Review of Public Law 106-170
The Ticket To Work and Work Incentive Improvement Act of 1999
by: Bruce Growick, Ph.D.
The Ticket To Work and Work Incentive Improvement Act of 1999 (TTWWIIA) passed the Congress in the Fall of 1999, and was signed into law by President Clinton in December of last year. This law has the potential to increase the employability of America’s disability community, in the same way that ADA has increased their participation and accessibility to public activities.
Passing the TTWWIIA was not a simple task though. Current congressional regulations require all new legislation to be “budget-neutral”, meaning that the anticipated spending associated with a bill needs to be offset by expected savings, or cutbacks elsewhere. The effort was critical, however, as the Social Security system has been severely overtaxed for more than a decade. The TTWWIIA provides critical first-steps toward the removal of barriers to work for Social Security Beneficiaries, and the ability to bring financial solvency to the SSA trust fund.
Background to Passage of TTWWIIA
Current policy in administering SSA benefits have unfortunately created numerous barriers for people with disabilities who want to return to work; beneficiaries are faced with a plethora of diminishing returns for their rehabilitative efforts. Beneficiaries of Social Security (both Supplemental Security Income [SSI] and Social Security Disability Insurance [SSDI]) who want to return to work, risk losing their cash benefits as well as their healthcare coverage from either Medicare or Medicaid. What the TTWWIIA does is provide an opportunity for beneficiaries to receive return-to-work services, and not lose their indemnity and healthcare benefits entirely.
Theoretically, the TTWWIIA supports the major principles of the ADA, that all individuals should have the same opportunity to be productive citizens without sacrificing their benefits from being disabled. The language of the ADA departed historically from prior disability legislation in that it was based in a civil-rights context, rather than an entitlement context. The innovation of the Workforce Incentive Improvement Act is that it tries to bridge the two contexts, providing one method of achieving the ultimate purpose of the ADA by combining return-to-work services with sustaining disability benefits.
According to Senator Ted Kennedy, this legislation will not only help people to help themselves, but it will also increase the solvency of the SSA trust fund . It is estimated that the cost of the new program will be recouped if 70,000 people leave the SSA disability roles and return to work, and if 210,000 do so (only 10% of the number of people in the disability community who are estimated to be willing to avail themselves of this new opportunity according to the GAO), the savings would reach $1 billion annually in disability payments. The best-case scenario could ideally yield savings in excess of $10 billion per year to the SSA disability trust fund.
For an excellent review of the historical antecedents to TTWWIIA, we suggest you read “Growth in Disability Benefits”, edited by Kalman Rupp and David Stapleton (1998) in which the history of the administration of SSA disability benefits is traced and the need for reform articulated.
Implementation of TTWWIIA
To assist in the implementation of TTWWIIA, the act calls for establishing a Work Incentives Advisory Panel within 90 days of the bill’s passage. This panel composed of 12 members of different political and constituent backgrounds has the responsibility of helping the SSA to devise the rules and regulations for the program. Overall, different parts of the legislation (extension of healthcare benefits, availability of return-to-work services, etc.) have different phase-in dates. The Act in its entirety is to be phased-in over a five year period from the date of its passage.
Major Provisions of TTWWIIA
There are three major provisions of TTWWIIA which are important to rehab professionals and their clients. They are expanded healthcare coverage, new and improved employment services, and the elimination of certain disincentives to return-to-work.
1. Expanded Availability of Healthcare Services
The TTWWIIA provides the opportunity for SSA beneficiaries to retain their healthcare when they return to work. For SSI beneficiaries who receive Medicaid, the TTWWIIA removes limits on a buy-in option for workers with disabilities; States will now be allowed to remove the upper income limit which was 250% of the established poverty-level for income (about $21,000 per year). This provision allows individuals to buy into Medicaid when their jobs pay more than low wages, but doesn’t give them the level of healthcare they need. The TTWWIIA also gives the States the option to allow people to retain Medicaid when their medical condition improves secondary to medical coverage. Finally, the TTWWIIA also provides $150 million over the course of five years to States to help them administer this new benefit.
For SSDI recipients who receive Medicare, under previous rules, they could maintain medical benefits through Medicare parts A and B for three-and-half years post employment at the rate of $350 per month. Under TTWWIIA, people with disabilities who return to work will be able to extend Medicare Part A for an additional four-and-a-half years (reducing the aforementioned cost to about $46/mo. during eight years of gainful employment).
Additionally, prescription drug assistance will be available nationwide, even in states that do not elect the Medicaid options.
Interestingly, a 250 million dollar demonstration project is included in the law which will support the early intervention of medical treatment for those individuals who are working, and their medical condition has not deteriorate enough to prevent employment. For individuals with muscular dystrophy, Parkinson’s disease, AIDS or diabetes, they can obtain Medicaid coverage in order to prevent further deterioration, and lose employment.
As verified by the GAO in a national survey of SSA recipients who have returned to work, healthcare is the greatest barrier for SSA beneficiaries returning to work. By providing the opportunity for adequate healthcare regardless of salary level, it is hoped that many more individuals will chose employment over benefits.
2. New and Improved Return-to-Work Services
The Ticket to Work portion of TTWWIIA enhances the employment opportunities of SSI and SSDI recipients by allowing beneficiaries to obtain vocational rehabilitation and employment services from their choice of provider. In addition to the State-Federal system of vocational rehabilitation, which has been the sole provider of services, beneficiaries will be able to chose from a registry of private providers. These private providers will be called employment networks, and their responsibility will be to help the beneficiaries return to work. If a beneficiary becomes gainfully employed, providers can be paid a portion of the annual savings to the trust fund for up to five years after employment. This way it is hoped that providers will maintain contact, and reduce any recidivism.
To encourage the utilization of these new services, a work incentives outreach program will be established to help workers with disabilities to obtain employment services and support. It is hoped that the new service delivery paradigm will result in many more people receiving rehabilitation and training services. To this end, $23 million annually over five years has been appropriated to help consumers understand the new benefits through Work Incentive Planning Assistance Outreach grants.
3. Elimination of Certain Work Disincentives
The single greatest disincentive to returning to work for individuals with disabilities is the sudden and complete loss of benefits. For people with disabilities who achieve gainful employment, disability cash benefits will be phased out based upon incom. Rather than suddenly cutting-off of benefits, a sliding-scale will be established where benefits would be reduced by $1 for every $2 earned (removing the “cash cliff” disincentive in the SSDI program). This impediment was one of the often-cited disincentives to employment for people with disabilities, as reported by the GAO. Additionally, obtaining employment by beneficiaries will now NOT trigger a disability review for termination. It simply prohibits the SSA from using work activity as a basis for disability review as long as the individual had been receiving benefits for at least 24 months. Finally, if a SSA beneficiary does have their benefits terminated for employment reasons, they can have themselves reinstated within a five year period from the date of termination without a judicial review by SSA.
This is a brief review of some of the major provisions of TTWWIIA. Obviously, like any piece of new legislation, there is a lot of work that still needs to be done to codify its intent, and to draft the rules and regulations that will govern its implementation. But, as the New York Times boasted, the TTWWIIA is the biggest new piece of federal disability legislation since the ADA, and will have measurable impact on the life of individuals with disabilities. It behooves the rehabilitation community to learn as much as possible about the new law. If you would like to review the TTWWIIA, point your Web browser to http://thomas.loc.gov, and look up H.R. 1180 for a complete copy of the law.
Bruce Growick is on faculty at The Ohio State University, and is a past-president of NARPPS. He represented NARPPS during the development of TTWWIIA, and edited a special issue of our journal on rehabilitating SSA beneficiaries in the Fall of 1997.
Below is a picture of those attending the bill signing ceremony on behalf of NARPPS were (left to right) Tristan North, NARPPS’ Lobbyist, Stephen Cooley of Florida, Past-President of NARPPS, Bruce Growick, Legislative Chair, Tina Stambaugh, NARPPS Executive Director, Rob Teplansky, and Steve Start of Washington State (not pictured).
