Ms. SUTER. I would----
Mr. JOHNSON. And while I am at it----
Ms. SUTER. I would be happy to.
Mr. JOHNSON [continuing]. Mr. Chairman, can we have both of
Dr. Growick's papers inserted into the record?
Chairman TANNER. Without objection.
[The information follows:]
Mr. JOHNSON. Would you do that for us?
Mr. GROWICK. Absolutely, sir.
Mr. JOHNSON. Thank you, sir. Ms. Suter, since the program
has begun, how many Ticket users have had benefits suspended
and/or left the rolls due to work and earnings? Do you know
that?
Ms. SUTER. We have had about 2,700 individuals who have
left the rolls due to work and earnings. Six hundred of those
have left the rolls since last July under the new Ticket regs.
Mr. JOHNSON. Yes, that is amazing to me, that it took from
1999 to 2009 before we finally got the program revised, and now
we're still having trouble with it.
Since the beginning of the Ticket program, how much in
total benefit savings has occurred due to earnings by Ticket
users? Do you know?
Ms. SUTER. We don't have the figures for the total savings,
but I would be happy to get that for you.
It is about 3,700 years of benefits that we have not paid
beneficiaries.
Mr. JOHNSON. Okay. And since the beginning, how much has
been spent to administer the program? Are we saving more than
we are spending, or not?
Ms. SUTER. Well, there are a couple of different figures on
that. Our actuaries say, for the SSI program, that will pay for
itself in 10 years in the Ticket program, because of the 1-for-
2 in the SSI program. In the SSDI program, because there are
different work incentives, about 600 people have to leave the
rolls annually in order for the Ticket program to pay for
itself over the next 10 years.
Mr. JOHNSON. So how many are leaving right now?
Ms. SUTER. Pardon?
Mr. JOHNSON. How many are leaving right now?
Ms. SUTER. Well, we have the 2,700, but we have 304,000
tickets that have been assigned. So we think that's a
reasonable number. We have had an increase in work activity,
people starting to work, and have work and earnings since the
new regs came out about an 83-percent increase, and that just
since last July.
We have had a 167-percent increase in people using their
tickets since the new regs have come out. We have had ENs sign
up about seven times as much since the new regs. So we think
the trends are looking good, and we think that's doable, to be
able to get 600 individuals on SSDI off the rolls in a year.
Mr. JOHNSON. Okay. Thank you, Mr. Chairman. No further
questions.
Mr. POMEROY. Thank you, Mr. Chairman. I am really
disappointed that a conflict kept me from most of the original
statements of the panel, so I am not going to try to take you
over the same ground you have already covered.
But I would be interested in trying to get a sense from
some of our experts as to what they think the core problems
are, and whether progress is being made. So, Dr. Growick and
Dr. Kregel, I would ask you, kind of representing maybe
slightly different perspectives, a couple of questions. And no
offense to the rest of the panel, but we will try and cut to
the chase this way.
Do you think that the 2008 reforms, in terms of how this
program is being run, are going to be helpful?
Mr. KREGEL. I will respond first. I think, in terms of
evaluating the Ticket program itself, we ought to think of
everything prior to the 2008 regulatory revisions as pilot, or
what was done previously, or what didn't work. And the program
really needs to be measured on the effect of the regs, and the
activities of the Agency, and the activities of beneficiaries
since July of 2008.
If we look at that, then everything about paying for
itself, everything in terms of administration of the program
versus the savings of the program, can be much more accurately
evaluated, and it will be evaluated much more positively.
Mr. POMEROY. Okay. Without having data reflecting an
evaluation, what is your gut sense in terms of what--is it a
new day? Is this thing likely to achieve some of the results we
had hoped for earlier?
Mr. KREGEL. I have looked at the WIPA programs, for
example, that are serving beneficiaries in each of the
congressional districts represented on the Committee. What we
are seeing right now in each district is five people moving off
of benefits in the last 6 months, three people moving off of
benefits since the first of the year. These are small numbers,
but it doesn't take very much to get to the number of 6,000 per
year, or 600 per year that Ms. Suter talked about, in terms of
the overall cost efficiency of the program.
This is a program that will pay for itself over time, both
in terms of the Ticket program as well as, very significantly,
the WIPA program. If you look at, for example----
Mr. POMEROY. I mean 600 per year in the Social Security
program, to me, is not even a token anything.
Mr. KREGEL. Because this is a very small program, in terms
of an administrative perspective, we're talking about a program
that costs $100 million in the overall programs that are
represented here today to address $150 billion that are spent
every year to provide benefits to these individuals and the
corresponding health insurance. So what we are doing is, we
are----
Mr. POMEROY. But you are not suggesting 600 is an
acceptable national goal.
Mr. KREGEL. I am suggesting that that is a benchmark which
we can blast through in the very near future.
Mr. POMEROY. Dr. Growick.
Mr. GROWICK. Yes, thank you. In all deference to my
colleague, I would have to disagree. Unfortunately--and I was
involved with the Ticket since its genesis, since its
beginning, and I would have to say it's the greatest
professional disappointment that I have had in my entire
career.
I am not sure what the solutions are. I think that the
Ticket has been overwhelmingly disappointing because of the
numbers. Six hundred is, as you say, minuscule, tiny in
comparison to--we're talking 11 million.
The basic premise of the Ticket--if you go back to the
political implications article that I have just entered into
testimony, I think you will see that the basic premise of the
Ticket was to use private rehab providers, much like the
insurance companies. The question is, is Social Security
Administration an insurance company run by the Federal
Government, or is it a Federal bureaucracy that is not doing
anything to help itself?
And, unfortunately, it has been the latter, which has been
a tremendous disappointment. And, you know, and I don't mean--
--
Mr. POMEROY. I would say, you know, first of all, I pretty
much accept what you just said. But I do think Congress has to
own--Congress and the Administration, prior Administration,
especially--have to own a lot of the responsibility for not
funding up the resources required to make--I mean this is a
labor-intensive business, it's going to require some staffing
and an Administration commitment that simply has not been
there. So that's part of the problem.
Mr. GROWICK. Well, part of the problem is money and
appropriations, yes, sir. But I think part of the problem is
the philosophical approach to who should be the primary
provider for services for individuals under Social Security,
whether it should be public entities, like the State-Federal
system, which still has 88 to 90 percent of the tickets. The
initial intent was to move away from that, and to have more of
a balance between the private sector and the public sector, and
that certainly hasn't occurred.
So I think, until you get to the foundation of what the
problem is, I don't think you're going to solve the problem. I
think all of this, including the new regulations--and, again, I
hope that my colleague is correct, I hope we have turned a
corner, but I fear not.
Mr. KREGEL. But since July of 2008, the percentage of folks
served by the public vocational rehabilitation agencies and the
private ENs, that percentage has flip-flopped. And recent
ticket assignments are, overwhelmingly--the vast majority are
going to private entities, as opposed to the State vocational
and rehabilitation----
Mr. POMEROY. I don't care who does it, public or private.
But I know that we have, in the hearts of many of the people on
disability rolls, the same kind of guts and courage and
determination that our lead panel demonstrated with their
tremendous stories. And they are not getting the kind of
assistance they need. And when we set the bar so low as 600, I
mean, I don't even think we're taking a meaningful shot at
this.
And so, I must say I am hopeful we may--there may be some
improvement with 2008, but I am quite disappointed. I mean,
count me in the ranks of--Dr. Growick, I am with you. We should
have had more success than this. And, by God, we have to figure
out what is causing us to not achieve greater numbers of
successful graduates in this program.
I know that my time is up. Mr. Chairman, thank you for this
important hearing. Ms. Suter might want to make a response. I
see that she--and I won't ask any further questions. Thank you.
Ms. SUTER. The 600 figure is just to break even. We think,
as I said, we have about 304,000 tickets assigned. We think in
the next 2 years we can at least double that number. That is
one thing.
The other thing is the Ticket program, we know, is for a
small number of people. We have very high standards to meet--as
Congress set--to meet the definition for disability in Social
Security. So we know, if we're doing our job, there are not a
lot of people that are going to be able to go back to work. So
it is a small piece.
The other thing, only 14 percent of our ENs right now are
public entities. So we want very much to expand the universe,
and that's why we have the Partnership Plus program. So we want
to expand, and we want to give beneficiaries as much choice as
possible.
And, under the old regs, that was very true. The majority
of our tickets--by far, 90 percent--went to State VR agencies.
As Dr. Kregel said, since the new regs have come out, 81
percent of our tickets are going to employment networks, and
only 19 percent are going to State VR agencies. So we have
flipped that, to offer more choice for our beneficiaries.
Chairman TANNER. Before--do any of you all have any
comment, before we close the public part that has been sparked
by this latest round? Mr. Golden.
Mr. GOLDEN. I appreciate your frustration with the program.
I don't think you can look at the Ticket to Work in isolation
of the broader disability standard that has been the foundation
of the Social Security Administration. I don't think that you
can just say that the reason people aren't going to work is
because the Ticket to Work program isn't working. I think you
are forgetting that for 1, 2, 3 years, people have to prove
that they can't work to get on to those rolls.
And so, we have a system that is busted. All Congress did
was layer on top of a very archaic definition of disability a
return-to-work program and prayed that it was going to work
without really addressing the issue that is at hand, and that
is that we have to tackle that disability standard.
The fact that it takes 700 pages in a training manual to
train WIPA about the different work incentive provisions that
have been created by Congress tells me there is a fatal flaw
there. It shouldn't be hard to go back to work. It shouldn't be
hard to learn how to go back to work. So I would encourage you
to look at some of those programs that we have just stacked on
top of one another. The data shows us that they are not
working. And is there a way for us to take that demonstration
authority that has expired, and to really push the limits?
I challenge you to think bigger than Ticket to Work, and
think about--I believe, with Dr. Kregel, that that program can
work. I think it's got great potential. But I think, without
changing some of the basic premises that it's built on, we are
not going to begin to see those numbers going back.
And in my testimony I reference looking at a demonstration
that streamlines the work incentives that are currently on the
books, so that maybe you have one work incentive versus a
laundry list of them that takes 700 pages to train people how
to use them, and that you think about a new way of defining
disability, that you think about a short-term program that is
an option for beneficiaries with disabilities that want to go
back to work.
They don't want to spend 3 years of their life proving to
Social Security that they are so disabled they need to get that
benefit. They need health insurance, they need quick cash
benefit, and they need access to a program like Ticket to Work
and WIPA, to help get them on that path to work. That's short-
term.
But currently, the system is long-term. And it seems like
there is competing demands there that we need to reconcile if
we're going to really, truly help the Ticket to Work program
recognize its full potential. Thank you.
Mr. KREGEL. One other thing, sir, that I would really like
to add relates to the demonstration authority. The
demonstration authority is badly needed, but the Congress has
been ill served by recent efforts to implement SSA's
demonstration authority.
There is a recent report out about four of the major
demonstration programs, $200 million. And if you read that
report, it keeps saying, ``Results will be available to
Congress in 2014,'' or the two-for-one offset demonstration,
``Results will be available to Congress in 2017.'' What is the
Social Security landscape going to look at at that time?
There are lots of things that people have raised today that
could be addressed through 2-year, 3-year demonstration
programs, to give you actual empirical information that you can
use to drive some of these major policy changes that are being
contemplated. And I think that looking at ways to get
information much sooner and more policy-relevant out of the
demonstration authority would help you all a great deal. Thank
you very much, sir.
Ms. BATES-HARRIS. One of the things that I didn't get to in
my testimony that I think is really important to say here is
that when we're talking about Social Security beneficiaries,
we're talking about people with serious health and medical
conditions. And I think that we have to remember that health
care is critical.
And a number of reports have indicated--a recent report I
read by Mathematica said that 40 percent of the people who were
surveyed in the beneficiary study indicated that they are not
going back to work because of their health conditions.
And so, I think it's really important that the Committee
work in conjunction with the Commerce Committee to ensure that
things like the existing--or the Medicaid infrastructure
grants, the Medicaid buy-in for workers with disabilities, to
maintain independence and the Medicaid buy-in be continued.
Because, without access to health care, people with
disabilities are not going to physically be able to return to
work.
Chairman TANNER. Yes. Mr. Johnson is saying would you
accept questions we might have, written questions that we can
then place in the record?
This hearing has been enormously helpful. I want to thank
all of you.
I may have one other question. Ms. Suter, about the program
integrity, and the CDRs, do you have a program in place to
address the backlog there?
Ms. SUTER. Mr. Chairman--I think Thomas Golden said it very
well--we are very concerned about the overpayments. It is
demoralizing to our beneficiaries who want to at least try
work. We have several programs in place to manage that
workload. We appreciate the leadership you have shown in giving
us more resources for the workload.
As you know, and you have heard today, one of the dilemmas
we have, and challenges, is just the competing workloads,
paying people, getting people on benefits in a timely
responsive manner, just the competing priorities. We have
instituted a program called eWork, where we get receipts and
show working and work activities. That helps with the CDR
process and managing the workload.
We have another program for SSI that looks at monthly wage
reporting. We have telephone wage reporting. We have our WIPAs
and our PABSS, who help out with overpayments. So we can do
things to manage the workload.
However--and Thomas said it very well--whether we are
talking about return-to-work or CDRs or whatever, our program
is so complex for our beneficiaries and their families, that we
have to provide almost individual case management to
individuals, just to navigate our programs. And we need to be
responsive, and that's a timely process.
So, as Mr. Golden said, we can manage the workloads, but
until we simplify the program and make the SSI work incentives
closer to the DI work incentives, we are going to run into
being unresponsive and not providing timely service to our
beneficiaries. And it's very confusing for them, and very
fearful.
So, to get back, we have instituted new ways to manage that
workload. The Commissioner has been working with advocacy
groups on simplifying the work incentives. And, within the
Agency, we are going full tilt on that, and we will continue to
do that. The Commissioner recognizes we need to simplify and
cut out these layers of the program that Thomas talked about.
Chairman TANNER. Well, thank you all. This is--as I said,
this has been an extremely thoughtful presentation on your
part, and has given us a charge to get to work, which we fully
intend to do. And we may be back in touch with you.
So, thanks once again, for all you are doing and will
continue to do to help make this program a success. Thank you
very much. We stand adjourned.
[Whereupon, at 4:10 p.m., the Subcommittee was adjourned.]
[Submissions for the Record follow:]
Statement of the American Network of Community Options and Resources
(ANCOR)
The American Network of Community Options and Resources (ANCOR)
appreciates this opportunity to provide comments and recommendations
for the record to the House Ways and Means Subcommittee on Social
Security on Social Security's employment support programs for
beneficiaries with a disability. ANCOR is the national organization
representing over 800 private providers of community living and
employment supports and services to over 500,000 individuals with
disabilities.
The focus of ANCOR's testimony is on the Ticket to Work and Work
Incentives Improvement Act (TWWIIA) as signed into law as P.L. 106-170
and effective January 28, 2002. ANCOR strongly supported the passage of
TWWIIA because of the program's possibility to remove work
disincentives that prevent individuals with disabilities from working.
ANCOR believed that the new Ticket program would strengthen individual
choice and help individuals with disabilities work by allowing them to
access a larger universe of private vocational and employment services
providers rather than relying solely on the State vocational
rehabilitation agency and access to benefit planning services.
Despite the program's initial potential, the original regulations
were insufficient to support the intent of the legislation. In
September of 2005 and August 2007, the Social Security Administration
(SSA) issued Notices of Proposed Rule Making (NPRM), which proposed
changes to the original regulations, and became effective in July 2008.
These regulations aimed to improve the payment systems for Employment
Networks (EN) and provided greater financial incentives and flexibility
for ENs. ENs now earn milestone payments earlier in the employment
process and are reimbursed at a higher rate based on beneficiary
attainment of specific earnings targets.
Many ANCOR members who initially signed up to be ENs were forced to
withdraw because they could not afford to sustain providing services.
The expenses associated with providing services as EN outpaced
revenues. Under those regulations, an EN outcome payment was worth only
40 percent of an average SSDI or SSI benefit. An EN that opted to
receive payments under the Milestone System was limited to four
milestone payments. Furthermore, an EN would receive these milestone
payments only when a beneficiary it served engaged in substantial
gainful activity (SGA). For many individuals with significant
disabilities, reaching SGA is often difficult because of challenges due
to their disability. The regulations set the bar for ENs receiving
payments too low and the bar for receiving payments too high.
Because of limited EN participation, the early vision of
beneficiary choice could not be realized. To address the issues
imparted by the initial regulations created a more attractive EN
payment structure. The 2008 regulations increased the value of outcome
payments (they are now worth 67 percent of an average SSDI or SSI
benefit) and increased the value of milestone payments (increasing the
total payout under the Milestone System relative to the Outcome
System). The new Ticket regulations increased the number of milestone
payments an EN can receive from 4 for serving any Ticket beneficiary to
15 for SSDI beneficiaries and 22 for SSI beneficiaries. The regulations
also allow an EN to receive the first four milestone payments when a
beneficiary it serves earns $700 in a month, which is below the SGA
level.
In addition, many beneficiaries may need to ease their way back
into the workforce via part-time work. However, since the previous EN
payment structure based payments on attainment of SGA, ENs were
reluctant to accept Tickets from beneficiaries seeking part-time
employment. The current EN payment threshold removes previous
disincentives to serve these beneficiaries.
However, it remains extremely difficult to achieve SGA for severely
disabled consumers working part-time. As an EN it takes the same amount
of resources to support a consumer working part-time as it does someone
working full-time. It is significant to note that 20 to 30 hours per
week is the maximum that many severely disabled consumers can work. One
ANCOR member (an EN) has one beneficiary who has been working part-time
for more than 6 months; in all likelihood she will not be able to reach
SGA.
SSA also increased available services by permitting State VR
agencies to work collaboratively with ENs in an arrangement known as
Partnership Plus. This ``team'' approach allows State VR agencies to
provide training and job placement services and then refer
beneficiaries to ENs, who can offer job retention supports. This
initiative increases the likelihood that beneficiaries will keep
working and leave the rolls. In addition, the new regulations
abbreviated the process for the One-Stop Career Centers to become ENs.
SSA reports that prior to publishing the new Ticket program
regulations, it identified three key indicators to assess the degree to
which the new regulations addressed many concerns. The new regulations
were measured by: (1) the number of new EN contracts, (2) the number of
beneficiaries accessing EN services, and (3) the number of
beneficiaries entering the workforce. SSA reports that compared to the
11 months preceding the new Ticket rule's publication, the number of
new EN contracts has increased from 5 to 34 per month. At the end of
April, there were over 1,300 ENs. Furthermore, the number of
beneficiaries assigning their Tickets has increased from 332 per month
to 867, and the number of job starts has increased by 83 percent.
SSA also committed to recruiting more ENs. Through their marketing
contractor, Cherry Engineering Support Services, Inc. (CESSI), SSA is
contacting ENs that have gone 6 months without taking a Ticket to
determine whether they can resolve any problems. CESSI also holds State
and regional ``Ticket Express'' conferences to recruit new ENs and
share best practices and has made a lot of educational materials
available online and through conference calls. In addition, SSA made a
point to attend and present at conferences, such as ANCORs, in order to
reach out and educate potential ENs.
Social Security beneficiaries were also extended outreach activity.
For example, they created the Work Incentive Seminar (WISE) event to
encourage beneficiaries to attempt to work. WISE events educate
beneficiaries and their families about work incentives. Employers, ENs,
State VR agencies, Protection and Advocacy agencies, and other
employment support providers attending these events share information
with beneficiaries about available services and employment
opportunities in their communities.
Benefit Offset Demonstration
Long before TWWIIA, SSA was required to initiate a national
demonstration to test alternate methods of treating work activity in
the Social Security Disability Insurance (SSDI) program through a
benefit offset project. The purpose of the Benefit Offset demonstration
was to determine the effect of employment outcomes including wages,
benefits, hours worked, and job retention when a financial offset in
benefit payment is applied reducing Title II disability benefit
payments by only 1 dollar for each 2 dollars earned. This work
incentive already exists in the SSI program and enables a beneficiary
to successfully and gradually work their way off benefits and move
toward self-sufficiency by decreasing benefit payments as earnings
increase. This encourages work but does not penalize the individual or
force them to give up a full benefit amount when they are working their
way back to full employment.
Despite years of planning and design, the Benefit Offset National
Demonstration (BOND) is not scheduled for implementation until FY 2010.
Prior to this national implementation, SSA conducted a four-State pilot
demonstration, which began in August 2005. The results have not been
shared publicly. This long overdue project will allow beneficiaries to
face a gradual reduction in their benefits eliminating the abrupt loss
of cash benefits in the Title II disability programs when the
beneficiary works and has earnings over the Substantial Gainful
Activity (SGA) level which is currently $940.00 a month. If properly
conducted and implemented, the strategies developed for this project
could serve as a powerful incentive and should considerably reduce
barriers to work for SSDI beneficiaries by allowing them to maintain or
increase their employment, earnings and financial independence. ANCOR
believes it is imperative that this project not languish any longer but
instead move forward with full deliberation and intent. In addition SSA
should be required to report the results of their findings to the
public in a timely manner.
Overpayments
As you know, the SSI and SSDI programs include numerous work
incentives which allow beneficiaries to work and test their ability to
become self-sufficient. The success of these work incentives, as well
as that of the Ticket to Work program, rests heavily on the ability of
SSA to record and track wages and make prompt adjustments to benefit
levels when working beneficiaries report earnings, thereby reducing
overpayments. According to an SSA Office of Inspector General report
dated April 2006, income or earnings from work activity was the most
significant reason for overpayments. These overpayments were said to be
much larger and spanned longer periods of time than the overpayments
identified by SSA's normal processes of Continuing Disability Reviews
(CDRs) and data matches to detect deaths, prisoners, fugitives, and
other issues that impact eligibility.
Overpayments have been a huge concern for many years and are
recognized as a tremendous disincentive for beneficiaries to try work.
Many beneficiaries do the right thing: They report their work in person
or to the 800 number and are told that SSA will let them know if
anything is a problem. At best SSA takes a month or two to process the
report, which causes overpayments that the beneficiary is obligated to
repay. However, SSA very often fails to process the earnings reports
and adjust the payments for months or even years. Beneficiaries
reasonably assume that SSA is paying them the correct amount. When SSA
finally gets around to processing the earnings reports, the beneficiary
is hit with a demand to repay overpayments that often amount to
thousands of dollars. This can be devastating for someone whose sole or
primary source of income is their benefit payment (currently a maximum
of $674 per month for SSI beneficiaries).
ANCOR and the disability community continue to struggle with the
inability of SSA to record and appropriately adjust benefits in a
timely manner. SSA does not require earned income reports to be made in
any specific way; they can be made in writing, by calling the 800
number, or by stopping in to report at an SSA field office. There is no
particular form to complete or file, and until the Social Security
Protection Act of 2004 was implemented, there was no official record
for the beneficiary to use that proved the report was made. In
addition, there appears to be no effective internal system for
recording the income which beneficiaries report. And despite the
development of internal electronic tools such as eWorks, this program
is not used consistently across the country. In addition SSA does not
seem to realize that people do not understand the terms of art used by
the Agency when making SGA determinations and staff are not always
clear in their explanations or do not have the time necessary to
explain them well enough. Therefore important wage deductions such as
Impairment Related Work Expenses (IRWEs) Blind Work Expenses, Subsidies
and Special Conditions do not get reported or considered.
In terms of overpayment issues, field office staff seem to have a
single rule: ``You worked; you are at fault for the overpayment.'' The
staff is very reluctant to apply the other work incentive rules, like
IRWEs or special conditions after wage reporting has occurred, and
rarely are these questions asked during the submission of this type of
wage information.
One ANCOR member has several consumers who have tried to work in
the past and have been penalized for overpayment. In one case in
particular a consumer contacted SSA and informed them of her employment
and income, a year later she was contacted by SSA for overpayment of
benefits. This had a traumatic effect on her and evoked a fear of
benefit loss in regards to employment. In this case WIPA (see below)
was used to discuss her benefits in relationship to employment.
SSA clearly needs to improve its processing of work and earning
reports. Most individuals who receive these benefits are overwhelmingly
low-income and do not have the income cushions to deal with unreliable
application of the work rules. Some at SSA seem to have a cavalier
attitude about overpayments (considering them low interest loans), not
understanding the financial and emotional effect of a large overpayment
on someone who is low-income and who thought s/he was doing a good
thing by going to work.
Many claimants do not understand the differences between SSI or
Title II disability benefits and many do not know which is which even
though they may get both. These concurrent beneficiaries will not know
to report work activity separately to the Claims Representatives
assigned to each of the benefit programs. As a result, concurrent
beneficiaries are doubly impacted with overpayments over time. The SSI
file and Title II disability file are separately maintained and
information within the office is not communicated across programs. SSA
staff who are assigned to only one benefit program (SSI or Title II
disability) should understand that claimants will not know to
separately report work and they should make sure that the work report
gets to all the right places, including the payment processing center,
and that it is acted on in a timely fashion.
Expiring TWWIIA Provisions
There are several expiring or expired provisions contained within
TWWIIA that are critical to facilitating the participation of those on
Title II and/or Title XVI in the workforce. The failure to extend these
programs could undermine the long-term impact of the law in improving
employment opportunities for this population of people with
disabilities. Two such programs include the Work Incentive Planning and
Assistance (WIPA), and the Protection and Advocacy for Beneficiaries of
Social Security (PABSS).
Work Incentive Planning and Assistance (WIPA) Program.--The Social
Security Administration has long been committed to the WIPA program and
issued a Request for Proposal inviting application for these programs
in May of 2000, with a second round of application in the fall of 2006.
WIPA grants to nonprofits and other agencies fund outreach, education
and benefits planning services to Title II Disability and SSI
beneficiaries about work incentives and services for finding,
maintaining and advancing in employment.
WIPA grantees inform beneficiaries of the impact that employment
will have on their disability income and medical coverage, and address
many of the real fears that individuals have about going to work,
including the risk of losing health coverage. These grants have
consistently demonstrated their effectiveness in explaining work rules
and stressing the important information that people need to know before
going back to work. Relevant pamphlets and the ``Red Book'' are not
enough to help individuals understand the confusing work rules. People
often need more than one explanation and need to see the rules applied
to the facts of their cases. Trained WIPA staff is skillful at making
sure that beneficiaries know what will happen to their benefits when
they go to work. Often, the fear of losing ones benefits is enough to
prevent someone from seeking employment.
The Protection and Advocacy for Beneficiaries of Social Security
(PABSS).--This program was created in TTWWIIA to protect the rights of
beneficiaries as they attempt to go to work and was the last programs
within TWWIIA to be fully implemented. It is the responsibility of the
PABSS programs to provide information, advice, and remedy to complaints
of beneficiaries utilizing their options to explore work.
In addition to resolving work related overpayments and assisting
individuals to access the services and supports they need to work, this
program assures that legal protections are given to beneficiaries in
the difficult economic climate where discrimination against people with
disabilities may increase. PABSS helps people with disabilities
maintain employment, enforces the nondiscrimination provisions of the
ADA, works for the provision of reasonable accommodations, and seeks to
protect other basic employment rights that are important to the
employment of people with disabilities.
SSA and Work Incentives
The Ticket to Work program and other provisions of TTWWIIA are only
one part of a larger discussion needed concerning barriers to
employment for Social Security disability beneficiaries. Many other
policies within the Social Security Disability and Supplemental
Security Income programs serve as disincentives to workforce
participation for people receiving these benefits.
The elimination of the 24-month waiting period for Medicare.--Good
health is essential to a successful return to work. Failure to have
access to health coverage undermines the person's ability to stabilize
his or her condition and to attempt a return to work when that is
appropriate. This waiting period also forces individuals to impoverish
themselves to qualify for Medicaid, putting even greater burden on this
already strapped program.
Allowing permanent premium-free access to Medicare for
beneficiaries who work.--Social Security disability beneficiaries who
have lifelong conditions should retain lifetime access to Medicare.
Once someone goes beyond the premium-free Part A coverage provided
under TTWWIIA, a working person with a disability can buy-in to
Medicare but at significant expense. Providing continued attachment to
Medicare for working beneficiaries would ensure ongoing eligibility for
health care. Some beneficiaries, based on their earnings, should have
the ability to obtain this coverage through a buy-in program.
Increasing Medicaid asset and resource limits.--SSI assets/resource
limits have increased only minimally since 1974. As a result, working
people with disabilities who rely on that program for critical services
and supports cannot earn and save like most Americans.
Modifying ``deemed'' SSI eligibility to protect Medicaid for
certain working people who transition to Title II.--The deeming of SSI
eligibility is important to avoid creating an unintended disincentive
to work, especially for younger individuals who receive Disabled Adult
Child or DAC benefits. Current law creates a constraint against
attempting to work because it only provides protection when the sole
reason a person's income exceeds the SSI level is the Title II benefit
increase. Thus, working and having any earnings will automatically make
the person ineligible for the deemed SSI status that protects his or
her Medicaid. This is especially ironic, because if s/he had been
solely an SSI recipient, the person would be able to benefit from the
1619(a) and (b) work incentives. This can be fixed by providing that
SSI deemed status will continue so long as the person's only other
reason for ineligibility is earnings from work.
Statement of Austin Area Mental Health Consumer
During the hearing there were positive and negative statements made
about the current Ticket to Work programs under the Social Security
Administration, specifically the employment support programs: The
Protection and Advocacy for Beneficiaries of Social Security (PABSS)
program, which provides advocacy services for beneficiaries who are
attempting to work; and, the Work Incentives Planning and Assistance
(WIPA) program. Our organizations, Austin Area Mental Health Consumers,
Inc., Return to Work program has been attentive and has attempted to
access these programs with updates obtained through teleconferences and
webinars. WIPA program has been helpful, although we have not been able
to fully implement this program in our core: Texas Austin-Travis Mental
Health Mental Retardation (MHMR) funded for clients and Texas
Department of Assistive Rehabilitative Services. This program was
created to help beneficiaries navigate Social Security's complex maze
of work incentive policies; also, we recognize the overburdened SSA
field office staff are often not able to provide the indepth, one-on-
one assistance to beneficiaries, therefore we are able to facilitate
and bridge the gap. We understand the need to fully inform clients
about work incentives and some effects that working would have on their
benefits including well-being. Work is used as therapy for many of our
clients. Under the WIPA program, this critical personalized assistance
is provided by community-based organizations, such as Austin Area
Mental Health Consumer's, with funding from SSA. Since this is a new
component of our program our success rate has been flat, about 5%.
Letter of Barbara Barbin
My name is Barbara Barbin and I am a Community Work Incentives
Coordinator (CWIC) employed by the Houston Center for Independent
Living. We are also a part of the Gulf Coast Work Incentives Planning
and Assistance program. I read the release concerning the Social
Security Administration's Employment Support Programs for Disability
Beneficiaries dated May 19, 2009. As a CWIC, it is my responsibility to
provide SSA beneficiaries with ``accurate information about work
incentives and benefits planning'' as stated in the Work Incentives
Planning and Assistance Privacy Act notice from Social Security. I am
only speaking about the part I play in our program. I feel that CWICs
do a great deal to educate consumers about the work incentives that are
available to them whether they are on Social Security Disability
Insurance or Supplement Security Income. We do this by explaining on
the telephone, in outreaches, in Transition Fairs, individual meetings,
and monthly Employment Workshops held here at the Center the guidelines
SSA has outlined for them in using the Ticket to Work. As stated in the
release, consumers are free to give their ticket to Employment Networks
(EN) who assist them in preparing to go to work. Consumers may also
choose not to assign their ticket yet still go to work. For many
consumers, this is a good idea because they may already have expertise
in certain fields and may not require the services of an EN; however,
the advantage of their using an EN is that as long as their ticket is
assigned to an EN, they will not have any disability reviews.
Speaking as an individual CWIC, I can say that the consumers I have
dealt with have expressed a great deal of satisfaction with my work and
I am sure all CWICs throughout the country will tell you the same
thing. Beneficiaries call asking about how they can go to work without
losing their benefits and we explain the Ticket to Work program to
them. Supplemental Security Income beneficiaries benefit greatly from
going to work because in many cases they are able to maintain
employment and continue to receive a portion of their check on top of
that. Because we are able to explain under what circumstances they can
maintain both checks, they are more willing to attempt to work in spite
of their disability. Without the information and ongoing followup we
provide, which is grounded solely in SSA's guidelines, many consumers
would not even consider returning or even going to work for the first
time. Additionally, they know they will receive reliable information if
a problem should arise and they have questions. Though I might not have
all the answers, I know where to turn to obtain the answer. Personally,
if I were a beneficiary, I would feel very secure in knowing there is
an organization out there contracted by SSA that is there exclusively
to keep me on track and in compliance with their guidelines.
In conclusion, the Release stated, ``Of course, the ultimate
measure of success will be whether more individuals are able to return
to work and end their receipt of benefits as a result of the Ticket and
SSA's other employment support programs.'' That's a very tall measure.
Does that take into consideration that though an individual may not
leave the rolls entirely, he is becoming more self-sufficient and is
paying taxes where he may not have in the past or would not have even
attempted were it not for such a program? This may seem like small
progress, but to the beneficiary, it is hard-earned success.
Thank you,
Barbara Barbin
Statement of Brenda Peterson
Social Security Administration's (SSA's) Employment Support Programs
for Disability Beneficiaries
For me personally ticket to work (TTW) has not been very helpful.
Increased awareness for those involved in helping would assist in
removing some of these challenging obstacles for those like myself who
have hidden (non-apparent) chronic painful disorders. I appear healthy
so most assume that I am a healthy individual with no disabilities.
My battle has been that I need accommodations that would qualify me
to most likely fall under the reasonable category.
The vendors under TTW that I have contacted were not familiar with
the main disorder (I have more than one) that has caused the most
trouble. These vendors did not know how to be helpful. There is only
one rehab person out of four in two different States and in different
cities that were slightly familiar with the disorder. When I was first
diagnosed one State rehab person said that there was nothing they could
do. Another one said that she had two individuals with this disorder
during her entire career and both of them were only able to work for a
brief period of time after sending them to school to be trained. Vendor
awareness and training is a necessity for the TTW to be successful in
assisting people with hidden chronic painful disorders.
There are additional obstacles that I have had to deal with. I am
unable to do repetitive writing with my dominant right hand or do
anything that causes further aggravation and increased pain and
inflammation to my right hand and the right side in particular.
Fortunately, I recently found an information factsheet published by Job
Accommodation Network (JAN) that specifically deals with this disorder
that I share with a prospective employer.
I would really like to see changes to the program that support
people with hidden (non-apparent) disabilities. I hope that my personal
testimony provides insight to the difficulties in the TTW program for
someone with hidden (non-apparent) disabilities.
Thank you,
Brenda Peterson
Statement of Council of State Administrators of Vocational
Rehabilitation
On behalf of the Council of State Administrators of Vocational
Rehabilitation (CSAVR), we submit this statement for the record
regarding the Social Security Administration's Ticket to Work program
and other work incentive related issues.
The State Vocational Rehabilitation agencies have a long history of
working with Social Security beneficiaries on Social Security
Disability Insurance and Supplemental Security Income due to a
disability in their efforts to return to work. Every year we help
thousands of Social Security beneficiaries find work, leave the
disability rolls, and become taxpaying citizens. In return, SSA
reimburses State agencies for the costs of providing services. The
Social Security Administration most recent data indicates that for
every dollar SSA reimburses the State VR agencies, SSA has saved 7
dollars in benefits that it would have paid out; a net savings of $754
million to the SSDI and SSI programs last year. In addition, we help
beneficiaries navigate the myriad of complicated Social Security rules
around work and help beneficiaries avoid overpayments once they return
to work.
The Ticket to Work and Work Incentives Improvement Act (TTWWIIA)
was passed by both houses of Congress in 1999 by overwhelming
bipartisan majorities. It was signed into law by President Bill Clinton
in December 1999. This legislation created the Ticket to Work program
with the goal of expanding the employment services and resources
available to help SSA beneficiaries return to work. It expanded and
extended health care coverage to beneficiaries who return to work so
that they would not have to worry about losing their health care
coverage. The bill also created several initiatives designed to help
beneficiaries utilize the work incentives in the Social Security
program.
Despite the high expectations of the disability community,
rehabilitation providers, and Congress for the Ticket to Work, the
first regulations, issued in December 2001, and the subsequent
Transmittal 17 policy, undermined the objectives of the Ticket. It was
clear that revisions were necessary.
We applaud Associate Commissioner Sue Suter and the Office of
Employment Support Programs (OESP) at SSA for listening to the
stakeholders who brought their concerns to SSA, the Ticket to Work and
Work Incentives Act Advisory Panel, and to Congress. The new
regulations, particularly Partnership Plus, take the Ticket program in
a new and positive direction. These new regulations, which became
effective 1 year ago, enhance payments to Employment Networks (ENs),
allow SSA beneficiaries to access both Vocational Rehabilitation
services and those services offered by ENs, and will help ensure that
SSA makes payments to providers on a more timely basis. Although
Associate Commissioner Suter is departing SSA, we hope that the new
leadership at OESP continues the good work she has started there.
Benefit Offset National Demonstration (BOND)
Long before TWWIIA, SSA was required to initiate a national
demonstration to test alternate methods of treating work activity in
the SSDI program through a benefit offset project. The purpose of the
Benefit Offset demonstration was to determine the effect of employment
outcomes including wages, benefits, hours worked, and job retention
when a financial offset in benefit payment is applied reducing Title II
disability benefit payments by only 1 dollar for each 2 dollars earned.
This work incentive already exists in the SSI program and enables a
beneficiary to successfully and gradually work their way off benefits
and move toward self-sufficiency by decreasing benefit payments as
earnings increase. This encourages work but does not penalize the
individual or force them to give up a full benefit amount when they are
working their way back to full employment.
Despite years of planning and design, the Benefit Offset National
Demonstration (BOND) is not scheduled for implementation until FY 2010.
Prior to this national implementation, SSA conducted a four-State pilot
demonstration, which began in August 2005. This long overdue project
provided the opportunity for beneficiaries to face a gradual reduction
in their benefits, eliminating the abrupt loss of cash benefits in the
Title II disability programs when the beneficiary works and has
earnings over the Substantial Gainful Activity (SGA) level which is
currently $940.00 a month. If the BOND is properly conducted and
implemented, the strategies developed for this project could serve as a
powerful incentive and should considerably reduce barriers to work for
SSDI beneficiaries by allowing them to maintain or increase their
employment, earnings and financial independence.
In fact, the four-State project has shown promising results. In
2008, the four Pilot States (Connecticut, Vermont, Utah, and Wisconsin)
started to produce preliminary outcome data on the impact of the $1 for
$2 for all participants, albeit over a limited time period. Among the
findings: In Connecticut and Vermont, the rate of beneficiaries in the
test group who earned above the SGA threshold increased by
statistically significant margins of 17.5 percentage points and 5
percentage points, respectively, compared to controls.
In Utah, the same analyses conducted by the other States did not
reveal significant differences for the test group at five quarters
after enrollment because early project enrollees took longer to
increase their earnings. However, SGA comparisons for the five quarters
before enrollment with the most recent available quarters (the first
and second quarters of 2008) were statistically significant, with the
increase in people earning above SGA being 7.3 percentage points higher
for the test group than the control group. These analyses using recent
calendar quarters recognize the time needed for the project to become
effective.
Wisconsin has not yet demonstrated statistically significant
differences between the test and control groups.
SSA Demonstration Authority and Employment First
SSA's authority to conduct SSDI demonstration projects has expired
and we believe Congress should work expeditiously to renew that
authority. Legislation introduced last Congress by Representative Kind
(D-WI), Representative Ryan (R-WI), and Representative Petri (R-WI)
called for renewed SSDI demonstration authority. The Wisconsin Division
of Vocational Rehabilitation and WI VR Administrator Charlene Dwyer and
her staff have worked tirelessly with the Wisconsin congressional
delegation to develop this proposal. Among the provisions in the bill
is authority for three types of experiments or demonstration projects:
1. Reduction of benefits based on earnings.
2. An earned income cost share with no benefit offset.
3. Early intervention diversion programs.
The State of Wisconsin, and the Wisconsin Division of Vocational
Rehabilitation, has been in the forefront for many years looking for
ways to improve Social Security and other programs that beneficiaries
rely on to work. It is time to allow States to once again work with
their Federal partner to find ways to make our Nation's programs work
for people on Social Security.
CSAVR strongly support these efforts and in particular the idea of
testing early intervention or employment first. CSAVR's Employment
First proposal, which can be found at http://www.rehabnetwork.org/red/
red.htm, calls for a completely voluntary program, in which
participation does not stop the disability application process, a
person receives immediate access to temporary cash assistance,
immediate access to health care coverage, immediate access to
vocational services to assist the person to find work, and suspension
of the Social Security disability application once employment above SGA
is found or if employment fails, the work effort is not considered as
evidence of ability to engage in SGA.
Expiring TTWWIIA Provisions
There are several expiring or expired provisions contained within
TWWIIA that are critical to facilitating the participation of those on
Title II and/or Title XVI in the workforce. The failure to extend these
programs could undermine the long-term impact of the law in improving
employment opportunities for this population of people with
disabilities. Two such programs include the Work Incentive Planning and
Assistance (WIPA), and the Protection and Advocacy for Beneficiaries of
Social Security (PABSS).
Work Incentive Planning and Assistance (WIPA) Program.--The Social
Security Administration has long been committed to the WIPA program and
issued a Request for Proposal inviting applications for this program in
May of 2000, with a second round of application in the fall of 2006.
WIPA grants to nonprofits and other agencies fund outreach, education
and benefits planning services to SSDI and SSI beneficiaries about work
incentives and services for finding, maintaining and advancing in
employment.
WIPA grantees inform beneficiaries of the impact that employment
will have on their disability income and medical coverage, and address
many of the real fears that individuals have about going to work,
including the risk of losing health coverage. These grants have
consistently demonstrated their effectiveness in explaining work rules
and stressing the important information that people need to know before
going back to work. Relevant pamphlets and the ``Red Book'' are not
enough to help individuals understand the confusing work rules. People
often need more than one explanation and need to see the rules applied
to their specific situation. Trained WIPA staff is skillful at making
sure that beneficiaries know what will happen to their benefits when
they go to work.
WIPA programs have been flat-funded at $23 million since their
inception and are struggling to maintain their high level of service.
In addition, these grants will terminate 6 months into FY 2010 unless
renewed by Congress. Increased appropriations are needed to continue
and expand this very important program.
The Protection and Advocacy for Beneficiaries of Social Security
(PABSS).--This program was created in TWWIIA to protect the rights of
beneficiaries as they attempt to go to work and was the last program
within TWWIIA to be fully implemented. It is the responsibility of the
PABSS programs to provide information, advice, and remedy to complaints
of beneficiaries utilizing their options to explore work. This work is
consistent with the mission of the Protection and Advocacy (P&A)
system, created by Congress in the 1970s to protect individuals with
disabilities from abuse, neglect, and discrimination based on
disability. With a presence in every State and U.S. territory, and the
District of Columbia, the P&A systems offer an advocacy and legal voice
to individuals with disabilities as they venture into the workforce.
Medicaid Infrastructure Grants
These grants were authorized from 2001-2011 by section 203 of the
TTWWIIA and are administered by the Centers for Medicare and Medicaid
Services. These grants provide States with flexible funds to enhance
State infrastructure that supports workers with disabilities. Due to
the MIGs, over two-thirds of States have implemented Medicaid buy-ins,
redesigned Medicaid waivers and personal care programs to ensure that
individuals can go to work, and improved coordination between Social
Security, WIPAs, Medicaid and related agencies. In 2009, 42 States and
the District of Columbia received these grant funds and they have been
an incredibly valuable vehicle for linking across systems, and building
infrastructure within States.
Medicaid Buy-in
The Medicaid buy-in provides Medicaid coverage to people with
disabilities who would be receiving SSI but for their earnings from
employment. Many of these individuals need services beyond what private
insurance covers, or they would be unable to acquire coverage on the
individual market. Over 40 States have created a Medicaid buy-in under
TWWIIA or under the earlier buy-in created under the 1997 Balanced
Budget Act and are experiencing positive fiscal returns. However,
participation in the Medicaid buy-in as in current legislation is those
``at least 16 years of age but less than 65 years of age'' despite the
increase in normal retirement age beyond age 65. Thus, someone can be
using the buy-in to work until he/she retires at ``normal retirement
age'' but then is confronted by the loss of the resource/asset limit
suspensions when they reach age 65. This anomaly needs to be corrected.
Overpayments
Finally, we believe that SSA must address the problem faced by
beneficiaries who return to work and still continue to receive their
benefits even AFTER Social Security has been notified by the
beneficiary about their work and income. There is no greater burden,
and no greater disincentive to work, than when a beneficiary receives a
notice from SSA stating that they owe thousands or perhaps tens of
thousands of dollars because SSA couldn't stop their checks.
Beneficiaries do the right thing: They report their work in person or
to the 800 number and are told that SSA will let them know if there is
a problem. Months or even years in some cases may have gone by with no
cessation of benefits. If the beneficiary has received good advice they
have saved the funds and can repay them when asked. But even if they do
this, a beneficiary must still pay TAXES on the benefits they are not
supposed to be receiving. They must then file amended State and Federal
tax returns. This is simply outrageous. SSA simply must improve the
income reporting process or, in the alternative, Congress should stop
SSA from collecting overpayments if the person has followed the rules
and reported their income. Beneficiaries who follow the rules should
not have to pay for SSA's negligence.
Thank you again for the opportunity to submit these comments for
the record and CSAVR looks forward to working with the Subcommittee on
these important issues for people with disabilities.
CSAVR Social Security Relations Committee Cochairs:
Brenda Moore, Director, Connecticut Bureau of Rehabilitation
Services
Donald R. Uchida, Executive Director, Utah State Office of
Rehabilitation
Statement of Diana Bell
I have a Ticket to Work, and have had trouble finding any quality
Employment Networks. I am including an attachment of the ones we have
here in Denver and the list is not very good. The only one who seems to
have a sincere interest in doing anything is Jeffco Work Force.
I have been signed up with an individual out of State. There seems
to be a lot of EN's that only take your ticket and give you back part
of the money that SSA pays them.
The program seems to be a good program with incentives but does not
seem to be doing what it should be doing in reality.
The program is not financially beneficial for an individual and for
organizations, I think it is very time consuming but at the same time
they have other monies to support the program.
One of the mistakes that everyone seems to be making is what the
program is supposed to do. People are supposed to go to work but with
the intention of keeping them working. But that can't be accomplished
when we are not addressing the individual (ticketholder) as a whole.
The program can not go forward with creating a plan for self-employment
when someone is hanging off a cliff already by one arm and that is what
this program is doing. It is hard to do a business plan when the
individual is dealing with the possibility of being homeless and
wondering about life's other challenges.
We need to look at how Australia has dealt with this issue of
putting people to work with disabilities. We need to create
``businesses or nonprofits'' to hire ticketholders and provide support
services for them while they work.
I have been working with Voc Rehab now for almost a year, countless
wasted hours. And we are still nowhere near a workable plan for me. I
think that Voc Rehab is involving too much of their own thoughts on
people's plans and lives. We are not being allowed to make choices for
ourselves and what our choice of work should be. I recently had
problems where I live and almost ended up homeless. Voc Rehab had no
resources or ideas for me to deal with this. But they did remind me I
had an appointment the following week.
I think that by creating places where they work and work more with
people with disabilities they are more likely to stay on the job
because this place becomes a home away from home and now they have
friends with similar issues and interests. To put them to work with so-
called normal people only creates a situation for isolation.
I am sorry if this sounds rather scattered but I have medical
issues that sometimes deal with my train of thought.
I am also including a plan on how this program needs to work to
make it more financially appealing to individuals and attract more
qualified ENs.
You need a support system that picks up these ticketholders after
they go to work and that is the program I am working on. Hindsight is
20-20--providing the resources before they need it. This would free up
the time for ENs to actually do what they hopefully do best. It works
kind of like some of the nonprofits do it--you have the nonprofit that
strictly deals with the ones listed under it--for example all of the
paperwork, funding, etc. . . . freeing up the ones that are under its
umbrella to do what they do best. This is also how the Australia
Disability Enterprises do it.
The Australia Disability Enterprises have about 600 nonprofits
under it from landscaping, nursery wholesale, retail, shipping,
catering and janitorial, etc.
The goal is to keep them working, but making them happy is what is
going to keep them on the job.
Voc Rehab is refusing to help me become an EN--they justified it by
telling me that I don't have a Master's degree like they do and that I
would be in direct competition with them. This is all ridiculous. We
should all have the same goal and outcome for these disabled
individuals.
I currently am working on my website and do classes on the ticket
to work. I have also had lots of people call me on how to apply to SSA
on their new hiring initiative. That part has expanded to disabled
veterans. I now take calls from the workforces on how to do the
``Schedule A'' and provide support for one of the coalitions for the
homeless. I also do a blog on the Disability Digest covering SSA
updates. Outreach with what is available with the Ticket to Work is not
reaching individuals and so many don't even know they have a ticket to
work or what it is.
You need to start with more outreach and support services for the
individuals for when they go to work and then move into creating
workplaces for them.
I have done all of this work on what my disability check is and no
income yet. But SSA has plenty of money and can not seem to accomplish
these goals. I mean, really, how difficult is it to go to these low-
income HUD-subsidized apartment buildings and do the ticket to work
class there???? Most of these individuals all have a ticket to work.
How about creating some kind of work at these locations?? Lets get to
thinking outside of the box. Sometimes you all spend too much time in
meetings and the goal is lost in everything.
I have already created a database with information but again Voc
Rehab won't let me do it as a self-employment plan, so therefore will
not help me financially. They want me to think in smaller terms, which
is something I can't do. I asked for software to create an automated
system to send out info and request info to help ENs but the answer is
no.
This has not stopped me. I am using Go Daddy products at this
point, piecing the database together.
It makes no sense to me. Something that would improve and help both
the ticketholder and the ENs that work with them, but they have no
problem giving me more money to do an organic seed business. Just how
wisely is this planning working????
Diana Bell
World of Disability, LLC
Statement of Don C. Kandlbinder
I have a ticket to work and would love to see if I could do some
part-time work but figuring out how to go about applying for a job is
very difficult. It is like you make it that way just to stop us from
trying.
However, I do appreciate the program and I appreciate my VR rep
here in Indiana. This is about all I have to say on the matter.
Sincerely,
Don C. Kandlbinder
Statement of Don Fitch, Center for Career Freedom
The Center for Career Freedom is a 501(c)(3) with a mission of
recovery and rehabilitation of persons with severe and persistent
mental illness leading to competitive employment. The Center is the
only nonprofit in New York State that is a NYS Department of Education
Licensed Business School, a Microsoft Certified Office Specialist
Training Center, an SSA Employment Network and, recipient run. We have
served over 1,500 recipients of SSI and SSDI since our founding in
1998.
Our analysis of the recipients' economics of recovery and the
Governments' Work Incentives have lead us to the conclusion that SSI
recipients, except under rare circumstances, cannot work their way off
their benefits to self-sustaining employment.
To document this conclusion, we respectfully submit to the
Committee the following five points:
1. In spite of the millions SSA has spent for Employment Support
programs these past 10 years, they have had no appreciable effect in
returning recipients to self-sustaining employment.
According to SSA, less than 1 percent (545 out of 5.9 million)
of the SSI recipients successfully returned to work (Annual Statistical
Reports, 2007, Table 43 for SSI, Table 53 for DI).
2. For most recipients, the cost to replace their benefits
outweighs the advantages of returning to work.
The average monthly dollar value of typical government
benefits for persons with disabilities in NYS is over $2,300 or about
$28,000 per year. A person would have to gross about $35,000 a year to
replace these benefits. The operational definition of recovery at the
Center is: ``Our students must acquire sufficient skills to earn $17 an
hour and the stamina to work 35+ hours per week.''
3. Persons on SSI suffer from the earlier onset of their illness
and more severe work-related impairments.
By definition, recipients of SSI do not have 10 or more years
of work (40 Qtrs.). Our studies of over 500 recipients found this
correlated with fewer years of education, fewer years of competitive
employment and consequentially, less lifetime earnings. We have
reaffirmed that the best predictor of future job success, is past
success. Recipients of SSI require many more job supports than SSA
offers.
4. SSAs' (and other government agency) work deductions, together
with ordinary work-related expenses, prevents recipients from returning
to work.
A typical SSI recipient receiving $761/Mo. disability income
plus $200/Mo. food stamps, Medicaid, Section 8 rental assistance and
half-price bus pass would have over $175 deducted from their monthly
benefits if they attempted to work just one 7-hour day a week, at $8 an
hour ($224/Mo. gross salary). Their average work-related expenses,
taxes, transportation, personal, food, etc. would be about $107 per
month. Even if they bring all their own food, snacks and beverages and
take advantage of HUDs' Earned Income Disallowance, they will keep
about $30 a month, that's $7.50 for the day or $1.07 an hour. This is a
fraction of what they expected to earn and it is why recipients stop
working.
5. SSAs' Work Incentives do not work for 99 percent of the almost
12 million persons with disabilities.
As an EN, we have found that while Ticket-to-Work offers our
students 60 months of avoiding a CDR, in return, they will have to earn
at least $670 a month for 3 months in year 2, again, for 6 months in
year 3 and, again, for 9 months in years 4 and 5--to maintain this
``protection.'' In order to increase the payments to the EN, SSA has
simply raised the bar on the recipients. They have shifted the cost of
the new rate structure to the recipient. We predict it won't be
effective for the reasons cited above. Indeed, Mathematica Policy
Research, Inc., one of SSAs' research vendors, has so stated
(www.mathematica. mpr.com/). According to SSA, the '08 Ticket-to-Work
enrollment is about one-tenth of 1 percent.
The Pass Plan currently has no enrollees in New York State (less
than 1 percent nationally) for the simple reason that persons on SSI,
after benefit and expense deductions, have no money left over to save.
Provision 1619(b) and the Medicaid buy-in only kick in when the SSI
recipients earn over $45,000 a year. The odds of that happening are 1
in 100,000.
Of the IRWE's, only medically-prescribed transportation would apply
to our population.
We have seen subsidies work when the recipient works for a family-
run business--but there are few of these situations.
Work Opportunity Tax Credits don't help the recipient keep more of
their salary.
SSAs' Subcommittee testimony is almost identical for 1999 and 2009.
They would have us believe that their incentives would be effective in
returning recipients to self-sufficient work if only more people knew
about them. They talk of demonstrations and studies that will prove
their effectiveness in years to come if the Committee will only be
patient. SSAs' requests are always the same: ``Give us more time and
money.''
Conclusion
In spite of the hundreds of billions spent in the United States for
the recovery and rehabilitation of persons with disabilities; health
care, housing, education/VR, community supports, job development and
more, we are unable to help more than one-half of 1 percent achieve
self-sustaining employment. Denial of this fact doesn't solve the
problem.
This failure affects every one of the over 12 million persons with
physical and mental disabilities; it is a waste of their lives and
talents, an enormous loss to the economy, an unnecessary burden to the
taxpayer and a drain on the Social Security Trust Fund.
America cannot afford to continue this colossal waste of life and
resources. It is time for change. It is time to act. We don't need
another study, SSA has already provided the data.
Whatever the answer, it will require the Committees' leadership and
bipartisan coordination. History has demonstrated it won't be solved by
SSA and the academics.
We envision a series of public-private partnerships, with
businesspersons leading the way. These pilot studies could include a
variety of scenarios:
European-style integrated onsite employer-caregiver
programs.
Progressive incentivized task training based on
demonstrated ability/performance and government earnings restrictions.
Parity SSA return-to-work regulations for SSI and SSDI
populations.
Outsource transition-to-work programs from SSA/VR to DOL
and Manpower, Goodwill Industries or?
In light of this evidence, it is our recommendation that the
Committee postpone reauthorization of WIPA and PABSS until a thorough
review of the Economics of Recovery can be conducted for both SSI and
DI recipients.
Thank you for your time and consideration.
Respectfully submitted,
Donald M. Fitch, MS
Executive Director, Center for Career Freedom
One East Post Road, White Plains, NY 10601
[email protected]
Statement of Francoise Frigola
As a self-employed disabled individual on SSDI and on the 250%
California Working Disabled program, I urge the Social Security
Administration to implement a sliding scale benefit reduction as soon
as possible.
For self-employed individuals, medical insurance coverage is also
part of the ``cliff'' preventing us from becoming self-sustainable.
Most of us cannot be without medical insurance. Assuming we can find an
insurer, our ``pre-existing conditions'' make the premiums
unaffordable. Please offer the continuation of Medicare coverage with
reasonable premiums.
Francoise Frigola
Member, California Work Group--specializing in self-employment
issues
Statement of Health and Disability Advocates (HDA)
Health and Disability Advocates (HDA) is a national policy and
advocacy group that works to promote policies and programs that ensure
the economic security and comprehensive health coverage for children
and adults with disabilities and older adults, particularly those with
limited incomes. A major part of our work is assisting individuals,
community-based service providers, and advocates who assist individuals
with disabilities with employment, in understanding and navigating the
complicated State and Federal benefits systems, identifying barriers to
accessing those systems, developing policies and solutions that will
eliminate those barriers, and assuring that policies promote rather
than hinder an individual's efforts to gain or maintain employment.
Through this work, we have had the chance to observe first-hand and on
the ground the impact of the Social Security Administration's
Employment Support programs. These experiences inform our comments on
the programs, set out below.
I. The new regulations promulgated by the Social Security
Administration will have a positive impact on the Ticket to Work
Program and employment outcomes for beneficiaries of Social Security.
However, these regulatory changes alone are not enough to support a
substantial number of SSA beneficiaries in obtaining and maintaining
employment and/or leaving the SSA benefits rolls due to employment.
Most advocates and stakeholders agree that there were at least four
major problems with the Ticket to Work Program prior to the
implementation of the new regulations:
1. The payment system was inadequate at attracting meaningful
participation from service providers. The payments were too little and
the outcomes and their timeframes were unreasonable.
2. The original regulations put the Employment Networks and the
State VR agencies in direct competition for the tickets. Because many
Employment Networks were also VR contractors, and the VR system paid
better, most Employment Networks opted not to compete against VR and
stick to their VR contracts. VR agencies were forced to take tickets in
order to receive reimbursement from SSA under their preexisting cost
and did so. The statistics bear this out: With a few exceptions, VR was
the only one meaningfully participating in the Ticket to Work Program.
Before and after the Ticket to Work Program, VR was the only viable
choice in most parts of the country.
3. In order for the Ticket to Work Program to succeed, you need a
significant portion of the beneficiary population to be ``ticket
ready'' or ready to work at levels of employment that produce payments
for the EN system supporting them. This can only be done with extensive
and intensive education and outreach to the beneficiary population and
all the systems with which they interact. The message must be that it
is ``safe'' to work and successful utilization of the work incentives
will lead to a life of greater self-sufficiency that can be sustained.
4. In addition, you need an employment service provider system
that is able to get beneficiaries placed and maintained in employment
at a level high enough to produce payments. For too long, much of the
employment services system used by people with disabilities has NOT
produced placements that would move people toward less reliance on
public benefits.
The new regulations take the necessary steps to correct the first
two problems. The new regulations created a better payment system that
is more attractive to service providers and the Ticket to Work Program
is seeing an increase in participation. The new regulations also now
allow VR and ENs to work together under a model called Partnership
Plus. This should allow for more participation as well.
However, the regulations do not address the problems described in
#3 and #4. Nor could they, as these two issues cannot be solved by
regulations alone. Rather, #3 and #4 can only be tackled by SSA
utilizing its authority under Section 121(2)(B) of the Ticket to Work
and Work Incentives Improvement Act to conduct extensive and intensive
education and outreach to beneficiaries and service providers about the
work incentive programs and promising practices in assisting SSA
beneficiaries in returning to work at meaningful wages. Up until this
point, SSA has failed to do this in any comprehensive way.
II. Through the creation of the SSA work incentives, extension of
Medicare eligibility, extension of SSI Medicaid eligibility through
1619(b), and the implementation of Medicaid buy-in programs in the vast
majority of States, many of the significant benefits barriers to
returning to work have been removed. However, unless beneficiaries and
the service providers know and understand these rules and how to
utilize them, all of these changes will have a negligible impact on the
number of SSA beneficiaries seeking, obtaining, and maintaining
employment.
For many years, a significant and very real barrier to returning to
work was continuing access to cash benefits from Social Security and/or
Medicare and Medicaid. To put it simply, SSA beneficiaries would not
work because it would require them to lose necessary cash benefits or
health care. Over time, and culminating in the Ticket to Work and Work
Incentives Improvement Act, these barriers have been removed. There are
still issues, especially involving the sudden loss of all SSDI
benefits, ``the cash cliff,'' when a person works over the Substantial
Gainful Activity amount. But, for the most part, there have been
significant strides in lessening and removing these barriers.
Given these vast improvements, why have we not seen a significant
increase in SSA beneficiaries working and even leaving the SSA cash
rolls? As cited by John Kregel in his important testimony on the WIPA
programs, Mathematica's 2006 National Beneficiary Survey estimates that
44% of SSA beneficiaries may be interested in employment. Yet, this
interest is not translating into actual employment for millions of
these beneficiaries. To be sure, there are still other barriers to
employment faced by SSA beneficiaries, including discrimination, that
cannot be addressed through cash benefits and health care programs.
But, in our work at Health and Disability Advocates, we still hear SSA
beneficiaries interested in employment express hesitation about
pursuing it every day because of unfounded fears of what will happen to
public benefits and health care by returning to work. We believe many
SSA beneficiaries are still not taking that leap into employment
because of fears and misinformation about the work incentives and
public benefits programs.
Prior to the passage of the Ticket to Work and Work Incentives
Improvement Act, many SSA beneficiaries had bad experiences with
returning to work. They lost access to Medicaid. They were assessed
overpayments. They could not get back into the benefits system when
their medical condition worsened without going through the long,
difficult process of another initial application. These personal and
negative experiences of employment live on in our communities.
Now, the rules and regulations governing the back to work process
of an SSA beneficiary work well on paper. Congress has built a path to
employment for SSA beneficiaries that is free of many of the previous
benefits-related barriers to employment. But, these rules and
regulations are never going to have a real world and significant impact
until SSA makes it a priority to show SSA beneficiaries, their
families, service providers and other support systems that the path has
been cleared.
Congress provided SSA with the authority to build a comprehensive,
intensive and large scale education and outreach effort to
beneficiaries under Section 121(2)(B) of the Ticket to Work and Work
Incentives Improvement Act. While it has done some work, but not
enough, in the area of promoting the Ticket to Work Program, it has
done virtually nothing to promote the broader work incentives and
changes to the health care programs. Instead, it has relied almost
exclusively on the WIPA Projects, described below, to do the heavy
lifting on education and outreach in the community. Although they do
what they can, 104 underfunded community-based programs, who are also
expected to spend the vast majority of their time on individual
counseling, cannot possibly implement an education and outreach
strategy that will have maximum impact and result in significant levels
of employment. While we wholeheartedly support fully funding and
expanding the WIPA program as suggested by others in their testimony, a
larger and better funded WIPA program could perform all of the
individual benefits counseling work necessary to support SSA
beneficiaries, but not all of the education and outreach work necessary
to fully promote the SSA Employment Support programs. Indeed, this is
not even what Congress intended, since the authority to create the WIPA
Projects is separate and apart from the outreach and education
authority under Section 121(2)(B).
Ultimately, it is not fair to SSA beneficiaries that the Ticket to
Work and Work Incentives Improvement Act built a path for their self-
sufficiency and so many of them don't even know it.
III. Work-related overpayments continue to be a serious problem and
concern for both the integrity of the SSA programs and the
beneficiaries who incur them. SSA continues to ignore this growing
problem and fails to address it in any meaningful and comprehensive
way.
The Social Security Administration (SSA) has been plagued with the
issue of maintaining accurate payments for workers with disabilities
who are beneficiaries. There are various reasons this occurs. One
primary reason is that disability is a narrow margin of the number of
beneficiaries served by SSA and even smaller is the population of
beneficiaries with disabilities who return to work. The issue is
compounded by the various work incentives available to workers with
disabilities, which causes a great area of confusion and often even
congruency between programs. This has resulted in a large backlog of
reviews, delaying notification and causing larger overpayments while
decreasing the likelihood that individuals will make positive decisions
about working in the future. The issue is best highlighted in the
September 2004 GAO report entitled: Disability Insurance--SSA Should
Strengthen Its Efforts To Detect and Prevent Overpayments. The summary
reads:
Disability Insurance (DI) program is one of the Nation's
largest cash assistance programs for disabled workers. In
fiscal year 2003, the DI program provided about $70 billion in
financial assistance to approximately 7.5 million disabled
workers, their spouses, and dependent children. This program
has grown in recent years and is poised to grow further as the
baby boom generation ages. The Senate Committee on Finance
asked GAO to (1) determine the amount of overpayments in the DI
program, particularly those attributable to earnings or work
activity, and (2) identify any vulnerabilities in SSA's
processes and policies for verifying earnings that may
contribute to work-related overpayments.
Overpayment detections in the DI program increased from $772
million in fiscal year 1999 to about $990 million in 2003. The
true extent of overpayments resulting from earnings that exceed
Agency guidelines is currently unknown. Based on available data
from SSA, GAO found that about 31 percent of all DI
overpayments are attributable to DI beneficiaries who worked
and earned more than allowed. Moreover, GAO found that these
overpayments contributed to mounting financial losses in the
program. From 1999 to 2003, total overpayment debt increased
from about $1.9 billion to nearly $3 billion. Three basic
weaknesses impede SSA's ability to prevent and detect earnings-
related overpayments. First, the Agency lacks timely data on
beneficiaries' earnings and work activity. Second, SSA uses
inefficient processes to perform work continuing disability
reviews (work CDRs). Third, the Agency relies on potentially
inaccurate management information to effectively monitor and
oversee some parts of this workload. These weaknesses
contributed to some work CDR cases GAO identified that were as
much as 7 years old, resulting in potential and established
overpayments as large as $105,000 per beneficiary.
The full report can be found at http://www.gao.gov/new.items/
d04929.pdf. Close to 5 years after the date of the report, many of the
options identified to expedite and decrease overpayments have been left
unfulfilled. SSA identified a similar issue in the Supplemental
Security Income (SSI) program many years before. As SSI overpayments
became a recurring issue, SSA made a policy decision to utilize the
quarterly wage reports from OCSE (Office of Child Support Enforcement)
for early income notification on individuals who were not reporting
employment. This policy change has been noted as a huge success in
reducing SSI overpayments. The GAO report from 2004 suggests SSDI
process employment identification just like SSA uses that same source
for SSI income tracking. Yet 5 years have passed and SSA has not moved
forward with the OCSE quarterly wage reports for SSDI. For this reason,
we would strongly suggest the Commissioner of Social Security study and
implement the integration of the early alert similar to the process
used by SSI by monitoring all the quarterly wage reports from OCSE.
This would have immediate impact on identifying individuals who are in
immediate need of review or continued eligibility, which could
dramatically reduce the number of overpayments expected to occur in
subsequent years.
Identification of individuals who require Work Continuing
Disability Reviews (Work CDRs) to evaluate ongoing eligibility is only
one-half of the equation. The report also identifies the desperate need
to evaluate the growing backlog of Work CDRs already identified, which
tend to be experiencing significant delay at SSA's Office of Central
Operations (OCO). One reason many of these cases are backlogged is
because 70 to 75% of all case reviews for Work CDRs are performed in
the OCO in Baltimore leaving only 25% of Work CDRs performed in the
field offices. Work CDRs are much easier to perform when they are
completed by a claims representative who has an ongoing relationship
with the client in question. In practice, the local claims
representative has an understanding of the previous work activity and
ongoing employment status of the individual, which makes it much easier
to make a decision regarding the Work CDR decision in question. It
eliminates the need for an immediate review of all the basic background
information because the claims representative often already has a
relationship with a client and knows this information.
For the reasons cited above, we strongly suggest a transition of
Work CDR review to 50/50% review by OCO staff and local field office
staff. If the impending result of the policy change is shown to
decrease overpayments and expedite Work CDRs, then we would suggest
shifting the reviewer balance to greater numbers in local field offices
and away from OCO. This shift should create greater continuity between
SSA and its clients, while decreasing the excessive costs and damage
done by unnecessary overpayments.
IV. The WIPA and PABSS programs play a key and necessary role in
supporting SSA beneficiaries who are working or considering work. These
programs should be reauthorized and refunded with direction that SSA
create and enforce key performance measures to assure that
beneficiaries are getting the same quality services no matter where
they live.
The WIPA and PABSS programs provide vital services that are an
integral and necessary part of any workforce system that supports SSA
beneficiaries in returning to work. Since their inception, they have
supported many SSA beneficiaries with a smooth transition into
employment. Given this, it is imperative that these programs become a
permanent and adequately funded part of the SSA Employment Support
programs. In doing so we would also suggest that SSA provide specific
employment measures and quality assurance procedures to guarantee each
beneficiary receives the same level and quality of service regardless
of where they live. These measures currently do not exist, which has
resulted in a vast array of service quality across the U.S.
Strengthening these measures will go a long way in ensuring the cost
effectiveness of the funding spent and the direct impact that results
from these services.
Respectfully submitted,
Health and Disability Advocates
Barbara A. Otto, Executive Director
John V. Coburn, Senior Policy Attorney
Joe Entwisle, Senior Policy Analyst
Statement of Joann Barnes
We are a small minority women-owned community business located in
North Los Angeles County, Antelope Valley, California. We have been
participating in the Ticket to Work program since 2004 with much
success. This program is greatly needed in our community and support
from our partners is invaluable. To discontinue this program would be a
tremendous drain on our economy. We provide employment opportunities to
disenfranchised individuals, who are preparing to enter or reenter the
workforce, through comprehensive training in preparation for job
readiness. We help individuals promote values of self-reliance and
commitment to the community in which we live.
I thank you for your review of this matter.
Sincerely,
Joann Barnes
Statement of Joe Hennen
Employment supports in our public disability benefit programs are
very important to the recovery process of individuals receiving these
benefits. The employment supports however need to be simple to access,
understandable, easy to use and helpful/friendly. When one looks at our
current SSA ``employment supports'' we find a system that is much too
complicated, way too hard to administer, difficult to use without
getting an overpayment and is not always helpful or friendly. The
purpose of this statement is not to attack Social Security or the folks
that staff our local offices. There are many individuals in our local
SSA offices that I applaud for their commitment and our Social Security
system does provide an important safety net for many of our most
vulnerable neighbors. There are, however, many problems in our SSA
employment support rules that need to be addressed.
Today (5/26/09) I attended a SSA reconsideration/waiver request
``personal conference'' of a recent Social Security Disability
Insurance (SSDI) beneficiary who was challenging an overpayment of
$25,232.00. This woman is a success story. She's come back from living
in shelters, regained her two children, obtained a full-time job and is
close to getting her AA degree. She no longer receives benefits, has
learned to take care of herself, is now paying taxes into our Social
Security/Medicare system and is taking care of her family. We should
celebrate her success but instead we tell her she owes $25,232.00 and
ask her to send SSA a check. How can this happen and how would you
feel? There are only so many mountains one can climb.
This morning when the SSA Claims Rep shook Lou Ann's hand hello and
commented on how warm her hands were, Lou Ann relied that ``it's
probably sweat because I am real nervous.'' The SSA Service Rep was
very helpful, friendly and supportive. Lou Ann left the conference
still owing $17,400.00. She wants to share her story to help others
facing the same issues.
My name is Joe Hennen. I am a Benefits Planning Specialist with
Vocational Rehabilitation Services in San Mateo County, California. I
have a Master's degree in Clinical Psychology and over 25 years of
experience providing vocational services to individuals living with and
recovering from psychiatric disabilities. I have been counseling
individuals around SSA benefits since the early 80s and I am a strong
advocate for including benefits information in all vocational planning.
I served as a Benefits Coordinator on a ``Social Security Demonstration
Project'' in California called the Individual Self-sufficiency Planning
Project (ISSP) from 2000-05. This was a research project funded by SSA
to identify innovative strategies and services to successfully assist
individuals with mental health disabilities in their efforts to reenter
the workforce. I have been working with the CA Department of Mental
Health and the CA Department of Rehabilitation as a Benefits Planning
trainer and consultant since 2002. As a trainer I provide 6 hour
training on SSDI/SSI general information and work incentives co-
facilitated by a SSA staff person (SSA-AWIC). I also teach a class on
Public Assistance and Disability Benefits programs at two of our local
Community Colleges (Canada College and the College of San Mateo). I
believe in the power of hope and options in the process of recovery and
value the principle of self-determination.
I am very pleased to see that Congress is reviewing our current SSA
``Employment Supports'' and taking public testimony. I would like to
submit the following comments for consideration in your review. My
thoughts and observations are based on my experience and my day-to-day
contact with SSA disability beneficiaries (SSDI and/or SSI) and SSA
staff. This statement is my recommendations as a concerned professional
and is not those of any agency I am currently affiliated with.
Recommendation #1
Local SSA offices and local community organizations need to try to
develop stronger partnerships to assist beneficiaries of SSDI or SSI in
their efforts to return to work. This objective needs to be a strong
part of the SSA employment supports program.
For anyone who regularly interacts with SSA it is obvious that
there are not enough staff in our local offices to effectively
administer the ``employment support'' program/rules while still doing
everything else SSA staff does. Without more staff the Agency's
employment support mission can not be achieved alone. Although I
believe we need more direct service SSA staff I also know that stronger
working partnerships between SSA and local vocational/disability
service providers would help achieve the goals of SSA's employment
support mission and benefit those we all serve. Local service providers
can help educate beneficiaries about their benefits, help beneficiaries
report earnings to SSA and support our mutual clients in their efforts
to become more self-supporting and provide advocacy as needed. As SSA
moves toward more online services, community partners could assist
beneficiaries with using online services.
I've had the experience of a close working relationship with our
three local SSA offices in San Mateo County, CA. Over the years our
local SSA managers have helped us provide ``work incentives''
presentations for local SSDI/SSI beneficiaries. My experience with our
SSA research demonstration project in California from 2000-05 clearly
showed that working partnerships are possible and beneficial to all
involved. As a trainer for CA Mental Health I provide 1-day training on
SSDI/SSI general information and work rules usually with the assistance
of an SSA Area Work Incentives Coordinator (AWIC). These kinds of
partnerships benefit beneficiaries in many ways and bring SSA staff
closer to those they serve.
Recommendation #2
Modify the SSDI ``all or nothing'' rule. SSDI cash benefits should
gradually go down as a beneficiary's earned income goes up.
Right now if an SSDI's recipient completes his Trial Work Months
(9) and earns over $980 a month he will lose his entire SSDI check
after a short grace period. Nine hundred eighty dollars a month is how
we currently define ``substantial work.'' Having one's entire check
stop is a scary event for any individual who is still not sure about
how much he/she can work and still manage the disability. Over the
years I have seen many individuals stay below the ``substantial
earnings'' level because they couldn't make a jump to full-time
employment.
If we want to encourage SSDI beneficiaries to work as much as they
can, we need to change the ``all or nothing'' rule. We need a rule that
allows the person's monthly SSDI check to gradually go down, say $1 for
every $2 earned, after he/she achieves our current substantial work
level of $980 a month. This approach would allow a beneficiary to test
out how much he/she could work, build confidence and skills, and
perhaps reach full-time employment. I still believe many individuals on
SSDI can return to work and know at least 10 individuals I still see,
who are completely off cash benefits and paying taxes.
I believe SSA has a demonstration project currently underway in
four States to study this issue. Although I have not seen any results I
would predict that a gradual reduction in SSDI benefits would lead to
higher earned incomes for beneficiaries working and a decrease in SSDI
paid to those beneficiaries.
Recommendation #3
Overpayments happen way too frequently to SSDI/SSI beneficiaries
who are trying to go to work. They are discouraging and at times can be
devastating. We need to decrease the frequency and size of
overpayments.
No one likes to owe the government money. SSA overpayments cause
beneficiaries to stop working and often seem unfair. Overpayments can
occur for a variety of reasons, however if we just address those that
occur because a beneficiary returns to work there are some specific
areas to study.
If you get SSI and try to go to work you will definitely get an
overpayment. The SSI ``retrospective accounting'' rules are designed to
fail and a major reason for SSI overpayments of individuals who try
working. This rule says income you earn this month will change your SSI
check 2 months later. That means for earned income I have to report my
pay stubs for May 2009 to SSA by June 10, 2009 so my July 2009 SSI
check is correct. Imagine how many places this process can break down?
If the beneficiary does not report on time or SSA staff does not input
the pay information into their records on time, the July check will be
wrong and probably lead to an overpayment. SSA is implementing a new
``wage reporting by phone'' program that may help reduce overpayments.
Online reporting would probably also help but is not yet available. One
other idea is for SSA to hire some part-time workers who are SSI/SSDI
beneficiaries to assist in helping get reported wages quickly into the
system. SSA could also look at using a 3 month window instead of a 2
month window to allow more time for wage information to be gathered and
input into the system.
For SSDI beneficiaries overpayments occur when you continue to get
a SSDI check after you have completed your ``trial work period and
grace period and are earning at a substantial level.'' Confused? Lou
Ann's story on the first page is an example of this problem. In the
announcement for these hearings you identified an April 2009 report by
the SSA Inspector General that found that SSA was not acting quickly
enough to terminate the benefits of SSDI beneficiaries who lose
eligibility because they return to work. This occurs even if the
beneficiary has informed SSA they are working. SSA needs to find a way
to complete SSDI work reviews in a more timely and efficient manner. A
major part of the problem is the complexity of the SSDI work rules.
There should also be a time limit on how far back in time SSA can go in
charging beneficiaries overpayments.
Recommendation #4
Provide adequate legal assistance for individuals dealing with
post-eligibility issues, like overpayments or reduction/cessation of
benefits.
Related to the issue of overpayments and cessation of benefits is
the lack of adequate legal support for beneficiaries who face these
problems. Most beneficiaries can't afford to pay a lawyer and few
lawyers take post-eligibility cases because SSA doesn't pay anything.
With initial eligibility cases lawyers can earn up to 25% of a
beneficiaries past due benefits.
In our community we are lucky to have the support of an excellent
attorney from our local legal aid. We haven't always had this kind of
help and know it's not available to many beneficiaries.
Recommendation #5
Benefits Planning and Assistance services are crucial in helping
SSI/SSDI beneficiaries return to work. We need to continue and if
possible expand our Benefits Planning and Assistance services.
In our community we have a partnership between county mental
health, a county vocational rehabilitation program and our State
Department of Rehabilitation to help beneficiaries return to work. In
the vocational program is a unit called the Financial Empowerment
Project (FEP) which provides a range of services aimed at helping
beneficiaries better understand their benefits, know their choices
regarding the SSA work rules and better manage their finances. The
beauty of this model is that FEP is part of a vocational program that
supports individuals in their efforts to return to work.
FEP has a benefits peer support team made up of individuals living
with a disability and many of them receiving SSDI/SSI. This model
allows beneficiaries, who are working, the opportunity to assist other
beneficiaries who are working, or want to work.
Most of FEP's funding comes from our county Department of Mental
Health. SSA and State Departments of Rehabilitation should look at
expanding their funding of benefit planning and assistance services.
Recommendation #6
Talk with those individuals who have returned to work full-time and
are off cash SSI/SSDI benefits. This would be a worthwhile
demonstration project.
The last time I looked, the success rate of individuals returning
to work and leaving the SSDI/SSI benefit roles was less than 1%. At
this very moment I can think of 10 individuals who have returned to
full-time employment and no longer receive SSDI/SSI benefits. I believe
studying their experiences and the recovery journey of others could
help us better understand what beneficiaries need to be successful in
returning to work.
Final Recommendation
If I could offer one recommendation it is simply the SSA
``employment support'' rules and programs.
As the Committee reviews SSA's ``employment support'' rules and
programs I would encourage you to try to find ways to simplify the
rules. Currently the rules are too complex and confusing which often
scares beneficiaries away from trying to work. I also believe that the
complexity of the rules causes many of the overpayments beneficiaries
encounter. For concurrent beneficiaries who receive both SSDI and SSI,
understanding and following both sets of work rules can be an
overwhelming challenge.
Again, I appreciate the opportunity to provide this statement and
look forward to seeing some positive changes in the way SSA encourages
and supports beneficiaries in their efforts to return to work.
Sincerely,
Joe Hennen,
MA Benefits Planning Specialist
Statement of Joe Ramirez-Forcier, Positive Resource Center
I am writing today to tell you about my experience as a Managing
Director of a Vocational Services agency that assists people who have
disabling HIV/AIDS to return to work. The Ticket to Work program was
just implemented this year at my agency at the Positive Resource
Center. Consumer acceptance of the Ticket program has been good. We
have signed 45 people up in 2 months. Consumers have stated that they
like the CDR protections offered by the Ticket program as well as the
timely progress elements and allowing them to take or complete
schooling at local colleges and universities. In San Francisco over 50
percent of the workforce has a college degree so advanced education is
key in entering the workforce here in San Francisco.
The process a consumer goes through in the Ticket To Work program
is also one of intention and allows the consumer to state their
commitment to return to work which the consumer sees as beneficial and
instills hope in the individual consumer. Although there are no startup
funds for Ticket programs we are fortunate enough to have matching
dollars we received in our program from other city and State workforce
development funds to serve the individual. The unfortunate part is that
we must compete with other local populations for these dollars and can
become a nonprioritized population. Specific monies set aside as they
are for youth in local Workforce Investment Boards to start and manage
the vocational rehabilitation and adjustments aspects of our
programming would be beneficial as these efforts are not well funded by
VR agencies or by local Workforce Investment Boards.
Thanks for your time.
Joe Ramirez-Forcier,
Managing Director, Employment Services,
Positive Resource Center
Statement of John M. Connelly and Joseph Dunn,
Ohio Rehabilitation Services Commission
It could be argued that there is no greater factor in improving
one's life than the ability to work and live independently in the
community. Often, people with disabilities are not given an equal
opportunity to improve their lives because barriers to employment and
independence are too prevalent in society. The programs administered by
the Ohio Rehabilitation Services Commission (RSC) strive to remove
these barriers and partner with people with disabilities to achieve
quality employment, independence, and disability determination
outcomes.
RSC operates two core programs and administers several related
programs benefiting Ohioans with disabilities. The core programs are:
Vocational Rehabilitation (VR) and Disability Determination.
Vocational Rehabilitation (VR)
This competitive jobs training and workforce development program
assists people with disabilities to obtain or retain employment. VR
stands out from other employment programs because qualified
rehabilitation professionals provide eligible individuals with
disabilities fully individualized services that ensure effective job
matching and ongoing job success, thereby strengthening the bottom line
for businesses and consumers alike. The VR program is funded with a
combination of State and Federal funds with a generous match ration of
nearly $4 of Federal funds for every $1 invested by the State (78.7%
Federal funds and 21.3% State funds).
Some of the key results of Ohio's Vocational Rehabilitation efforts
over the past year include the following:
RSC successfully assisted a record 9,370 individuals into
competitive employment--the 6th straight year of record performance;
Successful VR consumers contribute to the economy and pay
more than $34 million in taxes each year; and will repay the total cost
of their rehabilitation in 2-4 years;
Disability Determination
RSC's Bureau of Disability Determination (BDD) is charged with
determining medical eligibility for Social Security Disability
Insurance (SSDI) and Supplemental Income. BDD is proud of the service
it provides to all of its customers for the Social Security
Administration. This is perhaps best exemplified by the numerous awards
given to the agency and its staff in recognition of meeting and
exceeding the high standards of our customers. Highlighting these
awards is a recent SSA Commissioner's Citation for continually meeting
and exceeding performance goals. The Disability Determination program
is 100% federally funded through the Social Security Administration.
Key results relating to our Disability Determination program
include the following:
176,252 cases processed--an increase of 6,860 cases from
the previous year.
Reduced the average time for a SSDI case decision from 97
days in 2004 to 84.6 days in 2007.
The Ohio Rehabilitation Services Commission (RSC) commonly provides
vocational rehabilitation services to consumers who are fully or
partially supported by Social Security Administration (SSA)
Supplemental Security Income (SSI) or Social Security Disability
Insurance (SSDI). RSC receives reimbursement for the cost of
rehabilitating Social Security disability beneficiaries or recipients
as long as those consumers meet certain requirements. Ohio currently
places third in the Nation and first in our region in terms of the
amount of reimbursement funds received. Ohio has traditionally ranked
near the top as far as national rankings for SSR funds allowed. Through
April of the current fiscal year, RSC has already been reimbursed with
nearly $4.4 million in funds.
Ohio has demonstrated success in working with consumers receiving
SSI and SSDI and would like to submit for the record its support for
the early intervention proposal known as Employment First as presented
by the Council of State Administrators for Vocational Rehabilitation
(CSAVR). CSAVR's concept is strong and would provide a means of both
saving taxpayer money and offering prospects to people made vulnerable
by the onset of a disability. This proposal for early intervention
utilizes the combined expertise of the SSA and public vocational
rehabilitation (VR) professionals.
In short, CSAVR's proposal would provide beneficiaries a choice of
the long-term disability program or a short-term opportunity including
access to cash and medical benefits, plus the help of experts in
employment support for returning to work.
As it stands now, when someone applies for disability benefits,
that person must demonstrate a long-term inability to work. SSDI
eligibility requires the applicant to demonstrate that she/he has been
unable to work for at least 5 months. Consequently, instead of
encouraging a person to reenter the workforce at a time when the desire
to work is still strong, current SSA rules generally reinforce an
applicant's belief that work is not an option.
It is not so surprising, then, that less than \1/2\ of 1% of
beneficiaries ever leave the disability cash benefit rolls and find
another job. With their long history of providing employment supports
to individuals with disabilities, including people already receiving
Social Security benefits, we believe that State VR programs can target
a vital niche in serving the newly-disabled population.
Here is how CSAVR members envision Employment First working. Upon
entering the SSA office, a disability applicant would be referred to a
Social Security Rehabilitation Counselor (SSVRC). The SSVRC would do a
preliminary screening to determine immediate allowance decisions. If
the individual is not presumptively eligible for Social Security, the
SSVRC would begin to discuss vocational options, assisting the
individual in making an informed choice about participation in
Employment First.
Because the applicant may have immediate need for income support,
the Employment First program would offer short-term cash assistance.
This would provide the applicant some time-limited income while
pursuing employment. In return for immediate cash assistance and
vocational services, the applicant would agree to suspend his/her SSDI
application. However, it is important to note that the applicant will
always have the option of reactivating the disability application or
making a new application.
Additionally, the SSVRC would help the applicant to explore and
apply for health care such as Medicaid and locate other supports
including food stamps or community services where applicable. In States
like Ohio where Medicaid buy-in is an option, this possibility would
also be addressed to assure health care coverage even once an applicant
returns to work.
The concept of moving the employment discussion to the front end of
the disability benefits process would lead to better use of taxpayer
funds as disincentives to work are removed. As mentioned previously,
when a claimant applies for disability benefits he/she could spend up
to 3 years of their lives convincing the Federal Government and
themselves that they cannot work. If that consumer is given the option
of working with the VR system the notion of ``I can't work'' does not
come into play.
If VR services provide a successful employment outcome, the SSA
benefits system would be saved the cost of adjudicating the case.
Further, a significant return on the investment would be realized as
the consumer becomes a taxpayer instead of a tax consumer. In Ohio
alone, RSC estimates that our successful consumers paid more than $34
million in State and Federal taxes last year.
It also ultimately reduces other human service program costs, since
people with disabilities gain a greater measure of self-reliance. Tax
revenues will increase as these individuals bring their new found
earning power into the economy.
Integrating all available workers into the workforce, including
workers with significant disabilities, will be required for employers
to meet the demands of the 21st century economy. Significant numbers of
large and small employers have acknowledged that hiring individuals
with disabilities makes good business sense. It provides them with
diverse reliable workers and access to a market of individuals with
spending power, which has historically been untapped.
In closing, RSC has a long history of providing employment supports
to individuals with disabilities, including those individuals on the
Social Security disability programs. Increased partnership between
Social Security and Vocational Rehabilitation will lead to efficiencies
and help to further reduce barriers to independence for people with
disabilities.
Ohio RSC and the other public VR programs are committed to
providing needed services and tools to maximize employment and
independence opportunities for some of our most vulnerable citizens,
while also contributing to the economic well-being of the Nation.
Statement of John Riley
I honorably submit my comments for the May 19, 2009 hearing on the
Social Security Administration's Employment Support Programs for
Disability Beneficiaries so the Subcommittee may better formulate an
informed effective strategy to improve incidence of economic
disparities caused by beneficiary attempts at work reentry and the
inability of the Social Security Administration (SSA) Payment Center to
efficiently process reported earnings from beneficiary work activity as
applied to program entitlement for cash benefits.
Recalling the experiences of more than 300 of my clients seeking
counseling for reporting earnings from work activity throughout the 5
years of the Benefits Planning Assistance and Outreach (BPAO) program
and the nearly 5 years of the Work Incentive Planning and Assistance
(WIPA) program, I must strongly urge the Subcommittee to recommend the
implementation of the gradual reduction formula used with Supplemental
Security Income (SSI) beneficiaries receiving earned income from work
in determining the monthly cash benefit of an SSDI beneficiary engaged
in work activity greater than Substantial Gainful Activity (SGA) after
completion of the Trial Work Period. This adjustment to the current
work incentive regulations for SSDI beneficiaries will enable these
individuals who sincerely report earnings with due diligence to the SSA
to be at less risk of a ballooning overpayment determination by SSA.
Most of my long-term rolling caseload clients who are still working
or have terminated from their SSDI cash benefit due to extended work
activity have experienced the psychological and emotional hardship of
the SSA claiming an overpayment of entitlement payments despite the
beneficiary reporting, in most cases with over diligence, to the local
SSA field office and the national 1-800 switchboard. For most, the
result is an extended legal arbitration with SSA and the Internal
Revenue Service (IRS) due to inaccurate income tax presumptions. Many
reverted back to full disability status at great financial and
emotional hardship. A few still remain employed full-time, have
exhausted all Medicare extended eligibility, and continue to pay on
their SSA overpayment and their outstanding IRS income tax presumed
from the combination of their work activity earnings and unearned
income from SSDI.
The gradual reduction formula allows the SSA to be regarded as a
partner in a beneficiary's quest for work reentry instead of an
adversary for a possible financial attack years later. Most of my
clients who have made sincere attempts at part-time or full-time work
reentry have had to endure an overpayment issue of some sort with SSA.
Most have said, `` I should never have done this'' or ``I should have
worked under the table,'' not because they ignore the benefits of
continued payroll contributions to their FICA and Medicare funds and
the self-esteem building value of work, but because of the debilitating
and humiliating SSA interaction of an overpayment.
The smaller the overpayment amount, the easier it is for a
beneficiary to financially accommodate the repayment to SSA without it
sabotaging their zeal to work and create a future life of opportunity
for themselves. The higher the overpayment the more a financial loss
exists for and is sustained by SSA. I don't profess I know the answer
to how the SSA Payment Center can be given a method or device for the
capacity to accurately report earnings and fluidly process beneficiary
entitlements. That will take someone with the skill of computerized
financing to develop. All I can encourage the Committee to do is to
acknowledge that the current system of ceasing a beneficiary's cash
benefit once they earn greater than SGA after completing their Trial
Work Period is an incentive for those entitled to restrict their
earnings to sub-SGA levels so they do not have to grapple with the
strong probability of financial hardship enacted by SSA in the form of
an overpayment.
I still positively encourage beneficiaries to follow through on
their desires to return to work. But I wonder how much of a disservice
I am doing to them by setting them up to be abused by the SSA system
later in their lives. The gradual reduction formula will work. It needs
to be written into the SSA work incentive code.
Thank you for you time and consideration in this matter.
Sincerely,
John Riley,
BSW and CWIC
[email protected]
Statement of Kenneth McGill
My name is Kenneth McGill, retired from the Social Security
Administration, formerly the Associate Commissioner for Employment
Support Programs. I had the opportunity during my tenure at SSA to be
involved in the development of the Ticket to Work and Work Incentives
Improvement Act of 1999, and to manage the Agency's implementation of
most of the provisions of this important piece of legislation.
I applaud the Subcommittee on Social Security for holding its May
19 hearing on several areas of concern for the continued success of
Social Security's employment support programs. I am submitting the
following comments for the record:
The recent regulatory changes to the Ticket to Work program hold
much promise for SSA to be able to deliver a successful Ticket program
as intended by the drafters of the TWWIIA of 1999. The new regulations
are beginning to attract the necessary numbers of active, engaged
Employment Networks to afford disability beneficiaries choice in
service provision and assistance. The potential for successful public-
private partnerships under the ``Partnership Plus'' process is huge.
And increased emphasis by SSA on recruitment of a diverse group of
Employment Networks as well as outreach to beneficiaries is starting to
pay off in improved participation rates.
The success of the Ticket program is dependent on much more than
the specific set of rules governing Ticket eligibility, reimbursement
rates, Employment Network processes and the like. That success is
extremely sensitive to other major factors--the overall economy,
employer attitudes, health insurance issues, and beneficiary fears and
opinions about work and benefits. The vision of the Ticket to Work and
Work Incentives Improvement Act of 1999 was always to work for
improvements in many of these areas. The Ticket to Work was envisioned
as one of several important interlocking policy and infrastructure
changes. One of the most important underpinnings was the
institutionalization of benefits planning in this country's service
structure. Prior to the TWWIIA, benefits planning was purely ad-hoc--
funded and provided by an informal network of State and Federal
grantees, private organizations, and community agencies. The TWWIIA
provided for a national set of SSA-funded grantees, as well as national
standards for training and procedures. The former Benefits Planning
Assistance and Outreach (BPAO), now Work Incentives Planning and
Assistance (WIPA) grantees have been one of the nationally-recognized
success stories of TWWIIA--and their effect on the Ticket program's
success cannot be underestimated. I am concerned that once the
congressionally-designated 5-year funding stream ended, that SSA did
not take the necessary steps to extend and improve the funding for
these valuable community resources. The uncertainty of current-level
funding and the flat-line funding that has characterized the program
since 2004--all have led to unnecessary uncertainty over the future of
the BPAO/WIPA program--and a reduction in service to SSA beneficiaries.
SSA can easily measure the direct effects of the BPAO/WIPA program on
beneficiary work behaviors. The cost-effectiveness has been
demonstrated--I urge the Subcommittee and the Congress to move quickly
to stabilize and increase the funding for this hugely important
program. Reauthorization and specific guidance to SSA for increased
funding of this program should be a priority for this session of
Congress.
Thank you for the opportunity to comment on these issues.
Statement of Laura L. Dawson
The purpose of this testimonial is to discuss the difficulties and
successes incurred in the Ticket to Work program. There have been many
pitfalls in the program and the supporting programs, the Employment
Networks, Work Incentive Planning and Assistance (WIPA), Protection and
Advocacy for Beneficiaries of Social Security (PABSS) program.
Therefore, I have attempted to chronologically describe the benefits
and some of those difficulties in order that those who follow behind me
may see fewer of these.
Most importantly the communication between the duties of each of
these agencies and their beneficiaries is effective in some regions
more so than others. There have been occasions when one agency provides
services with the assurance of a pass off into the next program, yet
there is not a clear process for us, the beneficiary to follow through
to completion.
My disability review was initiated June 5, 2002 by Social Security.
I was informed September 20, 2002 of the permanent disability award
which was retroactive to January 16, 2002. I was referred to the Ticket
to Work program for retraining and employment while residing in Santa
Barbara, California. From their Department of Rehabilitation, I was
assisted to relocate to Nevada, and then with the assistance of the Job
Coach assigned to my care, was assisted to license and locate in North
Carolina.
The following is a chronological listing of assistance and
difficulty encountered by myself in attempts to use Ticket to Work and
your adjunctive support services as a self-employed beneficiary:
1. Disability was awarded September 2002, after a previous request
by me in 1996 for help under the disability programs. With the
significant impact on my income earning potential and large student
loan debt, the impact took me some time to get my medical bills and
records in order. This was done with the assistance of local Social
Services outside of the Ticket to Work program to reestablish my
credentials, while the State of California's Department of
Rehabilitation (DOR) helped me to be employed in my trained profession
of alternative medicine, including nutritional education programs.
The Santa Barbara DOR helped get me part-time work for trials
periods while I was in recovery since my former career was too
stressful and hired a person to help me prepare a formal business plan
for my newly formed company. My disability benefits were not meeting my
cost of living needs even in an affordable housing complex. The
counselors were advising me how to get food stamps, and other social
programs to help me while I was recovering and working. The Ticket to
Work program was being used to help my small business to buy paper,
print cartridges, and office goods. Still it was not enough to provide
me with income to pay my student loans or affordable housing. I decided
that by adding my skills and tools of acupuncture to my business model
I would create another income stream. My counselors helped me to
relocate to Nevada where I pre-cleared licensure, so that I would not
be too far from my parents and siblings.
The benefits specific to California were:
i.
Assisted by trained professional to complete a business plan.
ii.
Provided with computer training in DOR office.
iii.
Some educational costs reimbursed, including a tutorial
program/partial.
iv.
Assistance with costs for national membership.
v.
License fees.
vi.
Upon relocation provided with Dell laptop for business use
(still used).
While in California, I was not ever able to become independent of
disability benefits using employment income for any period of time.
Cost of professional continuing education and licensing, supplies, and
insurance, cost and burden of documentation, made it prohibitive to
earn a living wage, let alone repay a significant student loan debt.
2. The relocation to Nevada went well enough to begin with, however
the program was not prepared for someone who wanted to become self-
employed in acupuncture. The licensing had changed while I was in the
process to reside in Nevada. My case and Ticket were assigned to a
contracted agent, Larry Gilbert. He was familiar with the medical
profession in Las Vegas and could help me interview to share a practice
using my scientific training in nutrition. I was also sent to another
agency, the Independent Living Resource Center in Las Vegas, where I
wrote a PASS plan (similar to a business plan) for a counselor to use
in placement.
This all was happening in the backdrop of a booming real estate
bubble where social services were trying to keep up with applications
for assistance that my counselor set up for utility help, food
assistance, and job interviews. My counselor got me multiple interviews
and several part-time jobs to hold me over and help me get to know the
community of Las Vegas. After multiple failed interviews and
applications, during which I kept up my skills and consulted on
nutrition, my counselor suggested that I use my current credentials and
relocate to a State that would accept my license. He recommended that I
not share this information with anyone else until it was complete. I
successfully obtained my license in two States. Indiana and North
Carolina were my two picks due to the potential to grow my business
through corporate insurance programs based in Indiana, and/or community
needs in North Carolina.
The benefits specific to Nevada were:
i.
My case was assisted by a trained professional counselor.
ii.
My business card and brochures were printed for my company.
iii.
A luggage carrier on wheels was purchased for me to use for
mobile business.
iv.
A miniature Power Point project was purchased for mobile use
to present my nutritional education program.
v.
I received assistance to find programs that helped with gas,
utility costs and food stamps.
vi.
My counselor helped me to get gas and plan support to relocate
to North Carolina where he continued to work with me for a month or
two.
3. When I arrived in North Carolina, I had already introduced
myself to the acupuncture community in the area. I made contact with
the NC DOR to set up an appointment for counseling and to be able to
apply for a new startup small business loan. That representative was
not receptive to helping me. I was told that I would have to write a
new business plan and I ``probably would not get a loan anyway.'' With
that in mind, I signed the documents to keep my Ticket to Work options
open and left her office. When I phoned for the business plan names to
start the process on my own, the three numbers that she gave me were
either disconnected or no longer provided that service.
From that point in 2005 in North Carolina, it appeared that I would
be on my own with little help or oversight. I was able to enter the
acupuncture market and served on the Association Board for a period. I
treated patients, some who were able to pay for their care. There have
been other patients who have chronic needs and do not make payments
causing me to `carry' the financial burden of malpractice insurance,
license fees, supplies, and cost of facility to provide care. All of
these costs have been absorbed by me. The NC DOR has not been willing
to come forward to help with any of these costs. In fact, one of the
difficult things about the lack of support is that I can not afford to
receive acupuncture or any of the herbal prescriptions that are
beneficial to protect me against disease.
Additionally, the health care insurance company that one of my most
costly patients uses has lost the claim and informed me that
acupuncture by acupuncturists was `still under investigation,' so
although she was willing to send me another claim form to complete for
the patient, I would most likely not be paid.
North Carolina's Ticket to Work program when assigned to the NC DOR
has not been able to help me to use my benefits under the programs here
to be employed in the profession which I am trained and experienced to
perform. The WIPA person was unable to help me understand my benefits
and made the recommendation that I complete the contract to use my
company as an Employment Network and assign my Ticket to my own
company. This has not taken place.
The benefits specific to North Carolina have been:
i.
Transportation to evaluations that were required more often
than prescribed.
In order to continue to work enough to cover living costs I elected
to contact the Santa Barbara DOR for help. They referred me to Virginia
Commonwealth University where they have programs to assist disabled
self-employed people with counseling, reference, resources, forms and
encouragement and have a strong online presence.
4. After receiving the printed Ticket in the mail in 2005, I
attempted to assign several times. The first in 2006 to an EN in Ohio
who was interested in creating franchises at my financial expense.
Another to a NY EN who could not provide services as advertised on the
Ticket to Work website. In the following years I contacted and
interviewed three other ENs who did provide the services to help in
self-employment. One had other criteria and services than was posted.
The most recent one lost my contact information after I provided them
with confidential company data. When I made a followup call, they asked
me to visit the website and call back later. When I did, the website
was gone and they have not called me. These opportunities have all
failed to meet the needs my Ticket to Work is designed to fulfill:
http://www.yourtickettowork.com. There is also concern the beneficiary
data distributed to all of these ENs may need more oversight.
On a more positive note, the best resources have been referred to
me by a counselor from the Santa Barbara DOR and the Las Vegas TTW
program counselor. Griffin-Hammis LLC, who have literally `written the
book on disability employment,' continue to answer my calls for direct
and resource sites. Virginia Commonwealth University has a department
of people who continue to provide recommendations and connections to
other self-employed disabled, forms for business use and referrals to
advisors. CESSI employees helped me to submit my own company to
contract with the SSA to serve as an Employment Network in June 2008.
It was a great learning experience which has led me to formally submit
other contract proposals to Federal agencies.
There are many things that have been positive about the Ticket to
Work program, for which I am grateful.
It is my hope that this testimonial will help those who follow me
through the Social Security programs to benefit from better interagency
communication, improved inclusion of the beneficiary in communication
and services, and a followup review on random beneficiary cases.
Thank you for this opportunity to help improve our government
programs.
Be In Good Health.
Laura L. Dawson
Statement of Linda Landry, Sarah Anderson, Teresa Lacava,
and Mark Bronstein
Chairman Tanner and Members of the Subcommittee, thank you for the
opportunity to provide this statement on topics of great importance to
people with disabilities who seek to reduce dependence on public
benefits through work. The undersigned have long experience providing
representation on Social Security matters for individuals with
disabilities. The Disability Law Center (DLC) is the Protection and
Advocacy agency for Massachusetts and provides free civil legal
services to people with disabilities throughout Massachusetts. A key
mission of the DLC is to help ensure that people with disabilities are
able to access the services they need to live and work in the
community. Greater Boston Legal Services (GBLS) provides civil legal
services to eligible low-income clients in 23 cities and towns in
eastern Massachusetts. Legal Assistance Corporation for Central
Massachusetts (LACCM) is the State-funded civil legal aid program for
Central Massachusetts. LACCM provides civil legal assistance to low-
income and elderly residents of Worcester County. Mark Bronstein is an
attorney in private practice concentrating in disability law who
frequently advises and represents individuals with overpayment and work
incentive issues in claims before the Social Security Administration.
We support the testimony presented by Cheryl Bates-Harris, Senior
Disability Advocacy Specialist, National Disability Rights Network on
behalf of the Consortium for Citizens with Disabilities Employment and
Training Task Force and Social Security Task Force. We note the gains
made in the Ticket to Work program under the regulations revised in
2008 and agree that the program should be reauthorized. We also urge
that the funding for the important services provided through the WIPA
and PABSS programs be reauthorized. We support simplification of the
Title II work incentives through the Benefit Offset Demonstration
project and support the health coverage access improvements noted in
the testimony of Ms. Bates-Harris. These programs and projects are
important supports for disability benefits recipients who want to
attempt work.
What we want to emphasize with this statement is the extent to
which benefit overpayments are a preventable work disincentive. We are
all in-the-trenches practitioners who see a big demand for
representation on overpayments of Social Security Disability Insurance
(SSDI) and Supplemental Security Income (SSI) benefits from
beneficiaries who have tried to work. We would rather not see these
cases because they hurt beneficiaries, discourage work attempts, and
harm Social Security's image as an effective, efficient agency. These
work-related overpayments are often very large and the result is that
beneficiaries are often terrified of making another work attempt. In
our experience, most beneficiaries have reported the fact that they
were working to the best of their abilities. When recipients have
reported work and still amass large overpayments, they may feel
punished for having tried to work. In addition, the overpayment crisis
results in the word on the street being that one cannot attempt to work
with incurring big problems with Social Security.
We have yet to encounter any beneficiary who adequately understood
the work rules for SSDI or SSI benefits, regardless of education or
type of disability. The work rules are very complex, and we can attest
that it takes a considerable amount of information and training to
accurately apply the work rules to specific cases. Indeed, many
beneficiaries do not understand which benefit they receive, let alone
which of the work rules apply to their benefits. In our experience,
those recipients who are interested in trying work care less about
losing cash benefits than in knowing reliably when benefits will end.
Planning is very important to beneficiaries as most are low income and
do not have the financial security to manage surprise decreases in
income. This year the SSI Federal Benefit Rate is only $674 per month
(74.6% of current Federal poverty guidelines) and the estimated average
SSDI benefit is only $1,074 per month (109% of current Federal poverty
guidelines). These benefit levels do not allow for rainy day savings.
Solving the Overpayment Problem Requires that Beneficiaries Receive
Accurate and Timely Information on Reporting Requirements and
Work Rules
Part of the problem is that SSA has not had sufficient staff for
many years to spend the time necessary with benefit recipients to
explain the work rules and reporting responsibilities, neither when
benefits begin nor when recipients report work. SSA has developed some
written materials to help make up for this lack of staff time. Some of
these materials are helpful to those of us who have the background to
understand them. But, it's difficult to explain the current work rules,
and many, if not most, benefit recipients simply do not understand the
terminology used in the work rules and are not able to accurately
determine on their own whether they should or should not continue to
receive their benefits at any particular time while working. It's
simply too confusing. In addition, many claimants are functionally
illiterate, have low reading comprehension levels, or are otherwise
unprepared to understand the rules and terms used by Social Security.
SSA must have the resources to make sure benefit recipients have
sufficient information about the relevant work rules and reporting
responsibilities at relevant times. Some of this information may be
presented at application, but this is at a time when many applicants
are in crisis and less able to take in complex information. It's not
clear when, if ever, this information is presented or explained again
in person. Beneficiaries need to understand and be regularly reminded
that they can attempt work without immediate loss of cash and
associated health benefits but that there is information they need to
know when they are ready to attempt work. They must be invited back to
Social Security or this information or Social Security must be prepared
to refer them to a reliable resource (e.g., WIPA programs) for this
information. In order to maximize limited staffing resources, Social
Security seems to have provided special work rule training for some
employees. Many of these employees are very knowledgeable and helpful,
but they are too few for the need and beneficiaries and those who work
with them still get work rule information from less well trained staff,
resulting in inconsistencies, omissions and even errors.
In addition, beneficiaries, representative payees, and community
agencies providing services to disability benefit recipients must
receive accurate and consistent information about the effect of work on
benefits and how and when to report work. One example of this need
involves beneficiaries who incur Impairment Related Work Expenses
(IRWEs), extra out of pocket expenses for disability related items and
services they need in order to be able to work. The work rules allow
these beneficiaries to deduct the monthly cost of IRWEs from gross
earnings before the earnings reduce their benefits. Yet, many
beneficiaries do not hear about this and other beneficial rules that
can ease the transition to work at a time when they can take advantage
of them. For example, the lack of timely information about IRWEs may
mean that beneficiary does not have the necessary receipts to verify
the expenses, losing the value of the IRWE deduction. Other common
misconceptions include thinking that Social Security looks at net,
rather than gross income, that beneficiaries receive a new trial work
period with every work attempt, and that the Ticket to Work means that
the old rules about work do not apply.
Recipients must also receive accurate and timely information about
when and where to report work. Common misconceptions about reporting
include: (1) paying FICA on earnings is the same as reporting work; (2)
reporting means responding to Social Security's requests for
information; and (3) my representative payee must make all my reports
to Social Security. Social Security must regularly provide simple and
clear messages to beneficiaries that it is not enough for, e.g., SSI
recipients to wait for the yearly eligibility review to report work. In
addition, Social Security staff must stop telling beneficiaries with
representative payees that only their payees can report their work. In
one recent case, a young man with a developmental disability who is his
own guardian kept incurring overpayments he did not understand because
his payee, a community organization, did not report his work. When he
had tried to report work on his own he was sent away and told that his
payee had to make the report. The lawyer who was helping him with an
overpayment insisted that he had the right to make the work reports and
that he must do this, but he was afraid to return to his local Social
Security office. Finally his lawyer made an appointment to go with him
and arranged for him to have pre-addressed envelopes in which to submit
his monthly pay stubs to Social Security. This was a great result but
it should not have taken a lawyer to work this out for this young man.
Social Security should make it easy for all recipients to report work.
Beneficiaries who report work now receive a receipt to show that
the report was made and notations seem to reliably be made in the
individual files. This is a great improvement, but more needs to be
done. When beneficiaries come in to report work, that's a great time to
take the opportunity to make sure that they understand the work rules
relevant to their benefit or refer them to, e.g., their WIPA program.
We believe that more beneficiaries will feel comfortable attempting
work if they feel welcomed when they report work and are provided with
accurate and timely information on which they can rely. The final piece
is that Social Security must make timely benefit adjustments and
provide accurate notices to reduce overpayments.
Solving the Overpayment Problem Requires that Social Security Have
Sufficient Staff To Work in a Timely Manner on Post-Entitlement
Matters, Including Reports of Work
Social Security must have the resources to respond to reports of
work with timely and appropriate adjustments of benefits. Anything else
feels arbitrary and capricious, creates overpayments and discourages
work. Most beneficiaries do not understand what should happen to their
benefits and when. They rely on Social Security to do its job to make
the adjustments if they have done theirs by reporting. Social Security
must also immediately solve the completely preventable problem that
arises when local Social Security offices are organized so that some
employees work only on SSI and others work only on Title II. We have
all seen overpayment cases where a beneficiary has reported work, only
to find out much later when the large overpayment notice arrives that
only the SSI worker or only the SSDI worker received the work report.
Social Security must either clearly tell recipients to whom they must
report and when or make sure that reports of work are forwarded to all
relevant workers for benefit adjustment.
Title II overpayments are often the largest and the hardest to deal
with, in part because of the complexity of the work rules. In addition,
these cases seem to be handled by special cadres or in the Payment
Centers. It is our experience that cases seem to sit in these places
for a long time and that it is impossible to communicate with or get
any information from these places. Indeed, local Social Security staff
have told us the same thing.
Finally, Social Security notices do not explain the work rules well
and generally lack sufficient information to determine the reason for a
change in benefits or the cause of overpayments. Payment Center notices
and Title II work related overpayment notices are especially bad. We
are pleased to note that Social Security also recognizes that its
notices need improvement and has already begun working on solutions.
Social Security must have the resources to continue this work.
Examples of Why Social Security Needs Resources To Do Timely Post-
Entitlement Work
The following are examples of cases we have seen where overpayments
and disruption to beneficiaries could have been prevented or reduced.
Mary, a recipient of SSDI, went to her local Social Security office
to report work about 2 weeks after finding a job. She did not
understand all the ins and outs of the trial work period, extended
period of eligibility and substantial gainful activity, but she did
know that it was important that Social Security know that she was
attempting to work. Local office staff told her that the report would
be logged in and she would be contacted. When she did not hear
anything, she called the 800 number. The person to whom she spoke said
there was no record that she had reported work and sent her a Work
Activity Report form to complete. Mary completed the form and took it
to her local Social Security office. She heard nothing further until
she received a Notice of Change in Payment, which said that her SSDI
benefits were increasing due to her earnings. She believed that this
notice meant that Social Security knew she was working and that she was
entitled to the benefits she continued to receive. Unfortunately for
Mary, she did not know that this notice was from a part of Social
Security that updates primary insurance amounts and not from those that
are charged with deciding when work should result in stopping her
benefits. Mary did not learn this until she received notice that she
had been overpaid $14,000 and contacted a legal aid lawyer. She is no
longer working.
Walter, an SSDI recipient with psychiatric disabilities, started
attempting work after receiving benefits for 3 years. He worked part-
time sporadically, very occasionally exceeding the substantial gainful
activity level by small amounts, due to his disability, and there is no
dispute that he reported his work attempts. He also had no accurate
understanding as to how the trial work period and extended period of
eligibility worked or applied to his earnings. One day, Walter received
a notice terminating his benefits retroactively to a month 6 years
prior and a notice that he had been overpaid $115,000. It turned out
that Walter had earnings just over the substantial gainful activity
level in that 1 month, which was after the end of his extended period
of eligibility. This meant that, despite his reports of work and
unbeknownst to him, he had not been entitled to any of the benefits he
had received since that month 6 years earlier. This caused Walter
extreme stress and his psychiatric status still has not returned to the
level he had achieved prior to receiving the overpayment notice. He is
currently unable to work.
June became eligible for SSI and SSDI in the early 1990s due to a
combination of psychiatric disabilities, including a Personality
Disorder. She was a young person then and made a number of work
attempts. There is no record that she reported her work attempts and
June herself no longer remembers. However, the record does show that,
in early 1998, Social Security asked her for information about wages
posted to her earnings record. The notice stated that Social Security
was checking to see whether she was still eligible for benefits. She
provided the information and did not hear from Social Security again
until 2003, again asking about her work. Again she responded. She next
heard from Social Security in 2005, again asking about work. Again she
responded. Finally, in 2008, she received notice from Social Security
stating that her extended period of eligibility had ended in September
1996 and that she had been overpaid $90,000. Social Security recently
completed a continuing disability review finding that she continues to
meet the medical disability standard. She is not working.
George became eligible for SSDI in 1995 due to psychiatric
disabilities. Four years later he felt stable enough to attempt part-
time work. He is well educated, knew he knew he had to report, and
asked questions about the ongoing effect of work on benefit
eligibility. He worked part-time on and off as his condition permitted
and reported the stopping and starting of work at his local Social
Security office. Each time he says he was told that his part-time work
would not affect his benefits. In 2003, he reported that he was going
full time, but the full time work proved too much and he experienced an
exacerbation of his condition, stopping work after only 5 months. Then,
in 2004, he received notice that he had been overpaid $56,000 (almost 3
years worth of benefits) and was determined at fault for not reporting
his work attempts. The decision ignored the frequent communications
with his local office whenever his work status changed and also failed
to give him the benefit of the IRWE rules. At his own expense he has
had to engage an attorney to appeal the decision. The experience has
been extremely troubling to George and he now is reticent about
returning to any work for fear of triggering more problems with his
benefits.
In conclusion, we understand that recipients who work will
necessarily be overpaid because it is currently impossible for Social
Security to pay the correct benefit in each month. However, recipients
must be informed of this and must know how to reduce overpayments
through reporting and understanding the relevant work rules. Social
Security must have the resources to make sure that recipients
understand when and how to report and understand how the work rules
apply to their benefits. Finally, Social Security must have the
resources to timely respond to reports of work by making timely
adjustments of benefits. We urge you to help ensure this result.
Thank you very much for this opportunity to provide this testimony.
Respectfully submitted,
Linda Landry,
Senior Attorney, Disability Law Center
11 Beacon Street, Suite 925, Boston, MA 02108
Sarah Anderson,
Managing Attorney, Greater Boston Legal Services
197 Friend Street, Boston, MA 02114
Teresa Lacava,
Senior Paralegal, Legal Assistance Corporation of Central
Massachusetts
405 Main Street, 4th Floor, Worcester, MA 01608
Mark Bronstein, Esq.,
Law Office of Mark Bronstein
288 Walnut Street, Newton, MA 02460
Statement of Marion Moore
As a mental health advocate I see many people who are excited about
returning to work and others who have returned unsuccessfully and now
have to make payment to SSA for 30 years or more. It seems apparent to
me that the Committee understands and is reaching out to these two
groups. There is a third group which I believe it is important to
address--people who prefer to stay in the workforce rather than go on
Social Security.
I see a large number of people who take pride in their employment
yet cannot access mental health treatment. Receiving early and timely
treatment can prevent disability. As you may know the number of people
with a mental illness has increased as a percentage of the total number
of people collecting disability payments. If we recognize that some
disabling illnesses are nonlinear and may be preventable, perhaps the
rate of people on disability would level off.
Obviously a good community mental health system or universal
coverage would also help but I believe that it is the responsibility of
the SSA and the Committee to show the American public that they are
aware of this situation and are advocating for change.
Sincerely,
Marion Moore, President
Statement of Paralyzed Veterans of America
Paralyzed Veterans of America (PVA) is pleased to submit these
comments on the Social Security Administration's (SSA) employment
support programs for disability beneficiaries, with particular focus on
the Ticket to Work program (TTW) authorized under P.L. 106-170. PVA is
the only congressionally-chartered veterans' service organization
exclusively dedicated to serving veterans with spinal cord injuries
and/or dysfunction.
Background on PVA Vocational Rehabilitation Program
Most studies on vocational adjustment for persons with spinal cord
injury and/or dysfunction (SCI/SCD) report relatively low rates of
employment. PVA estimates that 85% of veterans with SCI/SCD are
unemployed. The employment rate for veterans with SCI/SCD not only lags
behind the general population, but also falls short when compared to
the greater population of veterans with disabilities.
To address this dire situation, in 2007, PVA launched a vocational
rehabilitation (VR) program under its Veterans Benefits Department
(VBD) to serve veterans with severe disabilities, service-connected and
non-service-connected. PVA's first VR counselor is himself a veteran
with a spinal cord injury who personally understands the unique
challenges faced by veterans with this condition. He also has access to
PVA's nationwide network of National Service Officers and chapters who
can provide additional referral resources, peer counseling and
troubleshooting.
Working with the Richmond, Virginia Veterans Administration medical
center (VAMC) rehabilitation personnel, PVA's counselor seeks to
introduce employment expectations into the achievement of medical
rehabilitation goals. He contacts each new case of a veteran with SCI
or SCD admitted to the center, follows up with them every 6 months to
ascertain their interest in employment and at 18 to 24 months post
injury, increases those contacts to every 3 months.
His case management includes referral to service providers, regular
communication with the client, mentoring by working veterans with SCI/D
and extended followup once employment is attained. He has developed
relationships with several hundred employers around the country,
educating them on working with employees with these disabilities and
following up with those that hire a veteran to respond to any questions
or problems that arise.
There are a number of advantages in the approach being taken by the
PVA VR program. One key is early intervention. Many PVA members have
long criticized the fact that they received little to no information
about the possibility of returning to work as they went through medical
rehabilitation. For many, it was months or even years after they left
the VA medical center's SCI unit before they heard about the VA
vocational rehabilitation and employment program (VR&E). The
collocation of PVA counselors within the VA medical facility allows
them to begin the conversation about employment with injured veterans
at the start of their medical rehabilitation.
Second, because the funding for PVA's program is private and
dependent on corporate largesse, this forces the PVA counselors to
utilize existing resources from all aspects of the rehabilitation
field. These counselors can then serve as a liaison for the veteran
client between community rehabilitation programs, State VR or VA VR&E
depending on the veteran's particular situation. Recognizing the value
of this program, Virginia's Department of Rehabilitative Services
assigned its own liaison to our Richmond program and sponsors joint job
clubs each week.
Third, PVA's program is more flexible than many government
programs. To enter a State VR or VA VR&E program, a person must undergo
a long, complex application and eligibility determination process. If a
veteran comes to the PVA program, all he/she needs is a power of
attorney. Our counselors can begin serving them with vocational support
while helping them begin the admission process to State VR or VR&E.
While those formal applications are moving through the bureaucracy, PVA
counselors can still work with the veteran. And if a veteran wants
immediate employment, the PVA counselors can assist with that without
having to take them through the formal eligibility determination
processes of VR and VR&E.
Beyond Richmond, Virginia, the program today has offices in
Minneapolis, Minnesota and San Antonio, Texas. PVA has plans to open a
fourth Vocational Rehabilitation Services office in Long Beach,
California in the near future. Since its inception, PVA's VR program
has served 324 veterans with severe disabilities and placed 50 in an
employed status, with most of them being full time. Average annual
salary exceeds $38,000.
PVA Becomes an Employment Network
In 2007, PVA met with officials of SSA to discuss the possibility
of its VR program becoming an employment network (EN) with the SSA
Ticket to Work program. Since most veteran clients of PVA are also
recipients of Social Security Disability Insurance (SSDI), it made
sense to explore the merits of the Ticket program and how it might
benefit PVA's VR efforts. Because the regulations were in flux at the
time, PVA held off on applying to become an EN until the regulations
were finalized. In October 2008, PVA became an employment network with
the Ticket to Work program.
PVA is still very new to the TTW process and is currently serving
seven ticketholders. We have not yet reached the point where we have
made payment requests and thus cannot comment on that part of the EN
experience. However, we can offer the following observations on our
experience in applying to become an EN in the hope that some of the
stumbling blocks we encountered can be alleviated for other VR
providers.
Completing the contract to become an EN is not an easy process. The
management of PVA's VR program has suggested that applying to become an
EN might work better if it is a grant process, rather than a contract
process. CESSI--the contractor hired by SSA to deliver outreach
services and supports to prospective ENs--proved to be very helpful to
PVA's VR program. CESSI staff provided very good training and their
consultants were able to answer questions in a thorough and timely
manner. Unfortunately, prior to engaging CESSI, the assistance provided
by SSA on completing the EN contract was inconsistent at best.
As noted above, PVA is currently serving seven ticketholders that
are working under individual work plans [IWPs] developed by our
counselors and approved by SSA. The TTW work approval process is very
labor intensive and time-consuming on the part of PVA's VR counselors.
To see if a veteran is a valid ticketholder and to determine if an IWP
is approved, the counselors are asked to fax and/or email at least
twice for each ticketholder and more times if any changes to the IWP
are needed. The counselors also often need to follow up with phone
calls to SSA to check on approvals. At the request of SSA, PVA has had
to change its approved IWP template three times since its first version
was approved. Bear in mind that PVA's Ticket program has only been in
operation for a little over 7 months. Most of the changes involved
adding statements to the work plan. This has caused a lot of
frustration on the part of our VR counselors who have had signed plans
returned from SSA with new requirements for additional statements from
the client to be added to the IWP. This compels our counselors to redo
the work plan and obtain new signatures from our veteran clients who do
not always reside close to the counselors' offices. Moreover, PVA's
counselors have expressed concern that SSA has added so many required
statements to the IWP, that it may be overwhelming to some of the
veterans with whom they work.
In addition, in order to make the employment plan templates more
accessible to our VR counselors, PVA downloaded the template onto the
PVA website portal. Whenever SSA changes the requirements for the
employment plan, PVA's information technology department must take the
form off the portal and make the changes. This creates a lot of
redundant effort for PVA's IT department and VR staff.
To date, VBD estimates that the PVA VR program has spent 50 staff
hours working on TTW and without any funds coming in to offset these
costs. There is concern among the VR program management that the work
to support the Ticket process will outweigh the benefit of the funding.
As noted in our earlier description of PVA's VR program, one of its
advantages is the greater flexibility it has than many government
programs. PVA can serve veterans with disabilities without becoming
mired in government red tape. A major goal of PVA's Vocational
Rehabilitation Services program is to reduce the administrative burden
on the counselors as much as possible to help improve our vocational
services and outcomes. If serving these veterans through Ticket to Work
becomes excessively burdensome, PVA may need to reconsider its
participation in the program.
Thank you for the Committee's interest in the Ticket to Work
program and attention to PVA's concerns. We would be happy to answer
any additional questions that the Committee may have.
Statement of Paula Vieillet, Employment Options
My name is Paula Vieillet and I am the CEO of Employment Options,
Inc. I personally have been involved in the Ticket to Work program
since 2002. I started providing TTW services as an addition to my work
as a certified vocational evaluator. I am particularly good at job
placement and the ticket appeared to provide a great residual income
stream and provide just the kind of opportunity that entrepreneurs in
the true spirit of America need. It has not been an easy journey
financially, but very rewarding. Helping disabled individuals see their
vocational potential and go to work is a great feeling. Over 200
ticketholders have returned to work through my Employment Options
Employment Network.
We had a difficult time financially with the extremely low
reimbursement rates prior to the new regulations of July 2008. To
illustrate this, in 2006, we signed up 103 ticketholders and 41 of our
ticketholders went to work. We screened, counseled and provided
professional, practical and moral support to hundreds of ticketholders
without any guarantee of ever being compensated. My staff and I put in
countless volunteer hours as we believe in the mission of the Ticket
program. Being outcome based, until a person is working, getting paid
and submitting paystubs to us and SSA, Employment Networks are not paid
a penny. At the end of 2006 we had lost money on the Ticket program.
Our total TTW earnings of $69,000 just didn't cover our costs.
Since the new regulations went into effect, we have become a
profitable and booming business.
EARNINGS VALIDATION
There remain some glitches in the program; payments continue to
come in very slowly. SSA has been most responsive, but the payment
process is cumbersome and presents our biggest obstacle to continued
growth and sustainability. Our clients who work and who are no longer
receiving cash benefits, do not understand and resent having to send
their paystubs to EN's and the SSA. Many times, we lose contact with a
client over this issue and more than once, a ticketholder's job has
been jeopardized by attempts to collect paystubs from the employer.
We coach our clients to find jobs within their abilities and that
the ADA protects them from disclosing their disability to a prospective
employer. Most of our clients' employers do NOT know that their new
employee is a Social Security recipient and our ticketholders do NOT
need or want to disclose this information to them.
The requirement that ticketholders submit evidence of earnings once
the ticketholders' cash benefits have been suspended burdens both EN's
and the SSA. With a reduction in workload created by these reporting
requirements, SSA staff would have more time to ensure that payments
are stopped once the 9-month trial work period is completed. Assuming
that a ticketholder continues to work instead of chasing paystubs would
reduce overpayments to Social Security recipients.
It still remains the Social Security recipients' responsibility to
report changes in work activity if they want their payments to start
back up after an unsuccessful work attempt. A SSA recipient will be
sure to call the SSA if their check did not arrive as expected.
Overpayments to EN's can be easily recovered by deducting overpayments
from subsequent payments.
UNDERSTANDING BENEFITS STILL BARRIER TO EMPLOYMENT
What continues to be a major barrier to employment is that most
ticketholders do not understand how their benefits will be affected if
they return to work. We do refer people to the WIPA's for help, but
often the wait time is excessive. No matter how many times we explain
the trial work period, it still helps to have an official from SSA
confirm how this program works. Our experience with the PASS program is
similar. Both of these programs, in my opinion, provide much needed
services to disability recipients but caseworkers seem to have more
requests for help than they can reasonably handle.
WHY THE TICKET TO WORK PROGAM SHOULD CONTINUE
The Ticket to Work program is a great program and should continue.
EN's across the United States volunteer their time and resources to
ticketholders without any guarantee of ever being compensated.
We estimate that for every person who returns to full-time
employment the Social Security Administration no longer has to pay out
$700.00+ a month saving our country millions of dollars. In my
experience, people who return to work also utilize less medical
services, mental and physical; generating another `hidden cost
savings.'
EFFECTS OF NEW REGULATIONS
According to SSA, 2009 statistics reveal a huge increase in the
number of tickets being accepted and a whole new slew of EN's ranging
from traditional providers, VR and nonprofit agencies to employers,
staffing services, private rehabilitation counselors and schools. This
diversity of providers is the intent of the Ticket to Work program and
it is succeeding in reducing the number of beneficiaries receiving SSI,
SSDI and Medicare benefits. The TTW program just needs more time to
prove itself.
DISABILITY CAN HAPPEN TO ANYONE
I am often asked what a ticketholder looks like. I then hold up a
mirror. Illness and disability can and does affect persons from all
walks of life. With the help of the Ticket to Work program, people who
have lost their health, jobs and financial stability can reenter the
workplace and become productive and self-sufficient. I thank the U.S.
Ways and Means Social Security Subcommittee for your efforts and our
opportunity to be of service to our country.
Statement of Peter Kierpiec
I have, for your consideration, a suggestion to improve the Social
Security Disability programs. My suggestion would require changes to
the Social Security Act (Act) concerning disability beneficiaries' work
after the Social Security Administration (SSA), i.e., the Commissioner,
awards benefits.
I believe the suggestions will please beneficiaries and their
advocates and taxpayers. I believe the suggested amendments to the Act
will save SSA resources, including thousands of work years, and allow
SSA to divert those resources to other workloads (e.g., serving all
beneficiaries, processing disability and aged benefits applications,
and actions on awarded claims) more timely and efficiently. It will
save administrative and program dollars.
The suggestion will make Social Security Disability programs much
easier for claimants, beneficiaries, and SSA employees to understand.
This, in turn, will make the programs much easier to administer and
much more efficacious to automate. At the same time, the suggestion
will provide disability advocates, disability beneficiaries, and their
caregivers something that they have desired for years, a safety net on
which disability beneficiaries may rely and can understand. The
suggestion will reduce or eliminate the work years needed to conduct
continuing disability reviews (CDRs), and it will so simplify the
processes that SSA will be able to automate work that currently
requires thousands of work years to process.
I believe my suggestion will save millions of program and
administrative dollars! (OK, I am being redundant, but to emphasize the
points.)
The three integral pieces of the suggestion are as follows, and the
three must occur together to achieve the outcomes and savings described
above:
(1) Once the Commissioner awards benefits based on
disability (including blindness) to an applicant, the beneficiary's
disability benefits shall continue until the individual:
(a) Shows medical recovery to the extent necessary to
perform substantial gainful activity (SGA).--[This is consistent with
existing provisions under the Act; disability benefits end when as a
result of a medical continuing disability review, SSA finds the
individual's condition improved, based on the medical improvement
review standard (MIRS).]; or
(b) Attains 65 or full retirement age (whichever is
later).--[This is according to existing provisions under the Act.]; or
(c) Dies.--[This also is according to existing law.]
NOTE: Section (1) above means that a beneficiary's disability
benefits will not ever end because s/he worked and performed SGA, with
one exception. The exception applies if the individual returned to SGA
within 12 months of disability onset. [This is consistent with existing
provisions under the Act.] That is, if SSA issues a disability award
notice to an individual, and SSA later learns that the individual
returned to work within 12 months of disability onset, then SSA must
reopen the award decision and deny the claim.
NOTE: Implementing item (1) above, would be a cost if items (2) and
(3) below are not included in the amendments to the Act, and items (1)
and (2), above, are the sweetener for item (3) below.
(2) For any work and earnings over a certain limit (the
amount and language to be determined and provided by SSA's Office of
the Actuary and Office of the General Counsel, respectively), apply a
reduction to the monthly disability benefits by 1 dollar for every
``X'' dollars over the ``earnings limit.'' SSA's Office of the Actuary
would determine the amount of the benefit reduction (e.g., 1 dollar for
every $1.50, $2, $3, or other (``Y'') dollar amount over the ``earnings
limit.'')
(a) If an individual earns so much as to result in
reducing his/her cash benefits to zero for a month, then the
beneficiary will receive no (will not be due) cash benefits for that
month, and if the beneficiary is entitled to Medicare, the beneficiary
would have to pay the full Medicare premium for that month.
(b) If an individual's earnings for a month would not
reduce his/her cash benefits to zero for a month and the beneficiary is
entitled to Medicare, then the beneficiary must pay the balance due for
his/her Medicare premiums, after SSA first uses any cash benefits due
the beneficiary for that month to pay or reduce the amount of the
individual beneficiary's Medicare premiums.
NOTE: This ``earnings limit test'' for disability beneficiaries
would work and function much like the annual earnings (or retirement)
test worked under the Retirement and Survivors Insurance program. For
example, disability beneficiaries who return to work would estimate
their earnings for a given calendar year at the beginning of that year
(or as soon as they return to work in a year for the remainder of that
year). SSA would withhold benefits, if necessary, based on such an
estimate. Final accounting for a given year would occur when the
disability insurance beneficiaries submit their true earnings report
for a calendar year by April 15 of the following calendar year.
NOTE: Implementing item (2) above, may be a cost, if item (3) below
is not included in the changes.
(3) Eliminate ALL work incentives, which are essentially
adjustments to income to mollify the SGA earnings limit, because SGA
would no longer be a factor in determining if entitlement disability
insurance benefits continue. The new ``earnings limit'' and cash
benefit reduction would take the place of all work incentives,
including the Ticket to Work. This would make the disability programs,
under Title II and Title XVI of the Act, simpler for claimants and
beneficiaries to understand and for SSA to explain, administer, and
automate. Eliminate all work incentives, including:
The trial work period and trial work period month
earnings limit (Title II).
Impairment-related work expenses earnings reduction
(Titles II and XVI).
Blind work expenses earnings reduction (Title XVI).
SGA as a CDR earnings test (Title II).
Subsidy and special conditions earnings reduction.
Expedited reinstatement.
Ticket to Work, including contracts to employment
networks, cooperative agreements with work incentives planning and
assistance organizations, and other grants and contracts (Titles II and
XVI).
The existing disability work incentives are difficult for SSA
personnel and others to understand and for SSA to explain. As a result,
beneficiaries do not often use the work incentives. And when
beneficiaries do use them, SSA spends many man-hours and work years
verifying the work incentive(s) and determining the amount of the
benefit of the work incentive(s) to the beneficiary.
The Ticket to Work Program has not ever and is not working. The SSA
fully implemented the Ticket to Work Program nationwide in 2004, during
a time of supposed American prosperity. Yet, no more beneficiaries, in
statistically significant percentages or numbers, return to work or
work for the first time under the Ticket to Work Program than prior to
its implementation in 2002.
The Federal Government could save millions in disability Trust Fund
and general fund program and administrative dollars eliminating the
Ticket to Work Program. If a program similar to the Ticket to Work
should exist anywhere, it should exist in either the Department of
Labor or the Rehabilitation Services Administration. However, I repeat
the numbers show after almost 10 years the Ticket to Work Program is
not working.
Titles II and XVI would be and would appear more similar in ways
SSA would handle disability work issues after SSA awards disability
benefits, making the programs easier to explain, administer, and for
the public to understand.
Disability beneficiaries, their caregivers, and advocates would
celebrate enactment and implementation of the above changes. This would
give them what they have desired and have been requesting for decades,
a dependable safety net of medical insurance and cash benefits, when it
is required.
These changes would have to be marketed to disability
beneficiaries, their advocates, and the public to ensure everyone
understands that the new earnings limit and benefit reduction factor
(reduce monthly cash benefit by $1 for $X over the earnings limit).
Thank you for your consideration of my suggestion. I understand the
hard work Congress must perform to assist our economic recovery and in
the near future to balance the budget.
Peter Kierpiec
Statement of Randall Bosin
In the press release for the hearing Chairman Tanner says, ``Of
course, the ultimate measure of success will be whether more
individuals are able to return to work and end their receipt of
benefits as a result of the Ticket and SSA's other employment support
programs.'' And with this statement we have the central problem with
the Ticket to Work Program--the conflict between Congress' goal of
moving beneficiaries off benefits and the impracticality and
inadvisability of giving up benefits for work for the vast majority of
beneficiaries. In other words, the interests of Congress to save the
Social Security Trust Fund money is fundamentally at odds with the
economic and other interests of the vast majority of SSDI and SSI
recipients such as myself. Hence the predictable failure of the Ticket
Program to date in helping significant numbers of beneficiaries work
AND go off disability benefits.
Therefore, the first thing that is needed is for Congress to
reexamine and modify the (its) purpose of the Ticket Program and other
work incentives to be: Enabling the maximum number of beneficiaries to
work and earn the maximum amount they can, WHETHER OR NOT THEY REMAIN
ON THE DISABILITY ROLES. Enabling and facilitating a much higher
percentage of beneficiaries working at all or increasing their earnings
(or profits from self-employment) rather than moving a tiny fraction of
beneficiaries off of benefits entirely (as anticipated by ``the
experts'' when the Ticket Program was developed) would (a) benefit far
more beneficiaries and (b) may well generate greater total savings, at
least to the Social Security Trust Fund. If it is now the
Administration's position that we must move to universal health care
coverage, even the goal of trying to eventually move beneficiaries out
of Medicare or Medicaid coverage doesn't make sense. After all, these
are among those who are likely to have the greatest need for ongoing
health care coverage and treatment for disability-related medical
issues.
Beyond changing the very purpose of the misleadingly advertised
Ticket Program, there are other obvious and more basic and important
changes needed in the other work incentives and policies related to
beneficiaries who work. These include:
1. Raising the earned and unearned income exclusions (which have
never been raised and thus never adjusted for inflation).
2. Removing the SSDI cash-cliff and substituting a gradual
decrease in SSDI benefits with increased earnings. (I suggest counting
1 dollar for every 4 earned, AFTER excluding the first $400 to $500 of
earnings).
3. Making continuation of Medicare or Medicaid a noncontingent
guarantee, certainly at least with respect to any disability-related
health care costs. Any form of contingency--be it based on income,
assets, whether the employer provides insurance, disability status,
etc.--will not, and should not, be trusted by beneficiaries, due to the
complexity and unanticipated consequences of changing circumstances.
Beneficiaries have fluctuations and relapses related to their
disability and ability to work or work significantly. Jobs change or
drop health care. Beneficiaries' income and/or assets change. Making
needed health care contingent on these or ANY factors is nonsensical.
The only thing that both makes sense and is fair and ethical is to
provide needed health care to disabled persons, period; not contingent
on any other factor or circumstance.
I could go on with other suggestions, but will just give one more
for now: It is imperative for Congress and other policymakers to seek
out and hear from longstanding beneficiaries such as myself, who have
the true expertise of experience, and not just with the disability
programs, but of the totality of the impact on Federal, State, county
and other benefits, programs, services and eligibilities that working,
working more or increasing one's earnings or assets can have. From my
observation at Social Security meetings, the ``experts'' on Social
Security rarely have much awareness, let alone the comprehensive
perspective of, the effect on the individual beneficiary who is often
simultaneously dealing with various other governmental and private
programs, each with their own rules, ways of counting income, criteria,
etc.
In fact, this leads to one final recommendation, albeit one that
goes beyond the purview of this Subcommittee: The imperative to
establish a high-level Federal department of disabilities, with the
statutory authority to coordinate all the various Federal policies and
programs which disabled persons typically and frequently interact with.
Thank you for considering my suggestions.
Randall Bosin,
Chevy Chase, Maryland
SSDI and SSI beneficiary and disability advocate
Statement of Robert Wittmer
During the hearing there were positive and negative statements made
about the current Ticket to Work Programs under the Social Security
Administration, specifically the employment support programs: The
Protection and Advocacy for Beneficiaries of Social Security (PABSS)
program, which provides advocacy services for beneficiaries who are
attempting to work; and, the Work Incentives Planning and Assistance
(WIPA) program. Our organizations, Austin Area Mental Health Consumers,
Inc., Return to Work Program has been attentive and has attempted to
access these programs with updates obtained through teleconferences and
webinars. WIPA program has been helpful, although we have not been able
to fully implement this program in our core: Texas Austin-Travis Mental
Health Mental Retardation (MHMR) funded for clients and Texas
Department of Assistive Rehabilitative Services. This program was
created to help beneficiaries navigate Social Security's complex maze
of work incentive policies; also, we recognize the overburdened SSA
field office staff are often not able to provide the indepth, one-on-
one assistance to beneficiaries, therefore we are able to facilitate
and bridge the gap. We understand the need to fully inform clients
about work incentives and some effects that working would have on their
benefits including well-being. Work is used as therapy for many of our
clients. Under the WIPA program, this critical personalized assistance
is provided by community-based organizations, such as Austin Area
Mental Health Consumer's, with funding from SSA. Since this is a new
component of our program our success rate has been flat, about 5%.
Statement of Stephen J. Mitchell, Unum and Lara Heal
Unum and its employees thank you for the opportunity to discuss the
importance of providing timely, high quality return-to-work services to
disabled individuals with the goal of successfully reintegrating them
into the workforce. Unum believes that many of the tools which it uses
to accomplish this goal may offer some guidance to the Social Security
Administration as it addresses return-to-work efforts on behalf of its
own disability claimants.
About Unum
Unum is a market leader in disability, group life, long-term care
and voluntary benefits insurance. Unum has been the number one group
long-term disability carrier in the United States for 32 consecutive
years, providing benefits to 42% of Fortune 500 companies.
Our companies protect more than 25 million hard-working people and
their families. We process more than 400,000 claims every year, and we
pay our insureds more than $6 billion in benefits annually. As an
industry leader, Unum also offers its insureds significant experience
and resources to support their return-to-work efforts.
Unum's insureds appreciate the high quality services and support
they receive from the company. Based on our recent national survey
results:
98% of our customers are likely to recommend Unum to
others.
94% of employers give our customer service team positive
marks.
9 out of 10 claimants say their claims were handled
favorably.
Disability Insurance Provides a Financial Safety Net
Economic times are tough. American's savings rates have dropped to
historic lows. This creates a degree of financial vulnerability that
means the majority of the workforce is unprepared for the potentially
catastrophic expenses that come with injury or illness. There are also
likely to be fewer jobs to return to as claimants try to reintegrate
into the workforce after a period of disability.
Many people are asking themselves:
Can my family survive financially if I have a serious
illness?
If I am hurt, will it hurt my bank account, too?
What would my family do without my income?
Do I have benefits that could offer return-to-work
assistance or financial help for me and my family if I could not work
for a period of time?
Most people who do not have disability coverage would need to draw
down savings, borrow from credit cards, or ask friends or family to
help support them, according to a recent study commissioned by Unum
through Harris Interactive entitled Consumer Attitudes about Financial
Products: Research Across the Generations.
With these pressing issues facing working people and their families
in today's economy, private disability insurance provides a critical
safety net that ensures beneficiaries have the financial resources to
meet their needs as well as advocates to help them successfully reenter
the workforce.
Disability benefit payments provide a financial bridge between the
time when someone leaves work due to sickness or injury and the point
they are able to return to the workforce. Private disability insurance
covers many people who do not qualify for Social Security benefits, and
supplements those benefits for those who do. Private disability
insurance enables sick or injured people to buy food, pay their
mortgages and pay other bills while they are out of work due to illness
or injury.
More importantly, private insurers like Unum also help people
return to work while paying them a benefit.
Vocational Return-To-Work Programs
Unum believes that the services the private sector provides to
assist individuals in their return to work efforts are an important and
significant element of our offerings. The safety net the private sector
provides extends far beyond simply providing a benefit check to people.
As you heard in prior testimony, people want to work, not only for
economic reasons, but in order to be contributing members of our
society. Unum's programs help people achieve this goal, while at the
same time helping the government conserve scarce resources that are
needed for people who do not have the ability to rejoin the workforce.
While there are many facets to enabling individuals to return to
work, the focus of our testimony is on four elements.
These key components to successful return to work are all familiar
to you based on the testimony you have heard from others and we would
like to focus on how they could assist the public sector as viewed
through the prism of the private sector. They include:
Creating incentives for individuals to return to work;
Developing relationships with individuals that help
identify and create opportunities in alignment with their situation;
Providing high quality services through knowledgeable and
credentialed staff; and
Partnering with the individuals and employers.
Incentives
As others have testified before this Committee, an important
element of facilitating a successful return to the workplace is to
eliminate barriers and potential financial disincentives for the
individual to return to work. Many of our products are designed to
reduce or eliminate these barriers. Some of the relevant provisions are
standard in our products, while others are options an employer can
offer to its employees.
A large proportion of disability insurance is provided as an
employer sponsored benefit. In other words, the employer provides the
venue for an employee to purchase the coverage, or even purchases
protection directly for its workers. Disability insurance is a
discretionary benefit that employers can choose to make available,
often at an additional cost to their own bottom line.
A significant provision in our offerings provides that an
individual who returns to work in partial capacity may earn up to 100%
of his pre-disability income for a fixed period after his return to
work without a reduction in his disability benefit. This provision
therefore removes any early financial disincentives for an individual
to return to employment. Further, a provision for recurrent disability
in the offerings assures that an individual who attempts to return to
work, but finds he must leave employment due to the same cause, is not
penalized by having to satisfy another waiting period before benefits
resume.
These provisions are similar to concepts discussed in other
testimony before the Committee that the public sector utilizes or is
considering for use. The difference is that the private sector has
invested substantial capital and honed techniques over many years in
order to determine the most efficient way to assist insureds without
placing undue burdens or disincentives on their return to work efforts.
Other provisions in our offerings are designed to support
participation in rehabilitation programs. These include additional
benefits for participation in a tailored rehabilitation plan, and
benefits that reimburse expenses related to child care. Also available
are additional benefits that assist with secondary education costs or
funds to meet expenses associated with continuation of medical
coverage.
Product design also allows for monies to be available for worksite
accommodation. This can reduce the financial burden either on the
individual or the employer because we can provide adaptive devices and
consultation around accommodations that may be necessary to return a
person to the workplace.
Relationships
Our claim specialists develop relationships with individual
insureds to help them explore their motivations, interests and goals.
The insured and the claim specialist work together to ensure that all
pertinent medical and vocational information is properly documented.
The relationship developed between the claim specialist and the
insured, and the data collected, allow the claim specialist to identify
and work with those individuals who want to benefit from a Unum
vocational service based on the individual's future plans.
If both parties agree to utilize vocational services, the
relationship will continue as the individual works with one of our
vocational professionals, who will also often have significant contact
with them and work with them in programs discussed below.
Staff and Services
There are many barriers to a successful return to work that must be
overcome. A critical element of helping an individual successfully
return to work is providing high quality services by well-trained
professionals. These services take place in the context of an
individually tailored program to meet the insured's needs and goals,
and are backed by robust internal policies, procedures and quality
review programs.
Unum Vocational Rehabilitation Consultants (VRCs) have degrees in
rehabilitation counseling or a closely related field, most are
nationally Certified Rehabilitation Counselors, and all have experience
helping employers hire workers with disabilities and matching these
workers with appropriate jobs. In addition, our Vocational
Rehabilitation Consultants work closely with our claim teams to ensure
claim management and return to work assistance are being effectively
coordinated.
The Vocational Rehabilitation Consultants are expert at integrating
and partnering with outside resources, such as State and Federal
rehabilitation programs and rehabilitation counselors from public and
private agencies, to develop efficient and effective individualized
vocational rehabilitation programming/planning. This individualized
plan reflects our knowledge of an individual's medical conditions, her
capabilities and her skills and interests. The plan also is often
structured to provide interim milestone events as a way to monitor
progress.
Services span a wide range, and are offered based on an assessment
of the insured's needs. The scope of services most commonly employed
are:
Vocational Return to Work (RTW) Assessment: The
Vocational Rehabilitation Consultant assesses the employee's
employability potential by interviewing the employee and all
appropriate health care providers to determine the employee's
functional capacity for work, skill level for employment, career
interest, and reemployment options in the labor market.
Transferable Skills Analysis (TSA)/Vocational Analysis
(VA): The Vocational Rehabilitation Consultant analyzes the employee's
transferable (reemployment) skills to different types of employment
situations by utilizing knowledge of the employee's education,
training, work history, and professional accomplishments. A TSA/VA will
yield a list of jobs that accommodate the individual's physical
capacity for work, as well as the demonstrated level of skill.
Job Goal Development: Partnering with the insured, Unum
offers direct vocational counseling in which job placement goals are
developed and agreed upon. This process can include vocational testing
and vocational exploration activities (interest and ability testing,
labor market research, etc.) before appropriate job goals are
crystallized. Once a job goal is identified, an individualized written
return to work plan is developed, which identifies the job goal,
rationale for the job goal and responsibilities of all partners in the
job search and placement activities. The plan places the responsibility
for a successful return to work on all interested parties and is
developed in a ``win-win'' spirit.
Labor Market Survey (LMS): The Vocational Rehabilitation
Consultant surveys the appropriate labor market for suitable
reemployment options matching the employee's vocational and medical
profiles and providing suitable commensurate wages.
Job Search Skills Training (JSST): The Vocational
Rehabilitation Consultant mentors and coaches the insured in specific
job-seeking skills. These skills can include: Resume and cover letter
development, completing an application, cold calling, interviewing
techniques, appearance, discovering hidden job leads, using Internet
job search engines, and posting an ``eye catching'' resume on the
Internet.
Job Placement: During the job development and placement
phase of the return-to-work process, the employee and Vocational
Rehabilitation Consultant collaborate at appropriate intervals on the
job search results. Job placement efforts are documented by the
Vocational Rehabilitation Consultant.
Skills Enhancement: Identifying and helping to secure
training as appropriate for return to work.
Additionally and importantly, by working closely with an employer,
a Vocational Rehabilitation Consultant can assist an employee in
staying at work after the onset of an illness or injury, before a claim
has been filed. This is a win-win situation as the insured is able to
return to or stay in productive employment and thus presumably would
never have to file a claim for Social Security benefits.
Employer, Employee and Insurer Partnership
In many cases the individual may want to return to his or her
previous employer in the same or a different role. This makes close
partnership with the employer a significant factor in a successful
return-to-work effort, and could be considered as an option by
government entities as well.
Many employers recognize the value of a trained and tenured
employee, and work with us to partner on behalf of the individual.
Working with an employer to facilitate a successful work return can
take several forms. In some cases, a reduced schedule of work hours may
be necessary while an individual returns to capacity to support a full
work day. In other cases, it is possible to have an individual take a
different role in the organization for a fixed period of time while he
regains capacity. Sometimes, the new role becomes a permanent one.
Employers may also partner with Unum and assist in providing
adaptive equipment or other accommodations that allow individuals to
function at a level needed to succeed in a role.
For specific employers, based on their needs and requests, Unum
will have experienced resources partner with them to assess the total
impact to their operations of lost time from absences, and assess their
practices with regard to absence management. This work has the
potential to better inform the employer of the true and full cost to
their business of disability, and to recommend changes in practice
which can minimize that cost and create an environment that is
conducive to a successful return to work.
Summary
The private sector plays a key role in assisting disabled
individuals in their return-to-work efforts. Through a combination of
financial resources, individualized attention, and refined vocational
techniques, private sector return-to-work support and services not only
benefit individual insureds, but also help the Federal Government and
the American taxpayer by working to reduce the number of people who
need government benefits.
By utilizing some of the innovative techniques, tools and resources
from the private sector, we can help people receiving Social Security
return to work. Even more importantly we may get people back to work
before they ever need to take advantage of government programs. We
assist with direct return-to-work efforts as well as helping the
insured overcome various barriers, from navigating various Federal and
State vocational programs to helping with ergonomic accommodations.
This critical social safety net, paying people while helping them
get back on their feet, helps ensure that many don't slip through the
cracks and that they get the services they need to become productive
workers again.
We would like to thank the Committee for the opportunity to submit
testimony and to consider the role the private sector can play in
assisting claimants, the government and American taxpayers in getting
people back to work. We would be pleased to continue to be available
for any questions you may have. Thank you.
Statement of Victor Quibas
I wanted to share some testimony from my personal experience using
the ticket to work program. During the late 90s I was in a motorcycle
accident that crushed lower vertebrae in my back and had left me
partially paralyzed from the waist down. After 6 long months of
surgeries and treatments I was able to gain mobility and walk.
During this time period I was working for a very large
manufacturing firm that required long periods of time standing and
walking. When I went back to work the company was unable to accommodate
me with a sitting position. Unfortunately I worked as long as I could
and was unable to resume my regular duties. I had to leave my job and
apply for Social Security disability benefits.
It was a very long process but I was able to receive Social
Security disability benefits. Even though I was very thankful to be
receiving this income, the payments I received monthly were barely
enough to maintain bills. It was a constant struggle to survive. With
this being said, having a wonderful spouse and two young children we
could not afford to enjoy the simple things in life such as eating out
or going to the movies.
One day when going to church my wife Karla met a man who told her
about the ticket to work program and asked her to share the information
with me. After Karla shared the information with me I was hesitant to
reach out to the program in fear of losing the benefits we had, but
with Karla's support and encouragement I went to Goodwill of Central
Arizona and enrolled in the ticket to work program and the customer
service skills classes that would teach me needed service skills and
resume writing and interviewing techniques.
During the orientation process I was assured that I would retain my
benefits for a period of time and had found gainful employment. I
graduated from the class and went out to find work searching for jobs
by bus transportation. Proudly, I can say I found a great job here at
the Pointe Hilton as a resort operator and have been here for over 5
years and have been promoted to communications supervisor and have
confidence I will become communications manager. Truly, I want to
convey that the ticket to work program does work and my experience with
it has been extremely positive. I can say that it has helped me and my
wonderful family regain our lives and become self-sufficient. Thank you
for hearing my testimony.
Victor and Karla Quibas, Nick and Veronica