John Williams' Column: TWWIIA - Removing Stumbling Blocks to Employment for People with Disabilities

John M. Williams
Date: March 06, 2002




When the Ticket to Work and Work Incentives Improvement Act (TWWIIA) was signed into law by President Clinton on December 17, 1999, in front of the statue of Franklin Delano Roosevelt in his wheelchair at the FDR Memorial, a major stumbling block to employment was removed, and the disability community was excited and optimistic. This legislation gives people with disabilities greater choices in work preparation, and expanded health care coverage when they go to work.

Marty Ford of the Arc in Washington, DC said, "This legislation will have a major positive impact on the lives of people with mental retardation by removing some of the most serious barriers to work for people with mental retardation and other disabilities." The Arc represents more than seven million children and adults with mental retardation and their families.

There are two parts to the law - the Ticket to Work program and the Work Incentives Improvement Act. Under the Ticket to Work program, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries receive a "ticket", which they can give to an Employment Network, which will help them design an individual employment plan of services to assist the person in getting hired. The Ticket program is voluntary. Social Security and SSI beneficiaries who receive a Ticket are not required to work, but may choose to use their Ticket to attempt to go to work. Likewise, Employment Networks are not required to accept Tickets.

The Ticket program is designed to provide people with disabilities with more choices and expanded opportunities to help them find work. Individuals receive services from an Employment Network for free. The Social Security Administration pays the Employment Networks for successfully helping a beneficiary become employed. Employment Networks may choose to be paid based solely on helping an individual achieve self-sufficiency, or they may choose to receive payments when beneficiaries achieve milestones in job preparation.

One weakness with the Employment Networks is they lack knowledge of assistive technology products and training programs. As a result, it will be more difficult to place people with disabilities who would otherwise benefit from these products.

Last month, Jo Anne Barnhart, Commissioner of Social Security, delivered the first Tickets to Work under SSA's Ticket to Work and Self-Sufficiency Program. The recipients of these first Tickets were Delaware residents Rose Blair of Lincoln, Vernard D'Amboise, Jr. of Lewes, Ormaine Hawthorne, and Phyllis Keys, both of Wilmington.

This year, between February and June, 2.4 million beneficiaries will receive tickets in Arizona, Colorado, Delaware, Florida, Iowa, Illinois, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont and Wisconsin.

The second phase of the Ticket program is scheduled for late 2002. Twenty-one states and the District of Columbia will participate.

The final phase of the Ticket program is scheduled for 2003, when the remaining states and American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands will begin participating. The program is expected to be operating nationwide by January of 2004.

The Work Incentives Improvement Act (WIIA) helps people with disabilities receiving Social Security disability benefits - approximately eight million - to maintain adequate medical coverage once they enter the workforce. In the past, Social Security disability recipients experienced a drastic loss of coverage once they started working - a true disincentive to employment. Under WIIA, Social Security disability recipients who work will receive expanded health care coverage.

People receiving disability benefits through Title II of Social Security can maintain Medicare coverage without the payment of Part A premiums for an additional four and one-half years beyond current law.

States have two options to offer Medicaid coverage to people with disabilities who work. They can offer a Medicaid buy-in to workers with disabilities who earn over 250 percent above poverty level, and they can cover people who have a severe disability but who lose Supplemental Security Income (SSI) or Social Security Disability (SSDI) because of medical improvement. Additional provisions allow States to cover people who have disabilities that will increasingly impact the person's ability to work.

The new law requires the Social Security Administration to conduct an extensive program illustrating the gradual reduction in Title II disability benefits as the individual's earnings increase. It will demonstrate the work incentive effect of reducing the benefit by $1 for every $2 the individual earns, similar to the reduction made now in the SSI program.

Andy Imparato, President and CEO of the American Association of People with Disabilities in Washington, DC believes the Medicaid buy-in provision has made incredible progress, given the downturn in the economic conditions and the reluctance of the states to expand Medicaid. AAPD works to empower people with disabilities politically and economically.

The federal government is proud of the success of the Medicaid buy-in. According to a spokesperson for the Social Security Administration, 16 states have a Medicaid buy-in program and four are pending. The spokesperson added it is believed the remaining 30 states will "buy into" the Medicaid buy-in program by 2004.

According to Imparato, the reason for the buy-in's success has been the groundswell action of advocates in the states to convince conservative legislators that the buy-in is good policy. Imparato believes greater numbers of people with disabilities must be employed under TWWIIA before the law can be considered successful.

What percentages of people with disabilities entering the workforce under TWWIIA are needed to make it successful? According to SSA Commissioner Barnhart, about one percent of the people reeciving Social Security and SSI disability benefits leave the rolls each year to go to work. President Bush knows that figure must be raised, and has said, "My Administration is committed to tearing down any barriers that unreasonably prevent the full participation of Americans with disabilities. And we will work to help disabled Americans realize their dreams through meaningful and successful careers...And the Ticket to Work gets us there."

While it is too soon to determine whether TWWIIA will be successful, the Bush administration appears committed to making TWWIIA work. However, to ensure TWWIIA's success, the administration must be more forceful in persuading the remaining states to participate in the Medicaid buy-in. It must lead by educating the networks and disability community on the importance of assistive technology in employing people with disabilities. It must make it easier for Medicaid to purchase assistive technology products for people needing them, and it must guarantee at least $1 billion in loans to help people with disabilities buy assistive technology.


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The opinions expressed in this article are those of the author, and not necessarily those of the National Organization on Disability.

© 2002 National Organization on Disability

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Point of Contact 1: John Williams, an award-winning columnist, has been writing about disability issues for 22 years. He has written a weekly column for Business Week Online magazine and is knowledgeable about assistive technology products. If you have any comments or questions, or would like more information on this week's article, please contact John Williams at JMMAW@aol.com.