Ticket-to-Work, Work Incentives Improvement Act (PL 106-170)
Testimony on the Purpose of the new Federal Law entitled Ticket-to-Work, Work Incentives Improvement Act (PL 106-170)
Provided by Bruce Growick, Ohio State University, 3/1/01
Thank you Chairperson Harris and members of the Ticket to Work Study Committee for inviting me to present to you today on the overall intent and purpose of the new federal legislation entitled Ticket-to-Work, Work Incentives Improvement (TTW-WIIA) Act of 1999.
I have been involved in the development of this law for the last six years, representing the International Association of Rehabilitation Professionals (IARP). IARP is a 3200 member association representing rehabilitation professionals who work mostly in the insurance industry by helping individuals with disabilities in workers’ compensation, long and short-term disability, and even personal injury become employed. During the last six years I have attended meetings in Wash., D.C., presented at the Social Security Subcommittee of the U.S. House Ways & Means, and published a number of articles on the reason for and the development of TTW-WIIA. I have also helped one of our local social service agencies here in Central Ohio, the Center on Vocational Alternatives, obtain a five year, 1.2 million dollar federal grant from SSA to assist beneficiaries in understanding and accesssing this new law.
At present, we are at the implementation stage of TTW-WIIA in that the federal Social Security Administration is promulgating the rules and regulation governing the implementation of the ticket portion of TTW-WIIA, while many States, like Ohio, are examing the advantages of extending healthcare to Medicaid recipients who become employed. I think it is indeed important that Ohio provide a Medicaid extension for those beneficiaries who want and can return to work. It is in Ohio’s best interest to do so.
But, just as important, the members of this committee need to understand that there are two parts to this law: incentives to beneficiaries to obtain employment, such as extended healthcare, and vouchers for improved access to VR services. The extension of healthcare, either Medicaid or Medicare to individuals with disabilities who work, is predicated on the expectation that SSA Beneficiaries will be able to receive vocational rehabilitation (ie, return-to-work) services. In fact, the initial impetus for the development of TTW-WIIA as legislation was based on the GAO conducted research indicating that the availability of VR services from the public sector alone was not enough to help beneficiaries return to work. The GAO reviewed and recommended the provision of rehabilitation services in the private sector to SSA beneficiaries. The GAO also confirmed the fact, through a national survey, that most beneficiaires of SSA would indeed try to obtain employment if they could assure themselves of continued healthcare, and were not penalized for doing so.
So interestingly, the Ticket portion of TTW-WIIA actually preceded the introduction of healthcare incentives related to beneficiaries obtaining work. Both parts of the bill certainly complement each other in helping to address the much needed access and use of vocational rehabilitation by persons who want to become employed. The eventual expectation is that TTW-WIIA will save the SSA disability trust fund from bankruptcy, and at the same time provide much needed access to VR services by those individuals who can benefit from it.
However, to accomplish this outcome, it is paramount that the States do two things: extend healthcare to beneficiaries when they return to work, AND develop ways in which the private-sector will be able to complement the public-sector in the delivery of rehabilitation services. I know it is the immediate purview of this committee to investigate the fiscal propriety of extending healthcare to medicaid recipients who return to work. We need to do that. But, I think it is equally important to encourage collaboration between the public and private sectors of rehabilitation. The field of vocational rehabilitation has undergone some tremendous changes in the last few years that have produced the need for this collaboration.
Most dramatically, in 1996 according to the GAO only 1 in 500, or less than 1/2 of 1% of the beneficiaries who were referred to the State-Federal system of VR, were returned to work. The goals/objectives and some of the procedural elements of the State-Federal system of VR have not always been conducive to the efficient and effective delivery of services to SSA beneficiaries. For example, the Rehabilitation Services Commission in Ohio operates under an “order of selection” rule in that the most severely disabled are served first. Only recently have SSA Beneficiaries met this criterion, and therefore have not always been served promptly. Also, the State-Federal system does not have a preferred hierarchy of providing services where clients are expected to return to their same work field with a reasonable accomodation.
The collaboration between the private and public sectors of VR services has been most evident right here in our own state in the area of workers’ compensation. The Ohio Bureau of Workers’ Compensation, of which I am also a past Director under the Celeste Administration, has transferred the responsibility of the delivery of rehabilitation services from the public to the private-sector. It has closed its operation of two Rehabilitation Centers, the Camera Center in Columbus and the Walker Center in Cleveland, and has restructured the responsibilities of their case managers. Instead of providing services directly, the rehabilitation counselors at the Ohio BWC now oversee services provided by the private-sector.
Both the cost savings, and the improvement of services have been significant at the Ohio BWC . So much so, the Ohio BWC has issued rebates to its premimum holders without sacrificing the quality and quantity of rehabilitation services to its claimants. The Ohio Rehabilitation Services, through the TTW-WIIA legislation, has the same opportunity to collaborate with the private-sector so that consumers have real choice in the delivery of services.
I urge you as legislators and guardians of the tax fund to encourage the Ohio Rehabilitation Services to embrace TTW-WIIA not only for the extension of healthcare coverage to medicaid recipients who can work, but also for the opportunity to deregulate itself through the ticket portion of the law . In this way, more beneficiaries who want to avail themselves of services can, and the disability trust fund of the SSA will remain solvent.
For your further edification as part of my testimony, I have submitted for your perusal a copy of the slides I use in presenting an overview of PL 106-170, a copy of an article which summarizes the law, and a copy of a commentary I wrote stressing the overall political implications of TTW-WIIA. I hope this information is helpful to you in your deliberations, and I am happy to answer now or later any questions you might have. Thank you for this opportunity to share with you my viewpoint on the implementation of TTW-WIIA in Ohio. I appreciate it.