January 2002 Newsletter
Volume 1, Number 3
New Team Member Joins Working Healthy
Mary Ellen O'Brien Wright assumed her new job as the Benefits Specialist Team
Leader on January 2. Mary Ellen will be responsible for hiring, training, and
managing the 11 Benefits Specialists who will work at the area SRS offices with
consumers interested in enrolling in Working Healthy. Mary Ellen brings a broad
background in disability issues to her job, including her most recent experiences
as the Executive Director of KATCO, a loan program for people who need assistive
technology. She also worked for more than seven years with the Kansas Association
of Centers for Independent Living (KACIL). Mary Ellen can be reached at (785)
296-5217 or emailed at meow@srskansas.org.
Policy Updates
On December 4th & 5th Marianne Deagle and Sharon Johnson attended the Center
for Medicare and Medicaid Services (CMS) conference "Access to Employment:
Getting the Most Out of Your Infrastructure Grant." On December 6th, they
attended the National Consortium For Health Systems Development (NCHSD) Annual
Meeting. Both meetings were held in Baltimore, Maryland. NCHSD provides technical
assistance to states awarded Infrastructure grants by CMS. Representatives from
many of the states who attended the conference related similar challenges in
implementing their programs. Some of the important topics discussed at this
national meeting are highlighted on the following pages.The issues most every
state attending the conference are facing are declining revenues and massive
budget shortfalls. November reports from the National Governor's Association
and the National Council of State Legislators report that 46 states have significant
revenue shortfalls and diminishing reserves.
At issue for Medicaid Infrastructure Grant (MIG) states is the implementation
or expansion of Personal Assistance Services (PAS) as required by the MIG. States
developing programs, including Kansas, have asked CMS for guidance regarding
the scope of PAS offered to all who qualify under the State Medicaid Plan. This
question must be addressed in order to assist the state in containing costs
in the face of an ever rising state Medicaid budget, and rapidly diminishing
state revenues.
To date, CMS has not allowed states to define levels of work in order to access
PAS. The inability to require participants to be engaged in a certain level
of work, defined by number of hours worked, in order to obtain PAS could potentially
deepen the financial problems states are struggling to resolve.
Kansas remains committed to making PAS available to people to expand their
work levels or return to work. Shannon Jones, Gina McDonald and Mike Lynam,
members of the Working Healthy Advisory Council, along with Sharon Johnson,
Marianne Deagle and Jean Hall are forming a subcommittee to discuss the many
issues associated with providing personal assistance services in the work place.
Their recommendations will be presented to the Working Healthy Advisory Council
in the future.The U.S. Supreme court has agreed to review the definition of
disability used for Social Security Disability Insurance (SSDI) and Social Security
Insurance (SSI). In Barnhart v. Walton, the court will address the question
of whether an individual's impairment meets the statutory definition of disability
when he/she returns to the substantial gainful activity (SGA) level within twelve
months of the date of the onset of the person's disability. The Court will also
take up the question of whether an individual who has returned to SGA within
12 months of onset and before adjudication is entitled to a trial work period
(TWP).
Initial eligibility criteria for SSI/SSDI are the same, unless an applicant
is under 18 years of age. These criteria are:
- Individuals must have a disability that can be documented by a qualified medical
examiner and they must meet a certain level of disability;
- The disability must be expected to last 12 or more months or be expected to
result in death;
- Individuals cannot be working at the time of application, or, if working,
cannot be earning more than the SGA level of $740 per month for individuals
with a disability other than blindness or $1,240 if they are blind;
- By federal law, individuals who are blind and applying for SSI do not need
to meet an SGA test but rather a test to ascertain a level of blindness.
- Each state has a Disability Determination process administered by Social Security
Administration. Disability Determination Services (DDS) does an evaluation of
the individual applying for SSI/SSDI. DDS follows a five step process to determine
the presence or absence of a disability. Those five steps are:
Is the person working at a substantial level?;
Is the individual's medically determinable impairment or combination of impairments
considered "severe"?;
If the impairment is determined to be severe, does it meet or medically equal
the severity of a listing in SSA's Listing of Impairments?;
If the impairment is severe, but does not meet or equal the severity of a listing,
does the individual retain the capacity to do his or her past relevant work?;
- If past relevant work is precluded, does the individual retain the capacity
to do any other kind of work which exists in significant number in the national
economy, considering the individual's residual functional capacity and the vocational
factors of age, education and work experience.
Reviewing again the questions in SSA's petition to the Supreme Court:
1. Is an SSA disability claimant entitled to disability benefits under the SSI
and SSDI programs if he or she has a physical or mental impairment that has
lasted or can be expected to last at least 12 months, but this inability to
engage in substantial gainful activity by reason of that impairment has not
lasted or cannot be expected to last 12 months.
2. Whether a claimant under the SSDI program may be under a disability and entitled
to a trial work period if, at the time his/her disability insurance benefits
claim is adjudicated, his/her impairment no longer prevents him/her from performing
substantial gainful activity.
Michael Cheek, Director of the American Public Human Services Association's
(APSHA) Center for Worker's with Disabilities, has summarized the implications
of the Court's decision on Medicaid Buy In Programs. He points out that a major
concern of states operating or developing these programs is reconfiguring the
process used to decide the presence or absence of a disability. The Balanced
Budget Act of 1997 and the Ticket to Work and Work Incentives Improvement Act
of 1999, for the purposes of eligibility, allow state DDS agencies to ignore
the first step in the five step evaluation process, and, to ignore the presence
of work activity when considering working persons with disabilities. States
have taken different approaches to factoring out SGA and work in the disability
determination process. However, most states need clearer guidance from SSA and
CMS on how to address this policy issue while also providing states legal shelter
and protection for individuals already enrolled in Buy-In Programs. Barnhart
v. Walton brings to the forefront this policy difficulty of considering impairment,
but also requiring the absence of work at or above SGA as a necessary step in
determining disability.
The Supreme Court will hear the case January 16, 2002. CMS and SAA have recognized
the need for policy clarification and legal guidance on this issue. Both agencies
are committed to working together to resolve these issues, and will begin meeting
early in 2002.
Howard Ray Moses
December 6, 1950 - October 28, 2001
"Howard Moses was a simple man - but simple only in the respect that he
knew all of the basic ingredients that make up a FULL life. With his keen knowledge
of human character and his unfailing belief in the goodness of people, he profoundly
affected the lives of all of us here and indeed, the lives of millions of others
around the world."
D. Ray Fuller, Jr.
3 November 2001
"Howard Moses will be remembered as a public policy strategist and enlightened
intellect whose commitment to human and civil rights was an inspiration to those
who knew him. Howard influenced every piece of major disability rights legislation
in the last fifteen years including the ADA, the reauthorization of the Rehabilitation
Act, TW-WIIA, and the IDEA.
Howard grew up in Kansas and began working at the grassroots level to improve
the lives of people with disabilities immediately after graduating from college.
He later used his innate political skills working for Democratic candidates
in Kansas and then came to work in Washington in the 1980's. He was a civil
servant in the Department of Education working with Justin Dart, Commissioner
for the Rehabilitation Services Administration and worked with the late Evan
Kemp at the Equal Employment Opportunity Commission. In 1993, he was named by
President Clinton and Secretary Richard Riley to be the Deputy Assistant Secretary
for the Office of Special Education and Rehabilitative Services at the US Department
of Education.
Most recently, Howard returned to Kansas to work on implementation of the TW-WIIA
and the Olmstead decision. Kansas was thrilled that he returned home to work
on these critical pieces of legislation. This allowed him to use his wealth
of experience to continue to fight for the civil and human rights of disabled
people.
Howard's tenaciousness must be carried on by those who knew and loved him and
by those who believe in his dream of Justice for All."
The Washington D.C. Blade
30 October 2001
"Howard was a man of profound intellect, profound principle, profound
courage and especially, profound love. Howard radiated love from every aspect
of his being. If the term 'saint' refers to an existence of love and courage
rising to the sacred, Howard was a saint.
Howard made monumental contributions to the quality of human being. These contributions
of love and truth will warm the lives of millions in future generations - millions
who will never know his name, but who will be lifted by his love.
Let us honor Howard by multiplying in our lives his heritage of advocacy for
a society of love, truth and justice. We love you."
Justin and Yoshiko Dart
28 October 2001
All of us involved with the Working Healthy program would like to extend our
love and respect for Howard. His vision for the world, the nation, the state
of Kansas and this program will be a part of us as we do our work each day.
We thank Howard for the work he did throughout his life and we vow to carry
on and to persevere to make his vision a reality.
Ticket to Work
Regulations Finally Published!
After a great deal of debate, the final regulations for the Ticket to Work program
have been published in the Federal Register. The regulations confirm that Kansas
will become a Ticket state sometime during calendar year 2002. They also contain
a question and answer section about how tickets will be issued, how consumers
can use them, and how providers will be reimbursed.
Look for more information about this important topic in our next newsletter
(April 2002). In the mean time, you can access a copy of the regulations at
the following web site by scrolling down to Social Security Administration,
Rules:
http://www.access.gpo.gov/su_docs/fedreg/a011228c.html
Frequently Asked "Ticket" Questions
What is a ticket under the Ticket to Work program?
The ticket is issued to a consumer by the Social Security Administration under
the Ticket to Work and Self-Sufficiency Program. If he or she wants help in
returning to work or going to work for the first time, he or she may offer this
ticket to an Employment Network of his or her choosing or take it to the State
Vocational Rehabilitation agency for services. If a consumer chooses an Employment
Network and it agrees to take the ticket, or if he or she chooses a State agency
and qualifies for services, these providers can offer the services needed to
go to work.
An Employment Network provides the services at no cost to consumers. The Social
Security Administration will pay the Employment Network if a ticket is assigned
to it, and the Employment Network helps the consumer go to work and complies
with other requirements of the Program. An Employment Network serving under
the Program has agreed to abide by the rules and regulations of the Program
under the terms of its agreement with the Social Security Administration for
providing services under the Program. The State agency can inform consumers
about its rules for getting services.
Who is eligible to receive a ticket under the Ticket to Work program?
A SSDI disabled beneficiary must be age 18-64, and a SSI disabled beneficiary
must be age 18-64 and be eligible for disability payments under the disability
standards for adults.
What do I do when I receive a ticket?
A consumer's participation in the Ticket to Work program is voluntary. When
a ticket is received, consumers are free to choose when and whether to assign
it. If he or she wants to participate in the program, the ticket can be taken
to an Employment Network of his or her choosing or to the State Vocational Rehabilitation
(VR) agency.
Regional Meeting Held in Chicago
KU and SRS staff members as well as two consumers from Kansas attended one of
three regional meetings hosted by the National Consortium on Health Systems
Development (NCHSD). The meeting was held in Chicago on January 15 and focused
on measurement capacity and development for Medicaid Buy-In programs. The emphasis
of the meeting was what information and data is important to collect and how
best to collect it. The meeting also provided the opportunity for states at
different stages in their programs to share successful strategies and barriers
encountered. NCHSD will provide a summary of all of the meetings in late February,
and we will share highlights of that summary in the next newsletter (April 2002).
Mark Your Calendar...
Working Healthy will hold its first statewide outreach conference in conjunction
with the Kansas Conference on Social Welfare. The conference will be held at
the Lawrence Holidome, April 7-9. We are very pleased that Bryon R. MacDonald
will be our keynote speaker. Bryon is a Public Policy Advocate with the World
Institute on Disability in Oakland California, a board member at large of the
National Council on Independent Living, and a presidential appointee to the
Ticket to Work and Work Incentives Advisory Panel. For many years, he has developed
employment support and benefits counseling programs and served as a consultant
to various advisory committees on employment support for persons with disabilities.
For more information about the conference, please contact:
Candace Eck
c/o CSE
P.O. Box 47154
Wichita, KS 67201-7154
Phone - (316) 337-6535
Email - cve@srskansas.org
This newsletter and other Working Healthy program information can be found
online at: http://das.kucrl.org/medicaid.html
Working Healthy is published quarterly 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@ku.edu
KU Research Team
Michael Fox, Principal Investigator
Jean Hall, Project Director
Noelle Kurth, Editor
Erin Rink, Research Assistant
SRS, Division of Health Care Policy Staff
Marianne Deagle, Acting Director
Sharon Johnson, Deputy Director
Mary Ellen O'Brien Wright - Benefits Specialist Team Leader