July 2001 Newsletter
Volume 1, Number 1
New Law to Increase Employment of People with Disabilities
In 1999, Congress passed the Ticket to Work and Work Incentives Improvement
Act (TW-WIIA), a law designed to help increase the employment of people with
disabilities, partly by removing federal disincentives to employment. The implementation
of parts of this law began in October 2000.
The first part of the legislation creates a new program called the "Ticket
to Work." This program, which will be phased in nationally over a three
year period, provides a voucher that consumers can use to select their own employment
or rehabilitation provider. Persons receiving SSI or SSDI and using the Ticket
would be exempt from continuing disability reviews during their job search.
In addition, the law provides for expedited benefits reinstatement for Ticket
users who are not successful at achieving gainful employment.
The second part of the Act is intended to remove barriers to employment by increasing
access to health care. The law gives states the option and provides incentive
grants to create a program for SSI and SSDI beneficiaries who enter gainful
employment to retain their Medicaid coverage. The Health Care Financing Administration
(HCFA) made funds available to facilitate the creation of these "Buy-In"
programs through Infrastructure Change grants. States may elect to: raise the
income limits for eligibility, disregard some earned and unearned income, raise
asset limits, exempt certain assets, and charge premiums on a sliding scale
(see page 4 for Kansas eligibility guidelines). The law also extends to eight
and one half years the cost-free period for Part A Medicare coverage for SSDI
beneficiaries who return to work. Why Was This Law Needed?
Federal disability programs have tended to punish, rather than reward, people
with disabilities who start or return to work. For this reason, the number of
people receiving disability benefits has steadily increased, but the number
of people who successfully gain employment remains very low. Consider the following
facts*:
1. From 1986 to 1995, the number of individuals receiving federal disability
benefits rose almost 70%, to 7.5 million.
2. Currently (as of 12/99), more than 9 million people with disabilities are
receiving benefits--about half through SSI and about half through SSDI.
3. Less than 1 out of every 500 SSDI beneficiaries currently leaves the rolls
by returning to work.
4. Only 6.7% of SSI recipients had any earned income in December of 2000, with
average monthly earnings of $481. Of this 6.7%, 24% were making $65 per month
or less.
5. Americans with disabilities spend more than four times as much on medical
care, services, and equipment, on average, than their non-disabled counterparts.
6. Seventeen percent of people with severe disabilities have no health insurance
coverage at all.
*Sources: National Institute on Disability and Rehabilitation Research, Social
Security Administration, World Institute on Disability
Advisory Council
The Kansas Working Healthy Program has recruited people with a wide variety
of knowledge and expertise to serve on an advisory council, which meets on a
quarterly basis. The first meeting took place in Lawrence on April 17, 2001.
Future meetings include: Lindsborg, July 6th; Topeka, October 5th; and Wichita,
January 4th. The members of the advisory council are as follows:
• Crystal Ashenbrenner, Ottawa
• Dale Barnum, KS Rehabilitation Services, Topeka
• Larry Cupps, TECH Inc., Hutchinson
• Brenda Eddy, Topeka
• Michael N. Flesher, LINK, Hays
• Michael Fox, KU Health Policy and Management, Lawrence
• Wendy Fuqua, Nuts & Bolts Inc., Hugoton
• Mary Fusco, HIV Program KU School of Medicine, Wichita
• Martha Gabehart, KS Commission on Disability Concerns, Topeka
• Jim Germer, KS Advocacy and Protective Services, Topeka
• Meri Gifford, Ottawa
• Jean Hall, KU Health Policy and Management, Lawrence
• Jennifer Hendrix, Community Supports and Services, Topeka
• Bob Hull, Cerebral Palsy Research Foundation, Wichita
• Randy Johnson, HCP/Mental Health/SATR, Topeka
• Sharon Johnson, SRS Division of Health Care Policy
• Shannon Jones, Statewide Independent Living Council of KS, Topeka
• Noelle Kurth, KU Health Policy and Management, Lawrence
• Leigh Liggett, Brain Injury Association of KS, Kansas City
• Shirley Martin Smith, Adecco/Martin Smith Personnel, Lawrence
• Gina McDonald, KS Association of Centers for Independent Living, Salina
• Karen McNally, Comcare, Wichita
• James R. Miller, Lawrence
• Tricia Morgan, Stockton
• Howard Moses, SRS Division of Health Care Policy
• Mike Lynam, Central KS Mental Health Center, Salina
• Chris Owens, Prairie Independent Living Resource Center, Hutchinson
• Mike Oxford, Topeka Independent Living Resource Center, Topeka
• David Reyes, KS Elks Trainings Center for the Handicapped, Wichita
• Jane Rhys, KS Council on Developmental Disabilities, Topeka
• Daryl Rutschmann, KS Association for the Medically Underserved, Topeka
• Peg Spencer, KS Rehabilitation Services, Topeka
• Donna E. Sweet, KU School of Medicine, Wichita
• Cindy Taylor, Topeka
The Kansas Infrastructure Change Project
Background
In October, 2000 the state of Kansas received an Infrastructure Change grant
from the US Department of Health and Human Services. The grant was awarded to
facilitate changes in the Kansas Medicaid system that will increase services
and supports to individuals with disabilities who want to work, as well as those
currently working, without the fear of losing health coverage. Kansas will use
the grant to begin a Medicaid Buy-In program starting in January, 2002 which
will allow Kansans with disabilities to maintain or initiate Medicaid coverage
when they enter competitive employment (see page 4 for details of the program
and eligibility requirements). In explaining the importance of the grant and
the changes it will support, SRS Secretary Janet Schalansky recalled a statement
of "the great labor priest, George Higgins, 'Work is an important way in
which we exercise our humanity. In return, society offers us not only our daily
bread, but a sense that we, ourselves, are honored for the contributions we
make.'" Program
Philosophy and Services
The Kansas Buy-In program, called "Working Healthy: Making Health Care
Work," is founded on the philosophy of encouraging people to develop assets
that will prevent them from needing to go back to reliance on any type of public
assistance. By allowing the accumulation of assets such as savings and checking
accounts, retirement funds, and equity in homes, the program empowers people
with disabilities to have a buffer to face emergencies, undertake new life ventures,
and become self-sufficient.
The Kansas program is also committed to providing services that are person-centered
and wraparound in nature. Wraparound is a person/family-of-choice-centered,
strengths-based, needs-driven planning process for creating individualized services
and supports for eligible recipients with disabilities wishing to work and also
for their designated families of choice who facilitate access to inclusive community
options, activities, and opportunities. The project permits flexible use of
state Medicaid, Workforce Improvement Act, SSA Benefits Counseling, and other
funds targeting employment to permit the individualized, intensive, wraparound
service packages necessary to keep eligible individuals who wish to work and
their families of choice in gainful employment settings.
Other Activities
Regular participant satisfaction surveys will be conducted by the University
of Kansas Health Care Policy and Management Department to ensure that the program
is meeting its stated goals. An advisory group (see page 2) comprised of at
least 50% people with disabilities will provide guidance, feedback, and concerns
for the project. In addition, the project will fund outreach activities to increase
public awareness of the program and its potential benefits. In 2002 and 2004,
the project will host statewide training and input conferences for consumers
and providers. These conferences will provide a forum both for learning about
the program and suggesting ways to make it work better.
Goals of "Working Healthy: Making Health Care Work"
Goal one: Emphasis on Work Outcome - With this initiative, the State of Kansas
will be able to announce by 2004 "the highest growth rate of percentage
of individuals with disabilities placed in employment than in any other state."
Goal two: Inter-Connected Infrastructure Necessary - Program design must be
accessible, coordinated with other public policy and programs (health care,
training, and benefits eligibility), and understandable to agency staff, consumers
of services, and others.
Goal three: Do No Harm- Public program policy and outcomes shall do no harm
to people with disabilities and/or to other family of choice members.
Many people with disabilities want to work but worry that doing so could jeopardize
their vital health and long term care coverage. The Working Healthy Program
offers people with disabilities who are working or interested in working the
opportunity to keep their Medicaid coverage while on the job.
Benefits Include...
• The same as those available through Kansas Medicaid.
• The opportunity to earn more without the risk of losing health care coverage.
• Higher asset and income eligibility.
• Increased personal and financial independence.
• Personal assistance services (PAS) and targeted case management.
Eligibility...
If you meet the following criteria, you may be eligible:
• Assets and income. You have individual assets of less than $15,000 and
net family income below the Working Healthy Program limits.
• Age. You are 16-64 years of age.
• Disability. You meet the SSI or SSDI disability standard, whether or
not you have received SSI or SSDI in the past.
• Employment. You have verified earned income from competitive employment.
• Residency. You are a Kansas resident.
Monthly premium...
Some people may be required to pay a monthly premium. The premium is:
• never more than 7.5% of your total monthly income and
• calculated on a sliding fee scale based on your income.
In addition, some of your income may be disregarded in calculating this premium.
The personnel who assist you with the program will be able to calculate your
monthly premium for you.
If you are interested in pursuing your career goals but have been afraid that
doing so might disqualify you from the health coverage you need, the Working
Healthy Program may be the program for you!
Check out our website: http://das.kucrl.org/medicaid.html
On-line Resources
• http://www.ssa.gov/work/ResourcesToolkit/legisregfact.html
This website of the Social Security Administration provides a simple "fact
sheet" of information about the Ticket-to-Work and Work Improvement Incentives
Act of 1999 (TW-WIIA).
• http://www.uiowa.edu/~lhpdc/work/index.html
This site maintained by the University of Iowa Resource Center for Developing
& Implementing Medicaid Buy In Programs and Related Employment Initiatives
for Persons with Disabilities gives detailed downloadable narratives on the
formation of new state policies related to the Medicaid Buy-In.
• http://www.thearc.org/ga/wiia_summary.html
The Arc, an advocacy group for people with developmental disabilities, provides
a summary of selected provisions of TW-WIIA, including Medicaid Buy-In at this
web site.
• http://www.pacer.org/employ/workinc.htm
This portion of the PACER (Parent Advocacy Coalition for Education Rights) web
site provides information focusing on employment strategies for youth and adults
with disabilities, including information regarding TW-WIIA and Medicaid Buy-In.
• http://www.ssa.gov/work/panel/index.html
The TW-WIIA legislation includes a provision for establishing an advisory panel
"to advise the Commissioner of Social Security and report to the President
and Congress on issues related to work incentive programs, planning and assistance
for individuals with disabilities." This web site is the home page for
this panel and contains information about the members, their meetings and updates
of their activities.
• http://www.hcfa.gov/medicaid/twwiia/ksinf.htm
This site of the Health Care Financing Administration (HCFA) provides information
about the activities of and contact information for Kansas' Medicaid Buy-In
Project.
• http://www.ssic.org/primer.html
This web page by the SSI Coalition for a Responsible Safety Net includes information
on Buy-In programs, TW-WIIA, and the Health Insurance Portability and Accountability
Act (HIPAA).
"Not since the passage of the Americans with Disabilities Act in 1990
has legislation promised to so significantly improve my quality of life. Finally,
there is a program that will allow me to use my talents, skills, and education
in a way that is productive and meaningful without losing the benefits that
I need in order to thrive in my community."
-Lorraine C.
Lawrence, KS
"Working Healthy" is the new name of the Kansas Medicaid Buy-In Program.
All future reference to the Buy-In Program will be under this new title, "Working
Healthy."
Working Healthy is published by the KU Department of Health Policy and Management,
in cooperation with the KU Division of Adult Studies and the Kansas Department
of Social and Rehabilitation Services.
Additional copies and copies in alternate formats are available upon request
by writing the University of Kansas Department of Health Policy and Management,
c/o Division of Adult Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall
Rm. 517, Lawrence, KS 66045,
by phone (785) 864-7085, by email: pixie@ukans.edu
KU Research Team:
Michael Fox, Principal Investigator
Jean Hall, Project Coordinator
Noelle Kurth, Editor
Erin Rink, Research Assistant
SRS, Division of Health Care Policy Staff:
Marianne Deagle, Communications Director
Howard Moses, Program Administrator
Sharon Johnson, Program Analyst