Notes

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HIGHLIGHTS OF THE NEW TICKET LEGISLATION: CREATES THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM ALSO KNOWN AS THE TICKET PROGRAM FOR BENEFICIARIES WHO HAVE BEEN RECEIVING SSDI FOR AT LEAST 24 MONTHS, NO WORK-TRIGGERED MEDICAL CONTINUING DISABILITY REVIEWS WILL OCCUR.  ALSO, WORK ACTIVITY CANNOT BE USED AS EVIDENCE THAT A DISABILITY HAS ENDED EXPEDITED REINSTATEMENT EMPLOYMENT SUPPORT REPRESENTATIVE POSITION (CORPS OF WORK INCENTIVE SPECIALISTS)

HIGHLIGHTS OF THE NEW TICKET LEGISLATION: CONTINUED BENEFITS PLANNING, ASSISTANCE AND OUTREACH GRANTS AND COOPERATIVE AGREEMENTS FUNDING FOR PROTECTION AND ADVOCACY GRANTS ESTABLISHED THE 12-MEMBER WORK INCENTIVES ADVISORY PANEL IMPROVEMENTS TO HEALTHCARE (MEDICARE & MEDICAID) AUTHORIZATION FOR DEMONSTRATION AND RESEARCH PROJECTS

THE TICKET PROGRAM WILL BE PHASED IN NATIONALLY FROM 2001-2004, BEGINNING WITH 13 INITIAL ROLL OUT STATES.  THE INITIAL ROLL OUT STATES ARE:  ARIZONA, COLORADO, DELAWARE, FLORIDA, ILLINOIS, IOWA, MASSACHUSETTS, NEW YORK, OKLAHOMA, OREGON, SOUTH CAROLINA, VERMONT, WISCONSIN THE SOCIAL SECURITY ADMINISTRATION (SSA) SELECTED MAXIMUS INC. TO SERVE AS THE PROGRAM MANAGER FOR THE TICKET PROGRAM.  THE TELEPHONE NUMBERS FOR MAXIMUS ARE:  1-866-968-7842 OR 1-866-YOURTICKET; TTY: 1-866-833-2967; 1-866-TDD 2 WORK. ESTABLISHES EMPLOYMENT NETWORKS.  EMPLOYMENT NETWORKS CAN BE ANY QUALIFIED STATE, LOCAL OR PRIVATE ORGANIZATION TO INCLUDE STATE VR AGENCIES; ONE-STOP DELIVERY SYSTEMS; PUBLIC OR PRIVATE SCHOOLS THAT PROVIDE VOCATIONAL REHABILITATION OR EMPLOYMENT SERVICES; OR EMPLOYERS. PROVIDES PAYMENT FOR EMPLOYMENT OUTCOMES, NOT SERVICES

FEATURES OF THE TICKET PROGRAM TICKETS WILL BE MAILED AUTOMATICALLY TO ALL ELIGIBLE BENEFICIAREIS IS VOLUNTARY PROVIDES CUSTOMER CHOICE IN SELECTION OF EMPLOYMENT NETWORK/SERVICE PROVIDER ENCOURAGES OWNERSHIP OF AND ACTIVE PARTICIPATION IN THE DEVELOPMENT AND IMPLEMENTATION OF THE INDIVIDUAL EMPLOYMENT PLAN  PROVIDES PROTECTION AGAINST THE INITIATION OF CONTINUING DISABILITY REVIEWS (MEDICAL) FOR THOSE INDIVIDUALS WHO ARE USING A TICKET,AS DEFINED BY THE COMMISSIONER OF THE SSA ESTABLISHES WORK AND EARNINGS GUIDELINES FOR TIMELY PROGRESS WAS DESIGNED TO ACCOMMODATE RELAPSES IN PROGRESS DUE TO HEALTH CONDITIONS THAT MAY TEMPORARILY PREVENT AN INDIVIDUAL FROM PARTICIPATING IN THE PROGRAM

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What is Expedited Reinstatement ? (EXR) Allows former disability beneficiaries to come back on the rolls without having to file a new application Up to 6 months of provisional benefits are paid while a medical decision is made on reinstatement Is eligible for Medicare/Medicaid during the provisional period

Expedited Reinstatement Ticket to Work and Work Incentives Improvement Act of 1999 Effective January 2001 in all States Allows individuals to request reinstatement of their Social Security or SSI benefits based on disability or blindness

Who is eligible for EXR? A former Social Security beneficiary Disability Disabled Widow/er, surviving disabled divorced spouse Child benefits based on disability A former SSI beneficiary Disability Blindness

How do you qualify for EXR? Your benefits were previously terminated due to work you did You are no longer able to work or perform Substantial Gainful Activity (SGA) because of your impairment Your impairment is the same as or related to the impairment you had from the previous entitlement

Timeframe for requesting EXR? You must request EXR within 60 consecutive months following the month of prior termination of benefits Your request for EXR can be done in writing or verbally

How much is the Provisional Benefit? Social Security Beneficiaries The provisional benefit is equal to the last monthly benefit payable to the beneficiary  increased by any intervening cost of living adjustments.

How much is the Provisional Benefit? SSI beneficiaries The provisional benefits is the same amount any SSI-eligible individual would receive based on normal income counting rules.  State supplement is not included.

Approved for Reinstatement of Social Security Benefits Reinstatement can be retroactive for one year, but no earlier than January 2001 The first 24 payments are paid for months of non-SGA Reinstatement of Medicare with a new initial enrollment period

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SSA’s DISABILITY PROGRAMS Social      Security Disability Insurance SSDI Title II of the SSAct. Medicare Supplemental Security Income Program SSI Title XVI of the SSAct. Medicaid

SSDI-Medicare SSDI recipients get medical coverage via Medicare AFTER 24 months on the rolls (Medicare Qualifying period).

Health Care Health Care is important to all Americans Health Care is particularly important to individuals with disabilities Fear of loosing health care is the greatest barrier SSDI and SSI beneficiaries risk loosing Medicare and/or Medicaid

"Health insurance improvements" Health insurance improvements Extended Medicare coverage Medicaid buy-in, Ticket legislation Medicaid Infrastructure Grants Medicaid Demonstrations Medigap Suspensions

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Comparison of Before and After Ticket Legislation Before Medicare continues at least 39 months(3 yrs., 3 mos.)  after the trial work period  (TWP) ends. Medicare continues for at least 4 years (includes TWP) when you return to work. After Medicare continues at least 93 months (7 yrs., 9 mos.) after the trial work period (TWP) ends. Medicare continues for at least 8 and 1/2 years (includes TWP) when you return to work.

WHO is Eligible for The Additional 4 1/2 yrs. of the  Extended Medicare Coverage ? This new law applies  if the individual is:

"starting to work for the..." starting to work for the 1st time, after disability entitlement, or Currently in a TWP, or Is in an Extended Period of Eligibility (36 month-reinstatement period) that began on or after 7/97. Note: Others may qualify whose EPE began prior to 7/1/97,  but it depends on their SGA activity.

Example : SSDI DOE 07/96 TWP ends 12/98 with SGA and continuing EPE begins 01/99 Medicare termination date (TWWIIA): 10/1/2006

SSDI-Medicare for People With Disabilities Who Work IF: The individual continues to have a disabling condition ... THEN: After the Extended Medicare ends, the individual may purchase Medicare by paying the Hospital Insurance and Supplemental Medical Insurance monthly premiums. NOTE:  - States may pay Hospital Insurance premiums if individual has low income and resources.

Medicare Hospital Insurance (Part A) Premium Reduction $300 for Part A $50 for Part B (Medical Insurance) Reduced Rate $165 for Part A 30 Quarters of Coverage (QCs) or married at least 1 year to a NH with 30 or more QCs. Many beneficiaries would meet the 30 QC requirement.

Employer Group Health Plans & Premium HI Medicare is primary payer for Premium HI beneficiaries with disabilities. A Special enrollment period can apply for these beneficiaries who is in a group plan and who decide to purchase premium HI, or if the group plan ends.

Suspension of Medigap Insurance Allows workers with disabilities who have Medicare and Medigap insurance to suspend the premiums and benefits of the Medigap insurance if the have employer-sponsored coverage. When effective--effective for requests for suspension after December 17, 1999.

Medicaid Permits States more flexibility to cover people with disabilities who work Permits States to allow buy-in for those on SSI/SSDI who have medically improved HHS provides infrastructure grants to States for workers with disabilities HHS now has demonstration projects.

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Health Care --Medicaid, continued Effective when--October 1, 2000 SSA Role--Works with CMS (formerly HCFA) on State activities, grants, and policies. CMS awarded grants to 26 States.  Others pending HCFA awarded 2 demonstration projects and still has funds available for more.

Return to Work! And Keep Health Insurance

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Speaker Information Pam McHugh--Pamela.McHugh@ssa.gov Kristine Erwin-Tribbitt--Kristine.Erwin-Tribbitt@ssa.gov B.J. Olson--B.J.Olson@ssa.gov Wanda Nenner--Wanda.Nenner@ssa.gov www.ssa.gov/work