Communication with Ohio Senator Harris

Dear Senator Harris, thank you for the opportunity to present in front of your committee as you deliberated the implications of the new Social Security Administration (SSA) Ticket to Work legislation. I appreciate your openness, and our frank discussion.

As I stated in my non-partisan remarks, the “Ticket” represents a unique opportunity to improve both the availability and quality of return-to-work services to Ohio citizens with disabilities. The most important result of extending Medicaid coverage will hopefully be the concurrent increase of the availability of services. Without a deregulation of rehab services by our State system, the new law will not be truly effective. The federal government in debating and creating this law wanted increased services, as well as increased benefits. To accomplish this goal, may I respectfully suggest a couple of recommendations:

1) The Ohio Rehab Services Commission (RSC) has established a taskforce to develop Ohio-based rules/regulations for the “Ticket” portion of the law. This taskforce should be chaired by an independent third party that does not have a proprietary interest in the outcome. Currently, RSC chairs the committee as both a service provider, AND a regulator or rule-maker of the new process.

2) RSC is currently searching for a new Director of their Agency. It is imperative that the Commissioners of RSC choose an individual who embraces the principles and precepts of the new SSA law. Approximately 40% of the consumers of RSC services are SSA beneficiaries, and they need such leadership.

3) RSC should be required to report to the Ohio legislature on the results of implementing “Ticket” in Ohio, both on the extension of healthcare to Medicaid recipients who return to work, as well as the extension of services to SSA beneficiaries who want/need help.

Unfortunately, without oversight and prodding, the best State agency will remain stagnant and resist necessary, even legislated, change. That is the overall mandate of the Ticket. I truly hope your committee embraces the law’s full intent.

Once again, thank you for the opportunity to present at your committee mtg., and to share these thoughts. I wish I could have attended more of the mtgs., and I look forward to reading your final report.

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.

The Political Implications of TTW-WIIA

Abstract. It is generally acknowledged that the high unemployment rate among individuals with disabilities in America today is unacceptable. However, finding a solution to this problem will not be simple. The Ticket to Work-Work Incentives Improvement Act (TTW-WIIA) represents a small step in the right direction because it addresses two major obstacles to solving this problem: (a) the absence of government-supported healthcare to individuals who are not unemployed, and (b) the failure to use the private sector more fully in the provision of rehabilitation services.  But, the politics of change are never easy, especially when competing political philosophies regarding the role of government are involved.

The politics of change are never easy. In the case of developing new legislation in Social Security, entitled the “Ticket to Work-Work Incentives Improvement Act” (TTW-WIIA), this statement is especially true. The passage of TTW-WIIA was a compilation of negotiation and compromise, which is not unusual in producing legislation. However, TTW-WIIA is unique in that it embodies two major paradigm shifts: (a) the creation of a national healthcare system, and (b) the privatization of public services (Growick, 2000). It is somewhat ironic that these two major issues of national interest, one from the political left and the other from the political right, should meet in the development and passage of TTW-WIIA.

During the long process of congressional hearings, government reports, and bill rewrites, these major issues were often sidestepped or circumscribed. For example, as long ago as the 1980s, when the Social Security Administration (SSA) commissioned studies to explore the feasibility and effectiveness of the private sector in delivering rehabilitation services, the issue of complementing the services of public agencies was downplayed (Weaver, 1986). Indeed, the results of those studies that demonstrated the positive impact of private services were not disseminated widely, In fact, other than a few perfunctory government reports, the issue of private sector rehabilitation complementing the public sector has been largely ignored (Weaver, 1994). Similarly, the extension of government-supported healthcare to individuals who are not indigent and “on welfare” has been clearly problematic. A major political issue of the 1990s was national healthcare reform in which affordable universal healthcare was proclaimed a necessity. However, for a variety of reasons, the Clinton-Gore Administration failed to convince the Congress and the public of the superiority of national healthcare over the current medical delivery system.

With the passage of TTW-WIIA, national healthcare and the privatization of public rehabilitation services have come again to the forefront. For the first time, government-supported healthcare, namely Medicare and Medicaid, has been extended to individuals who are not unemployed. Although the issue of disability and employment has concerned society for many years, it was the fiscal crisis of the Social Security Administration (SSA) that forced the government to look at the way in which it was supporting return-to-work efforts of individuals with disabilities and how rehabilitation services can be best delivered. Both the government and disability advocates now have the opportunity to demonstrate that the extension of healthcare, and the deregulation of rehabilitation services can decrease the unemployment rate of individuals with disabilities. It will not be easy, however. Political and bureaucratic changes never are, especially when legitimate questions could be raised about the appropriateness of establishing a national healthcare system, and many Americans are instinctively skeptical of the motives of the profit-making individuals and organizations who would benefit from deregulation.

Healthcare

The challenge of providing healthcare to Supplemental Security Income (SSI) recipients who return to work is a difficult one. Recipients of SSI receive Medicaid as part of their benefits. Medicaid is administered by the states where the recipients reside, not by the federal government. As such, it will require a change in state law to allow SSI beneficiaries, who take advantage of the new RTW services of TTW-WIIA, to receive an extension of healthcare benefits. Obviously, some states will embrace this opportunity to extend healthcare to those citizens who want to go to work. However, some states might see this new law as an intrusion into one of the basic principles of our society: personal responsibility for healthcare coverage. If the federal government forces the states to provide healthcare coverage to those who are working, regardless of their level of pay, then it might be able to do so for everyone. The politics of state sovereignty and states’ rights will be tested by TTW-WIIA.  It will be interesting to see who prevails.

Privatization

The deregulation of an industry is also never easy, especially when it is a governmental entity. In the case of rehabilitation services, the state-federal rehabilitation system has had a monopoly on the delivery of rehabilitation services for SSA beneficiaries, ever since the 1960s when SSA extended its coverage to persons with disabilities as well as to retired people (Berkowitz & Dean, 1996). At that time, an exclusive agreement between SSA and the state-federal rehabilitation system was developed in order to ensure that SSA would not be required to create its own system of rehabilitation delivery. Mary Switzer, who was director of the state-federal rehabilitation system at that time, initially engineered this Asweet-heart deal.@ It was envisioned that the existing national system of vocational rehabilitation could help SSA beneficiaries return to work. However, the agreement has been fraught with difficulties as has been reported by the United States General Accounting Office (GAO, 1987, 1997).

One of the most troublesome aspects of the agreement is the fact that reimbursement for services provided to SSA beneficiaries is made to the Rehabilitation Services Administration (RSA) regardless of outcome. That is, it does not matter whether the SSA beneficiary has returned to work as a result of the services rendered. Provided that a beneficiary received RTW services from a state-federal rehabilitation office, RSA obtained reimbursement for those services. Another troubling aspect of the arrangement, which has developed over the years, is RSA’s “order of selection.” In the late 1970s, RSA developed regulations stipulating that persons with severe disabilities would receive priority in receiving services. This order of selection for services was detrimental to the relationship between RSA and SSA in that not all SSA beneficiaries were considered to have severe disabilities as defined by RSA rules. Due to this order of selection, some SSA beneficiaries had to wait an inordinate amount of time to receive services, further delaying the rehabilitation process. These delays were particularly troublesome because one of the most important factors in successful rehabilitation is early intervention, or case velocity (the speed at which a client is served). By 1990s, the GAO (1996) had determined that less than one-half of one percent of SSA individuals eligible for services by RSA were indeed rehabilitated and returned to work.  The combined effects of a delivery mechanism predicated on service rather than outcome, coupled with rules and regulations that were not friendly to SSA beneficiaries, promoted the need for the passage of TTW-WIIA.

The TTW-WIIA is the largest piece of federal disability legislation since the passage of the Americans with Disabilities Act (ADA). The creators of TTW-WIIA hope that implementation of the bill will lower the unemployment rate of individuals with disabilities, in much the same way as ADA has removed many of the physical barriers and other obstacles to employment, generally, in our society (Bunning, 1996). However, in order for this goal to be realized, further political concessions and agreements will need to be negotiated. Most notably, there is the question of whether the states will agree to extend healthcare coverage to Americans with disabilities who are working. The cost to the states of extending such care is enormous and, as stated previously, there are issues of local rule and precedent involved. Another important question is whether the federal government will end the sole reliance of rehabilitation services delivery to SSA beneficiaries by the public sector (Tenney & McCray, 1997). Bureaucracies do not easily relinquish power, nor do they readily give up a reliable and generous source of income. They are also not noted for their readiness to engage in competition (Forgiel & Growick, 1997).

Work Incentives

In its simplest form, TTW-WIIA represents a bifurcated law in which both political parties made significant concessions. The ticket portion of the law represents the opportunity to infuse REAL choice into the delivery of rehabilitation services by providing an opportunity for clients to choose between public and private providers. The work incentives segment portrays individuals with disabilities as people who want to work if given the opportunity to retain adequate healthcare coverage. In a very real sense, it is the work-incentive part of the law that embodies what has always been at the core of rehabilitation philosophyBa faith in the basic goodness of the individual, an emphasis on the individual’s assets rather than on deficiencies, and a desire to treat the individual as the master of his or her own fate rather than as the helpless victim of circumstance. The work-incentive part of the law also draws heavily on the basic psychological principle that people will repeat activities for which they are rewarded. That is, people will work if they get more out of working than they do out of not working (Thomas & Strauser, 1995).

Conclusion

It is hoped that the concessions in political and philosophical ideology that led to the passage of TTW-WIIA will lead to real life achievements for individuals with disabilities. There are still many political barriers to overcome, but the rewards of overcoming these barriers could be extraordinary, not only for people with disabilities, but also for their families. There is also a potential gain for the rehabilitation profession because competition breeds excellence. The challenge of implementing TTW-WIIA will be accepting change in a world where change is never easy but always necessary.

References

Berkowitz, E., & Dean, D. (1996). Lessons from the vocational rehabilitation/social security administration experience. In J. Mashaw, V. Reno, R. Burkhauser, & M. Berkowitz (Eds.), Disability, work and cash benefits (pp.223-244). Kalamazoo, MI: Upjohn Institute for Employment Research.

Bunning, J. (1996). Rehabilitation and return to work opportunities Act of 1996. Paper presented as a Floor Statement to the United States House of Representatives, Washington, DC.

Forgiel, K., & Growick, B. (1997). Inspiring a partnership between private-sector rehab and SSA. NARPPS Journal, 12(4), 153-158.

Growick, B. (2000). The Ticket to Work-Work Incentives Improvement Act of 1999. NARPPS Newsletter, 8(1), 17-19.

Tenney, F., & McCray, D. (1997). Project network: Successful linkages between social security and private sector rehab. NARPPS Journal, 12(4), 137-152.

Thomas, K., & Strauser, D. (1995). Rehabilitating the rehabilitation delivery system: A commentary on the voucher system. Journal of Rehabilitation, 61(1), 18-22.

United States General Accounting Office. (1987). Social security: Little success achieved in rehabilitating beneficiaries. (GAO/HRD-88-11). Gaithersburg, MD: U.S. Government Printing Office.

United States General Accounting Office. (1996). Social security: Disability programs lag in promoting return to work. (GAO/HEHS-96-62). Gaithersburg, MD: U.S. Government Printing Office.

United States General Accounting Office. (1997). SSA disability: Program redesign necessary to encourage return to work. (GAO/HEHS 97-46). Gaithersburg, MD: U.S. Government Printing Office.

Weaver, C. (1986). Social security disability policy in the 1980s and beyond. In M. Berkowitz & M. A. Hill (Eds.), Disability and the labor market: Economic problems, policies, and programs (pp. 29-63). Ithaca, NY: Cornell University, Industrial Labor Relations Press.

Weaver, C. (1994). Privatizing vocational rehabilitation: Options for increasing individual choice and enhancing competition. Journal of Disability Policy Studies, 5(1), 6-28.

Author Note

The author would like to acknowledge the assistance of Ken Thomas in preparing this commentary.

Bruce Growick, Ph.D.

Rehabilitation Services

The Ohio State University

growick.1@osu.edu

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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).

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The Ticket to work, Work Incentives Improvement Act (TTW-WIIA) was passed by Congress in December of 1999.  This law has the potential to increase the employability of the disability community in America, in the same way that ADA has increased the participation of the disability community in public activities.  The New York Times calls TTW-WIIA “the largest piece of federal disability legislation since the ADA”.  To learn more about it, access one or more of my publications.

• Review of Public Law 106-170
• PowerPoint Presentation on TTW-WIIA: Genesis, development & implementation
• Political Implications of TTW-WIIA
• Timeline for Implementation
• Testimony to Ohio Senate on TTW-WIIA
• Communication with Ohio Senator Harris

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