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Fulfilling Dreams

Fulfilling Dreams. Cross-Training. Fulfilling Dreams. A Cross-Training for Promoting Work for people with disabilities. Fulfilling Dreams. INTRODUCTION Why Cross-Training? Overview of Grant Accomplishments Goals Increased Education + Increased Outreach = Increased Utilization

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Fulfilling Dreams

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  1. Fulfilling Dreams Cross-Training

  2. Fulfilling Dreams A Cross-TrainingforPromoting Work for people with disabilities

  3. Fulfilling Dreams • INTRODUCTION • Why Cross-Training? • Overview of Grant • Accomplishments • Goals • Increased Education • + Increased Outreach • = Increased Utilization • Increased employment of people with disabilities

  4. A Brief History • How did we get here? • Many circumstances at play • Society undervaluing people with disabilities • Federal government’s creation of benefits for people who were determined unable to work (SSA) • Benefits tied to income • Resulted in • Dependence on benefits • Fear of working/losing benefits, particularly Medicaid

  5. A Brief History • How did we get here, continued • Growing initiatives in recent years to encourage work and counter the effects of SSA’s benefit rules • Tri-agency effort – Ticket to Work • SSA • CMS • DOL • Medicaid Infrastructure Grants

  6. Work Incentives and Supports

  7. Work Incentives • Social Security • Overview of SSA Disability Programs • Supplemental Security Income (SSI) • Social Security Disability Insurance (SSDI)

  8. Work Incentives • Social Security Disability Insurance (SSDI) • Title II of the Social Security Act • Federally mandated • Paycheck withholding • Individualized accounts • Disabled Adult Children • Children of parents with disabilities • Medicare

  9. Work Incentives • Supplemental Security Income (SSI) • Title XVI of the Social Security Act. • State funded program for low-income or no-income individuals • SSI-Disabled for those who have disabilities and have no other income • Maximum amount determined by federal benefit rate (FBR) • 2009 Alabama rate is $674.00 each month (individual) • Medicaid

  10. SSI and SSDI • Comparison Table of SSI and SSDI • See Handout/Page 9 of Handbook

  11. Work Incentives Intersection of Work and Disability • Social Security Work Incentives • SSI and SSDI include a number of employment support provisions commonly referred to as work incentives

  12. Work Incentives • Summary of important Title II Work Incentives (SSDI, CDB, DWB) • Trial work period. • Substantial gainful activity level (SGA). • Impairment related work expense (IRWE)/Subsidy and Special Conditions. • Extended period of Eligibility.

  13. Work Incentives • Summary of Title II Work Incentives,continued • Continuation of Medicare. • Medicare for the working disabled. • Expedited Reinstatement of benefits. • Recovery During Vocational Rehabilitation.

  14. Work Incentives • Summary of important work incentives (Supplemental Security Income (SSI)) • Substantial Gainful Activity (SGA). • General Income exclusion. • Earned Income exclusion. • Student child earned income exclusion. • Impairment related work expense. • Blind work expenses.

  15. Work Incentives • Summary of SSI work incentives, continued • Plan to Achieve Self-Support (PASS). • Continuation of Medicaid Eligibility (1619B). • Expedited Reinstatement of benefits. • Recovery During Vocational Rehabilitation. • Student Earned Income Exclusion

  16. Work Incentives Ticket to Work Program • Goals of the Ticket to Work Program • What is a ticket? • Ticket benefits • How does it work?

  17. Work Incentive Program Assistance (WIPA) • WIPA Background • Grant from SSA • Mandated by Ticket to Work and Work Incentives Improvement Act of 1999 • Free program serving SSI and/or SSDI recipients who want to work and require more intensive long-term case management • Provides information about SSA disability program work incentives to encourage work

  18. WIPA • WIPA Goals • Promotes paid employment • Enhances self-sufficiency • Collaborates with community partners to accomplish 1 and 2 above • WIPA message (see handout)

  19. WIPA • Who is eligible? • At least age 14, but not yet full retirement age, • Disabled per SSA definition, and • Already receiving Social Security benefits based on disability (SSI or a title II disability benefit such as SSDI, CDB, or DWB). • Eligible beneficiaries who have specific interest in work and how work will affect their benefits

  20. WIPA • WIPA in Alabama • ALA-WIN: Central and North Alabama • Independent Living Resources of Greater Birmingham • UCP of Greater Birmingham • ADRS: South Alabama

  21. WIPA: Community Work Incentive Coordinators • WIPA agencies employ CWICs to assist in understanding complex requirements of work incentive programs • CWIC role • Ongoing case management • Work-related issue counseling • Healthcare planning and counseling

  22. Community Work Incentive Coordinators (CWICs) • What CWICs do • Case Management • Educate on available work incentives • Connect with services and supports • Ensure informed choice

  23. Community Work Incentive Coordinators (CWICs) • Specific CWIC Activities • Verify benefits • Make formal referrals • Proactive Follow-Up • Write a Work Incentive Plan (WIP) • Resolve work-related issues

  24. Community Work Incentive Coordinators (CWICs) • CWIC Partners • Program Manager for Recruitment and Outreach (PMRO) • SSA staff • Local Employment Networks (ENs) • Vocational Rehabilitation (VR) agencies • WISE: Work Incentive Seminars Events

  25. CWICs How community partners support CWICs Provide quality referrals Have access to information outside the CWIC's scope Education and information about scope of services and eligibility criteria from other partners Provide other avenues of outreach

  26. Community Work Incentive Coordinators (CWIC) • Partnership Examples

  27. Work Incentives • Group Exercise

  28. CommunityWork Supports

  29. Community Work Supports • Medicare and Medicaid • Common public benefits eligibility for people with disabilities • Links to Social Security

  30. Community Work Supports • Medicaid vs. Medicare • Medicaid is a program that provides medical assistance for certain individuals and families with low income and resources. • Medicare is a Health Insurance Program for people 65 years of age and older, some people with disabilities under age 65, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

  31. Community Work Supports • Eligibility for Medicaid • Supplemental Security Income (SSI) • Alabama “Medicaid for Low Income Families” • Pregnant women and children under 6 with family income below or equal to 133% FPL • Residents of medical institutions (nursing homes, hospitals, or facilities for the mentally retarded) for a period of 30 continuous days and meet very specific income, resource and medical criteria may be Medicaid eligible. • Dual Eligibles

  32. Community Work Supports • Special Medicaid Eligibility • Lost SSI eligibility because of: • Any reason, but who are not currently entitled to SSI because of Cost-of-Living Allowances SSDI (Pickle Amendment); • Entitlement to or increase in Childhood Disability Benefits (CDB); or • Entitlement to Disabled Widow(er)s Benefit (DWB) until Medicare starts.

  33. Community Work Supports • Special Medicaid Eligibility, continued • Increases: Individual entitled to retain Medicaid under these special provisions if he/she would otherwise be entitled to SSI if the increases had not happened.

  34. Community Work Supports • Medicaid Funding • Federal Funding/State Match • Adjusted Annually • 2009 Alabama Funding • 68.01% Federal • 31.99% State

  35. Community Work Supports • Medicaid State Plan Services • Medicaid Home and Community-Based Services (HCBS) • Medicaid • Waivers • Keep individuals from being institutionalized

  36. Community Work Supports • Medicaid State Plan Services vs. HCBS • Example State Plan Services • Doctor visits • Home health care • Durable Medical Equipment • Ambulance and Non-Emergency Transportation • Example Waiver Services • Personal care • Habilitation services • Home modifications • Supported Employment

  37. Home and Community-Based Services • HCBS Purpose and Goals • Health and Safety Focus • Community integration • Avoid unnecessary institutionalization • More recent emphasis (last decade) on independence and productivity F WORK

  38. HCBS • Relationship between Medicaid Eligibility, Waivers, and Income Limits • Medicaid eligibility bearing on Waiver eligibility • State Plan and waiver duplication of services • 300% rule

  39. HCBS • Waiver Implementation Responsibility • Administrating State Agency • Always Alabama Medicaid Agency • Operating State Agency • Department(s) providing services to the target population

  40. Alabama HCBS • Alabama’s HCBS Waivers • State of Alabama Independent Living Waiver • Elderly and Disabled Waiver • Mental Retardation Waiver • Living at Home Waiver • Assistive Technology Waiver • HIV Waiver

  41. HCBS • Personal Assistance Services • Common variable among most (5 of 6) HCBS waiver • How PAS can support work

  42. Alabama HCBS Waivers State of Alabama Independent Living (SAIL) Waiver (Since 1992)

  43. Alabama HCBS Waivers • State of Alabama Independent Living (SAIL) • SAIL ensures the consumer can live as independently as possible at home and in the community through three specialized programs: • Homebound • Independent Living Support Services • Waiver services • Operating agency: Alabama Department of Rehabilitation Services

  44. Alabama HCBS Waivers • SAIL Eligibility • To be eligible for services through the waiver, a person must: • be at least 18 years old • be medically and financially eligible for a nursing home • have experienced the onset of the disability prior to age 60 • have a disability as a result of reasons other than aging

  45. SAIL Target Population • The SAIL Waiver is approved to serve disabled adults with specific medical diagnosis who are at risk of being institutionalized in a nursing home. • The SAIL Waiver is approved to serve 630 individuals.

  46. SAIL Waiver Services are provided to, but not limited to persons with the following diagnoses: Quadriplegia Traumatic brain injury Amyotrophic Lateral Sclerosis Multiple Sclerosis Muscular Dystrophy Spinal Muscular Atrophy Severe Cerebral Palsy Stroke Other substantial neurological impairments, severely debilitating diseases, or rare genetic diseases (such as Lesch-Nyhan disease). SAILTarget Population

  47. SAILFinancial Eligibility • Individuals receiving SSI; • Individuals receiving State Supplementation; • SSI related protected groups deemed to be eligible for SSI/Medicaid; • Special HCBS Waiver disabled individuals whose income is not greater than 300% of the SSI Federal Benefit Rate.

  48. SAIL Covered Services • Case Management* • Personal Care Services • Environmental Accessibility Adaptations* • Personal Emergency Response System (Initial Set-up) • Personal Emergency Response System (Monthly) • Medical Supplies • Minor Assistive Technology • Assistive Technology • Evaluation for Assistive Technology* • Assistive Technology Repairs • Personal Assistance Services *Includes Transitional Services

  49. Alabama HCBS Waivers Elderly and Disabled Waiver (E&D) (Since 1982)

  50. E & D Waiver • Elderly and Disabled Waiver • Designed to provide services to allow elderly and/or disabled individuals who would otherwise require care in a nursing facility to live in the community. • Operating Agencies: • Alabama Department of Public Health • Alabama Department of Senior Services

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