The purposes of this Appendix are twofold. First, to provide an overview of our federal income maintenance programs targeted for persons with disabilities--the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. The overview includes a description of the work incentive provisions in these income maintenance programs. Second, to provide an overview of our federal health care programs, including provisions expanding health care services under Medicare and Medicaid programs for persons with disabilities who are working or who want to work but fear losing their health care. The overview reflects amendments to these programs added by the Balanced Budget Act of 1997 and the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA).
Title II of the Social Security Act establishes the Social Security Disability Insurance Program (SSDI). SSDI is a program of federal disability insurance benefits for workers who have contributed to the Social Security trust funds and meet the disability standard or become a blind individual before retirement age. Spouses with disabilities and dependent children of fully insured workers (often referred to as the primary beneficiary) also are eligible for disability benefits upon the retirement, disability, or death of the primary beneficiary. Section 202(d) of the Social Security Act also establishes the adult disabled child program which authorizes disability insurance payments to surviving children of retired, deceased or workers with disabilities who were eligible to receive Social Security benefits, if the child has a permanent disability originating before age 22.
For purposes of this paper, the term "SSDI" refers to all benefit payments made to individuals on the basis of disability under Title II of the Social Security Act.
SSDI provides monthly cash benefits paid directly to eligible persons with disabilities and their eligible dependents throughout the period of eligibility. Generally, an individual must wait five full calendar months after disability begins before receiving SSDI benefits. If an individual leaves the disability rolls and subsequently return with the same or a related impairment within five years, the Social Security Administration (SSA) does not require a new waiting period.
Title XVI of the Social Security Act establishes the Supplemental Security Income Program (SSI). The SSI program is a means-tested program providing monthly cash income to low-income persons with limited resources on the basis of age and on the basis of blindness and disability for children and adults. The SSI program is funded out of the general revenues of the Treasury.
Eligibility for SSI is determined by certain federally established income and resource standards. Individuals are eligible for SSI if their "countable" income falls below the federal benefit rate ($531 for an individual and $769 for couples in 2001). Not all income is counted for SSI purposes. Excluded from income is the first $20 of any monthly income (i.e., either unearned, such as social security and other pension benefits, or earned) and the first $65 of monthly earned income plus one-half of the remaining earnings. The federal limit on resources is $2,000 for an individual and $3,000 for couples. Certain resources are not counted, including, for example, an individual's home and the first $4,500 of the current market value of an automobile.
States may supplement the federal benefit rate (State Supplemental Payments, SSP). These state supplements are state-determined and vary widely by state and may be administered by SSA or by the state. Some individuals who have too much income to qualify for SSI may qualify for an SSP benefit only. States may elect to make such persons automatically eligible for Medicaid, just as they can for SSI beneficiaries.
The definition of disability for purposes of initial eligibility is identical under the SSDI and SSI programs. Disability is defined as the inability to engage in any “substantial gainful activity” (SGA) by reason of a medically determinable physical or mental impairment that is expected to last for a continuous period of not less than 12 months, or to result in death. SGA is defined in federal regulations as earnings of $740 per month (through the period ending on December 31, 2001). SGA will be adjusted annually effective January 1, 2002 and every year thereafter based on the Cost of Living Adjustment (COLA).
After the initial determination of disability for applicants for the SSI program, SSI recipients can continue to be eligible for SSI on the basis of disability even when they have earnings in excess of the SGA earnings test applied at the initial determination of disability. In contrast, for SSDI recipients, earnings above SGA are considered in determining their continued disability status.
The SSDI program includes a number of provisions designed to permit or encourage recipients to work:
These bullets reflect the policy in the SSDI program that work incentives are time-limited.
For persons receiving SSDI benefits, earnings above a certain amount are considered an indication that they may no longer meet the definition of disability under the program. Work may eventually affect their eligibility for health services under the Medicare program. Loss of disability status under SSDI will also eventually affect their eligibility for specific disability-related health and long-term support services in states that have chosen the Medicaid state option to provide Medicaid for low-income SSDI recipients under its "medically needy" program. The Medicaid program often includes services not available under the Medicare program or private health insurance (e.g., personal attendant services and medications).
As explained above, eligibility for SSDI requires an applicant to meet certain criteria, including the presence of a disability that renders the individual unable to engage in SGA. Continuing disability reviews (CDRs) are conducted by the SSA to determine whether an individual remains disabled and thus eligible for continued benefits. Prior to January 1, 2002, CDRs can be triggered by evidence of recovery from disability, including return to work. SSA is also required to conduct periodic CDRs every three years for beneficiaries with a nonpermanent disability and at times determined by the Commissioner for beneficiaries with a permanent disability.
Effective January 1, 2002, the Social Security Act, as amended by TWWIIA, establishes the standard that CDRs for a long-term SSDI beneficiary (i.e., an individual receiving disability benefits for at least 24 months) may not be scheduled for the individual solely as a result of the individual's work activity. SSA would continue to evaluate work activity to determine whether eligibility for cash benefits continued (e.g., the individual has earnings that exceed the established level), but a return to work would not trigger a review of the beneficiary's impairment to determine whether it continued to be disabling. An individual would still be subject to a regularly scheduled periodic review.
In addition, during any period for which an individual is using a "Ticket" under the Ticket To Work and Self-Sufficiency Program, the Commissioner (and any applicable state agency) may not initiate a continuing disability review or other review of whether the individual is or is not under a disability for purposes of the SSDI program. This provision is effective when the Ticket program is effective and is applicable to both the SSI and SSDI programs.
Prior to passage of TWWIIA, individuals entitled to SSDI benefits received expedited reinstatement of benefits following termination of benefits because of work activity (i.e., termination due to performing at the SGA level) any time during the 36 month extended period of eligibility so long as they continue to have a disabling impairment. In other words, during this period, benefits may be reinstated without a new application and disability determination.
Under the Social Security Act, as amended by TWWIIA, a SSDI beneficiary whose entitlement to SSDI benefits has been terminated due to the performance of SGA following the 36 month extended period of eligibility may request reinstatement of those benefits without filing a new application. The former SSDI beneficiary must be unable to engage in SGA due to his or her disability and the finding of disability must be the same as (or related to) the physical or mental impairment that gave rise to the initial finding of disability. The request for reinstatement must be filed within 60 consecutive months following the month the SSDI benefits were terminated.
Since the SSI program was implemented in 1974, there have been work incentives for persons with severe disabilities:
In addition, under the SSI program an individual whose earnings exceed the SGA earnings level can continue to receive SSI cash benefits and Medicaid under the provisions of Section 1619(a) of the Social Security Act as long as the individual meets the SSI income and resources tests. Further, an individual may retain his or her Medicaid eligibility as long as it is needed under specified circumstances under Section 1619(b) and Section 1905(q) of the Social Security Act even though he or she no longer receives SSI cash benefits (see below for more detailed description).
SSI recipients who become ineligible for SSI cash benefits or SSI status under Section 1619(b) because of income or resources go into a suspension status for up to 12 months. They can be reinstated to SSI payment status or SSI status under Section 1619(b) without a new application if their income and resources are reduced to a level that they once again meet the SSI criteria if they are within 12 months of their loss of SSI payment status or SSI status under Section 1619(b). However, if an individual is past the 12-month suspension period time limit and loses his or her SSI status, the individual must make a new application for SSI on the basis of disability, income and resources.
Under the expedited reinstatement provision added by TWWIIA, those individuals who are no longer eligible for SSI cash benefits because of earned income (or earned and unearned income) may apply for reinstatement for eligibility for SSI cash benefits, even though they are no longer in the 12 month SSI suspension period time limit.
In order to apply for reinstatement, the former SSI recipient's disability must render the individual unable to perform SGA and the finding of disability must be the same as (or related to) the physical or mental impairment that gave rise to the initial finding of disability. In addition, the individual must satisfy the nonmedical requirements for SSI benefits. The request for reinstatement must be filed within 60 consecutive months beginning with the month following the most recent month for which the individual was eligible for SSI (including Section 1619(b) status) prior to the period of ineligibility.
Under the Social Security Act, as amended by TWWIIA, while the Commissioner is making a determination pertaining to a reinstatement request under SSDI and SSI, the individual is eligible for provisional benefits (i.e., federal cash benefits and Medicare and Medicaid, as appropriate) for a period of not more than six months. If the Commissioner makes a favorable determination, such individual's prior entitlement to benefits will be reinstated (as would the benefits of his or her dependents). If the Commissioner makes an unfavorable determination, provisional benefits would end, but the provisional benefits already paid would not be considered an overpayment (except under specified circumstances). [Section 112 of the Act adds Section 223(i) to the Social Security Act and Section 1631(p) to the Social Security Act.]
Title XVIII of the Social Security Act establishes the Medicare program, which authorizes health insurance benefits for specified elderly persons and certain persons with disabilities (e.g., disabled workers receiving SSDI benefits). More specifically, individuals who have been entitled to SSDI benefits for 24 consecutive months are eligible to receive health insurance benefits under the Medicare program. The Medicare program is divided into three parts. Part A authorizes hospital insurance benefits; Part B provides supplemental medical insurance benefits; and Part C contains miscellaneous provisions, including coverage for end stage renal disease. For FY 2000, the Part A premium is $300 per month and the Part B premium is $50 per month.
As explained above, SSDI beneficiaries are allowed to test their ability to work for at least nine months without affecting their SSDI (and therefore their Medicare) status. SSDI payments stop after a three-month grace period when a beneficiary has monthly earnings at or above substantial gainful employment after the nine-month period. Prior to the enactment of TWWIIA, if the beneficiary remained disabled but continued working, Medicare can continue for an additional 39 months (for a total of 48 months). The Social Security Act, as amended by TWWIIA, provides for continued Medicare Part A coverage for 4½ additional years (for a total of 8½ years) without the payment of premiums. Part B of Medicare benefits would continue to flow from continuing eligibility for Part A, but the Part B premium would apply as usual. A Medicare Buy-In program is already available under current law, which allows disabled workers to obtain Medicare. The result would be that after the 8½ years disabled workers could continue to be covered under Medicare if their disability continues, and if they pay a required premium under Medicare Part A and Part B.
Title XIX of the Social Security Act establishes the Medicaid program. Medicaid is the nation's major public financing program for providing health and long-term services and supports to low-income persons. Medicaid is a means-tested entitlement program financed by the state and Federal Government out of general revenues. Within federal guidelines, states set their own income and asset eligibility criteria for Medicaid services.
Federal assistance is provided to states through federal matching payment rates based on a state's per capita income. Under Medicaid, states are required to serve some population groups (mandatory coverage groups) and are permitted to serve others (optional groups).
State policy makers enjoy broad discretion under federal law to establish eligibility criteria for adults with disabilities under the Medicaid program and to establish a state supplement to the federal SSI program (state SSI supplementation programs). State policy makers also enjoy broad discretion in selecting the methods used for administering the Medicaid eligibility criteria and a state SSI supplementation program (“methods of administration”).
Medicaid Eligibility Options for Federal SSI Recipients
State policy makers essentially have two policy options related to Medicaid eligibility for federal SSI recipients. Under Option 1, a state may provide Medicaid eligibility for all persons determined eligible for SSI (i.e., SSI recipients are categorically eligible for Medicaid).1 In order to be eligible for the SSI program, an individual must meet certain criteria related to his or her disability as well as criteria related to his or her income level. Under Option 2, a state may decide not to use the SSI criteria for eligibility for Medicaid and instead develop its own income, resources and disability criteria so long as the criteria are not more restrictive than the state’s approved Medicaid plan in January 1972--the year the SSI law was enacted. These states are commonly referred to as “Section 209(b) states.” This provision is also codified in Section 1902(f) of the Medicaid law.2
Extending Medicaid Eligibility to SSI Recipients and SSDI Recipients Through the State SSI Supplementation Program
As explained above under Option 1, a state may provide categorical Medicaid eligibility for federal SSI recipients. In addition, federal Medicaid law permits a state to extend Medicaid eligibility to individuals who are eligible for SSI on the basis of a state SSI supplementation program.3 Therefore, when a state decides to establish a state SSI supplementation program, it may also be making a decision affecting the income eligibility standard for Medicaid. One effect of this decision is to increase the percentage of SSDI recipients in the state who are "SSI recipients" and thus eligible for Medicaid.
A person is considered an "SSI recipient" if he or she is entitled to:
There are four scenarios describing how and from whom an individual receives SSI cash payments in a state with a state SSI supplementation program. A state that provides for a state SSI supplement of the federal SSI standard can choose to enter into an agreement with SSA to administer the state SSI supplementation program. If the state enters into such an agreement, under SSA regulations it must use the same income disregards and asset criteria as the federal SSI program. A state may also choose to administer its own state SSI supplementation program and provide categorical Medicaid eligibility for those individuals eligible for the state supplement. This includes individuals who are only eligible for the state SSI supplement but have too much unearned income to be eligible for federal SSI benefits. If the state administers its state SSI supplementation program, it can use its own income disregards and asset criteria. Understanding these scenarios is important because although the SSI program is viewed primarily as a federal program, state decisions regarding the nature and administration of a state SSI supplementation program have a significant impact on eligibility for and accessibility to a state's Medicaid program.
First, in a state in which SSA administers the state SSI supplementation program, an SSI recipient can receive a single check from SSA that includes both the federal SSI payment and the state SSI supplementation payment.4
Second, in a state in which SSA administers the state SSI supplementation program, an SSI recipient can receive a single check from SSA that includes only the state SSI supplementation payment. Under this scenario, the individual does not receive federal SSI funds because the individual has too much income to be eligible for the federal SSI benefit.
Third, in a state in which the state administers its state SSI supplementation program, an SSI recipient can receive two checks (a check for the federal SSI payment and a check from the state for the state SSI supplementation payment).
Fourth, in a state in which the state administers its state SSI supplementation program and the individual is not eligible for a federal SSI payment (because the individual has too much income to be eligible for the federal SSI benefit), an SSI recipient can receive a single check from the state (rather than from SSA).
Under existing federal policy, an individual is eligible for SSI if his or her unearned income (e.g., SSDI) is less than the federal SSI benefit standard ($531 per month in 2001) plus $20 (the initial federal SSI income disregard). In sum, $551 in 2001 is the "unearned income limit" for eligibility for federal SSI in a state with no state SSI supplementation program. It can be said that the federal SSI unearned income limit also creates an unearned income limit for the Medicaid program in those states that use SSI criteria for Medicaid eligibility.
As explained above, it is important to understand that under federal SSI regulations (not SSI law) when SSA administers the state SSI supplementation program, the income disregards used in the state SSI supplementation program must be identical to federal income disregards. In contrast, when the state administers its own state SSI supplementation program, it has the option to adopt the federal income disregards or it may adopt its own income disregards. Under existing federal Medicaid policy, a state can use SSI-related Medicaid eligibility standards based on the amount of state SSI supplementation and state-developed income disregards.
Medicaid Work Incentives under Section 1619(a) and (b) of SSI Law and Section 1905(q) of Medicaid Law
The federal SSI program provides for a gradual reduction in SSI benefits to a recipient as the individual's earnings increase. During this period, the individual remains eligible for Medicaid.5 Even after the federal SSI recipient's earnings make the individual no longer eligible for SSI cash payments, the individual still remains eligible for Medicaid as if he or she was receiving cash payments ((Section 1619(b) and 1905(q)) of the Social Security Act). This period of eligibility continues until the individual reaches an earnings level referred to as the "Section 1619(b) threshold."6
Under Section 1619(b) and Section 1905(q) of the Social Security Act, individuals continue to be eligible for Medicaid even if their earned income makes them no longer eligible for SSI benefits. This special eligibility status applies as long as the individual continues to have a disabling condition or is blind and meets the following additional criteria:
In making an initial determination under the criteria concerning reasonable equivalency of benefits, SSA compares the individual's gross earnings to a “Section 1619(b) threshold” amount applicable to each state. The threshold established each year is based on the average expenditures for Medicaid benefits for disabled SSI cash recipients in the individual's state of residence plus the SSI and state supplement rates for an individual living alone. In 2001, the threshold amount for states ranges from $14,690 to $36,598. If the individual's earnings exceed the threshold, an individualized threshold can be calculated which considers the person's actual Medicaid use, work expenses, and publicly funded attendant care.
Medicaid Eligibility Based on Medically Needy and Spend Down Options
Under Medicaid law, a state may also include under the Medicaid program individuals who are “medically needy.” Individuals are considered "medically needy" if they are determined to have severe disabilities (medical impairments and not working) and income too high to be eligible for SSI but low enough, after paying some of their health care bills, to meet the state's income criteria. The income criterion is called the "Protected Income Level" (PIL) in some states and the medically needy income level (MNIL) in other states. Medically needy persons with incomes above the state's threshold must “spend down” with health care expenses to these levels before becoming eligible for Medicaid benefits. Some states have chosen to provide for earned income disregards in determining the countable income for the income criteria for the medically needy program.
Also, if the state does not have a medically needy program and has elected to use the Section 209(b) option, they must allow a person to "spend down" to the federal SSI standard to become eligible for Medicaid.
Medicaid Eligibility Based on Poverty Level and Standard of Need Options
States also have the option to raise the countable income level at which a person with disabilities in the state can qualify for Medicaid as high as 100 percent of the federal poverty level. States also can use what is called the “standard of need” option to provide Medicaid coverage, which essentially has the same impact as the poverty level option. Under these options, state can use "income disregards" in determining the income to be counted toward the poverty level or standard of needs.
300 Percent of SSI Income Rule
States also have the option of allowing eligibility for persons with gross incomes at or above 300 percent of current SSI levels ($1,593 in 2001). This option is limited to persons residing in a medical institution and to persons receiving home and community services under a Section 1915(c) waiver (described below). Under this option, states may impose a post-eligibility cost-sharing amount.
Home and Community-Based Services Waivers and Demonstration Authority
Under the Medicaid program, the Secretary of Health and Human Services is authorized to grant waivers to allow a state to offer home and community-based services and supports to individuals who, in the absence of such services, would require institutional care as long as costs (in the aggregate) under the waiver do not exceed the cost of providing institutional care to the target population. [Section 1915(c) of the Social Security Act] The Secretary may also grant waivers under the Medicaid program for research and demonstration projects in accordance with Section 1115 of the Social Security Act.
The Balanced Budget Act of 1997 (Public Law 105-33) added a new provision in the Medicaid program that allows states to elect to provide Medicaid coverage to persons with disabilities who are working and who otherwise meet SSI eligibility criteria but have net income (after applying the SSI income disregards) up to 250% of the federal poverty guidelines. Beneficiaries under the more liberal income limit may "buy into" Medicaid by paying premium costs. Premiums are set on a sliding scale based on an individual's income, as established by the state. Medicaid law allows states to utilize more generous eligibility criteria under Section 1902(r)(2) of Medicaid law than SSI rules related to unearned income and resources to provide Medicaid eligibility under this new option. If a state uses the authority for a Medicaid Buy-In program under the Balanced Budget Act of 1997 (Section 1902(a)(10)(A)(ii)(XIII)) there are no restriction related to the size of the premiums. Also, a state cannot set age limits for a Medicaid Buy-In program established under the Balanced Budget Act of 1997 authority.
More recently under TWWIIA, states were provided two additional options for establishing Medicaid Buy-In programs:
Option 1 under TWWIIA--Basic Coverage
Group
(Section 1902(a)(10)(A)(ii)(XV) of the Social Security
Act)
States have the option to cover individuals with disabilities (aged
16-64) who, except for earnings, would be eligible for SSI. States are
allowed to permit working individuals with disabilities to buy-into the
Medicaid program by paying premiums and other cost-sharing charges on a
sliding-fee scale based on income. Under amendments to the Medicaid program
included in the TWWIIA, this option is available to individuals with incomes
above 250% of the federal poverty level (compared to the 250% income
ceiling included in the Balanced Budget amendments). Under this option and the
authority for a Medicaid Buy-In under the Balanced Budget Act of 1997 a state
cannot directly set a minimum work requirement.
Option 2 under TWWIIA--Medically Improved
Group
(Section 1902(a)(10)(A)(ii)(XVI) of the Social Security
Act)
If and only if a state provides Medicaid coverage to individuals
described in Option 1 under the Basic Coverage Group, the state would also have
the option of providing coverage to employed persons with disabilities (aged
16-64) whose medical condition has improved (and as a result are no
longer eligible for SSDI or SSI and therefore are no longer eligible for
Medicaid) but who continue to have a severe medically determinable impairment
as defined in regulations issued by the Secretary of the Department for Health
and Human Services (HHS). Under this option, individuals would be considered
employed if they earn at least the federal minimum wage and work at least 40
hours per month or are engaged in work that meets criteria for work, hours, or
other measures established by the state and approved by the Secretary of HHS.
Under both of these options under TWWIIA, states can establish uniform limits on assets, resources, and earned or unearned income (or both) for this group that differ from the federal SSI requirements. The state would be required to make premiums or other cost-sharing charges the same for both these two new eligibility groups. States may require individuals with incomes above 250% of the federal poverty level to pay the full premium cost. Under TWWIIA, in contrast to the Medicaid Buy-In authority under the Balanced Budget Act of 1997, in the case of individuals with incomes between 250 percent and 450 percent of the poverty level, premiums may not exceed 7.5 percent of income. States must require individuals with adjusted gross incomes above $75,000 per year (subject to annual adjustments after FY 2000) to pay all the premium costs. States may choose to subsidize premium costs for such individuals, but they may not use federal matching funds to do so.
TWWIIA requires that in order to receive federal Medicaid funds, states must maintain the level of expenditures they expended in the most recent fiscal year prior to enactment of this provision to enable working individuals with disabilities to work (maintenance of effort requirement).
Under TWWIIA, a state may apply to the Secretary of HHS for approval of a demonstration project under which a specified maximum number of individuals who are workers with a potentially severe disability are provided medical assistance equal to that provided to workers with disabilities whose income does not exceed 250% of the federal poverty level and who would be eligible for SSI, except for their earnings (the provision added by the Balanced Budget Act of 1997). In the case of a state that has not elected to provide medical assistance to these workers with disabilities, the state's demonstration project must provide such medical assistance as the Secretary determines is an appropriate equivalent to the medical assistance provided under such option.
A "worker with a potentially severe disability" is an individual (aged 16-64) who is employed and has a specific physical or mental impairment that, as defined by the state, is reasonably expected, but for the receipt of medical assistance, to become blind or disabled as defined under the Social Security Act for purposes of the SSI program. In accordance with the conference report, the states' definitions of workers with potentially severe disabilities can include individuals with a potentially severe disability that can be traced to congenital birth defects as well as diseases or injuries developed or incurred through illness or accident in childhood or adulthood.
Subject to the amount of funds appropriated for this demonstration, the Secretary must approve applications if the state demonstrates that it is maintaining fiscal effort and the state provides for an independent evaluation. The Secretary may allow for sub-state demonstrations (thereby waiving the statewide provision in the Medicaid legislation).
Congress must appropriate $42 million for each of the fiscal years 2001-2004 and $41 million for each of the fiscal years 2005-2006. In no case may payments made to the states by the Secretary exceed $250 million in the aggregate. In addition, in no case may the payments made by the Secretary to the states for administrative expenses relating to annual reports exceed $2 million.
A state with an approved demonstration project must submit an annual report to the Secretary. Not later than October 1, 2004, the Secretary must submit a report to the Congress regarding whether the demonstration project should be continued after fiscal year 2006.
Medicaid Infrastructure Grants
The Secretary of HHS must award grants to states to support the design, establishment, and operation of state infrastructures that provide items and services to support working individuals with disabilities. The Secretary must also award grants to states to conduct outreach campaigns regarding the existence of such infrastructures.
In order to be eligible for a state infrastructure grant, a state must demonstrate that it makes personal assistance services available under its Medicaid plan to the extent necessary to enable individuals with disabilities to remain employed, including working individuals with disabilities with incomes up to 250% of poverty buying into Medicaid under the provision added by the Balanced Budget Act of 1997. The term "personal assistance services" means a range of services provided by one or more persons, designed to assist an individual with a disability to perform daily activities on and off the job that the individual would typically perform if the individual did not have a disability. Such services shall be designed to increase the individual's control in life and ability to perform every day activities on or off the job.
With respect to the amount of a state's infrastructure grant, the Act directs the Secretary of HHS to reward states that adopt the state Medicaid buy-in option for working individuals with disabilities with incomes up to 250% of poverty (as added by the Balanced Budget Act of 1997). States may request funding for up to 10% of total expenditures for their Medicaid Buy-In program. States that choose not to adopt this option would be subject to a maximum grant award established by a methodology developed by the Secretary, consistent with the limit applied to states that take up the option.
States are required to submit an annual report to the Secretary on the use of grant funds. In addition, the report must indicate the percent increase in the number of SSDI and SSI beneficiaries who return to work.
The Act specifies that Congress must appropriate $20 million for fiscal year 2001, $25 million for fiscal year 2002, $30 million for fiscal year 2003, $35 million for fiscal year 2004, $40 million for fiscal year 2005, and for each of the fiscal years 2006-2011 an amount appropriated for the preceding fiscal year increased by the Consumer Price Index.
The Secretary, in consultation with the Ticket to Work and Work Incentives Advisory Panel is required to make a recommendation by October 1, 2010 to the Congress regarding whether the grant program should continue after fiscal year 2011.
Benefits Planning Assistance and Outreach
Under the Act, SSA is required to establish a community-based work incentives planning and assistance program for the purpose of disseminating accurate information to individuals on work incentives. Under the program, the Commissioner is required to:
The Commissioner is required to determine the qualifications of agencies eligible for grants, cooperative agreements, and contracts. Eligible organizations may include Centers for Independent Living, protection and advocacy organizations, client assistance programs, state Developmental Disabilities Councils, and state welfare agencies. State Medicaid agencies and Social Security field offices are ineligible.
Under TWWIIA, Congress may appropriate $23 million for each of the fiscal years 2000-2004. The provision is effective on date of enactment.
Protection and Advocacy Systems Grant Awards
The Commissioner of SSA is authorized to make grants to existing protection and advocacy systems established under the Developmental Disabilities Assistance and Bill of Rights Act to provide information and advice about obtaining vocational rehabilitation, employment services, advocacy, and other services a SSDI or SSI beneficiary may need to secure or regain gainful employment, including applying for and receiving work incentives. [Section 122 of the Act adds a new Section 1150 to the Social Security Act.]
Under TWWIIA, Congress may appropriate $7 million for each of the fiscal years 2000-2004. The provision is effective on the date of enactment.
SSDI Demonstration Authority
Section 505 of the Social Security Disability Amendments of 1980, as amended, provided the Commissioner of Social Security authority to conduct certain demonstration projects. The Commissioner was authorized to initiate experiments and demonstration projects to test ways to encourage SSDI beneficiaries to return to work, and was authorized to waive compliance with certain benefit requirements in connection with these projects. This demonstration authority expired on June 9, 1996. Effective as of the date of enactment (i.e. December 17, 1999), TWWIIA extends the demonstration authority for five years and includes authority for demonstration projects involving applicants as well as beneficiaries.
Demonstration Projects Providing for Reductions in Disability Insurance Benefits Based on Earnings
TWWIIA requires the Commissioner of Social Security to conduct a demonstration project under which payments to SSDI beneficiaries would be reduced $1 for every $2 of beneficiary earnings above a level to be determined by the Commissioner. The Commissioner must annually report to the Congress on the progress of this demonstration project.
TWWIIA establishes a Ticket to Work and Work Incentives Advisory Panel [web site www.ssa.gov/work/panel]. The panel must consist of 12 members with experience or expert knowledge as a recipient, provider, employer or employee in the fields of, or related to, employment services, vocational rehabilitation services, and other support services. At least one-half of the members must be individuals with disabilities or representatives of individuals with disabilities, with consideration given to current or former SSDI or SSI beneficiaries.
The Panel is to advise the Commissioner and report to the Congress on the implementation of the Ticket to Work and Self-Sufficiency Program, including such issues as the establishment of pilot sites, refinements to the program, and the design of program evaluations. In addition, the Panel is to advise the President, the Congress and the Commissioner on issues related to work incentives programs, planning, and assistance for individuals with disabilities, including work incentive provisions under the SSDI, SSI, Medicare and Medicaid programs. Further the Panel is to advise the Commissioner regarding the most effective designs for research and demonstration projects providing for reductions in disability insurance benefits based on earnings.
The state Medicaid agency can provide automatic Medicaid eligibility for all persons eligible for SSI or the state can require a separate application.
A Section 209(b) state is required to provide continued Medicaid for SSI recipients whose earnings make them ineligible for SSI cash benefits. Continued Medicaid must be provided if the SSI recipient had been eligible in the previous month for Medicaid under the state's Medicaid plan.
Forty-three states provide some state SSI supplement. In 23 states, however, the state SSI supplement is only for individuals in group living arrangements (not for those living independently).
Under federal SSI regulations, SSA will administer up to six "categories" of state SSI supplementation benefit standards. States with multiple categories of state SSI supplementation have created categories based primarily on special living arrangements needs related to individuals with disabilities.
A working disabled individual with no unearned income in a state without state SSI supplementation will continue to receive a declining amount of SSI benefits as his or her earned income rises until the individual reaches the "break-even" point, which in 2001 was $1,147 per month.
The threshold amount is based on the average expenditures for Medicaid benefits for disabled SSI cash recipients in the individual's state of residence plus the earned income break-even point of individuals living alone. If the individual's earnings exceed the threshold, an individualized threshold can be calculated that considers the person's actual Medicaid use, work expenses, and publicly funded personal assistant services.
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