The NEW Ticket To Work New Program, New Opportunities

1. The NEWTicket To WorkNew Program, New Opportunities Tom Gloss Ticket to Work Specialist CESSI, A Division of Axiom Resource Management Program Manager for Recruitment & Outreach Apr-14

2. Briefing for National Alliance for Mental Illness July 8, 2009 Thomas Hale, Project Officer Soosan Shahrokh, Alternate Project Officer

3. Why Mental Illness? • Largest group of disabled participants in the Social Security programs • 27% of SSDI beneficiaries (~2.1 ml)* • 39% of SSI recipients (~2 ml) ** • Most forms of mental illness are treatable; many promising treatments integrate work as therapy. * All beneficiaries in pay December 2007, from the Annual Statistical Report on the SSDI Program 2008 ** Recipients under age 65 in December 2006, from the SSI Annual Statistical Supplement Report 2006

4. Research & Policy Questions • To what extent does access to high quality mental health treatment and employment supports lead to better employment outcomes and other benefits? • What are the characteristics of beneficiaries who elect to enroll in the study (insurance, demographics)? • What are the characteristics of beneficiaries who choose not to enroll? • What are the costs of the services provided? • What programmatic disincentives exist that create barriers to return-to-work? • What specific programmatic changes can be made to support efforts to sustain competitive employment?

5. Design Overview • Enroll 2,200 SSDI workers with Schizophrenia or Affective Disorder • Randomly assign 1,100 to the treatment group and 1,100 to the control group • Recruit over a 21 month period • Treat/Monitor each recruit for 24 months post enrollment • Each recruit participates at one of 23 sites across the country

6. Data Elements • Treatment and control group each have 9 interviews over a two year period • Demographics and Work History • Psychiatric Diagnosis • Health Assessment • Health Status, Symptoms and Functioning • Health Care Coverage and Utilization • Attitudes toward Treatment and Work • Others (e.g., costs, outcomes, quality of life)

7. Management • Contract to Westat in October 2005 • Principal Investigators • William Frey, Ph.D., Westat • Robert Drake, MD, Ph.D., Dartmouth

8. Treatment Group Interventions • Baseline clinical diagnosis via SCID • General physical examination (if none in past 6 months) • Health insurance coverage • Behavioral health services • Supported employment services • CDR waiver for 3 years

9. Control Group Interventions • $100 in incentives distributed over the 9 interviews • Community resource manual provided upon randomization into control group

10. Heath Care Financing Study provides: • Insurance for participants with no insurance and supplemental insurance for underinsured beneficiaries • Out-of-pocket costs for all behavioral health services • Supported employment costs not reimbursed by insurance • Costs up to an average of $10,000 per person per year Study does not provide: • Co-payments for general health care

11. Interventions Employment Supports: Based on Individual Placement and Support (IPS) Model Placement at time participant expresses readiness Competitive employment Employment integrated with treatment Follow-along supports are continuous SystematicMedicationManagementEvidence-based use of individual medications

12. 22 Study Sites M Vancouver WA Portland OR Spring Lake Park MN Grants Pass OR Manchester NH Framingham MA Norwich CT Bridgeport CT Chicago IL Mentor OH New York NY Peoria IL Bethesda MD Indianapolis IN Washington DC Denver CO Kansas City KS Aiken SC Smyrna GA San Antonio TX St. Petersburg FL Ft. Lauderdale FL

13. MHTS Site Staff • Research Assistant • Recruit and enroll beneficiaries • Nurse Care Coordinator • Facilitate and monitor treatment • Case manager • Provide other non medical non employment supports (e.g., talk to families, recommend clothing, transportation to appointments)

14. Timeline • Start-up activities: Oct ‘05 to Sep ‘06 • Recruitment, enrollment and randomization: Oct ‘06 to Aug ‘08 • 24-month intervention: Oct ‘06 to Aug ‘10 • Analysis: Aug ‘10 through Jan ‘11 • Final Report: Jan ’11 http://www.socialsecurity.gov/disabilityresearch/mentalhealth.htm

15. Preliminary FindingPercent of Beneficiaries Employed

16. THE TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT

17. What Is the Ticket to Work Program? • A free and voluntary employment program run by the Social Security Administration (SSA) to assist SSA beneficiaries with disabilities who want to work. • Beneficiaries include individuals with disabilities ages 18 through 64 who are receiving Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits.

18. Ticket to Work Program • Increased choices for getting the services & supports you need to engage in work and reach your employment goals. • Approved providers of services are called “Employment Networks” or “ENs.” • Examples of services and supports offered by ENs include: • Help finding a job • Education and training • Vocational rehabilitation services • Ongoing services and supports

19. How Does the Program Work? • A paper Ticket is mailed to you when you are determined to be eligible for SSDI or SSI benefits. • If you already receive disability benefits, your Ticket may have already been mailed to you. • You do not need the paper Ticket to participate. • You decide: • Whether to use your Ticket • Where to assign your Ticket • When to assign your Ticket • MAXIMUS can help you through the process. Call them toll-free at 1-866-968-7842 (v) or 1-800-833-2967 (tty). • Remember, participation is free and voluntary – There are no penalties if you choose not to participate.

20. What Does the Program Do? • Connects you with the resources, personnel and programs to make full use of existing Federal, state and local programs. • Offers protection from medical Continuing Disability Reviews (CDRs). • The goal is to assist you to: • Go to work. • Make more money. • Reduce your need for cash benefits. • Increase your independence and self-sufficiency.

21. What Are Employment Networks? Employment Networks (ENs) are public and private agencies, schools, colleges, training programs, community-based service providers, employers and others that have agreed to provide services under the Ticket to Work Program to help you achieve your work goals. State Vocational Rehabilitation agencies (VR) are automatic ENs that provide a wide variety of services to help people with disabilities enter or re-enter the workforce. ENs and VR agencies receive payments when they help you get and keep a job.

22. What Types of Services andSupports can ENs Provide? • Counseling and guidance • Education and training: • Vocational • Technical • Postsecondary • Job search services • resume writing • interview skills • Job placement services • Job coaching and ongoing support services • Work adjustment counseling • Job retention services • Other supports and services Not all ENs offer the same services. Talk to the EN about services you need before assigning your Ticket.

23. Individualized Work Plan When you decide to work with an EN, you and someone from the EN will develop an Individualized Work Plan (IWP) An IWP: • Is developed and agreed to by you and the EN. • Identifies your chosen employment goal. • Lists the services and supports that the EN agrees to provide you in achieving that goal. • Signing the IWP = assigning your Ticket to that EN. • While working with the EN and progressing towards your employment goal, you will not have a medical (CDR). • Your IWP can be changed if your situation changes.

24. Your Ticket is the Key • ENs get paid a bonus from the Ticket program, but only if you work! • Your Ticket works as an incentive for the EN to provide you services and help you keep working.

25. Partnership Plus – A New Option under the Ticket to Work Program If you are receiving services from your State VR agency, you can choose to assign your Ticket to the EN of your choice after VR closes your case. The EN can: • Provide additional job training • Provide ongoing supports • Help you keep your job • Help you advance in your job

26. Work Incentives What Are Work Incentives • Work Incentives are SSA rules that help you keep your benefits as you explore work. • By using Work Incentives you can make more money, gain new skills, and achieve greater independence through work.

27. Examples of Work Incentives • Trial Work Period (TWP) (SSDI only) • The TWP allows you to test your ability to work for at least 9 months. • Extended Period of Eligibility (SSDI only) • For 36 months after the TWP SSA may restart your SSDI benefits without: • a new application, • disability determination, • or waiting period. • Earned Income Exclusion(SSI only) • Less than half of earned income is counted by SSA as earnings in determining the amount of your benefit check.

28. Work Incentives (continued) • Expedited Reinstatement (EXR) If: • your cash disability benefits ended because of your work and earnings, • and you stop work within 5 years of your benefits ending Then: • SSA may be able to quickly get you on benefits. • Up to 6 months of “temporary cash benefits” • Continued Medicare and/or Medicaid coverage

29. Work Incentives (continued) Medicare • You can keep your Medicare coverage for at least 8 ½ years after you return to work. Medicaid • If you have earnings too high for a SSI cash payment, you maystill be eligible for Medicaid through 1619(b). • If your state has a Medicaid Buy-In program it may provide Medicaid benefits while you work.

30. Other SSA Work Incentives • Social Security offers many Work Incentives that are designed to meet your needs. • Talk to your benefits planner to make sure that you take full advantage of other Work Incentives SSA offers.

31. Who Can Help Me Understand All of This? • Work Incentives Planning and Assistance (WIPA) Projects • Protection and Advocacy for Beneficiaries of Social Security (PABSS) • SSA Benefits Specialists • Area Work Incentives Coordinator (AWIC) • Work Incentives Liaison (WIL)

32. Work Incentives Planning and Assistance Projects WIPAs are SSA approved organizations that assist beneficiaries in making informed choices about work. • WIPA services are free. • WIPA staff: • Are trained to provide information about work and Work Incentives. • Can answer questions about how work will affect your Federal, state and local benefits. • Can help you find the resources or services to achieve your individual employment goals. • Host Work Incentives Seminar Events (WISE).

33. Work Incentive Seminars (WISE) At a WISE Event you can expect to: • Learn about the Ticket to Work program and other SSA Work Incentives. • Meet with: • ENs • The State Vocational Rehabilitation agency • WIPA Project staff • SSA staff • Other beneficiaries who want to go to work • Additional state agencies and community partners To find out if a WISE event is happening near you, visit www.cessi.net/WISE/

34. Protection & Advocacy (P&A) Services The Protection & Advocacy for Beneficiaries of Social Security (PABSS) Program • Provides advocacy and legal assistance for disability-related employment issues • Is the nation’s largest provider of legal advocacy services for individuals with disabilities • Services are free

35. Locating Your WIPA or P&A To find the WIPA Project nearest you or to locate your State Protection and Advocacy agency, visit: www.ssa.gov/work/providers

36. SSA Benefits Specialists Social Security has a team of Work Incentives Specialists to ensure that you receive: • Accurate information about how work will affect your benefits • Assistance in reporting your work activity They are: • Area Work Incentives Specialists (AWICs) • Work Incentives Liaisons (WILs)

37. What Are Area Work Incentives Coordinators (AWICs)? AWICs are experts on SSA’s Work Incentives and employment support programs. They: • Manage and coordinate Work Incentives Training • Provide public support services to beneficiaries with disabilities who want to start or keep working. • Conduct public outreach to other members of the community. Visit http://www.ssa.gov/work/awiccontacts.html to find your local AWIC.

38. What Are Work Incentive Liaisons (WILs)? Every local SSA office has a WIL who provides advice and information about: • SSA's Work Incentive provisions • Employment support programs. Contact your local SSA office for the name and telephone number of the WIL in your area. Visit www.ssa.gov or call 1-800-772-1213.

39. What Is MAXIMUS? MAXIMUS, the SSA contractor that assists in the administration of the Ticket to Work program: • Helps you assign, un-assign and re-assign your Ticket • Provides you with a replacement Ticket • Helps you locate ENs Contact MAXIMUS at 1-866-968-7842 (v), 1-866-833-2967 (tdd) or www.yourtickettowork.com

40. For More Information For more information on Ticket to Work: Visit SSA’s Ticket to Work Site at www.ssa.gov/work Contact MAXIMUS at 1-866-968-7842 (v), 1-866-833-2967 (tdd) or www.yourtickettowork.com

41. So, How Is it Going So Far? • As of May 2009, over 269,000 Tickets assigned (VR & EN); about 22,000 of those assigned to about 820 ENs • March & April 2009—first consecutive months with over 1,000 new Tickets assigned to ENs! • Total Ticket payments to EN’s hit all-time highs after the new regulations went into effect • There has been a steady increase in the number of Tickets assigned and Ticket payments requested under the new rules, telling us that the new payment structure is working

42. Ticket Payments

43. Ticket Payments

44. SSA Hiring Initiative • The Commissioner of Social Security has implemented a national recruitment and hiring initiative for people with disabilities. • This is a historic opportunity because SSA’s budget for 2009 has been increased enough to hire thousands of new staff, nationwide. • SSA wants to maintain it’s leadership in federal government in hiring people with disabilities and reach out to Ticket Holders, veterans with disabilities, and students with disabilities.

45. SSA Hiring Initiative There will be a variety of entry level positions as well as some higher level positions: Claims Representative and Service Representative positions. These are direct public service positions located in our 1300 field offices across the nation. Teleservice Representatives, 37 teleservice centers nationwide, to assist the public calling SSA’ 800 number. Claims Authorizers and Benefit Authorizers to process post entitlement claims related issues - 6 program service centers nationwide and Headquarters location in Baltimore. Support positions nationwide related to the hearings and appeals process including Legal Assistants, Paralegal Specialists, and Attorney Advisors.

46. SSA Hiring Initiative • For more information visit: www.cessi.net/ttw/SSAHires/index.html • Send resumes and Schedule A forms for SSA’s review to: Selective.Placement.Applications@ssa.gov.

47. Should Have Used My Ticket!David JonesCESSI Account Manager

48. SSDI Beneficiary Story • I became a beneficiary at age 19 • Because of work during High School I qualified for SSDI and also received some SSI. • While learning to cope with Bipolar disorder I received services from Department of Rehab in CA; a great counselor helped me set career goals and I decided on Social Work. • To make sure college was the right place I started at community college then transferred to a university. • I used a PASS Plan, one of the SSA Work Incentives, to pay for my BSW.

49. Volunteer Work • While obtaining my Social Work degree I volunteered my time with NAMI and helped with Family-to-Family Groups • I shared my story of success in college • This built my confidence to transition to a professional job after college

50. Received Ticket • I received a Ticket in the mail; wish I would have used it! • At the time I had no idea what it was and did not ask: • How would my benefits be affected? • Was this a program I would have to commit to? • Who would I be working with if I used the Ticket? • Some of the benefits of the Ticket I did not use: • After college I was on my own to find a job. • I did not receive help creating my resume. • After the second month of work I received a Continuing Disability Review notice; it was difficult to deal with on my own. • Not having the guidance of an EN, I was overpaid by SSA and had to pay them back! • I should have called MAXIMUS at 1-866-968-7842