A DISABILITY SYSTEM FOR THE 21 ST CENTURY

1. A DISABILITY SYSTEM FOR THE 21ST CENTURY SOCIAL SECURITY ADVISORYBOARD

2. SOCIAL SECURITY ADVISORY BOARD A Disability System for the 21st Century Cornell/AAPD Policy Forum Hon. Dorcas R. Hardy Board Member Former Commissioner of Social Security January 12, 2007 Social Security Advisory Board www.ssab.gov

3. SOCIAL SECURITY ADVISORY BOARD • Established in 1994 as an independent, bipartisan Board • 12 years of studies kept leading us back to the disability programs and the need to modernize • Disability system is disjointed and uncoordinated • Align more closely with the Americans with Disabilities Act • SSDI and SSI should be options of last resort – not the only option Social Security Advisory Board www.ssab.gov

4. TRENDS: DISABILITY BENEFICIARIES AND EXPENDITURES • 2002 Federal/State program costs: $276 billion or 2.7% GDP • Last 15 years: Working-age population 18% SSDI beneficiaries 117% SSI recipients 66% Long-range SSDI costs 38% Social Security Advisory Board www.ssab.gov

5. TRENDS: Persons with Disabilities 2005 Social Security Advisory Board www.ssab.gov

6. FUTURE TRENDS 2025 Social Security Advisory Board www.ssab.gov

7. FUTURE PUBLIC POLICY • Strength of workforce based on one’s ability to participate not one’s inability • Public disability policy should better focus on assisting workers to remain in the workforce. Social Security Advisory Board www.ssab.gov

8. SSDI and SSI TODAY • All or nothing definition Unable to engage in SGA due to impairment which results in death or lasts at least 12 months • Beneficiaries have significant limitations and bleak employment outlook • Efforts focus on returning to work after proving inability to work Social Security Advisory Board www.ssab.gov

9. DISABILITY PARADOX Is It Social Security’s Definition of Disability? OR Is SSA Targeting Persons with Disabilities At The Wrong Time? Social Security Advisory Board www.ssab.gov

10. A DISABILITY SYSTEM for the 21ST CENTURY • Invited an expert panel to assist SSAB: Richard Burkhauser, Cornell University Marty Ford, Disability Policy Collaboration, The Arc/UCP Allen Heinemann, Rehabilitation Institute of Chicago Andy Imparato, American Association of People with Disabilities Ken Mitchell, UnumProvident • Held public hearings and roundtable discussions around the country Social Security Advisory Board www.ssab.gov

11. A DISABILITY SYSTEM for the 21ST CENTURY • Developed a 21st century vision that: • Supports individuals and maximizes employment outcomes • Facilitates a culture of ability to work • Addresses dynamic nature of disability and impact on work • Coordinates and integrates services Social Security Advisory Board www.ssab.gov

12. CONCEPTUAL MODEL for ADULTS Assumptions: • Not a barrier to permanent disability benefits • Timely intervention is critical • Triage, assessment, and work Rx available before applying for SSDI/SSI Social Security Advisory Board www.ssab.gov

13. CONCEPTUAL MODEL for ADULTS The Process: • Establish a “front-end” that coordinates and integrates RTW assessment and service: a single point of entry • Focused and ongoing case management • Multidimensional evaluation using nationwide network of public and private providers Social Security Advisory Board www.ssab.gov

14. CONCEPTUAL MODEL for ADULTS The Process: • Development of tailored work prescription that includes: Income maintenance Medical treatment Rehabilitation, counseling, and training • Administration: external to SSA Social Security Advisory Board www.ssab.gov

15. CONCEPTUAL MODEL for ADULTS Adult Model Little or no work history Substantial work history Triage assessment Transition program • develop work Rx • coordinate supports SSDI/SSI Exit to employment Social Security Advisory Board www.ssab.gov

16. PROFILE OF SSI YOUTH • Less than half of SSI youth graduate from secondary school • 60% of SSI youth ages 19-23 are not working, in school, or attending vocational training • Post age 18 redetermination: 50% are not working, in school, or in a training program • On or off SSI: income just above the poverty line Social Security Advisory Board www.ssab.gov

17. INTEGRATED MODEL for SSI YOUTH Assumptions: • Early, comprehensive, functional assessment • Expectations of independence, self-support, and community inclusion • Continuing guidance and coordinated access to services and supports Social Security Advisory Board www.ssab.gov

18. INTEGRATED MODEL for SSI YOUTH • Life-progression plan – not another IEP element • Multidisciplinary assessments leading to dynamic educational and support program • Participation is voluntary; not linked to special education • Continue to receive SSI and Medicaid • Incentives to participate: differential program rules • Administration: external to SSA Social Security Advisory Board www.ssab.gov

19. POLICY CHALLENGES • Make work pay • Access to health care • Job preparation trust funds • Refocus criteria for age-18 redetermination • Address disincentives to work: create system-wide buy-in programs Social Security Advisory Board www.ssab.gov

20. MAKE WORK PAY • Create more effective incentives to make work pay • Wider availability of short-term benefits • Revise work, earnings, and asset rules • Earned income tax credit for people with disabilities • Tax sheltered savings to encourage asset accumulation that supports work efforts • New tax credits for employers with strong RTW programs Social Security Advisory Board www.ssab.gov

21. ACCESS TO HEALTH CARE • Any system change must address health insurance coverage. COBRA is available for some, but can be very costly. • Expand access through public programs based on cost-sharing • Establish lifetime certification for health coverage for those with lifelong conditions • Explore public/private partnership to provide health coverage Social Security Advisory Board www.ssab.gov

22. OPPORTUNITY: STATE SHORT-TERM DISABILITY PROGRAMS • Pre-test concept of an alternate coordinated path for adults with disabilities • Partner with the short-term programs that exist in CA, HI, NJ, NY, RI, and Puerto Rico. Add “upfront” assessment that leads to rehabilitation, and training. • State pays usual benefits; public/private partnership provides wrap-around program • Measure outcomes and determine cost-effectiveness of an integrated disability system Social Security Advisory Board www.ssab.gov

23. A DISABILITY SYSTEM for the 21ST CENTURY … the Nation’s proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living, and economic self-sufficiency… Americans with Disabilities Act • Social Security disability programs are vital supports that must continue • Urge policymakers to revisit a definition of disability that emphasizes inabilities rather than abilities • There is no magic answer, but the 21st century demands a system that fulfills the goals of the ADA and we believe that the time is now to explore alternatives. Social Security Advisory Board www.ssab.gov