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The Role of Work Incentives in Supporting the Employment of Ticket Holders with Psychiatric Disabilities John Kregel S

Title II Disability Benefits

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The Role of Work Incentives in Supporting the Employment of Ticket Holders with Psychiatric Disabilities John Kregel S

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    1. The Role of Work Incentives in Supporting the Employment of Ticket Holders with Psychiatric Disabilities John Kregel Susan O’Mara Sandy Hardy Smith The WIPA National Training Center Virginia Commonwealth University

    2. Title II Disability Benefits & Supplemental Security Income The Title II Disability benefit programs and SSI provide critical cash benefits and access to health coverage (Medicare, Medicaid) for millions of Americans. More than 6 million individuals receive SSI based on disability or blindness. More than 7 million adults receive Social Security Disability Insurance benefits.

    3. For the 6 million adult and children SSI beneficiaries, the maximum benefit of $674/month (2009) is less than 75% of the federal poverty level for a family of one. For the 7 million adults receiving Social Security Disability Insurance benefits, the average monthly SSDI payment is $1064 (2009). This is approximately 117% of the federal poverty level for a family of one. Work is key to enhanced financial and overall well being!

    4. Challenges and Concerns… Paid employment is viewed as a major risk! Fear of losing critical health coverage!!! Access to needed employment services and supports is often limited and most beneficiaries are not in a financial position to purchase these services themselves. Loss of connection to program and safety net.

    5. How do the Work Incentives Help?? Continued access to benefit supports while working. Continuation of health coverage under Medicaid / Medicare even after monthly cash payments are ceased. Financial supports for needed employment services. Extended Eligibility Status and Reinstatement of Benefits if employment is reduced or lost.

    6. SSI Work Incentives Earned Income Exclusions provide for a gradual reduction in SSI as earnings increase. Student Earned Income Exclusion of $1640/mo, up to $6,600 annual exclusion. 1619(a) provides for continuation of cash benefits and Medicaid when earnings exceed Substantial Gainful Work Activity (SGA).

    7. SSI Work Incentives 1619(b) provides for continuation of Medicaid when earnings are too high to receive cash benefit. Impairment Related Work Expense (IRWE) Blind Work Expense Plan for Achieving Self-Support

    8. Title II Disability Work Incentives Trial Work Period – protects eligibility and cash payments while testing ability to work. Extended Period of Eligibility (EPE) – protects eligibility status and provides for cash payments in months when earnings are below SGA. Extended Period of Medicare Coverage – coverage continues at least 93 months after TWP ends.

    9. Title II Disability Work Incentives Consideration of Subsidy / Extra Work Supports in determining SGA. Impairment Related Work Expense Expedited Reinstatement of Benefits - allows individuals who are terminated from disability benefits due to work to get benefits back again in an expedited manner without having to re-apply.

    10. Ticket and Work Incentives There are NO restrictions on using available work incentives for Ticket users. Effective July 21, 2008, initial milestone payments to ENs and timely progress are based on GROSS earnings, not countable earnings which eliminates previous penalty for using work incentives.

    11. CDR Protection for Ticket Users Additionally, using a Ticket does provide the beneficiary protection against the initiation of Medical Continuing Disability Reviews (CDRs).

    12. CDR Protection for Ticket Users SSA may not initiate a medical CDR while a beneficiary is “using a Ticket.” Under the new rules, this applies when a Ticket is assigned to an EN or the state VR agency acting as an EN, or when the beneficiary is receiving services from a state VR agency under the cost reimbursement option, and The beneficiary is making timely progress toward self-supporting employment. If a Ticket is assigned after a medical CDR is initiated, SSA will complete the review.

    13. Ticket Program and Access to Health Care What is the impact of Ticket use on a beneficiary’s health benefits and medication coverage? Basically, assignment and use of a Ticket has no impact on eligibility for Medicaid, Medicare, and other health benefits or medication coverage. SSA treats the earnings of a Ticket user in the exact same fashion as a non-user, and all of the standard work incentives – including those providing access to health insurance – apply.

    14. Opening Doors! Employer Insurance: May be an option once employment is secured Medicaid Buy-in: Check to see if there is a buy-in program in your state Can buy-in to Medicaid when earnings exceed the break-even point

    15. Work Incentives Planning and Assistance Program 104 SSA-funded community based WIPA projects across the country. Staffed by 480 certified Community Work Incentives Coordinators (CWICs) who provide direct services to Social Security Disability beneficiaries. Promote employment and enhanced self-sufficiency for beneficiaries of the SSA disability programs through the provision of work incentives planning and assistance services.

    16. Where do WIPAs fit into the new and improved Ticket initiative? WIPAs are all about promoting WORK – so is the Ticket! WIPA services are critically important for educating beneficiaries about how to use the Ticket and other work incentives to achieve their employment goals. As a work incentive, the Ticket offers valuable advantages to those beneficiaries for whom it is applicable.

    17. Benefits of Collaborating with WIPA Projects CWICs offer in-depth knowledge about Social Security Disability benefits, work incentives, and employment initiatives. Addressing fears of work impact on benefits increases the likelihood that beneficiaries will work, as well as set higher targets for work effort and earnings! Reliable source of information on other benefits received. Individualized analysis of all current benefits and impact of work and earnings on these benefits.

    18. Benefits of Collaborating with WIPA Projects CWICs Identify, develop, and support management of work incentives to assist with costs of employment. Long term planning for benefit transitions throughout the employment process to reduce benefit bumps in the road and increase the likelihood that beneficiaries stay employed!

    19. CWIC Obligations to Beneficiaries under the Ticket Program include … 1. Screening all beneficiaries to identify Ticket eligible individuals who would most benefit from Ticket assignment and who would make strong candidates for Ticket use and/or assignment. Explaining how the Ticket Program functions and what benefits individuals receive from using their Ticket. Encouraging beneficiaries who are strong Ticket candidates and would benefit from the Ticket Program to consider Ticket assignment.

    20. CWIC Obligations to Beneficiaries continued 4. Counseling beneficiaries on Ticket assignment by providing information about ENs in the area and helping the beneficiaries select an EN which best matches the individual’s service or support needs and preferences. 5. Having “firewall” procedures in place which prevent a conflict of interest when WIPA services are provided by an agency that also serves as an Employment Network. 6. Counseling beneficiaries on what constitutes “timely progress” for each 12-month review period in the Ticket program.

    21. CWIC Obligations to Beneficiaries continued 7. Having current and complete knowledge of all ENs serving the WIPA project catchment area and which of those ENs are currently accepting Tickets. 8. Knowing what services the various ENs provide, what participant eligibility requirements are and any restrictions on services or eligibility. 9. Referring beneficiaries to ENs based on individual service or support needs and preferences.

    22. CWIC Obligations to ENs under the Ticket Program include… 1. Providing information to ENs about the WIPA program, including: services provided, limits on services, eligibility requirements, and characteristics of a high priority WIPA referral. 2. Providing individualized work incentives planning and assistance to beneficiaries with Tickets assigned to local ENs. 3. Assisting ENs to use BPQYs, Benefits Summary & Analysis reports, and Work Incentive Plans to plan employment services and supports.

    23. CWIC Obligations to ENs continued 4. Assisting ENs to understand how paid employment or self-employment affects a beneficiary’s SSA disability benefits, Medicaid/Medicare, and all other applicable federal, state and local benefit programs. 5. Helping ENs to understand when and how specific work incentives are applied to the SSA disability benefit programs to help beneficiaries achieve employment goals. 6. Working collaboratively with ENs to resolve problems beneficiaries experience while using a Ticket.

    24. CWIC Obligations to ENs continued 7. Coordinating with ENs to insure that work incentives are properly applied, work CDRs are conducted in a timely fashion and cash benefits are adjusted or ceased appropriately. 8. Assisting with making Ticket assignment changes such as placing the Ticket in inactive status, un-assigning a Ticket, or re-assigning a Ticket. 9. Helping resolve any problems encountered with assigning or using a Ticket.

    25. Additional Benefits of Collaborating with WIPA Projects Information and linkages to other resources in the community that you may not be familiar with – such as entities promoting asset development. Educational programs and collaborative outreach to beneficiaries. Access to training and technical support available through the WIPA National Training Center at Virginia Commonwealth University.

    26. VCU WIPA National Training Center Access to Training & Technical Assistance: Initial CWIC Training based on Core Competencies CWIC Competency-Based Assessment & Certification Supplemental Training Sessions Technical Support delivered through cadre of TA Liaisons TA and Training related to providing effective WIPA services to Native American beneficiaries Core Group of VCU Faculty and Support Personnel Network of Collaborators Cadre of Technical ConsultantsCore Group of VCU Faculty and Support Personnel Network of Collaborators Cadre of Technical Consultants

    27. VCU WIPA National Training Center WIPA National and Regional Listservs WIPA NTC Web Site CWIC Training Manual Resource Documents,Tools, Links Information on training opportunities http://www.vcu-ntc.org

    28. VCU WIPA National Training Center Contact: Susan O’Mara 757.412.2342 soevans@vcu.edu Sandy Hardy Smith 325.677.0767 pn3381@aol.com

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