THE TICKET TO WORK and WORK INCENTIVES IMPROVEMENT ACT of 1999 Public Law 106-170 Referred to in FACT SHEET as "the Work Incentives Act"


The Work Incentives Act Provides: Increased health care coverage for workers with disabilities Increased choice in rehabilitation and employment services Social Security Work Incentive upgrades and reform For: Social Security Disability Program Beneficiaries and Workers with Disabilities Date of Enactment: December 17, 1999

The Work Incentives Act is an expansion of services and choices available to Americans with disabilities who work, or are planning to work. The Act begins the redesign of public long-term disability programs to keep pace with medical advances, assistive technologies, and the changing dynamics of the new workplace. The Act’s provisions are voluntary and grounded in the consumer’s control of when and what decisions will be made about work.

FACT SHEET BY: The California Work Incentives Initiative A WID/CIL Collaborative 510 16th Street, Suite 100, Oakland, CA 94612 Phone 510-251-4352 - Fax 510- 763-4109 - TTY 510-208-9493

THE TICKET TO WORK and WORK INCENTIVES IMPROVEMENT ACT of 1999 Public Law 106-170 “The Work Site” -- The Social Security Employment Support Web Site: FACT SHEET with EFFECTIVE DATES

Continuing Health Care Coverage for Workers With Disabilities ALL HEALTH CARE PROVISIONS EFFECTIVE OCTOBER 1, 2000 * MEDICAID: Buy-In for Workers with Increased Earnings or Resources The new federal law allows a state Medicaid buy-in option for workers with disabilities who earn over 250% of the federal poverty level. States may set their own income and resource limits and charge a premium for access to Medicaid services for workers with disabilities. * MEDICAID: Buy-in for Workers who “Medically Improve” State Medicaid buy-in option for workers with disabilities who lose eligibility for Social Security benefits due to medical improvement but continue to have severe medicallydeterminable disabilities. * MEDICAID: Demonstration to Maintain Independence A time-limited Medicaid buy-in demonstration program allowing states to extend Medicaid to certain workers who have a disability that, without ongoing health care, would become severe enough to qualify them for Social Security disability benefits. Federally funded at $250 million over six years. Grant text available at: * MEDICAID: State Infrastructure Grants Grants to states to develop and establish infrastructures to support working individuals with disabilities, for those states that provide personal assistance services (PAS) in their Medicaid state plan to the extent necessary to enable individuals with dis abilities to remain employed. Funds may be used to set up Medicaid buy-ins and demonstrations for workers with disabilities. Federally funded at $150 million over five years. Grant text available at:

* MEDICARE Access While Employed:


The Act provides for a new 4.5 year extension over current law for no-cost Medicare Part A after employment begins. Net effect: SSDI beneficiaries now receive at least 8.5 years of no-cost Medicare Part A after work begins at any earnings level. Effective date: October 1, 2000. Note: Medicare is available indefinitely, after 7.5 years of work credits are paid to a worker's FICA account, at a premium cost of $170.00/month, for as long as the worker remains disabled according to Social Security’s rules. Increasing Employment Services The Ticket-to Work and Self-Sufficiency Program PROVISIONS  SSI and SSDI beneficiaries receive a "Ticket-to-Work" from the Social Security Commissioner that allows them to choose a rehabilitation provider, employment services or other supports from a wider pool. Use of a Ticket and the Social Security Ticket program is voluntary. You must be a Social Security beneficiary to receive a Ticket. You assign the Ticket to an Employment Network service provider that meets your needs when you and the provider sign a written agreement, called an Individual Work Plan, or IWP. Social Security will reimburse an Employment Network when cash benefits stop for a beneficiary in the Ticket Program due to work activity. Payments to Employment Networks will be based on one of two reimbursement systems, a milestone payment system or an outcome based payment system. For up to date Ticket program information, please go to: The Ticket Program is being phased in gradually beginning in 2002. The first 13 states where beneficiaries are receiving Tickets in 2002 are AZ, CO, DE, FL, IL, IA, MA, NY, OK, OR, SC, VT, and WI. The Ticket Program comes to California Social Security beneficiaries in August 2003. The final Ticket program regulations took effect January 28, 2002. The first Ticket distribution began in February, 2002. For updates, go to: How Does the Ticket Program Work? Social Security has contracted with a private Program Manager, MAXIMUS, which recruits, monitors and oversees the Employment Networks, or ENs. An EN consists of Social Security approved public or private sector service providers authorized to accept a beneficiary’s Ticket based on the choice of the Social Security beneficiary.






An existing community service provider with other funding, a cooperative of individuals, or an employer could be in an Employment Network or could be their own Employment Network. See: An EN is not obligated to accept a Ticket and a beneficiary can switch providers without creating a problem. State Departments of Vocational Rehabilitation (DOR in CA) are required to be Employment Networks. One Stop Centers may elect to be service providers in an EN. (VR or One Stop Centers cannot be the Program Manager in the Ticket Program. The Program Manager will NOT provide actual employment services in an Employment Network.)


Continuing Disability (medical) Reviews or "CDRs" CDRs, or Continuing Disability (medical eligibility) Reviews, will not take place while a Ticket holder is enrolled and using the Ticket Program. Effective date: Upon implementation of Ticket Program in a region. (Cash benefits may still be subject to termination if earnings are substantial.) A beneficiary may change Ticket service providers. Program managers shall make payments to more than one Ticket Program service provider when a Ticket holder changes providers. The Social Security Commissioner has written proposed dispute resolution rules and other regulations when state and private providers serve the same Ticket user. A new and timely SSA Study and Report to Congress is mandated in the law to recommend provider payment rates for those who work with: Individuals with a need for ongoing support and services Individuals with a need for high cost accommodations Individuals who earn subminimum wages, and Individuals who work and receive partial cash benefits Click here to read the Advisory Panel's newly issued advice report to the Social Security Administration on the Adequacy of Incentives study and report required by the Ticket to Work and Work Incentives Improvement Act -- Microsoft Word Format


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Social Security Work Incentive Upgrades and Reforms PROVISIONS * Benefit Planning, Assistance and Outreach Program – The BPAO program Community based, cooperative agreements and competitive grants: statewide community based programs to work with consumers using work incentive rules and programs. $23 million dollars authorized per year for five years. 117 organizations across the country have been awarded BPAO grants (13 grants in California) from


Social Security (September 2001) For CURRENT grants and status:

* Social Security Employment Support Representatives - ESRs These are Social Security field personnel trained and assigned to work with beneficiaries and community based Benefits Planners on work incentive rules and programs. Effective upon enactment, now in 32 sites nationally. * "Expedited Reinstatement" Provision – or - “EASY BACK ON” Provision allows SSDI and SSI beneficiaries, when a work stoppage occurs, to get back on provisional benefits easily, pending a Social Security decision of their continuing disability. Cash benefits begin for six months while Social Security determines disability status. If the individual is found to be no longer disabled, the cash benefits do not have to be repaid to SSA. “EASY BACK ON” in the Act applies to former beneficiaries within the first five years after benefits cease due to work efforts and program rules. Effective date: January 1, 2001 * Continuing Disability Review (CDR) Protections Protection against work triggering a medical Continuing Disability Review or “CDR” for SSDI beneficiaries who have received benefits for 24 months. Protections against employment history being used as evidence of medical improvement in a medical CDR. Effective date: January 1, 2002. (Cash benefits may still be subject to termination if earnings are substantial.) * Protection and Advocacy Services Assistance for beneficiaries attempting to work who have disputes or difficulties. $7 million dollars authorized per year for 5 years. Effective upon enactment. 2002 CURRENT Grants and status: * Twelve Member Ticket to Work and Work Incentives Advisory Panel Consumers of services and other experts appointed by the President and Congress to advise the Social Security Commissioner, the President and Congress, and other federal agencies on the implementation of the Act and work incentive provisions. At least one-half of the panel members are required to be individuals with disabilities, or representatives of individuals with disabilities, with consideration given to current or former Social Security disability beneficiaries. Effective upon enactment. The Panel was sworn in by Social Security Commissioner Apfel and met for the first time July 24, 2000, in Washington. For information, go to: Write directly to the Panel at: TWWIIAPanel@SSA.GOV Demonstration Projects * Extension of Disability Insurance Program Demonstration Project Authority: Demonstration authority extended five years from date of enactment.


* "2/1" Demonstration Projects. Social Security is required to conduct adequate demonstration projects to provide for and study reductions in disability insurance benefits (SSDI) by $1 for each $2 that a beneficiary earns over a certain amount. Titles III and IV of THE WORK INCENTIVES ACT describe Government Accounting Office (GAO) studies and revenue "offsets."

APPENDIX I 2002 – CURRENT SSA WORK INCENTIVE RULES For current law and rules on the Social Security Disability Application Process and Work Incentives, go to: The Social Security Red Book -- CLICK ON RESOURCES/TOOLKIT, CLICK ON REDBOOK OR


Federal Poverty Level Guidelines From:

2002 HHS Poverty Guidelines
Size of Family Unit 48 Contiguous States and D.C. Alaska Hawaii 1 $ 8,860 $11,080 $10,200 2 11,940 14,930 13,740 3 15,020 18,780 17,280 4 18,100 22,630 20,820 5 21,180 26,480 24,360 6 24,260 30,330 27,900 7 27,340 34,180 31,440 8 30,420 38,030 34,980 For each additional person, add 3,080 3,850 3,540 SOURCE: Federal Register, Vol. 67, No. 31, February 14, 2002, pp. 6931-6933.


APPENDIX II SELECT WEB SITES ON: The Ticket to Work and Work Incentives Improvement Act (PL 106-170) and The Workforce Investment Act (PL 105-220) JOBS, HEALTH CARE AND PUBLIC PROGRAMS PRESIDENTIAL TASK FORCE ON EMPLOYMENT OF ADULTS WITH DISABILITIES Our mission is to create a coordinated and aggressive national policy to bring adults with disabilities into gainful employment at a rate that is as close as possible to that of the general adult population. SOCIAL SECURITY ADMINISTRATION “The Work Site” Social Security State Partnership Systems Change Initiative (SPI Programs) US CENTER FOR MEDICARE AND MEDICAID SERVICES WORK INCENTIVE ACT Informational Web site – What’s New? US DEPARTMENT OF LABOR Employment Training Administration WORK INCENTIVE ACT - Federal Grants and other Resources disAbility Online WORKSUPPORT.COM Information, resources, and research regarding the employment of people with disabilities. MEDICAID BUY-INS -- BACKGROUND and PROGRESS REPORTS State of Connecticut: A first state to adopt the Work Incentives Act Medicaid Buy-In Summary and Legislation Comprehensive, Person-Centered State Work Incentive Initiatives A Resource Center for Developing and Implementing Medicaid Buy-in Programs and Related Employment Initiatives for Persons with Disabilities

6 National Conference of State Legislators Ticket to Work: Medicaid Buy-In Options for Working People with Disabilities: by Julie Scales, NCSL, Donna Folkemer, NCSL, Allen Jensen, GWU The California "Workforce Inclusion Act" - AB 925, introduced February 23, 2001 Pending Legislation in the California Senate 2002 The provisions in AB 925, taken together, provide health care supports and information systems for workers with disabilities when they choose to seek services that support employment outcomes. Available at: EMPLOYMENT, HEALTH CARE, PUBLIC BENEFITS AND RELATED ISSUES Neighborhood Legal Services, Inc. A Legal Reference on the Net Home Page for SSA sponsored WorkWORLD Website Work Incentives NEWS at World Institute on Disability (WID) Benefits Assistance Resource Center - BPAO Programs Technical Assistance Website Rehabilitation Research and Training Center (RRTC) on Workforce Investment and Employment Policy for Persons with Disabilities A exceptional clearinghouse for policy briefs on both Acts: The Law, Health Policy & Disability Center: An emerging leader in technology, education, and research, focused on improving the quality of life for persons living with disabilities ONE STOP CENTERS AND THE WORKFORCE INVESTMENT ACT of 1998 Institute for Community Inclusion – A Great One Stop Web Site on One Stop Centers Got a question about One-Stop Centers or the Workforce Investment Act? Want to share your experience in using a One-Stop Center? Do you have any tips for people with disabilities using One-Stop Centers? Post your comment or question on our message board.


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