IL NET an ILRU/NCIL National Training and Technical Assistance Project Expanding the Power of the Independent Living Movement TWWIIA/WIA Participant's Manual April 23-24, 2001 Buffalo, New York (c) 2001 IL NET, an ILRU/NCIL Training and Technical Assistance Project ILRU Program NCIL 2323 S. Shepherd Street 1916 Wilson Boulevard Suite 1000 Suite 209 Houston, Texas 77019 Arlington, Virginia 22201 713-520-0232 (V) 703-525-3406 (V) 713-520-5136 (TTY) 703-525-4153 (TTY) 713-520-5785 (FAX) 703-525-3409 (FAX) ilru@ilru.org 1-877-525-3400 (V/TTY - toll free) http://www.ilru.org ncil@ncil.org http://www.ncil.org Permission is granted for duplication of any portion of this manual, providing that the following credit is given to the project: Developed as part of the IL NET: an ILRU/NCIL National Training and Technical Assistance Project. IL NET is funded through a special provisions cooperative agreement with the U.S. Department of Education, Rehabilitation Services Administration, Agreement No. H132B99002. TWWIIA/WIA Buffalo, New York April 23-24, 2001 Participant's Manual Table of Contents Agenda About the Trainers List of Trainers and IL NET Staff About ILRU About NCIL About IL NET Learning Objectives Work Incentives Act Work Incentives Act Fact Sheet Comments on Proposed Rule Making Ticket to Work and Work Incentives Advisory Panel Foundation Support for Employment of People with Disabilities The California Work Group on Work Incentives and Health Care CWG PUBLIC POLICY RECOMMENDATIONS To implement new state and federal law for workers with disabilities The Workforce Inclusion Act January 26, 2001 Draft The 250% California Working Disabled Program Question and Answer Sheet The Workforce Investment Act of 1998 Six State Review Appendix TWWIIA/WIA Buffalo, New York April 23-24, 2001 Agenda Monday, April 23, 2001 9:00 Welcome ? Housekeeping ? Introductions 9:30 Comprehensive Reform: What is it and when do we recognize it? ? Components and Grants of 'The Work Incentives Act' 10:45 Break 11:00 Key Elements of a Statewide Network ?Discussion 12:00 Lunch 1:15 Introduction to WIA ? Underlying Philosophy ? Key Components ? One-Stop Centers 2:45 Break 3:00 State/Local Workforce Boards ? Composition ? Appointments ? Responsibilities ? IL Opportunities ? Training 4:30 TWWIIA/WIA Discussion 5:00 End of Day One Tuesday, April 24, 2001 9:00 Six State Review ? Overview ? What Works and Why ? Discussion 10:15 Break 10:30 Development of State/Regional Approaches ?Small Group Strategies ? Report Out 12:00 Lunch 1:15 Integrating TWWIIA and WIA ?Developing Cutting-Edge Strategies 2:45 Wrap-up and Evaluation 3:00 End of Training About the Trainers Byron MacDonald is Public Policy Advocate at the World Institute on Disability. His involvement with employment and disability spans a 20year career including competitive supported employment and work incentives program development. He has a diverse, cross disability background with the practical relationships between Social Security, public health care programs and the employment of adults with disabilities. In June 2000 President Clinton appointed Bryon to the Social Security Ticket to Work and Work Incentives Advisory Panel. Bob Michaels has worked in independent living since 1984 as a center director, consultant and trainer. He provides considerable training and technical assistance to the field, oversees research efforts on the management and administration of centers for independent living and statewide independent living councils, and writes articles and briefs on a variety of related topics. Much of Bob's work has been in association with the ILRU Program in Houston. Prior to his current activities, he as CEO of Liberty Resources, Inc. in Philadelphia and Executive Director of Arizona Bridge to Independent Living in Phoenix. TWWIIA/WIA Buffalo, New York April 23-24, 2001 Trainers Byron MacDonald Public Policy Advocate World Institution on Disability 510 16th Street Suite 100 Oakland, CA 94612 (510) 251-4304 (V) (510) 208-9493 (TTY) (510) 763-4109 (Fax) byron@wid.org Bob Michaels Training and Curriculum Development Coordinator ILRU 65 East Kelly Lane Tempe, AZ 85284 (602) 961-0553 (V) (602) 961-0533 (Fax) michaels@impulsedata.net IL NET STAFF ILRU Lex Frieden Laurie Gerken Redd Executive Director Administrative Coordinator lfrieden@ilru.org lredd@ilru.org Richard Petty Carri George Program Director Publications Coordinator richard.petty@bcm.tmc.edu cgeorge@ilru.org Laurel Richards Dawn Heinsohn Training Director Materials Production Specialist lrichards@ilru.org heinsohn@ilru.org ILRU Program 2323 S. Shepherd Suite 1000 Houston, TX 77019 713-520-0232 (V) 713-520-5136 (TTY) 713-520-5785 (FAX) ilru@ilru.org http://www.ilru.org NCIL Anne-Marie Hughey Executive Director hughey@ncil.org NCIL 1916 Wilson Boulevard Suite 209 Arlington, VA 22201 703-525-3406 (V) 703-525-4153 (TTY) 703-525-3409 (FAX) 1-877-525-3400 (V/TTY - toll free) ncil@ncil.org http://www.ncil.org Kristy Langbehn Project Logistics Coordinator kristy@ncil.org Darrell Lynn Jones Training Specialist darrell@ncil.org Raweewan Buppapong Project Assistant toony@ncil.org ABOUT ILRU The Independent Living Research Utilization (ILRU) Program was established in 1977 to serve as a national center for information, training, research, and technical assistance for independent living. In the mid-1980's, it began conducting management training programs for executive directors and middle managers of independent living centers in the U.S. ILRU has developed an extensive set of resource materials on various aspects of independent living, including a comprehensive directory of programs providing independent living services in the U.S. and Canada. ILRU is a program of TIRR, a nationally recognized, free-standing rehabilitation facility for persons with physical disabilities. TIRR is part of TIRR Systems, a not-for-profit corporation dedicated to providing a continuum of services to individuals with disabilities. Since 1959, TIRR has provided patient care, education, and research to promote the integration of people with physical and cognitive disabilities into all aspects of community living. ABOUT NCIL Founded in 1982, the National Council on Independent Living is a membership organization representing independent living centers and individuals with disabilities. NCIL has been instrumental in efforts to standardize requirements for consumer control in management and delivery of services provided through federally-funded independent living centers. Until 1992, NCIL's efforts to foster consumer control and direction in independent living services through changes in federal legislation and regulations were coordinated through an extensive network and involvement of volunteers from independent living centers and other organizations around the country. Since 1992, NCIL has had a national office in Arlington, Virginia, just minutes by subway or car from the major centers of government in Washington, D.C. While NCIL continues to rely on the commitment and dedication of volunteers from around the country, the establishment of a national office with staff and other resources has strengthened its capacity to serve as the voice for independent living in matters of critical importance in eliminating discrimination and unequal treatment based on disability. Today, NCIL is a strong voice for independent living in our nation's capital. With your participation, NCIL can deliver the message of independent living to even more people who are charged with the important responsibility of making laws and creating programs designed to assure equal rights for all. ABOUT THE IL NET This training program is sponsored by the IL NET, a collaborative project of the Independent Living Research Utilization (ILRU) of Houston and the National Council on Independent Living (NCIL). The IL NET is a national training and technical assistance project working to strengthen the independent living movement by supporting Centers for Independent Living (CILs) and Statewide Independent Living Councils (SILCs). IL NET activities include workshops, national teleconferences, technical assistance, on-line information, training materials, fact sheets, and other resource materials on operating, managing, and evaluating centers and SILCs. The mission of the IL NET is to assist in building strong and effective CILs and SILCs which are led and staffed by people who practice the independent living philosophy. The IL NET operates with these objectives: ? Assist CILs and SILCs in managing effective organizations by providing a continuum of information, training, and technical assistance. ? Assist CILs and SILCs to become strong community advocates/change agents by providing a continuum of information, training, and technical assistance. ? Assist CILs and SILCs to develop strong, consumer-responsive services by providing a continuum of information, training, and technical assistance. Work Incentives Act and Workforce Investment Act Learning Objectives Participants will be able to: 1. Identify the key components of the TWWIIA and WIA programs 2. Describe how each of the programs is to be established within a state 3. Describe how the disability community can participate in the development of the program 4. Develop a plan for enhancing benefits to the disability community through these programs 5. Describe how TWWIIA and WIA can complement each other to improve services to people with disabilities 6. Prepare a strategy for improving services to people with disabilities through these programs TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT "WORK INCENTIVES ACT" Comprehensive Health Care and Public Benefits Reform for Workers with Disabilities TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT PL 106-170, enacted into law December 17, 1999 SEC. 2. FINDINGS AND PURPOSES. (a) FINDINGS- Congress makes the following findings: (1) Health care is important to all Americans. (2) Health care is particularly important to individuals with disabilities and special health care needs who often cannot afford the insurance available to them through the private market, are uninsurable by the plans available in the private sector, and are at great risk of incurring very high and economically devastating health care costs. (3) Americans with significant disabilities often are unable to obtain health care insurance that provides coverage of the services and supports that enable them to live independently and enter or rejoin the workforce. Personal assistance services (such as attendant services, personal assistance with transportation to and from work, reader services, job coaches, and related assistance) remove many of the barriers between significant disability and work . Coverage for such services, as well as for prescription drugs, durable medical equipment, and basic health care are powerful and proven tools for individuals with significant disabilities to obtain and retain employment. (4) For individuals with disabilities, the fear of losing health care and related services is one of the greatest barriers keeping the individuals from maximizing their employment, earning potential, and independence. (5) Individuals with disabilities who are beneficiaries under title II or XVI of the Social Security Act (42 U.S.C. 401 et seq., 1381 et seq.) risk losing medicare or medicaid coverage that is linked to their cash benefits, a risk that is an equal, or greater, work disincentive than the loss of cash benefits associated with working. (6) Currently, less than 1/2 of 1 percent of social security disability insurance and supplemental security income beneficiaries cease to receive benefits as a result of employment. (7) Beneficiaries have cited the lack of adequate employment training and placement services as an additional barrier to employment. (8) If an additional 1/2 of 1 percent of the current social security disability insurance (DI) and supplemental security income (SSI) recipients were to cease receiving benefits as a result of employment, the savings to the Social Security Trust Funds in cash assistance would total $3,500,000,000 over the worklife of the individuals. (b) PURPOSES- The purposes of this Act are as follows: (1) To provide health care and employment preparation and placement services to individuals with disabilities that will enable those individuals to reduce their dependency on cash benefit programs. (2) To encourage States to adopt the option of allowing individuals with disabilities to purchase medicaid coverage that is necessary to enable such individuals to maintain employment. (3) To provide individuals with disabilities the option of maintaining medicare coverage while working. (4) To establish a return to work ticket program that will allow individuals with disabilities to seek the services necessary to obtain and retain employment and reduce their dependency on cash benefit programs. End SEC. 2. "Work Incentives Act" FACT SHEET THE TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT of 1999 Public Law 106-170 Referred to as "the Work Incentives Act" FACT SHEET with EFFECTIVE DATES The Work Incentives Act Provides: Increased health care coverage for workers with disabilities Increased choice in rehabilitation and employment services Social Security Work Incentive upgrades and reform For: Social Security Disability Program Beneficiaries and Workers with Disabilities Date of Enactment: December 17, 1999 The Work Incentives Act is an expansion of services and choices available to Americans with disabilities who work, or are planning to work. The Act begins the redesign of public long-term disability programs to keep pace with medical advances, assistive technologies, and the changing dynamics of the new workplace. The Act's provisions are voluntary and grounded in the consumer's control of when and what decisions will be made about work. Fact sheet by: Bryon R. MacDonald, Chair, Social Security Subcommittee National Council on Independent Living Public Policy Advocate, World Institute on Disability 510 16th Street, Suite 100, Oakland, CA 94612 Phone 510-251-4304 - Fax 510- 763-4109 - TDD 510-208-9493 bryosemite@aol.com - bryon@WID.org (315/01) THE TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT of 1999 Public Law 106-170 Website for Work Incentives Act Text and Grant Applications/News: http://www.wdsc.org/disability/ -- Bobby Approved Text Edition "The Work Site" - The Social Security Employment Website: www.ssa.gov/work FACT SHEET with EFFECTIVE DATES Continuing Health Care Coverage for Workers With Disabilities ALL HEALTH CARE PROVISIONS EFFECTIVE OCTOBER 1, 2000 * MEDICAID: Buy-In for Workers with Increased Earnings/Resources The new federal law allows a state Medicaid buy-in option for workers with disabilities who earn over 250% of the federal poverty level. States may set their own income and resource limits and charge a premium for access to Medicaid services for workers with disabilities. * MEDICAID: Buy-in for Workers who "Medically Improve" State Medicaid buy-in option for workers with disabilities who lose eligibility for Social Security benefits due to medical improvement but continue to have severe medically-determinable disabilities. * MEDICAID: Demonstration to Maintain Independence A time-limited Medicaid buy-in demonstration program allowing states to extend Medicaid to certain workers who have a disability that, without ongoing health care, would become severe enough to qualify them for Social Security disability benefits. Federally funded at $250 million over six years. Grant available at: http://www.hcfa.gov/medicaid/twwiia/twwiiahp.htm * MEDICAID: State Infrastructure Grants Grants to states to develop and establish infrastructures to support working individuals with disabilities, for those states that provide personal assistance services (PAS) in their Medicaid state plan to the extent necessary to enable individuals with disabilities to remain employed. Funds may be used to set up Medicaid buy-ins and demonstrations for workers with disabilities. Federally funded at $150 million over five years. Grant available at: http://www.hcfa.gov/medicaid/twwiia/twwiiahp.htm * MEDICARE: A 4.5 year extension over current law for no-cost Medicare Part A. Net effect: SSDI beneficiaries will access a minimum of 8.5 years of no-cost Medicare Part A after work begins. Effective date: October 1, 2000. Note: Medicare is available indefinitely, after 7.5 years of work credits are paid to a worker's FICA account, at a premium cost of $170.00/month, for as long as a worker remains disabled. Increasing Employment Services The Ticket-to Work and Self-Sufficiency Program PROVISIONS * SSI and SSDI beneficiaries receive a "Ticket-to-Work" from the Social Security Commissioner that allows them to choose a rehabilitation provider, employment services or other supports from a wider pool. Use of a Ticket and The Ticket Program is voluntary. You must be a Social Security beneficiary to receive a Ticket from Social Security. You assign the Ticket to an Employment Network service provider that meets your needs when you and the provider sign a written agreement, an Individual Work Plan, or IWP. Social Security will reimburse an Employment Network when cash benefits stop for a beneficiary in the Ticket Program due to work activity. Payments to Employment Networks will be based on one of two reimbursement systems, a milestone payment system or an outcome based payment system. * The Ticket Program will be phased in nationally over a three year period beginning January 1, 2001, with the first 13 Ticket states announced for 2001: AZ, CO, DE, FL, IL, IA, MA, NY, OK, OR, SC, VT, WI. * The draft regulations for this Program have been published which included a public comment period ending February 26, 2001. See Appendix I or www.ssa.gov/work * Organizational Structure of the Ticket Program Social Security has contracted with a private for profit Program Manager, MAXIMUS, who will recruit, monitor and oversee the Employment Networks, or ENs. An EN will consist of Social Security approved public and private sector service providers authorized to accept a Ticket based on the choice of the beneficiary. An existing community service provider with other funding, an individual, a cooperative of individuals, an employer, could be in an Employment Network or could be their own Employment Network. * An EN is not obligated to accept a Ticket. State Department of Vocational Rehabilitation (VR) and One Stop Centers may elect to be service providers in an EN. VR or One Stop Centers will not be a Program Manager in the Ticket Program. The Program Manager will NOT provide employment services in an Employment Network. * Continuing Disability (medical) Reviews or CDRs CDRs, as in medical eligibility reviews, are suspended for a Ticket user while enrolled in the Ticket Program. Effective date: Upon implementation of Ticket Program in a region. (Cash benefits may still be subject to termination if earnings are substantial.) * A beneficiary may change Ticket service providers. Program managers shall make payments to more than one Ticket Program service provider when a Ticket holder changes providers. * The Social Security Commissioner has written proposed dispute resolution rules and other regulations when state and private providers serve the same Ticket user. * A new and timely Report to Congress is mandated in the law to recommend provider payment rates for those who work with: ( Individuals with a need for ongoing support and services ( Individuals with a need for high cost accommodations ( Individuals who earn subminimum wages, and ( Individuals who work and receive partial cash benefits Social Security Work Incentive Upgrades and Reforms PROVISIONS * Benefit Planning, Assistance and Outreach Program - BPAO Community based, cooperative agreements and competitive grants: a statewide community based program to work with consumers using work incentive rules and programs. $23 million dollars authorized per year for five years. 2001 CURRENT Grants and status: http://www.ssa.gov/oag/grants/announce.htm * Social Security Employment Support Representatives - ESRs Social Security field personnel trained and assigned to work with beneficiaries and community based Benefits Planners on work incentive rules and programs. Effective upon enactment, now in 32 sites nationally. * "Expedited Reentry" Provision - or - "EASY BACK ON" Provision allows SSDI and SSI beneficiaries, when a work stoppage occurs, to get back on provisional benefits easily, pending a Social Security decision of their continuing disability. Cash benefits begin for six months while Social Security determines disability status. If the individual is found to be no longer disabled, the cash benefits do not have to be repaid to SSA. "EASY BACK ON" in the Act applies to former beneficiaries within the first five years after benefits cease due to work efforts and program rules. Effective date: January 1, 2001 * Continuing Disability Review (CDR) Protections Protection against work triggering a medical Continuing Disability Review or "CDR" for SSDI beneficiaries who have received benefits for 24 months. Protections against employment history being used as evidence of medical improvement in a medical CDR. Effective date: January 1, 2002. (Cash benefits may still be subject to termination if earnings are substantial.) * Protection and Advocacy Services Assistance for beneficiaries attempting to work who have disputes or difficulties. $7 million dollars authorized per year for 5 years. Effective upon enactment. 2001 CURRENT Grants and status: http://www.ssa.gov/oag/grants/announce.htm * Twelve Member Ticket to Work and Work Incentives Advisory Panel Consumers of services and other experts appointed by the President and Congress to advise the Social Security Commissioner, the President and Congress, and other federal agencies on the design and administration of work incentive provisions. At least one-half of the panel members are required to be individuals with disabilities, or representatives of individuals with disabilities, with consideration given to current or former Social Security disability beneficiaries. Effective upon enactment. The Panel was sworn in by Social Security Commissioner Apfel and met for the first time July 24, 2000, in Washington. For information, go to: www.ssa.gov/work Please write directly to this Panel at: TWWIIAPanel@SSA.GOV Demonstration Projects * Extension of Disability Insurance Program Demonstration Project Authority: Demonstration authority extended five years from date of enactment. * "2/1" Demonstration Projects. Social Security is required to conduct adequate demonstration projects to provide for and study reductions in disability insurance benefits (SSDI) by $1 for each $2 that a beneficiary earns over a certain amount or amounts. Titles III and IV of THE WORK INCENTIVES ACT describe GAO studies and revenue "offsets." APPENDIX * 2001 - CURRENT SSA WORK INCENTIVE RULES For current law and rules on the Social Security Disability Application Process and the Work Incentives, go to: The Social Security Red Book -- www.ssa.gov/work CLICK ON RESOURCES/TOOLKIT, CLICK ON REDBOOK OR http://www.ssa.gov/work/ResourcesToolkit/redbook.pdf * DRAFT "Proposed Rule" TICKET PROGRAM REGULATIONS The following summary comes from the Federal Register: SUMMARY: We are proposing rules to implement the new "Ticket to Work and Self-Sufficiency Program" (Ticket to Work program) authorized by the Ticket to Work and Work Incentives Improvement Act of 1999. The Ticket to Work program will provide disabled beneficiaries with expanded access to employment services, vocational rehabilitation services, or other support services. We will pay the providers of those services after the beneficiaries achieve certain levels of work. ADDRESSES: Commissioner of Social Security P.O.Box 17703, Baltimore, MD 21235-7703; By telefax to: (410) 966-2830; By E-mail to: regulations@ssa.gov; or Delivered to the Office of Process and Innovation Management, Social Security Administration, 2109 West Low Rise Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401, between 8 a.m. and 4:30 p.m. on regular business days. You may also inspect comments during these same hours by making arrangements with the contact person shown below. FOR FURTHER INFORMATION CONTACT: Geoffrey Funk, Team Leader, Legislative Implementation Team, Office of Employment Support Programs, Social Security Administration, 6401 Security Boulevard, Baltimore, Maryland 21235-6401. Call (410) 965-9010 or TTY 1-(800) 988-5906 for information about these proposed rules. For information on eligibility or filing for benefits, call our national toll-free number, 1-(800) 772-1213 or TTY 1-(800) 325-0778. You may also contact SSA Online at www.ssa.gov. The Work Site (Employment Resources for People with Disabilities maintained by SSA) has a direct link to the Federal Register, which is where the regs are available for public commentary. Go to the Work Site Resources Toolkit/Ticket to Work and Work Incentives Improvement Act- Legislation page, http://www.ssa.gov/work/ResourcesToolkit/legisreg2.html, and follow the link that says "Ticket to Work Proposed Rulemaking Published for Public Comment." Or try the following link directly to the regs in the Federal Register (Comment period closed on 02-26-01. Comments received after 02-26-01, will not be considered in the final regulations. Links and information to the NPRM is for reference purposes.) * FEDERAL POVERTY GUIDELINES Federal Poverty Level Guidelines From: http://aspe.hhs.gov/poverty 2001 HHS Poverty Guidelines Size of Family Unit 48 Contiguous States and D.C. Alaska Hawaii 1 $ 8,590 $10,730 $ 9,890 2 11,610 14,510 13,360 3 14,630 18,290 16,830 4 17,650 22,070 20,300 5 20,670 25,850 23,770 6 23,690 29,630 27,240 7 26,710 33,410 30,710 8 29,730 37,190 34,180 For each additional person, add 3,020 3,780 3,470 SOURCE: Federal Register, Vol. 66, No. 33, February 16, 2001, pp. 10695-10697. The Ticket to Work Question and Answer Sheet A guide for SSI and/or SSDI beneficiaries about the new Ticket to Work Program This pamphlet is based on the Notice of Public Rule Making issued on December 28th, 2000. The regulations for the Ticket Program are in the public comment period which ends on February 26, 2001. For more information on the Ticket Program and the public comment period, please go to www.wid.org. A publication of the California Ticket to Work and Work Incentives Improvement Act Initiative. By: Mitch Jeserich Policy Analyst, World Institute on Disability 510 16th Street, Suite 100 Oakland, CA 94612 mitch@wid.org (510) 251-4350 AN OVERVIEW OF THE TICKET TO WORK PROGRAM The Ticket to Work and Work Incentives Improvement Act (TWWIIA) was signed into law by President Bill Clinton on December 17, 1999. The Ticket to Work portion of the Act creates a choice for SSI and/or SSDI beneficiaries of where to receive employment training services. The Ticket to Work is an entitlement for SSI and/or SSDI beneficiaries and is not mandatory. In the past, persons on SSI and/or SSDI benefits went through the Department of Vocational Rehabilitation (VR) for employment training. And though persons can still use VR services for vocational training, the Ticket to Work allows SSI/SSDI beneficiaries to choose from many more sources, known as Employment Networks, to get these employment services. An Employment Network, approved by The Social Security Administration, can be any agency, private company, or state entity. The Employment Network will be paid for 60 months that the beneficiary is off of cash benefits. During the duration of the Ticket, a beneficiary is protected from Continuing Disability Reviews. To maintain these protections, the Ticket User must show progress towards employment. The Ticket Program will begin in 13 states in year 2001. In the following two years, the remaining states will be included on the Ticket Program. The first 13 states are Arizona, Colorado, Delaware, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont, and Wisconsin. QUESTIONS AND ANSWERS 1. What is the Ticket to Work? The Ticket to Work is a documented agreement that The Social Security Administration will pay an Employment Network (an agency or company providing employment training) for employment training services to SSI/SSDI beneficiaries who choose to use the Ticket to Work Program. 2. Who is a disabled beneficiary? A beneficiary is a person who is on SSI and/or SSDI benefits. 3. Who can use a ticket? A person is eligible to use The Ticket to Work if s/he receives SSI and/or SSDI benefits and is between the age of 18 and 65 years. Except for those beneficiaries whom The Social Security Administration expects to medically improve (MIE) when first awarded benefits. The beneficiaries in this category have to wait until after the first Continuing Disability Review (CDR), and still be considered disabled, to be eligible for the Ticket to Work Program. 4. What is an Employment Network? An Employment Network is any qualified agency, private company, or state agency that has entered into an agreement with The Social Security Administration to coordinate and deliver employment services, vocational rehabilitation services, and other support services to beneficiaries. 5. What do I do when I receive a ticket? Ticket program information will be distributed to you when your state begins the Ticket to Work Program. Your participation in the program is voluntary. If you want to participate in the program, you can take your ticket to any Employment Network or VR agency that agrees to provide you with services. 6. Do I have to stay with an Employment Network or a VR agency? No. If you are dissatisfied with the services being provided, you can retrieve your ticket. Also, you may reassign your ticket to another Employment Network or VR agency. 7. How do I get started with an Employment Network? When the Ticket to Work Program comes to your state, you will be mailed the necessary information concerning local Employment Networks. Then you and the Employment Network of your choice will need to agree upon an individualized work plan (IWP). If you choose to use your ticket with a VR agency, then you and VR will need to agree on an individualized plan for employment (IPE). 8. When does the period of using the ticket begin? The ticket begins on the date of the assignment of your ticket to an Employment Network or a VR agency. 9. When does my period of using a ticket end? Your use of the ticket ends when you are off cash benefits and after the EN is paid by Social Security for the 60th month after you end benefits. 10. Will my participation in The Ticket to Work Program trigger Continuing Disability Reviews No. As long as you are making timely progress towards employment, you will be protected from Continuing Disability Reviews. 11. What is timely progress toward employment? You are considered to be making timely progress towards employment when you show an increasing ability to work at levels which will reduce or eliminate your dependence on cash benefits. During the first 24 months of your ticket, you must be actively participating in your employment plan. During your third year, you must work for at least 3 months in a 12-month period. During the 4th year, you must work at least 6 months in a 12- month period. If you are not making timely progress towards employment, you can still use the ticket as long as the Continuing Disability Reviews demonstrate that you are still disabled. 12. What if my Employment Network, the VR agency, or I report that I am not actively participating in my employment plan? The program manager will give you the choice of resuming participation in your employment plan or placing your ticket in an inactive status. You are not considered to be using a ticket during the months in which your ticket is inactive. The months in which your ticket is inactive do not count toward the time limitations for making timely progress toward employment. If you choose to resume active participation in your employment program, you will be allowed 3 months to demonstrate active participation according to your employment plan. 13. What if I disagree with the reports that I am not making timely progress toward employment? You may request that The Social Security Administration review the decision. You must make the request before the 30th day after the date which the Program Manager sent its notice to you. Then, The Social Security Administration will consider you to be making timely progress towards employment until it makes a decision. 14. What is a Program Manager? A Program Manager (PM) is an organization in the private or public sector that has entered into an agreement to assist The Social Security Administration in administering the Ticket to Work program. The Social Security Administration has selected the for-profit organization Maximus to manage the Ticket Program nationally. 15. Is there a process to resolve a dispute my between my Employment Network and I? Yes. Dispute resolution has three steps. 1. You can seek a solution through the EN's internal grievance procedures. 2. If the EN's internal grievance procedures do not result in an agreeable solution, either you or the Employment Network may seek a resolution from the Program Manager. 3. If either you or the Employment Network is dissatisfied with the resolution proposed by the Program Manager, then you or the EN may request a decision from the Social Security Administration. It is not required that you or the Employment Network go through a dispute resolution. If you are dissatisfied with the services being provided, you can retrieve your ticket at any time. Also, you may reassign your ticket to another Employment Network or VR agency. 16. Can I have legal representation during a dispute? Yes. Protection and Advocacy Inc. will be offering legal services to people with disabilities who are either using the Ticket to Work Program or who are interested in using the Program. Protection and Advocacy Inc. will solely represent the beneficiary and will not function as a mediator between the beneficiary and the Employment Network or Program Manager. A beneficiary can request Protection and Advocacy Inc. services during any time a beneficiary is using the ticket, when a beneficiary would like to begin using the ticket, or when a beneficiary returns to using the ticket if the ticket became inactive. PAI works in partnership with people with disabilities - to protect, advocate for and advance their human, legal and service rights. COMMENTS ON PROPOSED RULE MAKING The Social Security Administration Ticket to Work program of The Ticket to Work and Work Incentives Improvement Act NATIONAL COUNCIL ON INDEPENDENT LIVING COMMENTS AND RECOMMENDATIONS IN RESPONSE TO THE NOTICE OF PROPOSED RULEMAKING ON The Social Security Administration Ticket to Work program of The Ticket to Work and Work Incentives Improvement Act Notice of Public Rule Making Public Comment Period ending February 26, 2001 The National Council on Independent Living (NCIL) is the oldest cross-disability, national grassroots organization run by and for people with disabilities. NCIL's mission is to promote a national advocacy agenda that advances the full integration and participation of persons with disabilities in all aspects of our society. NCIL's membership includes centers for independent living (CILs), statewide independent living councils (SILCs), individuals with disabilities and other organizations which advocate for the rights of people with disabilities. The following comments and recommendations were developed by the NCIL Social Security Subcommittee with input from the NCIL membership and approved by the NCIL Executive Committee on February 15, 2001. NCIL STATEMENT NCIL is submitting to Social Security a response to the SSA Notice of Proposed Rulemaking (NPRM) on the Ticket program, published for public comment on December 28, 2000. The recommendations represent NCIL's values and principles of comprehensive reform, consumer control and choice. The summary of NCIL recommendations starts on page 4 under "Summary of NCIL Recommendations." Our full recommendations start on page 7 under "Full Recommendations." Choice NCIL members support equitable choice at every turn for Americans with disabilities, which is why we continue to support the objectives in the Ticket program. We commit to work with all forums that contribute to the successful implementation of the Ticket program and increased employment outcomes for SSA beneficiaries. The Ticket program establishes a new entitlement for SSA beneficiaries who meet specified criteria set by the Commissioner. The exclusions, exceptions and limits to Ticket eligibility, found in the proposed rule, establish a new and, we fear, dangerous layer of complexity within SSA, presumably for estimated cost savings for which we have seen no evidence. Comprehensive Reform The Ticket program is only one part of TWWIIA, crafted to work simultaneously with other work incentive provisions when a beneficiary goes to work. When and where all TWWIIA provisions are available, we expect more beneficiaries will seek employment services and other supports because more beneficiaries will seek work. Where health care coverage is portable, and available after work starts, and where beneficiaries have the information they need to access public programs and health care with less risk, demand for employment services such as those in the Ticket program will increase. More and new service providers are not likely to become Employment Networks (ENs) in the Ticket program if there isn't a growing beneficiary market for their services. Ticket Program Background Social Security is required by TWWIIA to design a Ticket program for SSA disability program beneficiaries, to be administered by an outside Program Manager (PM), who will recruit and monitor service providers in and to Employment Networks (ENs). Certain beneficiaries, as determined by the Commissioner, are entitled to receive a "Ticket" from SSA, which they can use to shop for services among qualified ENs in the Ticket program. ENs and beneficiaries will establish one on one relationships by creating and agreeing to a signed Individual Work Plan (IWP). The ENs will be paid most of the allowable moneys when employment begins and cash benefits cease to beneficiaries. The Ticket program is a new voluntary option for beneficiaries. The Proposed Rule for the Ticket to Work Program "Sec. 411.105 What is the purpose of the Ticket to Work program? The purpose of the Ticket to Work program is to expand the universe of service providers available to individuals who are entitled to Social Security benefits based on disability ..." NCIL strongly believes that Congress intended the Ticket program to be designed, implemented, staffed and evaluated in coordination with other TWWIIA provisions and other public programs. The purpose of the Ticket program in the proposed rule (Section 411.105) should include expanding the universe of employment support options for beneficiaries by collaborating with programs of the Departments of Health and Human Services, Labor and Education. In the background and introduction sections of the proposed rule there is no mention of the Health Care Financing Administration (HCFA) or the Ticket to Work and Work Incentives Advisory Panel, two legislative SSA partners for the success of Ticket program outcomes. NCIL recommends that SSA acknowledge working with these partners in the final rule. Finally, Maximus, the for profit national Program Manager (PM) chosen by SSA to administer the Ticket program, has a 50 million dollar stake in the Ticket program's hopeful and early success. NCIL encourages Maximus to contribute a statement to the SSA public comment period about working with a diverse SSA beneficiary community and the Ticket program. NCIL RECOMMENDATIONS SUMMARY PURPOSE OF THE TICKET PROGRAM Section 411.105 Recommendation: 1. AMEND THE PURPOSE OF THE TICKET PROGRAM The stated purpose of the Ticket program in the proposed rule, Sec. 411.105, should include: "...and to expand the universe of employment support options for beneficiaries by coordinating the Ticket program with related SSA provisions and collaborating with specified programs of the Departments of Health and Human Services, Labor and Education." TICKET ELIGIBILITY AND USE Recommendation: 2. ELIMINATE THE TRANSITION-AGED YOUTH RESTRICTION Section 411.125 (a) (1) Transition-aged youth (16-18) should be eligible to receive and use a Ticket in the Ticket to Work and Self - Sufficiency Program. Recommendation: 3. ELIMINATE THE ONE TICKET PER BENEFICIARY LIMIT Section 411.125 (b) A beneficiary should have access to the Ticket program as requested without a limit to the number of times a Ticket is available during a period of disability with SSA. Recommendation: 4. ELIMINATE THE "Medical Improvement Expected (MIE)" EXCLUSION FROM TICKET ELIGIBILITY Section 411.125 (a) (3) (i), (ii) SSA disability beneficiaries who are awarded benefits with a "MIE diary" should be eligible to participate in the Ticket program. CONTINUING DISABILITY REVIEWS AND "TIMELY PROGRESS" Sections 411.170, 411.180, 411.190, 411.210 Recommendation: 5. USE EMPLOYMENT NETWORK REPORTING REQUIREMENTS IN THE STATUTE TO TRACK "TIMELY PROGRESS" NCIL recommends defining "timely progress" as meeting the goals and objectives of the Individual Work Plan (IWP) created and agreed to between a beneficiary and an EN. The annual reports from the EN to the PM required by statute should be used to report timely progress with IWP goals and objectives. EMPLOYMENT NETWORK QUALIFICATIONS Sections 411.315, 411.325(g) Recommendation: 6. ENCOURAGE EMPLOYERS AND NON-TRADITIONAL SERVICE PROVIDERS TO BECOME EMPLOYMENT NETWORKS Four Recommendations: * Amend § 411. 315 (b) (1) (ii) - "To qualify and become an Employment Network (EN), an EN should be required to retain staff that are otherwise qualified based on education or direct services experience working with people with disabilities, such as by using staff with a college degree in a related field." * An entity, whom a beneficiary identifies to the Program Manager that he/she wants to retain for employment services and other supports, including but not limited to employers without direct services experience with people with disabilities, should be allowed into an Employment Network under individual circumstances, with approval of the PM, and with submission of a qualifying Individual Work Plan. * SSA should not require licensure and/or certification that would exclude employers or others qualified to work with people with disabilities who offer non-traditional supports that result in employment. (Delete § 411. 315 (c), proposed rule to require licensure etc., if required in a given state.) * Delete § 411.325(g) from the list of EN financial reporting requirements. It is invasive, as drafted, and could deter potential service providers from Ticket program interest. PAYMENT METHODS Recommendation: 7. PRIORITY REFORM FOR WAGE REPORTING AND OVERPAYMENTS Section 411.575(b)(ii)(2) NCIL recommends that SSA establish an efficient, sustainable, beneficiary-friendly method of collecting and recording information regarding a worker's earnings that equitably meets the requirements and needs of all new stakeholder groups. Recommendation: 8. UPGRADE THE EN MILESTONE/OUTCOME PAYMENT SYSTEM Sections 411.500, 411.525, 411.535, 411.540 and 411.545 The NCIL Board and membership agree with many others that the proposed rule's milestone/outcome payment system to ENs is inadequate to provide services as described in the Ticket program. NCIL members recommend, along the lines being developed by the TWWIIA Advisory Panel, that SSA modify the milestone/outcome payment system to support ENs realistically, more equitably for all beneficiaries, and early on when ENs need the resources most. See full recommendation below for details. Recommendation: 9. ELIMINATE INEQUITABLE INCENTIVES TO WORK WITH SSI VERSUS SSDI BENEFICIARIES Section 411.525(1)(i) SSA should consider applying the same $740 monthly SGA level applicable to Title II beneficiaries to all beneficiary groups as the threshold for the milestone payments to employment networks. DISPUTE RESOLUTION AND PROTECTION AND ADVOCACY The SSA Advisory Panel has developed sound recommendations for a complex area, with extensive input from consumers, NCIL members, consumer groups, Protection and Advocacy, and the disability community. Recommendation: The NCIL Social Security subcommittee recommends that NCIL members defer to the Advisory Panel's thorough development of these issues and use these community generated recommendations. Please see DISPUTE RESOLUTION AND PROTECTION AND ADVOCACY in the following pages. NCIL FULL RECOMMENDATIONS PURPOSE OF THE TICKET PROGRAM Recommendation: AMEND THE PURPOSE OF THE TICKET PROGRAM The stated purpose of the Ticket program in the proposed rule, Sec. 411.105, should include: "...and to expand the universe of employment support options for beneficiaries by coordinating the Ticket program with related SSA provisions and collaborating with specified programs of the Departments of Health and Human Services, Labor and Education." TICKET ELIGIBILITY AND USE Recommendation: ELIMINATE THE TRANSITION-AGED YOUTH RESTRICTION Transition-aged youth (16-18) should be eligible to receive and use a Ticket in the Ticket to Work and Self - Sufficiency Program. Background: The proposed rule limits participation in the Ticket program to disability beneficiaries between the ages of 18 and 64 who SSA has found disabled under adult rules. The younger age restriction limits choice for the age group, diminishes work expectations for the age group at exactly the wrong time in life and delays incentives for young adults to plan for work. The provision is out of step with youth and work focused federal policy. Programs and policy in the Individuals with Disabilities Education Act (IDEA) and the Workforce Investment Act (WIA) promote seamless programming from school to work for students and young adults with and without disabilities. Recommendation: ELIMINATE THE ONE TICKET PER BENEFICIARY LIMIT A beneficiary should have access to the Ticket program as requested without a limit to the number of times a Ticket is available during a period of disability with SSA. Background: NCIL does not think the legislation limits or Congress intended the Ticket program to be a one time only opportunity for beneficiaries. We have not seen any analysis to support limiting the Ticket program to one Ticket for life or the length of the disability status with SSA. There is current research (Rutgers, 2000) that people with disabilities are twice as likely to have part time, temporary and self-employment profiles as people without disabilities. In this context, NCIL believes there may be a basis to project cost savings to SSA with multiple uses of the Ticket program when beneficiaries go in and out of work depending on their individual circumstances. Recommendation: 4. ELIMINATE THE "Medical Improvement Expected (MIE)" EXCLUSION FROM TICKET ELIGIBILITY Recommendation: SSA disability beneficiaries awarded benefits with a "MIE diary" should be eligible to participate in the Ticket program. If they are excluded from participation in the program, the process for determining and assigning this designation should be changed. Beneficiaries should also be notified that they are being given this designation, informed that it will prevent them from participating in the Ticket program and a process for appeal/due process review should be created. Background: The proposed rule states that a person who is awarded benefits with an MIE diary for the scheduling of their first Continuing Disability Review (CDR) is not eligible for the Ticket program until after the completion of their first CDR. A beneficiary with this designation is scheduled to have their case reviewed within 6 to 18 months after receiving benefits. This category was created to determine when the first CDR for a beneficiary should be completed. There are about 43,000 DI and SSI adult beneficiaries who are classified first time MIEs on the rolls. Data from the disability determination services decision files indicate that about 16% of initial SSDI and SSI beneficiaries that come up for first-time continuing disability reviews (CDRs) are found no longer disabled, usually 18-24 months after allowance, for medical improvement. In other words, 83% remain disabled under SSA rules at their first CDR. NCIL believes there is no moral or administrative justification for this exclusion given the chronic backlog of scheduled CDRs in SSA. CONTINUING DISABILITY REVIEWS AND "TIMELY PROGRESS" Recommendation: USE EMPLOYMENT NETWORK REPORTING REQUIREMENTS IN THE STATUTE TO TRACK "TIMELY PROGRESS" NCIL recommends defining "timely progress" as meeting the goals and objectives of the Individual Work Plan (IWP) created and agreed to between a beneficiary and an EN. The annual reports from the EN to the PM required by statute should be used to report timely progress with IWP goals and objectives. Background: A beneficiary in the Ticket program is not subject to medical reviews, Continuing Disability Reviews (CDRs), if the beneficiary is making "timely progress" in the proposed rule. The "timely progress" tracking requirements in the proposed rule are complex for this suspension of CDRs to remain in effect. The requirements are "one size fits all" and tied to set earnings levels some beneficiaries with cognitive conditions may not meet, even when they may be making timely progress. The "timely progress" requirements in the proposed rule are not found in the statute. The statute and the proposed rule (in a separate section, Section 411.325 (e)) require annual progress reports from the EN to the PM. It is difficult to imagine cases where two parties would continue a signed Ticket contract for years unless there were timely progress underway between two signed contractors, the beneficiary and the EN. These requirements seem burdensome and redundant to statutory requirements. EMPLOYMENT NETWORK QUALIFICATIONS Recommendation: ENCOURAGE EMPLOYERS AND NON-TRADITIONAL SERVICE PROVIDERS TO BECOME EMPLOYMENT NETWORKS Four Recommendations: * Amend § 411. 315 (b) (1) (ii) -- To qualify and become an Employment Network (EN), an EN should be required to retain staff that are otherwise qualified based on education or direct services experience working with people with disabilities, such as by using staff with a college degree in a related field. * An entity, whom a beneficiary identifies to the Program Manager that he/she wants to retain for employment services and other supports, including but not limited to employers without direct services experience with people with disabilities, should be allowed into an Employment Network under individual circumstances, with approval of the PM, and with submission of a qualifying Individual Work Plan. * SSA should not require licensure and/or certification that would exclude employers or others qualified to work with people with disabilities who offer non-traditional supports that result in employment. (Delete § 411. 315 (c), the proposed rule to require licensure, etc., if required in a given state.) * Delete § 411.325(g) from the list of EN financial reporting requirements. § 411.325(g) requires the EN to submit to the Program Manager, annually, a financial report that shows the percentage of the Employment Network's budget that was spent on serving beneficiaries with tickets. It is hoped that continued SSA dialogue with interested stakeholders on this proposed rule will generate specific and timely recommendations on how to meet the needs that warranted this rule, but in less invasive ways for potential ENs. Background: Many people with disabilities have a "circle of support," that is, people whom they trust to provide ancillary and support services. Most often, these individuals are non-credentialed support providers. EN required qualifications should be broad enough to allow for non-traditional providers to accomplish the proposed purpose of the Ticket program, to "expand the universe of service providers available to individuals who are entitled to Social Security benefits based on disability..." § 411.105 PAYMENT METHODS Recommendation: PRIORITY REFORM FOR WAGE REPORTING AND OVERPAYMENTS Recommendation: NCIL recommends that SSA establish an efficient, sustainable, beneficiary-friendly method of collecting and recording information regarding a worker's earnings that equitably meets the requirements and needs of all new stakeholder groups. Background: NCIL members and current and former beneficiaries know all too well the current state of SSA wage reporting procedures, current work incentive programs, and the potential negative impact without reform on timely payments to ENs. The chronic SSA problem of overpayments to beneficiaries is an immediate and major threat to the Ticket program. While ensuring privacy and maintaining confidentiality, SSA has a prime responsibility to facilitate accurate monthly or quarterly payments to employment networks and to eliminate chronic and historic overpayments to beneficiaries. Recommendation: UPGRADE THE EN MILESTONE/OUTCOME PAYMENT SYSTEM The NCIL Board and membership agree with many others that the proposed rule's milestone/outcome payment system to ENs is inadequate to provide services as described in the Ticket program. Similar to proposals being developed by the TWWIIA Advisory Panel, NCIL members recommend that SSA modify the milestone/outcome payment system to support ENs realistically, more equitably for all beneficiaries, and early on when ENs need the resources most, as follows: a) Pay a minimal milestone when a beneficiary and employment network sign an IWP; b) Pay an additional milestone payment at the end of 12 months of SGA equal to the first two now in the proposed rule (i.e. 3 and 7 months of SGA) c) Amortize the milestone payments over the entire 60-month outcome-only payment period rather than the first 12 months of outcome payments, as proposed; d) Pay a 97% payment option under the milestone/outcome payment option rather than the proposed 85%; e) Equalize the monthly outcome payments under the milestone/outcome payment period rather than the graduated method proposed in the NPRM; f) Provide individualized milestones for individuals with a need for on-going support services, individuals who need high-cost accommodations, individuals who earn a subminimum wage, and individuals who work and receive partial cash benefits along the lines of systems already in use in Massachusetts, Oklahoma and other states. Recommendation: ELIMINATE INEQUITABLE INCENTIVES TO WORK WITH SSI VERSUS SSDI BENEFICIARIES Recommendation: SSA should consider applying the same $740 monthly SGA level applicable to Title II beneficiaries to these groups as the threshold for milestone payments to employment networks. Background: The proposed rule payment systems discourage ENs from serving SSI beneficiaries because the EN would receive a smaller return for similar effort and it can take longer for SSI beneficiaries to reach the point in employment when they leave cash benefits entirely due to work. DISPUTE RESOLUTION AND PROTECTION AND ADVOCACY The SSA Advisory Panel has developed sound recommendations for a complex area, with extensive input from consumers, NCIL members, consumer groups, Protection and Advocacy, and the disability community. The NCIL Social Security subcommittee recommends that NCIL members defer to their expertise, use these community generated recommendations, and add others as needed. FROM THE SSA TWWIIA ADVISORY PANEL: Dispute Resolution applies in two distinct situations under the TWWIIA statute and regulations: 1) individual disputes between an SSI or SSDI disability beneficiary and an Employment Network, a Benefits Planning Assistance and Outreach Provider, or the Program Manager; and 2) non-individual disputes between Employment Networks and Employment Networks, Employment Networks and State Vocational Rehabilitation Agencies, Employment Networks and Program Managers, and Program Managers & other providers. The Dispute Resolution / Protection and Advocacy Workgroup proposes the following recommendations for consideration by the full TWWIIA Advisory Panel: 1. Protection and advocacy services should be available to all SSA beneficiaries regardless of whether or not they are ticket users or living in a ticket rollout state. 2. Mediation should be available as an avenue for resolving disputes, but should not be mandatory. It should be an option available to the parties to the dispute after the matter has been referred to the Program Manager for resolution. Both parties must agree to enter into mediation. If the parties do not choose mediation prior to a decision by the PM, they may still do so prior to a further appeal to the SSA. 3. Mediation services should be external to the Social Security Administration and should not be provided by or paid for by P&A agencies. Because mediation is a more efficient and cost-effective way to resolve disputes, the Social Security Administration should set aside additional funds to support the use of mediation for all parties. 4. The current internal and external appeals process should be available to all beneficiaries who dispute a Social Security Administration agency decision. 5. An SSA beneficiary should receive a formal notice of the availability of protection and advocacy services when: (1) he/she applies to the Employment Network for services; (2) at the signing of his/her Individual Work Plan (IWP); (3) in the event his/her services are decreased, suspended or terminated; and (4) when he/she files a complaint against an Employment Network. 6. Information on how to access P&A services should be available from the EN to all beneficiaries seeking or using work incentives, the Ticket or other employment supports at any time, and specifically, when a beneficiary requests information about the availability of P&A services. 7. A beneficiary's filing of a complaint against an EN should, with the beneficiary's consent, trigger a notice to the P&A agency from the EN regarding the dispute and a subsequent inquiry by the P&A as to the beneficiary's wish for P&A assistance. 8. The respective State P& A System should, with the consent of the beneficiary, receive beneficiary contact information when the beneficiary deposits his/her ticket with an EN for services. 9. Notices from the EN and P&A agency, the beneficiary's IWP, and any other documents, should be in the beneficiary's primary or accessible communication language. 10. The EN should be given no more than 15 working days to resolve individual beneficiary complaints against it, after which time the beneficiary should be able to request review by the Program Manager. 11. In reviewing a dispute, the Program Manager should be required to request and accept documents and information from both the beneficiary and the EN and to ensure that all parties have timely receipt of all documents to be considered in the appeal decision. 12. The PM should complete its review and render a decision within 15 working days, unless the parties agree to mediation. If the parties agree to mediation, mediation should commence within 10 working days after the PM receives the parties' request for mediation and be completed within 20 working days after it is scheduled. Mediation does not foreclose a further appeal to the SSA. 13. The Social Security Administration should have no more than 20 working days to resolve appeals. Internal and external review involving a further appeal should be available to all parties. 14. During the appeals process, services and supports to the beneficiary should be continued at the same level; that is, services and supports should not be reduced or suspended by the EN without the consent of the beneficiary. 15. The Social Security Administration should reach a decision on a dispute involving two or more Employment Networks, State Vocational Rehabilitation Agencies, or the Program Manager not more than 60 working days after receipt of notice of the dispute and the requisite information from the parties to the dispute. 16. All decisions by the Social Security Administration involving disputes between two or more Employment Networks, State Vocational Rehabilitation Agencies, and/or the Program Manager should, at the option of the parties, be subject to external review by the courts. NCIL concludes its recommendation to Social Security by requesting that THE SOCIAL SECURITY ADMINISTRATION NOT ISSUE ANY TICKETS UNTIL THE FINAL REGULATIONS ARE PUBLISHED, DUE TO THE EXCLUSIONS DUE TO AGE AND THE EXCLUSION DUE TO THE "MEDICAL IMPROVEMENT EXPECTED" RULE. October 8, 2001 Acting Commissioner Halter Social Security Administration 6401 Security Blvd. Room 960 Altmeyer Building Baltimore, MD 21235 Dear Commissioner Halter: I am writing on behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel) to express the Panel's concerns regarding certain provisions in the Notice of Proposed Rule Making (NPRM), as well as the Social Security Administration's (SSA) plans for implementation and first year roll-out of the Ticket program in thirteen states. As you know, the Panel has received regular briefings and updates from the Associate Commissioner for Employment Support Programs, Kenneth McGill, on NPRM implementation activities such as contracting and grant-making, and other critical administrative rollout activities. We have also received updates and information on program evaluation activities from the Acting Deputy Commissioner of Policy, Paul Van de Water. Both have been helpful in briefing the Panel on SSA's activities and in responding to requests for information. We are very appreciative of their cooperation. The Panel recognizes that the implementation and rollout of the new TWWIIA programs pose enormous challenges to SSA and to the field of rehabilitation as a whole. We believe, however, if implemented cautiously, and with serious consideration given to input from the Panel and constituents, these programs have the potential to improve the overall quality and availability of rehabilitation services, employment services and supports, and related health services for our nation's citizens with disabilities. In keeping with this belief and with our commitment to the success of TWWIIA in increasing employment rates for people with disabilities, the Advisory Panel members take very seriously their responsibility to advise and assist the Commissioner of SSA. After the Panel's initial meeting in July 2000, and its subsequent briefings on both TWWIIA and the NPRM, Panel members felt it was essential to reach out to a variety of constituent groups and advocates to solicit comments and opinions about the NPRM and the plans for Ticket implementation. To achieve this the Panel has conducted eleven days public meetings and seven public conference calls since July 2000. We have hosted over twenty (20) hours of public comment at those meetings. Additionally, public meetings in Phoenix, Minneapolis, Salt Lake, and Atlanta as well as tele-conferences in California have been devoted solely to public comment on the NPRM. We have also solicited and received correspondence from the public regarding SSA's Ticket implementation plans and the NPRM. Not only have individual Panel members attended numerous meetings in their home states, but many also have been asked to speak to groups and organizations about the Panel and TWWIIA implementation. During the past six months of Panel activity, specific issues relating to implementation and rollout and the proposed regulations in the NPRM, have surfaced repeatedly in public comment and in Panel deliberations. After extensive discussion in our January and February meetings, the Panel concluded that a letter outlining key implementation issues and concerns should be sent immediately, prior to close of the NPRM public comment period. Issue one involves the NPRM's exclusion of certain beneficiaries from the Ticket program, specifically those who have a Medical Improvement Expected (MIE) diary and transition age youth 16-18 years old. We are aware that SSA officials did consider including both of these populations early in the development of the NPRM. We have requested an analysis of the cost implications for including these populations from the Office of the Actuary. With regard to the exclusion of beneficiaries with an MIE diary, the Panel has four specific concerns. They are: (1) reports indicate that the MIE designation has a disproportionate impact on consumers who are diagnosed with mental illness; (2) placing someone in the MIE category appears to be based solely on diagnosis; (3) the NPRM does not address appeal and due process issues raised when denying a benefit (i.e., a Ticket) to a beneficiary based on a designation that most beneficiaries do not even know they carry; and, (4) denying access to the Ticket program to over approximately beneficiaries a year when only a small subgroup of approximately 9,600 (i.e. actual ticket users) are ceased by a Continuing Disability Review (CDR), is questionable public policy. More specifically, in 1999, there were 60,766 DI and SSI adult beneficiaries on the rolls who were classified first time MIEs. The decision files of disability determination services indicate that in 1999, that same year, 9,663 beneficiaries with an MIE diary were ceased because of medical improvement. No one knows how many of those who were ceased would be likely to use a ticket. But, overall estimates of ticket use are very low. To exclude tens of thousands from the program for the savings realized by such a small number seems questionable. The Panel recommends that this entire population be included in the Ticket program in the final rule. Until a final rule is published, SSA's communications and information should be silent on this proposed exclusion. With regard to the exclusion of transition aged youth, the Panel strongly recommends that SSA include this population in the Ticket program in the final rule. Other Federal agencies, such as the Office of Special Education Programs, the National Council on Disability and the President's Task Force on Employment of Adults with Disabilities, also support their inclusion in the Ticket program. The President's Task Force has recommended and promoted the inclusion of transition aged youth in all Federal employment policies and programs in their annual report to the President issued in December 2000. A well researched finding with this population is that success in employment is directly related to early intervention. Panel members believe that working with young people early on is sound public policy and makes good common sense. We do not believe that the potential savings outweigh the benefits of reaching these young people to prevent a lifetime of poverty and dependence. The second major issue is the inadequacy of the proposed milestones payment system in the NPRM. After extensive public comments, testimony by experts and hours of deliberation, the Panel has concluded that the proposed milestone payment amounts and payment frequency outlined in the NPRM are grossly inadequate for the vast majority of private entities that are looking to become employment networks (ENs). There are thousands of small and medium-sized private non-profit and private for-profit rehabilitation and employment service providers in local communities all over the country that have expressed interest in this program. The Panel has received extensive public comments from individuals and organizations representing these providers and all have indicated that the proposed milestone payment system is inadequate. The inadequacy of the payment system as proposed in the NPRM would also restrict the use of Tickets by those who are harder to serve. If Ticket implementation moves forward without the payment system issue resolved, it is likely that many individuals who are harder to serve will be unable to find an EN willing to take their Ticket. Many commenters stated that if the milestone payment process issues are not resolved before SSA tries to enroll ENs, SSA will find that few, if any, ENs will sign up to provide services. Testimony from a number of State Vocational Rehabilitation Agencies (State VRs) further indicated that if no ENs sign up, all beneficiaries who want to use their Ticket will be forced to come to State VRs for services. This will create havoc in the VR Agency's system since State VR's are not prepared to deal with the onslaught of applicants. This will defeat the core purpose of the Ticket program -- to expand the number of providers working with SSA beneficiaries. It will also undermine the goal of providing a real choice of providers for all beneficiaries. The third major issue relates to the protections to be accorded beneficiaries and the provision of timely dispute resolution services. In the NPRM, the burden to know of, and seek out, assistance and dispute resolution services is on the beneficiary. This is unrealistic and can lead to the denial of critical advocacy services for beneficiaries in need. We received extensive public comment on this issue from a number of advocates in the current State Protection and Advocacy Systems for people with developmental disabilities, people with mental illness and other disabilities, as well as clients of the State Vocational Rehabilitation system. Their experience, specifically with the Client Assistance Program for individuals served by the State Vocational Rehabilitation Agency, is that consumers must receive up-front and regular notice of the availability of advocacy services in order for the service to be effective in protecting beneficiaries and preventing disputes. People with disabilities should be notified of the availability of advocacy services when they receive their Ticket and at critical junctures throughout the process. It is not sufficient to provide information about the availability of protection and advocacy services only at the beginning of the process. Beneficiaries need to be reminded often that the service is available to them at any time. The Panel recommends that early and frequent notice be instituted immediately, beginning with public education brochures and distributed with the initial mailing of Tickets to beneficiaries in the rollout states. A fourth issue reflects the Panel's concern regarding to two reporting requirements. They are the reporting requirements for beneficiary earnings and the requirement that ENs submit an annual financial report showing the percentage of the EN's budget spent on serving beneficiaries. To require ENs to provide monthly beneficiary earnings reports is unrealistic, costly, burdensome and unworkable for most ENs. Panel members believe that ENs will not be able to collect this information on a monthly basis and perhaps will find even quarterly difficult. The beneficiary has almost no incentive to provide earnings information after he/she is no longer receiving cash benefits. In addition, the requirement of an annual financial report is confusing at best, and can be burdensome and intrusive at worst. It appears unnecessary in the overall evaluation of effectiveness of the program. We believe it will discourage potential providers because it is unnecessarily intrusive and there is no indication what the government will do with the information once it collects it. What would an EN report? How would the information be used? Could it be used to propose a decrease in the payment and/or profit of ENs? In addition to these major issues, the Panel in a recent meeting discussed two non-NPRM concerns with regard to the actual rollout of the program during its January. After a briefing on the terms and conditions of the draft Request for Proposals (RFP) for employment networks, and after receipt of public comments from State VR representatives at the meeting, the Panel discussed the planned schedule for roll-out of the RFP and the Ticket. All of the members present agreed that the terms and conditions in the RFP appeared to unnecessarily limit the types of providers the program would enroll and that many of the terms were confusing. Some members were also very concerned that beneficiaries would receive a Ticket and there would be no ENs signed up to provide services. After receiving further information from Mr. McGill that appeared to address some of the Panel's concerns and thorough discussion and deliberation during its February meeting, the Panel passed a motion by a 4/3 vote to recommend that SSA not release the RFP for the ENs or Tickets to beneficiaries until the regulations are final. The final poll of the entire Panel after the meeting indicated that five (5) of the Panel members were in favor of the motion and six (6) were opposed. Further motions, one to delay the distribution of Tickets until the final rules are issued, and one to delay publishing the RFP for at least two months after the NPRM comment period closes, were supported by the majority of Panel members with 10/1 and 9/2 in favor respectively. The Panel is very appreciative of SSA efforts to move forward with the Ticket program and we are aware of the tight timeframes in the statute. Given the significance of the issues raised and concerns expressed, however, we recommend that SSA proceed with caution and with due regard for the input of the Panel and the public. Finally, the Panel recommends that all public information and public education materials, as well as communications to the field and to the public, include plain and clear language acknowledging that the above NPRM issues are not resolved and that current implementation activities should not be confused with final decision-making on the regulatory issues in question. Any such communication should indicate that SSA plans to work with advocates, providers, constituents, the new Administration and Congress to resolve the NPRM issues in a balanced and reasonable way. We further urge SSA to be very careful in public education materials and in all communication with beneficiaries to state clearly that to date, no one is excluded from the Ticket program. It takes only one rumor, regardless of its veracity, to have the effect of exclusion for large numbers of people whose history and experience is full of exclusions. The Panel shares your enthusiasm and commitment to this very important program, and we look forward to working with SSA to ensure that its promise becomes a reality for people with disabilities. To that end, we would appreciate receiving a written response to this letter. If you have questions, please contact Marie Strahan, Executive Director for the Advisory Panel, or me. Thank you for your cooperation and support. I look forward to hearing from you. Sincerely, Sarah Wiggins Mitchell, Chair cc: Marie Strahan Glenna Donnelly Ken McGill Paul Van De Water Message From the Panel It is the Panel's distinct honor to transmit to the Commissioner of Social Security its Preliminary Advice Report on the Ticket to Work and Self-Sufficiency Program (the Ticket program) in response to the NPRM published in the Federal Register on December 28, 2000. The Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170) authorizes the Ticket program to expand the universe of service providers available to beneficiaries with disabilities. Social Security beneficiaries who are seeking employment services, vocational rehabilitation services, and other support services to assist them in obtaining, regaining, and maintaining gainful employment can use a ticket and other work incentives to secure work. The recommendations in this report represent our informed deliberations after initial public and expert input from the field and briefings from agency officials. A final advice report will be published in early April and will reflect further input, deliberations, research and analysis by the Panel. It is the Panel's duty to advise and assist the Commissioner in the successful implementation of the Ticket Program so that individuals with disabilities nationwide can secure self-supporting employment. This report is an initial step toward achieving that goal. Table of Contents Table of Contents Executive Summary and Recommendations NPRM Issues, Public Input, Discussion and Recommendations Introduction Ticket to Work and Beneficiary Use Employment Network Requirements and Qualifications Dispute Resolution and Mediation Employment Network Payment Appendices A. Schedule of Panel Meetings and Other Activities B. List of Commenters C. Two EN Milestone Payment Models for SSI EXECUTIVE SUMMARY AND RECOMMENDATIONS This Preliminary Advice Report is comprised of the preliminary analysis and initial recommendations of the Ticket to Work and Work Incentives Advisory Panel (the Panel) to the Commissioner of the Social Security Administration on the proposed rules for the Ticket to Work and Self-Sufficiency Program. The proposed rules appear in a Notice of Proposed Rulemaking published in the Federal Register on December 28, 2000. The Panel intends to collect additional information, do further analysis and solicit additional public comment in order to develop and submit its final advice report on the NPRM to the Commissioner in late March or early April 2001. Public Law 106-170, The Ticket to Work and Work Incentives Improvement Act of 1999, establishes programs that are designed to provide SSA beneficiaries with disabilities with a broader array of providers and improved access to employment services and supports, vocational rehabilitation services and other support services. It also establishes the Ticket to Work and Work Incentives Advisory Panel, whose duty is to advise the Commissioner of Social Security and report to the President and Congress on issues related to work incentive programs, planning and assistance for individuals with disabilities and the Ticket to Work and Self-Sufficiency Program established under this Act. The Panel is composed of twelve individuals, four of whom were appointed by the President, four by the Senate and four by the House of Representatives. The appointees represent a cross-section of individuals with experience and expert knowledge as recipients, providers, employers and employees in the fields of employ-ment services, vocational rehabilitation and other related support services. The majority of the members are individuals with disabilities or their representatives. There are several current or former disability beneficiaries of Social Security on the Panel as well. A summary of the Panel's initial twenty-two (22) recommendations to the Commissioner of SSA on the proposed rules precedes the full report. SUMMARY OF PANEL RECOMMENDATIONS ON THE PROPOSED RULES TICKET TO WORK AND BENEFICIARY USE Recommendation 1: Sixteen (16) and seventeen (17) year old beneficiaries should be eligible to participate in the Ticket program. Recommendation 2: All SSA disability beneficiaries with a medical improvement expected (MIE) diary should be eligible to participate in the Ticket program. Recommendation 3: SSA should conduct a cost benefit analysis on the feasibility of a beneficiary receiving more than one ticket within a period of disability and the agency should assess the potential impact of beneficiaries using more than one ticket in its "Adequacy of Incentives" report due to Congress at the end of the Ticket imple-mentation period. EMPLOYMENT NETWORK REQUIREMENTS AND QUALIFICATIONS Recommendation 4: An employment network (EN) should be required to retain staff that are otherwise qualified based on education or direct services experience, such as employees with a college degree in a related field, including but not limited to vocational counseling, education, human resources, human relations, social work, teaching, or psychology or employees with equivalent experience. SSA should not require licensure and/or certification that would exclude employers or other types of providers qualified to work with people with disabilities such as those who offer non-traditional supports that result in employment. SSA should delete Section 411. 315 (c). Recommendation 5: Section 411.325(g) should be deleted from the list of EN reporting requirements. Section 411.325(g) currently requires "...among other things, submitting to the Program Manager, on an annual basis, a financial report that shows the percentage of the employment network's budget that was spent on serving beneficiaries with Tickets..." Recommendation 6: The Panel recommends that timely progress be defined as beneficiary compliance with the terms and conditions of the IWP, as agreed to by the beneficiary and EN and that the reporting mechanism be the annual report in Section 411.325(e). Recommendation 7: SSA should permit other individualized service delivery plans to be used as a substitute to the IWP provided they meet the minimum requirements detailed in the statute. Recommendation 8: SSA should re-write Section 411.385 to make it clear that an SSA beneficiary with a ticket who applies for State Vocational Rehabilitation services has a choice in deciding whether to assign his/her ticket to the State VR agency, to assign it to another EN, or not to assign it at all. DISPUTE RESOLUTION Recommendation 9: All beneficiaries should have access to P&A services. Recommendation 10: Mediation should be available as an avenue for resolving disputes but it should not be mandatory. It should be an option available to the parties to the dispute, after the matter has been considered for resolution by the Program Manager. * All parties must agree to enter into mediation. * Mediation should be external to the Social Security Administration and should not be provided or paid for by protection advocacy agencies. Mediation is a more efficient and cost-effective way to resolve disputes. * Participation in the mediation process should not bar a party's access to further appeals. * The Social Security Administration should set aside additional funds to support the use of mediation for all parties. * The Social Security Administration should look at other successful mediation program models such as those established at EEOC and the Department of Justice. Recommendation 11: All decisions by the Social Security Administration involving disputes between or among all parties should, at the option of the parties, be subject to external review by either the Social Security Administration's administrative review process and/ or judicial review. Recommendation 12: Information about protection and advocacy services and how to access them should be available at any time to all beneficiaries seeking or using SSA or other work incentive programs, including the Ticket. Specifically, a beneficiary should receive a formal notice of the availability of protection and advocacy services when he or she is issued a ticket and at the following junctures in the process: * When he or she applies to the employment network for services; * At the signing of his or her individual work plan; * In the event his or her services are decreased, suspended or terminated; or * When he or she filed a complaint against the network. Recommendation 13: The beneficiary's filing of a complaint against an EN should, with the beneficiary's consent, trigger a notice to the protection and advocacy agency regarding the dispute to allow for an inquiry by the protection and advocacy agency as to the beneficiary's wish for protection and advocacy assistance. Recommendation 14: Notices from the EN and the protection and advocacy agency, the beneficiary's IWP and any other documents should be in the beneficiary's primary or accessible language of communication. Recommendation 15: Timelines for dispute resolution should be follows: * Employment networks should have fifteen working days to resolve a complaint filed by a beneficiary. If not resolved satisfactory, the beneficiary should be permitted to request a review by the Program Manager. * The request for review, with the submission of all supporting documentation by both parties, should be submitted within ten (10) working days after the beneficiary receives the employment network's decision. * The Program Manager should complete its review and render a decision within fifteen working days, unless the parties agree to mediation. * If the parties agree to mediation, mediation should commence within ten (10) working days after the Program Manager receives the parties' request for mediation and should be completed within twenty (20) working days after it is scheduled. * The Social Security Administration should have no more than twenty (20) working days to resolve individual appeals. * All disputes involving Employment Networks, State vocational rehabilitation agencies, and the Program Manager must be resolved within sixty (60) working days, including Social Security Administration review and issuance of a decision. Recommendation 16: During the appeals process, services and supports to the beneficiary should be continued at the same level; that is, services and supports should not be reduced or suspended by the Employment Network without the beneficiary's consent. Recommendation 17: All parties in a dispute should have access to all information that is being considered and used to render a decision in the dispute. EMPLOYMENT NETWORK PAYMENT RECOMMENDATIONS Recommendation 18: SSA Ticket implementation staff should re-evaluate the proposed payment structure to determine the feasibility of adopting a system that pays at least four milestone payments: 1) at the signing of the IWP; 2) at 3 months of SGA; 3) at 7 months of SGA; 4) at 12 months of SGA. A second-tier of the milestone system would be a system in which milestones would be individualized for beneficiaries who need significantly more supports. Specifically the system would: a) Pay a minimal milestone when a beneficiary and employment network signs an IWP; b) Pay an additional milestone payment equal to the first two proposed (i.e., 3 and 7 months of SGA) at the end of 12 months of SGA; c) Amortize the milestone payments over the entire 60-month outcome-only payment period rather than the 12 months proposed; d) Pay a greater overall percentage of the outcome-only payment option under the milestone/outcome payment option than the proposed 85%; e) Equalize the monthly outcome payments under the milestone/outcome payment period rather than the graduated method proposed in the NPRM; f) Provide individualized milestones for individuals with a need for on-going support services, individuals who need high-cost accommodations, individuals who earn a sub minimum wage, and individuals who work and receive partial cash benefits along the lines of systems already in use in Massachusetts, Oklahoma and other states. (These systems use the individualized planning process to determine if and when a different set of milestones is necessary, and establish a plan for payments and accountability for the payments.) Recommendation 19: Because the Title II and Title XVI programs are distinctly different from each other with differing processes and timelines, SSA should develop two milestone payment systems; one for SSI beneficiaries and another for SSDI beneficiaries, that take into account the differences between the two programs. (See attachment C - Seifert and O'Brien models) Recommendation 20: SSA should consider applying the same earnings level ($740 monthly) for all Ticket users as the threshold for outcome payments to employment networks. Recommendation 21: SSA should commission a full cost benefits study to evaluate the ticket program. Such a study should begin with a more complete view of the direct savings to the SSA trust fund, but should also consider savings to the Federal treasury and increased productivity to the nation as a whole. Such a study would at a minimum consider the impact of increased FICA contributions by working beneficiaries, reduced use of Medicare, cash trust fund savings by beneficiaries who work but who only receive partial cash benefits and estimated trust fund savings beyond 60 months. The study should also consider reduced use of all other government transfers and increased taxes paid. It should consider the addition to net national product of increased work. It should evaluate costs and benefits from SSA's point of view, from the view of the Federal government, from the view of the beneficiary and from society as a whole. Recommendation 22: SSA should resolve the conflict between Sections 411.510 and 411.390 regarding VR's choice of payment systems for beneficiaries who are already clients of VR. NPRM ISSUES, SUMMARY OF PUBLIC INPUT DISCUSSION AND RECOMMENDATIONS INTRODUCTION The Ticket to Work and Work Incentives Advisory Panel take seriously its duty to advise and assist the Commissioner of the Social Security Administration and to report to the President and the Congress. Because one of the first major tasks outlined in the Ticket to Work and Work Incentives Improvement Act (TWWIIA) is to advise the Commissioner on the regulations for the Ticket program, the Panel, since their initial meeting in July, has focused its attention primarily on the Notice of Proposed Rulemaking (NPRM). In September, the Panel created four workgroups to focus on certain topic areas covered in the NPRM: Ticket to Work and Beneficiary Use of Ticket; Employment Network Requirements and Qualification; Dispute Resolution; and, Provider Payment. This Preliminary Advice Report reflects the work of these workgroups, expert advice from invited guests of the workgroups, public input and Panel deliberations. The Panel deemed it essential to reach out to a variety of constituents and advocates to solicit comments and opinions about the NPRM and the Agency's plans for Ticket implementation. To achieve this the Panel has conducted eleven (11) days of public meetings and seven (7) public conference calls since July 2000. We hosted over twenty (20) hours of public comment at those meetings. Additionally, public meetings in Phoenix, Minneapolis, Salt Lake, and Atlanta as well as two teleconferences in California have been devoted solely to public comment on the NPRM. At each meeting citizens with disabilities, their advocates, and other stakeholders, were provided ample opportunity to comment. Additionally, individual Panel members have attended numerous meetings in their home states and have been asked to speak to a variety of groups and organizations about the Panel and the Ticket's implementation. We have also solicited and received correspondence from the public regarding the agency's Ticket implementation plans and the NPRM. In sum, the Panel has made a concerted effort to solicit input from a broad cross-section of program constituents by holding meetings in Washington, D.C., as well as regional meetings and teleconferences across the country. The twenty (20) hours of public comments and the over eighty (80) sets of comments received by letter and e-mail reflect this diversity of input. During this first six months of Panel activity, specific issues and concerns regarding implementation and rollout of the Ticket program and the proposed regulations have surfaced repeatedly in public comments and in Panel deliberations. After extensive discussion in our January and February meetings, the Panel concluded that a letter outlining key implementation issues and concerns should be sent to the Acting Commissioner of SSA, prior to close of the NPRM public comment period. SSA has provided the Panel regular briefings and updates on the NPRM and administrative implementation activities such as evaluation plans, contracting, grant-making, and other critical administrative rollout activities. The Panel recognizes that the implementation and rollout of the new Ticket program pose tight timeframes and demands major changes in the culture and business practices of the Agency. However, if implemented carefully, with consideration given by the agency to public comments and to the input and advice of the Panel, the Ticket to Work and Self-Sufficiency program has the potential to improve vastly the quality and availability of rehabilitation services, employment services and supports, and related health services for this country's citizens with disabilities. TICKET TO WORK AND BENEFICIARY USE Issue 1: Should transition-aged youth (16-18) be eligible to receive and use a Ticket in the Ticket to Work and Self-Sufficiency Program? Summary of Input: The Panel received comments from the public that overwhelmingly supported providing Tickets to at least 16 and 17 year olds. There was consensus that the longer people receive cash benefits the less likely they are to be able to achieve independence and become self-supporting. The public also agreed that the expectations created for a young person with a disability might be the most important factor in whether they work or rely on benefits and that allowing them to participate in the Ticket program makes another tool available to encourage positive expectations. Experts told the Panel that schools themselves could potentially be Employment Networks for youth. Discussion: Making transition-aged youth ineligible for the Ticket program would send the wrong message to youth and could have the effect of encouraging lifelong dependency upon benefits. There may or may not be a determinable increase in cost to the program in the short-term. The long-term benefits to the program and the youth beneficiaries could far outweigh those expenditures. Many youth may not choose to participate in the program until after they are 18, but those who wish to participate should be allowed to do so. Programs and policy in the Individuals with Disabilities Education Act and the Workforce Investment Act promote seamless programming from school to work for students and young adults with and without disabilities. The proposed regulations limit participation in the Ticket program to disability beneficiaries between the ages of 18 and 64. 18-year-old SSI recipients must be determined disabled under adult rules before being able to receive a Ticket. As youth prepare to transition out of school to the workforce, the Ticket program could be a value-added tool to assist them to plan work. Recommendation 1: Sixteen (16) and seventeen (17) year old beneficiaries should be eligible to participate in the Ticket program. Issue 2: Should disability beneficiaries classified with a "Medical Improvement Expected (MIE)" diary be eligible to participate in the Ticket program? Summary of Input: Public comment supported the inclusion of beneficiaries with the MIE diary in the Ticket program. Members of the public indicated that services should be available to all disability beneficiaries sooner rather than later as policy, since recent research supports findings that the longer someone receives cash benefits the harder it is for them to become self-supporting. The public also cited that most people with MIE diary do not know they have been given that designation. Further, testimony to the Panel indicated that in their practical experience, people with MIE diaries undergo delayed initial Drs often times years after the date on which they are supposed to. Concern was expressed by national leaders from mental health and national organizations representing people who are developmentally disabled, that people with long-term mental illness (such as bipolar disorder) and cognitive impairments receive this designation disproportionately, often with no real indication that improvement is likely. In addition, members of the public were of the opinion that if the designation of the MIE diary category for CDRs would be used to limit a person's access to a benefit, it must be subject to due process review or appeal. In addition, agency officials stated that it is not known how many beneficiaries have their benefits terminated due to a CDR based on the MIE diary, and then reapply based on a decline in their condition and then are awarded benefits a second time. Discussion: The Panel agreed that limiting a person's access to a Federal benefit (i.e. the ticket) without providing for a due process review is questionable practice/policy. If this exclusion remains in the final rule, it should outline a procedure for timely review and appeal. This would increase the administrative burden to SSA, the cost of which may outweigh the possible savings to the programs created by such exclusion. One likely consequence may be that the length of time required to process all appeals, not just MIE cases, will be negatively impacted, that is, all appeal cases would take longer given the additional caseload. If the rule becomes final with its effect to limit a person's access to the benefits of the Ticket program, SSA should commit to policy and procedures that beneficiaries with the MIE designation receive their initial CDR on schedule. The exclusion of beneficiaries with the MIE diary from participation in the Ticket program does not appear to be justified. The SSA program and policy officials were not able to provide the Panel with sound statistical analysis to justify this exclusion. The Panel was not provided with data on how long it takes for a person with the MIE diary to have the initial CDR completed. There was also no information that indicated that a significant number of people with the MIE designation would be terminated after the completion of their initial CDR. There was no evidence to counter the argument that people with a MIE designation would be more successful in staying off the rolls through being allowed early participation in the Ticket program, even if their initial CDR would result in a termination of benefits. The proposed regulations state that a person who is awarded benefits with an MIE diary for the scheduling of their first Continuing Disability Review (CDR) is not eligible for the Ticket program until after the completion of their first CDR. A beneficiary with this designation is scheduled to have their case reviewed within 6 to 18 months after receiving benefits. This MIE category was created for the sole purpose of determining when the first CDR for a beneficiary should be completed. In 1999, there were 60,766 DI and SSI adult beneficiaries who were classified first time MIEs on the rolls. Data from the disability determination services decision files indicate that in 1999, 9,663 beneficiaries with a MIE diary were ceased for medical improvement. On the average, about 16% of initial Titles II and XVII MIE allowances that come up for first-time continuing disability reviews (CDRs) are ceased, usually 18-24 months after allowance, for medical improvement. Recommendation 2: All SSA disability beneficiaries with a medical improvement expected (MIE) diary should be eligible to participate in the Ticket program. Issue 3: Should a person be entitled to more than one ticket within a period of disability? Summary of Input: Concern was expressed by the public that beneficiaries would not be able to find ENs that would provide services to them if they have a partially used ticket. Current research (Schur, 2000) finds that people with disabilities are twice as likely as non-disabled people to work in part time and temporary work. Concern was raised that the program would not work for a large segment of beneficiaries particularly those with disabilities that are episodic in nature. Discussion: Many beneficiaries using the Ticket program are likely to go in and out of work, and not transition at first attempt from receipt of cash benefits to 60 months of continuous employment. A beneficiary whose ticket is partially used and needs other continuing support services may have a difficult time finding an EN willing to work with them. For example, a beneficiary returns to cash benefits after a work stoppage in the "Easy Back On" provision of TWWIIA. The person wants to return to work again and decides he/she needs support services. This consumer will be at a distinct dis-advantage even though if interested in continuing to work. There is nothing in the statute that prevents a beneficiary from receiving a second ticket and there may well be unassessed cash savings to SSA programs in allowing two or more tickets to a beneficiary, as warranted or appropriate. In Section 411.125(b), the proposed rule states that a person can have only one ticket during a period of entitlement for which a beneficiary is eligible to receive disability benefits. The Panel has asked for clarification from the agency on the difference between a period of eligibility, a period of entitlement and a period of disability. We expect that information shortly. Regardless, if a beneficiary returned to work and her or his Employment Network (EN) received 35 out of the 60 outcome payments and the beneficiary then became unable to work, his or her ticket would only have 25 outcome payments left to pay out. That is what is being described as a partially used ticket. A related issue is whether an EN, new or old, would be willing to provide a full array of services to a beneficiary with a partially used ticket and a significantly reduced number of payments. Recommendation 3: SSA should conduct a cost benefit analysis on the feasibility of a beneficiary receiving more than one ticket within a period of disability and the agency should assess the potential impact of beneficiaries using more than one ticket in its "Adequacy of Incentives" report due to Congress at the end of the Ticket implementation period. EMPLOYMENT NETWORK REQUIREMENTS AND QUALIFICATIONS Issue 4: Who should be in an Employment Network providing services to beneficiaries who are Ticket holders? Summary of Input: Many of the commenters stated that State licensure laws dictate requirements for certain providers so SSA should defer to those State rules. Some commenters expressed concern that the quality of services may be compromised if provided by less that trained personnel, however, they recognized the benefits of allowing support and other services by non-credentialed providers if under the auspices of an EN who is ultimately accountable for the services provided. Discussion: Many people with disabilities have a "circle of support," that is, people who they trust to provide additional support services. Most often, these individuals are non-credentialed support providers. In some instances, they are family members, neighbors, or friends who provide needed supports. The final rule regarding EN qualifications should be broad enough to accommodate non-traditional providers while accomplishing the stated purpose of the Ticket program, to "expand the universe of service providers available to individuals who are entitled to Social Security benefits based on disability..." § 411.105 According to the proposed rule, an Employment Network is any qualified entity that has entered into an agreement with SSA to function as an EN; and assumes responsibility for the coordination and delivery of employment services, vocational rehabilitation services, or other support services to beneficiaries who have assigned their ticket to that EN. The proposed rule would require that an eligible entity must assure that it is licensed, certified, accredited, or registered if so required by state law to provide these services either directly or through arrangements with other entities. Recommendation 4: An employment network (EN) should be required to retain staff that are otherwise qualified based on education or direct services experience, such as employees with a college degree in a related field, including but not limited to vocational counseling, education, human resources, human relations, social work, teaching, or psychology or employees with equivalent experience. SSA should not require licensure and/or certification that would exclude employers or other types of providers qualified to work with people with disabilities such as those who offer non-traditional supports that result in employment. SSA should delete Section 411. 315 (c). Issue 5: What financial reporting is needed by the Program Manager or SSA from the Employment Network? Summary of Input: Many commenters recommended that the agency try to "keep it simple" and not require reporting that is not necessary. Some were concerned that a few of the reporting requirements may place an undue administrative burden on ENs and discourage the participation of potential providers. Still others in the public and on the Panel were of the opinion that it is inappropriate, invasive and unreasonable for SSA to require these kinds of reports in an outcome-based program. Discussion: While there is a substantive evaluation component in the Ticket program, the Panel thinks that using the financial reporting requirements in Section 411.325 (g) is not the way to collect data for it. The requirement will prohibit providers and employers from participating who have no intention of adding to the financial disclosures they already make to the Federal government. Section 411.325 of the NPRM outlines the proposed reporting requirements of an EN. One of those requirements is for the EN to submit to the Program Manager, annually, a financial report that shows the percentage of the Employment Network's budget that was spent on serving beneficiaries with tickets. Recommendation 5: Section 411.325(g) should be deleted from the list of EN reporting requirements. Section 411.325(g) currently requires "...among other things, submitting to the Program Manager, on an annual basis, a financial report that shows the percentage of the employment network's budget that was spent on serving beneficiaries with Tickets..." Issue 6: Should "timely progress" toward an employment goal be measured by minimum standards for all beneficiaries, or, should the terms and conditions agreed to in each IWP determine timely progress? Summary of Input: The Panel did not receive extensive public comment on this issue, however the Panel did engage in extensive discussion and deliberation and they came to a consensus on a recommendation. Discussion: Beginning with a 24 month review after a Ticket is assigned to an EN, the proposed regulations require the Program Manager to assess whether a beneficiary is making "timely progress towards self-supporting employment" which will then keep Continuing Disability Review (CDR) suspensions in place. There are no "timely progress" requirements in the statute. "Timely progress" requirements in the proposed rule are directly related to the suspension of CDRs for Ticket program users. A ticket holder must meet the "timely progress" requirements to avoid a CDR. One option would be to have the same net outcome as the proposed rule for the first three years. It would require the same minimum work standards for all Ticket participants in years three, four and five of an EN-Ticket contract with a beneficiary. The second option, and the option that the Panel is recommending, would individualize "timely progress" and place the responsibility of proof and reporting on the EN with oversight by the Program Manager. Another question raised in discussion was, should there be set minimum requirements for employment in years four and five of Ticket use in order to keep CDR suspensions in place. The statute, and the proposed rule in Section 411.325 (e), require annual progress reports from the EN to the Program Manager using progress tracked in the Individual Work Plan. Recommendation 6: The Panel recommends that timely progress be defined as beneficiary compliance with the terms and conditions of the IWP, as agreed to by the beneficiary and EN and that the reporting mechanism be the annual report in Section 411.325(e). Issue 7: Should the State VR agency be allowed to use the Individual Plan for Employment (IPE) as a substitute for the Individual Work Plan (IWP)? If so, should other individualized service delivery plans be acceptable alternatives, provided they meet the minimum standards outlined in the statute for an IWP? Summary of Input: The few commenters who touched on this issue stated that the IPE or any other work plan that meets the minimum IWP standards described in the statute should be an acceptable alternative to the IWP. They stressed the need to reduce duplication with the same person, eliminate unnecessary paperwork, and reduce administrative burden. Discussion: If a document already exists that meets the statutory requirements of an IWP there should not be a requirement for a duplicate document. The proposed regulations recognize this and permit State VR agency to use the IPE as a substitute for the IWP. Other programs should be permitted to do the same. Recommendation 7: SSA should permit other individualized service delivery plans to be used as a substitute to the IWP provided they meet the minimum requirements detailed in the statute. Issue 8: When a SSA beneficiary with a ticket applies to the state VR agency for services, should the beneficiary have the option of retaining their ticket for use with other ENs? Summary of Input: The commenters we heard from are concerned about choice, both here and in the connected context of the rule allowing only one ticket per eligible beneficiary per period of entitlement for benefits. The proposed rule should not presume that an applicant for VR services who is a SSA beneficiary would assign their ticket to VR. Panel members received widespread comments that VR receives special treatment in many respects throughout the rule. In this context, there have been comments that § 411.385 needs clarification or change in the context of other special arrangements in the rule for the State VR agency. NPRM Section 411.385 states: "What does a State VR agency do if a beneficiary who is applying for services has a ticket that is available for assignment?" (a) Once the State VR agency determines that beneficiary who is applying for services has a ticket that is available for assignment (see § 411.140) and the State VR agency and the beneficiary have agreed to and signed the individualized plan for employment (IPE) required under Section 102(b) of the Rehabilitation Act of 1973, as amended, the beneficiary's ticket is considered to be assigned. Discussion: People with disabilities are eligible for a number of public programs that offer counseling, rehabilitation, training, job placement, other employment services and support services from a wide variety of state and Federal systems and delivered at Federal, state and local levels. These systems include Federal housing programs, State developmental disabilities services, State mental health services, transportation services, one-stop training and employment services, independent living services, transition and special education, health care and related supports, and assistive technology, just to name a few. The intent of the Ticket program was to expand services and supports, not to limit them. A ticket should be seen as yet another tool that the SSA beneficiary can choose to use to supplement what is already available to the individual under current public programs. Use of the ticket should improve that individual's chance of success in employment. Informed choice is a key concern of the Panel. The agency's outreach on the Ticket program should inform beneficiaries of the choice issues that are raised when they decide to apply for VR services. Eligibility for VR services and VR client status should not dictate when a beneficiary can use their ticket or where a beneficiary can deposit their ticket. Recommendation 8: SSA should re-write Section 411.385 to make it clear that an SSA beneficiary with a Ticket who applies for State Vocational Rehabilitation services has a choice in deciding whether to assign his/her Ticket to the State VR agency, to assign it to another EN, or not to assign it at all. DISPUTE RESOLUTION AND MEDIATION Issue 9: Should protection and advocacy services be available to all beneficiaries of the Social Security Administration regardless of whether or not they are Ticket users or living in a Ticket roll out state? Discussion: Section 1150(a)(b) (1) and (2) of the legislation provides that SSA beneficiaries are eligible for obtaining information and advice about vocational rehabilitation and employment services and advocacy or other services that a disabled beneficiary may need to secure or regain gainful employment. There is no requirement in the legislation that a beneficiary be a ticket holder or currently living in a roll out state in order be eligible for protection and advocacy services. Summary of Input: There was substantial public input in support of protection and advocacy services being provided to all SSA beneficiaries. Additionally, the Panel received substantial public comment regarding the fact that beneficiaries face many barriers to obtaining needed services and supports to enable them to go to work. Commenters stated over and over again that P&A services should be available to assist all SSA beneficiaries, regardless of their status as a Ticket holder or residence in a Ticket roll out state. Recommendation 9: All beneficiaries should have access to P&A services. Issue 10: Should mediation be a part of the dispute resolution process? Summary of Input: Commenters agree that voluntary mediation should be available to all parties involved in a dispute under the Ticket to Work Program and that mediation services should be paid for by the agency. Discussion: Subpart 1 of the proposed regulations on dispute resolution (Section 411.600 et seq.) does not address the use of mediation as a means of resolving disputes. Mediation is an informal, cost effective means of resolving disputes and should be available on a voluntary basis. Neither Section 411.600 et seq. nor Section 411.435 addresses the use of mediation as a means of resolving disputes. Sections 411.660 and 411.630 of the proposed regulations state that Social Security Administration makes the final decision in all disputes. There is no mention of an opportunity for an external review process. Recommendation 10: Mediation should be available as an avenue for resolving disputes but it should not be mandatory. It should be an option available to the parties to the dispute, after the matter has been considered for resolution by the Program Manager. * All parties must agree to enter into mediation. * Mediation should be external to the Social Security Administration and should not be provided or paid for by protection advocacy agencies. Mediation is a more efficient and cost-effective way to resolve disputes. * Participation in the mediation process should not bar a party's access to further appeals. * The Social Security Administration should set aside additional funds to support the use of mediation for all parties. * The Social Security Administration should look at other successful mediation program models such as those established at EEOC and the Department of Justice. Issue 11: Should there be an external appeals process for all parties? Should there be an opportunity for all parties to a dispute to have access to a review of SSA's decision, either through a SSA review process or an external judicial review process. Summary of Input: Commenters were unanimous in their recommendations that all parties to disputes should have the opportunity to an external appeal process beyond what is currently offered in the regulation. This more fully ensures that fairness and impartiality are observed throughout the dispute resolution process. Discussion: The Panel was in complete agreement. Recommendation 11: All decisions by the Social Security Administration involving disputes between or among all parties should, at the option of the parties, be subject to external review by either the Social Security Administration's administrative review process and/ or judicial review. Issues 12 - 14: At what point or points should a beneficiary receive information about the availability of protection and advocacy services and in what format should such information and other materials be provided? Summary of Input: The Panel heard widespread comments that beneficiaries should be provided with notice of their right to advocacy and representation several times throughout their Ticket experience. Beneficiaries will be overwhelmed with information about this new program and they should be reminded several times at key points throughout their experience of their right to legal advocacy and representation, especially, at the time of ticket issuance. All notices of this right as well as other materials must be available in the beneficiary's primary or accessible communications language the individual's primary language and or alternative formats that provides effective communication for that individual. Discussion: Section 411.465 (regarding requirements for an IWP) and Sections 411.605 and 411.610 require notice regarding the availability of protection and advocacy assistance in resolving disputes only to beneficiaries who become Ticket users. There is no reference in the regulations to the need or requirement that all beneficiaries receive information regarding protection and advocacy assistance in areas other than dispute resolution or to beneficiaries who have not exercised their option to use their ticket. Recommendation 12: Information about protection and advocacy services and how to access them should be available at any time to all beneficiaries seeking or using SSA or other work incentive programs, including the Ticket. Specifically, a beneficiary should receive a formal notice of the availability of protection and advocacy services when he or she is issued a Ticket and at the following junctures in the process: * When he or she applies to the employment network for services; * At the signing of his or her individual work plan; * In the event his or her services are decreased, suspended or terminated; or * When he or she filed a complaint against the network. Recommendation 13: The beneficiary's filing of a complaint against an EN should, with the beneficiary's consent, trigger a notice to the protection and advocacy agency regarding the dispute to allow for an inquiry by the protection and advocacy agency as to the beneficiary's wish for protection and advocacy assistance. Recommendation 14: Notices from the EN and the protection and advocacy agency, the beneficiary's IWP and any other documents should be in the beneficiary's primary or accessible language of communication. Issues 15 - 17: Should there be time limits and other requirements imposed on all parties involved in the dispute resolution process? Summary of Input: Commenters were concerned about the impact on a beneficiary once a dispute arises. One aspect of that concern is length of time it will take to resolve a complaint and what happens to the beneficiary's training and employment status during the complaint review process. It was suggested that there should be strict timelines to minimize the adverse impact on all parties when a complaint is filed. Discussion: The Panel hosted lengthy public discussion on this topic and they were in agreement that timelines need to be spelled out in the final regulations. The proposed regulations either do not reflect timelines for a dispute resolution or, where they do, they are inadequate. For example, there are no timelines for the employment network's internal grievance process or the Social Security Administration's review process. (See Sections 411.435, 411.615, 411.625, and 411.630.) Recommendations 15: Timelines for dispute resolution should be follows: * Employment networks should have fifteen working days to resolve a complaint filed by a beneficiary. If not resolved satisfactory, the beneficiary should be permitted to request a review by the Program Manager. * The request for review, with the submission of all supporting documentation by both parties, should be submitted within ten (10) working days after the beneficiary receives the employment network's decision. * The Program Manager should complete its review and render a decision within fifteen working days, unless the parties agree to mediation. * If the parties agree to mediation, mediation should commence within ten (10) working days after the Program Manager receives the parties' request for mediation and should be completed within twenty (20) working days after it is scheduled. * The Social Security Administration should have no more than twenty (20) working days to resolve individual appeals. * All disputes involving Employment Networks, State vocational rehabilitation agencies, and the Program Manager must be resolved within sixty (60) working days, including Social Security Administration review and issuance of a decision. Recommendation 16: During the appeals process, services and supports to the beneficiary should be continued at the same level; that is, services and supports should not be reduced or suspended by the Employment Network without the beneficiary's consent. Recommendation 17: All parties in a dispute should have access to all information that is being considered and used to render a decision in the dispute. EMPLOYMENT NETWORK PAYMENT Issue 18: How can the milestone payment system be structured to encourage providers to serve all eligible individuals, including those who are harder to serve? Summary of Input: As proposed, the milestone payment system allows two milestone payments to be made before the first outcome payment. These milestones recognize that those currently on either SSDI or SSI benefits who are provided job related services and return to work do not immediately reach a level of employment that makes them ineligible for cash benefits and their employment network eligible for outcome payments. For the most part, there was consensus among commenters and the experts consulted that the milestone payment method proposed in the notice of proposed rulemaking (NPRM) is not feasible. They encouraged the Panel to recommend to the Commissioner a payment design that addresses provider choice and capitalization. As proposed, the milestone payment structure is not attractive to potential employment networks since it yields a smaller total payment than the outcome payment system. It places the majority of burden/risk on the EN and, it requires an unrealistic up-front investment by the EN. Alternative proposals were presented that add additional milestones, spread the milestone payments over 5 years, and reduce the 15% penalty incurred by ENs who choose milestone payments to 5%. Discussion: A milestone payment system that has more payments earlier on in the employment process will attract more providers to the program and thus afford consumers more choice in service provision. A system that pays a greater overall percentage of the outcome-only payment option would be more appealing to ENs than that proposed and one that provides for individualized milestones could increase the likelihood that individuals with significant disabilities would be served by ENs. Also, allowing for individualized milestones for individuals who are more difficult to serve better matches the current work and payment rules and would provide incentives and supports necessary for ENs to serve these individuals. Recommendation 18: SSA Ticket implementation staff should re-evaluate the proposed payment structure to determine the feasibility of adopting a system that pays at least four milestone payments: 1) at the signing of the IWP; 2) at 3 months of SGA; 3) at 7 months of SGA; 4) at 12 months of SGA. A second-tier of the milestone system would be a system in which milestones would be individualized for beneficiaries who need significantly more supports. Specifically the system would: b) Pay a minimal milestone when a beneficiary and employment network signs an IWP; b) Pay an additional milestone payment equal to the first two proposed (i.e., 3 and 7 months of SGA) at the end of 12 months of SGA; c) Amortize the milestone payments over the entire 60-month outcome-only payment period rather than the 12 months proposed; d) Pay a greater overall percentage of the outcome-only payment option under the milestone/outcome payment option than the proposed 85%; e) Equalize the monthly outcome payments under the milestone/outcome payment period rather than the graduated method proposed in the NPRM; f) Provide individualized milestones for individuals with a need for on-going support services, individuals who need high-cost accommodations, individuals who earn a sub minimum wage, and individuals who work and receive partial cash benefits along the lines of systems already in use in Massachusetts, Oklahoma and other states. (These systems use the individualized planning process to determine if and when a different set of milestones is necessary, and establish a plan for payments and accountability for the payments.) Issue 19. How can SSA restructure the milestone-outcome payment system for SSI beneficiaries in order to account for existing work incentives? Summary of Input: Among the various suggestions to restructure the milestone system, the Panel received comments on specific models that would allow a distinctly different payment system for SSI beneficiaries and SSDI beneficiaries (See EN Payment Models in Appendix C.) Discussion: The milestone system was devised as a method of sharing risk between SSA and providers. Under the proposed system, most of the risk is with the provider and requires that a person not be receiving ANY cash benefits before an outcome payment is made. SSI beneficiaries are disadvantaged because of the current $1-for-$2 cash offset in SSI work incentives. This would require SSI recipients to earn more ($360 a month more) than those on SSDI before an outcome payment is paid to an EN. As a result, ENs will be discouraged from serving the SSI population, a group that has a lower education level and a much weaker work history than the SSDI beneficiaries. This would leave SSI recipients at a distinct disadvantage in the Ticket program. Recommendation 19: Because the Title II and Title XVI programs are distinctly different from each other with differing processes and timelines, SSA should develop two milestone payment systems; one for SSI beneficiaries and another for SSDI beneficiaries, that take into account the differences between the two programs. (See attachment C - Seifert and O'Brien models) Issues 20- 21: How can the financial incentives to serve beneficiaries be structured to be more equitable? Summary of Input: The Panel received briefings and documents from senior SSA officials on various return to work programs and studies undertaken by the agency, e.g., Gallup poll of potential employment networks. The results indicated that there is real interest in the program from potential providers but that certain beneficiaries, by virtue of their group affiliation (e.g., blind DI beneficiary)-may not be served as readily as others. One reason is the length of time from the beginning of service provision to the point when payments to the EN can start is distinctly longer for some groups. The Panel received extensive public comment on this issue and most advocated for a common earnings level threshold for outcome payments for all beneficiaries. Also, commenters encouraged the Panel to recommend a payment system with financial incentives to serve individuals who are harder to serve (i.e., individuals with a need for ongoing support and services, individuals who need high-cost accommodations, individuals who earn a sub minimum wage, and individuals who work and receive partial cash benefits.) Further, the Panel heard that it would be prudent of SSA to develop a payment system that includes all beneficiaries with disabilities to heighten the likelihood of savings to the programs. Discussion: Of particular concern to the Panel are the inequities in the financial incentives structure to serve certain beneficiaries, e.g., SSI beneficiaries and the harder to serve population. As proposed, the payment systems discourage ENs from serving SSI beneficiaries because the EN would receive a smaller return for similar effort and it could take considerably longer for SSI beneficiaries to reach the point in employment when ENs can be paid. The Panel is also interested in the development of an effective milestone/outcome payment structure that would address the barriers to service provision for individuals who are harder to serve. A consistent outcome-payment threshold for all Ticket users could level the playing field, making all Ticket users equally attractive to ENs in the context of when a payment can be made. Recommendation 20: SSA should consider applying the same earnings level ($740 monthly) for all Ticket users as the threshold for outcome payments to employment networks. Recommendation 21: SSA should commission a full cost benefits study to evaluate the ticket program. Such a study should begin with a more complete view of the direct savings to the SSA trust fund, but should also consider savings to the Federal treasury and increased productivity to the nation as a whole. Such a study would at a minimum consider the impact of increased FICA contributions by working beneficiaries, reduced use of Medicare, cash trust fund savings by beneficiaries who work but who only receive partial cash benefits and estimated trust fund savings beyond 60 months. The study should also consider reduced use of all other government transfers and increased taxes paid. It should consider the addition to net national product of increased work. It should evaluate costs and benefits from SSA's point of view, from the view of the Federal government, from the view of the beneficiary and from society as a whole. Issue 22: There is an internal conflict in the NPRM between the language in Section 411.510(c) and the language in Section 411.390 regarding the State Vocational Rehabilitation agency's (VR) choice of payment methods for beneficiaries who are already clients of VR. Summary of Input: There was no public input on this issue. Discussion: Section 411.390 of the proposed regulations says that the State VR agency may only seek payment under the cost reimbursement payment system for beneficiaries already receiving services under an IPE. This rule is in direct conflict with Section 411.510(C) that states that the state VR agency will notify the Program Manager of the payment system election for each such beneficiary. The Panel had no opinion about either of the rules but felt that the regulatory provisions should be consistent throughout. Recommendation 22: SSA should resolve the conflict between Sections 411.510 and 411.390 regarding VR's choice of payment systems for beneficiaries who are already clients of VR. APPENDIX A Schedule of Panel Meetings and Other Activities Ticket to Work and Work Incentive Advisory Panel Schedule of Panel Meetings and Other Activities 1. July 24-25, 2000 2 Day Meeting 1 hr. 2. September 11, 2000 Teleconference 45 min 3. September 26-27, 2000 2 Day Meeting Briefing 4. November 8, 2000 Teleconference 1 hr. 5. November 13-15, 2000 3 Day Meeting 1 hr. 6. November 27, 2000 Teleconference 1 hr. 7. December 12, 2000 Teleconference 1 hr. 8. December 19, 2000 Teleconference 1 hr. 9. January 3, 2001 Teleconference 1 hr. 10. January 9-10, 2001 2 Day Meeting 2 hrs. 11. January 23, 2001 Teleconference 1 hr. 12. February 6-8, 2001 3 Day Meeting 3 hrs. REGIONAL MEETINGS 1. January 22, 2001 Salt Lake City, Utah 0 2. January 24, 2001 Minneapolis, Minnesota 3 hrs. 3. January 25, 2001 West Coast Teleconference 2 hrs. 4. January 26, 2001 Phoenix, Arizona 4 hrs. 5. January 29, 2001 Atlanta, Georgia 4 hrs. 6. February 15, 2001 West Coast Teleconference 2 hrs. APPENDIX B List of Commenters Social Security Administration Ticket to Work and Work Incentives Advisory Panel Teleconference September 11, 2000 List of Commenters Ron Calhoun Office of Vocational and Educational Services for Individuals with Disabilities New York Department of Education Jenny Kaufmann National Senior Citizens Law Center Washington, DC Social Security Administration Ticket to Work and Work Incentives Advisory Panel Teleconference International Trade Commission Washington, DC November 8, 2000 List of Commenters Marty Ford Director of Government Affairs ARC of the United States Washington, DC Cheryl Bates Harris NAPAS Washington, DC Linda Landry Disability Law Center Boston, MA Ann Maclaine Director of the Louisiana Protection and Advocacy Agency New Orleans, LA Murray Manus Equip for Equality Chicago, IL Aleisa McKinlay Public Policy Analyst Advocacy Service Lincoln, NE Gary Richter Indiana Protection and Advocacy Indianapolis, IN Edward Wollman Disability Community Small Business Development Center Ann Arbor, MI Dave Ziskind Director of the Division of Program Administration, RSA, Vocational Rehabilitation Program Washington, DC Dave Zehner Protection and Advocacy for People with Disabilities Charleston, SC Social Security Administration Ticket to Work and Work Incentives Advisory Panel Quarterly Meeting Embassy Suites at Chevy Chase Pavilion Washington, DC November 13-15, 2000 List of Commenters Sue Augustus SSI Coalition Chicago, IL Alan Bergman President and CEO Brain Injury Association Alexandria, VA Kara Freeburg American Network of Community Options and Resources (ANCOR) Annandale, VA Marty Ford Director of Government Affairs ARC of the United States Washington, DC Charles Harles Executive Director International Association of Business, Industry and Rehabilitation (IABIR) Washington, DC Mitch Jessirich World Institute on Disability Oakland, CA Jenny Kaufmann National Senior Citizens Law Center Washington, DC Mary Kelly National Association of Developmental Disabilities Council Washington, DC Dan O'Brien Oklahoma Department of Rehabilitation Services Oklahoma City, OK Mike O'Brien Oklahoma Department of Rehabilitation Services Oklahoma City, OK Katherine Mario New York Vocational and Educational Services for Individuals with Disabilities (VESID) Albany, NY Celane McWhorter Association for Persons in Supported Employment Alexandria, VA Susan Prokop Paralyzed Veterans of America (PVA) Washington, DC Andrew Sperling Director of Public Policy National Association for the Mentally Ill (NAMI) Arlington, VA Michael Van Essen AIDS Assistance Organization Palm Springs, CA Social Security Administration Ticket to Work and Work Incentives Advisory Panel Meeting Holiday Inn Capitol Washington, DC January 9-10, 2001 List of Commenters Dennis Born Program Manager Supported Employment Consultation and Training Center Anderson, IN Paul Seifert IAPSRS Columbia, MD Charles Harles Executive Director of INABER Washington, DC Damon Hicks Supported Employment Consultation and Training Center Anderson, IN Mike O'Brien DRS Oklahoma City, OK Appendix C Model presented by Paul J. Seifert International Association of Psycho-Social Rehabilitation Services This proposal restructures the milestone-outcome system for SSI beneficiaries in order to account for the existing work incentives. It would allow outcome payments when the amount of earnings of a SSI recipient partially reduces their SSI check because of earnings or income. The amount paid would still be based on the maximum of 40% of the portion of the benefit not paid. Such a proposal might pay a $500 milestone the first month a SSI recipient worked and earned over $125 in gross income. A second milestone would be paid in the next month the SSI recipient earned over $325 in gross income. In any month after the second milestone was paid that the SSI recipient's income was between $326 and $550, SSA would pay an outcome payment of $53. In any month after the second milestone was paid in which the recipient's income was between $551 and $750, SSA would pay an outcome payment of $93. In any month where earnings were between $751 and $1002, SSA would pay $138. This is calculated using average Federal SSA payment as determined by SSA in calculating the payment calculation base for SSI. The amount of the outcome payment would be paid according to the 40% maximum allowed under the law. APPENDIX C Two EN Milestone Payment Models for SSI Prepared by: Paul J. Seifert, Int'l Assoc. of Psychosocial Rehabilitation Services -- February 7, 2001 SSA's PROPOSED SSI MILESTONE-OUTCOME PAYMENT SYSTEM Monthly Countable Amount of SSI Cash Milestone Monthly Outcome SSA Earnings Income Benefit Offset Payment Payment Payment Amt Breakeven $1 to $85 $0 $0 $459 $0 $100 $15 $7.50 $451.50 $0 $125 $40 $20 $439 $0 Under this $150 $65 $32.50 $426.50 $0 scenario, SSA $175 $90 $45 $414 $0 breaks even at $200 $115 $57.50 $401.50 $0 dollar one $225 $140 $70 $389 $0 $250 $165 $82.50 $376.50 $0 SSA shares no $275 $190 $95 $364 $0 risk under this $300 $215 $107.50 $351.50 $0 scenario $325 $240 $120 $339 $0 $350 $265 $132.50 $326.50 $0 $375 $290 $145 $314 $0 $400 $315 $157.50 $301.50 $0 $425 $340 $170 $289 $0 $450 $365 $182.50 $276.50 $0 $475 $390 $195 $264 $0 $500 $415 $207.50 $251.50 $0 $525 $440 $220 $239 $0 $550 $465 $232.50 $226.50 $0 $575 $490 $245 $214 $0 $600 $515 $257.50 $201.50 $0 $625 $540 $270 $189 $0 $650 $565 $282.50 $176.50 $0 $675 $590 $295 $164 $0 $700 $615 $307.50 $151.50 $0 $725 $640 $320 $139 $0 $740 $655 327.50 $131.50 $300/3 months $600/7 months Monthly Countable Amount of SSI Cash Milestone Monthly Outcome SSA Earnings Income Benefit Offset Payment Payment Payment Amt Breakeven $750 $665 $332.50 $126.50 $0 $775 $690 $345 $114 $0 $800 $715 $357.50 $101.50 $0 $825 $740 $370 $89 $0 $850 $765 $382.50 $76.50 $0 $875 $790 $395 $64 $0 $900 $815 $407.5 $51.50 $0 $925 $840 $420 $39 $0 $950 $865 $432.50 $26.50 $0 $975 $890 $445 $14 $0 $1000 $915 $457.50 $1.50 $0 $1003 $918 $459 $0.00 Year 1 2 3 4 5 $57, $141, $150, $158, $167 Prepared by: Paul J. Seifert, Int'l Assoc. of Psychosocial Rehabilitation Services -- February 7, 2001 ALTERNATIVE SSI MILESTONE-OUTCOME SYSTEM Monthly Countable Amount of SSI Cash Milestone Monthly Outcome SSA Earnings Income Benefit Offset Payment Payment Payment Amt Breakeven $1 to $85 $0 $0 $459 $0 $100 $15 $7.50 $451.50 $0 $125 $40 $20 $439 $500 $0 25 months $150 $65 $32.50 $426.50 $0 $175 $90 $45 $414 $0 $200 $115 $57.50 $401.50 $0 $225 $140 $70 $389 $0 $250 $165 $82.50 $376.50 $0 $275 $190 $95 $364 $0 $300 $215 $107.50 $351.50 $0 $325 $240 $120 $339 $1000 $0 13 months $350 $265 $132.50 $326.50 $53 11 months $375 $290 $145 $314 $53 $400 $315 $157.50 $301.50 $53 Total Payment $425 $340 $170 $289 $53 $4,680 $450 $365 $182.50 $276.50 $53 milestone $1,500 $475 $390 $195 $264 $53 outcome $3,180 $500 $415 $207.50 $251.50 $53 $525 $440 $220 $239 $53 6 months $550 $465 $232.50 $226.50 $93 10 months $575 $490 $245 $214 $93 $600 $515 $257.50 $201.50 $93 Total payment $625 $540 $270 $189 $93 $7,080 $650 $565 $282.50 $176.50 $93 milestone $1,500 $675 $590 $295 $164 $93 outcome $5,580 $700 $615 $307.50 $151.50 $93 $725 $640 $320 $139 $93 $750 $665 $332.50 $126.50 $93 6 months Monthly Countable Amount of SSI Cash Milestone Monthly Outcome SSA Earnings Income Benefit Offset Payment Payment Payment Amt Breakeven $775 $690 $345 $114 $138 7 months $800 $715 $357.50 $101.50 $138 $825 $740 $370 $89 $138 $850 $765 $382.50 $76.50 $138 Total payment $875 $790 $395 $64 $138 $9,780 $900 $815 $407.5 $51.50 $138 milestone $1,500 $925 $840 $420 $39 $138 outcome $8,280 $950 $865 $432.50 $26.50 $138 $975 $890 $445 $14 $138 $1000 $915 $457.50 $1.50 $138 5 months $1003 $918 $459 $0.00 $150 5 months milestone outcome Total payment $1,500 + $9,000 = $10,500 Example of a Ticket Scenario that Addresses a Number of the Equity of Access Issues Prepared by Dan O'Brien, OK Department of Rehabilitation Services Potential Breakeven Scenario for SSI Recipients If the intent of the Ticket is to create a breakeven scenario for the SSA, then SSI must be considered separately from SSDI as the baseline assumptions are different. Specifically, savings accrue, i.e., some benefits are not payable, from any SSI work activity that exceeds $85 per month whereas for SSDI no savings accrue below SGA. This allows a breakeven scenario for SSI based on payment of Milestone and Outcome payments using 35% of the benefits not payable due to work activity. Milestone Payment Criteria Payment Threshold Payment Cumulative Savings to SSA Total + or - Job Placement Minimum 1 month work Earnings of at least $200 $1,000 $58 -942 Job Training Complete Minimum 3 months work Avg. earnings in the last 2 months of at least $530 (trial work period amount) $1,000 $445+58=$503 -1497 Integration into Worksite Minimum 6 months of work Avg. earnings in the last 3 months of at least $600/month $1,000 $772+503=$1275 -1725 Attainment of SGA Minimum of 9 months work Avg. earnings in last 3 months at least SGA ($700) $1,000 $938+1275=$2213 -1787 Quarterly Job Retention Outcome Payment 3 months of job retention Monthly earnings at a) $530+/mo b) $700+/mo c) $1000+/mo Quarterly a) $234 b) $323 c) 480 35% of benefits not paid Breakeven point beyond 9 mo. Milestone a) 13 months b) 9 months c) 6 months The Ticket to Work and Work Incentives Advisory Panel Establishment of the Panel The Ticket to Work and Work Incentives Improvement Act of 1999, Public Law 106-170, established the Ticket to Work and Work Incentives Advisory Panel (the Panel) within the Social Security Administration on December 17, 1999. Members were appointed by the President, the House of Representatives and the Senate during May and June of 2000. The Commissioner of the Social Security Administration, Kenneth S. Apfel, swore in the Panel on July 24, 2000. Panel duties include advising the Commissioner of Social Security and reporting to the President and Congress on issues related to work incentives programs, planning, and assistance for individuals with disabilities and the Ticket to Work and Self-Sufficiency Program established under the Ticket to Work and Work Incentives Improvement Act (TWWIIA). The Panel is composed of 12 members. The President, the Senate and the House of Representatives each appointed four. Appointments are for four-year terms. Of the members first appointed, one-half are appointed for a term of two years and the remaining are appointed for four years. The Chair of the Panel is appointed by the President for a 4-year term. Members of the Panel Sarah Wiggins Mitchell, J. D. Chair Sarah Wiggins Mitchell, is the President and Executive Director of the New Jersey Protection and Advocacy, Inc., the designated protection and advocacy system for the State. She was appointed by President Clinton to chair the Panel for a four-year term. She is a member of the New Jersey and Pennsylvania Bars and has a background in nursing and social work. Richard V. Burkhauser, Ph.D. Dr. Richard V. Burkhauser serves as the Professor of Policy Analysis and Chair, Department of Policy Analysis and Management at Cornell University, Ithaca, NY. He is also active as a consultant, writer and researcher, focusing on various economic and social issues relating to persons with disabilities. Thomas P. Golden Mr. Golden, is a faculty member of Cornell University's Program on Employment and Disability in the School of Industrial and Labor Relations in Ithaca, NY. He is currently project director for numerous efforts focusing on training and activities relating to work incentives for people with disabilities. Kristin E. Flaten Ms. Flaten is an Employment Consultant for Lifetrack Resources, Inc., St. Paul, MN. She started her own small business, INITIATIVES, dedicated to enhancing the lives of persons with mental illnesses by providing educational and support services, advocacy, benefits analysis, and work incentive plans. Frances Gracechild Frances Gracechild is the Executive Director, Resources for Independent Living, Inc., Sacramento, CA and instructor at California State University at Sacramento. She is president of Health Access America and serves as a commissioner for the California Attorney General's Commission on Disability. Christine M. Griffin, J.D. Christine M. Griffin is the Executive Director, Disability Law Center, Boston, MA. She is a Trustee for the Paralyzed Veterans of America Spinal Cord Research Foundation and is a member of the Massachusetts and the Washington, DC Bar. Larry D. Henderson Mr. Henderson is the Executive Director of Independent Resources, Inc., Wilmington, DE and chair of the Developmental Disabilities Planning Council of Delaware. Prior to his current position he was associated with the Salvation Army's Family Service Department. Jerome Kleckley Jerome Kleckley, MSW, CSW, is the Director of Hospital Services for the Eastern Paralyzed Veterans Association in Jackson Heights, NY and an advocate for veterans with disabilities. He is a veteran of the U.S. Navy and has been actively involved in veteran's issues. Stephanie Smith Lee Stephanie Smith Lee is the Governmental Affairs Representative of the National Down Syndrome Society and resides in Oakton, VA. She has played a key role in the passage of Federal disability legislation and has led successful grass roots advocacy efforts at the local, state and Federal levels. Bryon R. MacDonald Mr. MacDonald is employed as a Public Policy Advocate with the World Institute on Disability, Oakland, CA. He is a Board member at large of the National Council on Independent Living and chair of that organization's Social Security Subcommittee. For many years, he has developed employment support and benefits counseling programs and served as a consultant to several advisory committees on employment support for persons with disabilities. Stephen L. Start Stephen L. Start is the founder, President and Chief Executive Officer of S.L. Start & Associates, Spokane, WA, a company that provides professional management, rehabilitation, and residential services for people with disabilities, seniors and economically disadvantaged individuals. He is a member of numerous national and regional residential and rehabilitation boards. Susan Webb Susan Webb is the President, Webb Transitions, Inc. of Phoenix, AZ. A former Social Security Disability Insurance beneficiary, she used work incentives and vocational rehabilitation services to return to work. She has served on the Board of Directors of the National Council on Independent Living for three consecutive years, serving as its Social Security Subcommittee chair. Advisory Panel Staff Marie Parker Strahan, Executive Director Kristen Breland Lisa Ekman Mildred Owens Gordon Richmond Ilene Zeitzer Tamara Allen, Consultant Theda Zawaiza, Ph.D., Consultant Problem Statement ~ Workers with Disabilities and Public Support Programs ~ PUBLIC TESTIMONY Before Human Services Committee The Honorable Dion Aroner (D-Berkeley), Chair California Assembly Teleconference Hearing CALIFORNIA LEGISLATURE March 14, 2001 Bryon R. MacDonald, World Institute on Disability SSI, the Supplemental Security Income program from the federal government, and SSP, the State Supplement Program, are the lean state and federal safety net programs that enable even a meager form of independent living in the community. Currently SSI/SSP beneficiaries must live on less than $700.00 a month in income. They allow an access to state Medi-Cal health care with its rainbow of goods and services essential to thousands of people with disabilities, a range of goods and services not found in the private or employer health care market. Any positive picture of the merits of the SSI/SSP program falls apart as soon as the consumer beneficiary seeks a job. First, the health care or personal assistance services access is perceived to be threatened or is threatened, depending on the accuracy of information and the benefits planning services one receives protecting the health care after employment begins. From our experience at the World Institute on Disability (WID), I must caution and add that for every consumer testifying today, there are many others who are too fearful to tell theirs story in public because they fear reprisals from the public programs they must rely on to live independently. Second, considering the rich diversity of talent in the disability community, there is little choice in employment services and other supports, and third, complex state and federal work incentive programs are disconnected and full of misinformation. New One Stop centers can be physically inaccessible and culturally incompetent to serve employers or employees with a mental illness, a developmental disability or someone living with AIDS. Self-determination and informed choice today still have few places to go. Employers are fearful of hiring talented people with disabilities because of fears and perceptions based on inadequate legal or health care information and perceptions of costly stereotypes. The pragmatic setup of One Stops, much like the early setup of welfare reform before it, seems to have left out people with disabilities as the chronically unemployable. California consumers and community groups have worked together since 1995 to solve system barriers to employment. In 1999, the California legislature supported our objectives with passage of Assemblywoman Dion Aroner's Assembly Joint Resolution No. 17, urging the US Congress to pass the Work Incentives Act, and passage of Assemblywoman Carole Migden's AB 155, allowing for one of the nation's early Medi-Cal buy-ins for workers with disabilities. The Medicaid buy-in movement across the country increases the state partnership role in employment supports for workers with disabilities. Today I choose to believe we face hurdles, not barriers, problems not dead ends, because the solutions are right next to the problems. This campaign is winnable as soon as we understand the connected nature of the problems. The disability community, with the state Legislature and state agencies, have fashioned first steps to bringing employment rates for people with disabilities as close as possible to that of the general population. The solutions are next to the problems. AB 155, our first Medi-Cal buy-in for workers with disabilities, has been up and running for a year yet only 275 adults are enrolled in the program. There has been no substantive community outreach on this program, or how it should work with IHSS program participants. County staff administering the program have actually turned applicants away from it because the applicant had a job in its first year of operation. Here is the road we are on. The Ticket to Work and Work Incentives Improvement Act, being implemented in conjunction with the Workforce Investment Act, sends one powerful policy message which we can take to heart and implement together: access to health care and personal assistance services for workers with disabilities, informed, inclusionary and increased choices in employment services, and excellence in public program service delivery are interlocked policy objectives that will NOT succeed taken separately. Workers with disabilities, just like any bank customer at the bank, deserve the right work incentive information at the right time at the right place in the appropriate format. Pending legislation sponsored by Assemblywoman Dion Aroner, AB 925, THE Workforce Inclusion Act, seeks an integrated and collaborative way out of the state and federal program disconnects we have had on our hands since the 1970s. SSI/SSP and Medi-Cal are part of the employment supports people need. We must reform them in ways that do no harm to beneficiaries who do not work and do no harm to workers or to any combination of the two. Thank you, Madame Chair, for the opportunity to introduce public testimony on current employment problems for workers with disabilities. Foundation Support For Employment of People with Disabilities FOUNDATION SUPPORT FOR EMPLOYMENT OF PEOPLE WITH DISABILITIES EXPAND THE POOL OF STAKEHOLDER SUPPORT AND RESOURCES The California Endowment Practical Commitments to People with Disabilities Partnerships for Change: Linking Healthcare Coverage and Employment for People with Disabilities Work Incentives Improvement Act-New Federal Legislation The Federal Ticket to Work and Work Incentives Improvement Act of 1999 (herein referred to as "the Work Incentives Act") expands access to medical coverage and employment services for Americans with disabilities who work or are planning to work. The Act begins the redesign of public long-term disability programs by enabling consumers of Social Security benefits to retain medical coverage when returning to work. Additionally, the Work Incentives Act improves choice of employment services through "The Ticket to Work and Self-Sufficiency Program," which provides Social Security (SSA) beneficiaries with a "Ticket," which they can exchange for employment-related services delivered by any provider authorized by SSA. The Work Incentives Act also offers increased flexibility for people getting on and off the Social Security rolls and creates a Benefits Planning Assistance and Outreach Program to publicize work incentives and to provide the information beneficiaries need to use them. Implementation of the Work Incentives Act at the State Level The Work Incentives Act offers states significant opportunities to eliminate barriers to employment for people with disabilities by improving access to healthcare coverage under Medicaid and Medicare and by increasing job training and placement services for disabled people who want to work. The Federal Legislation gives states the option of offering Medicaid buy-ins for workers with disabilities. It is left up to the states and communities to use the Medicaid buy-ins and other tools in the Federal legislation to create effective integrated systems of healthcare and employment supports. Like a number of other states, California had an existing Medicaid buy-in program established under the authority of the Balanced Budget Act of 1997. However, this program, the "Working Disabled Program," is limited in scope and has been significantly underutilized. The Work Incentives Act gives the state the option of creating a system whereby people with disabilities can earn a living wage and retain Medi-Cal benefits. The California Endowment's Partnerships for Independence The California Endowment is funding projects that aim to demonstrate the power of broad-based collaborative efforts jointly supported by public and private funders to realize the Work Incentives Act's potential to change the matrix of support systems for people with disabilities. The change is from one that fosters dependence and isolation to one based on independence and integration into the community. World Institute on Disability and Berkeley Center for Independent Living, The California Work Incentives Initiative The California Work Incentives Initiative, a joint effort of The World Institute on Disability (WID) and Berkeley Center for Independent Living (CIL), works with consumers, community-based organizations, employment networks, and state and federal agencies to partner in implementing the Work Incentives Act in California. The goal of the Initiative is to involve people with disabilities at all levels of policy implementation and incubate leadership in the disability community while helping to facilitate the state's implementation of the federal Act. The result of this collaborative approach is that people of all sectors, ethnicities and backgrounds work together to achieve the ultimate goal of reducing the unemployment rate among people with disabilities. Community Partnerships and Collaboration The California Work Incentives Initiative has developed a statewide network of disability advocates and other stakeholders called the California Work Group on Work Incentives and Health Care (the CWG). The CWG provides strong consumer input to define California's version of the Work Incentives Act. In just one year, the CWG has developed a reputation as the best source for consumer driven input on work-incentive laws and employment issues of importance to people with disabilities. Policymakers and government agency leaders alike regularly request technical assistance from the group to insure the effective state implementation of the legislation. CWG now meets at least twice monthly to produce policy documents for broad dissemination and meets with policymakers on a regular basis. Getting the Word Out Successful implementation of the Work Incentives Act depends on coordination between state government agencies involved in healthcare and employment and on all of the stakeholders receiving consistent information -- advocates, employers, federal and state agency leaders, and people with disabilities eligible for public program services. The California Work Incentives Initiative provides training to disabled consumers, employers and-very importantly-to the "benefits planners" who help Social Security beneficiaries navigate complicated public programs. Consumers and Government Agency Leaders Partnering to Learn about TWWIIA For effective implementation of the Act, disability community organizations and government agencies must work in collaboration. A recent example of collaboration and training took place in Grass Valley California. The TWWIIA project staff worked with a local disability organization to put together a two-day training forum involving consumers, local government agency leaders and direct services staff. Policy experts on staff of the CA Work Incentives Initiative project provided the training in a format that incorporated engaging and provocative cross agency discussions as well as visual presentations and hand-outs. Participants gave the workshop high marks for quality of information and opportunity for dialogue. This format is now being developed as a model for county-wide workshops in other areas of the state and has been cited in recently proposed state legislation, AB 925, incorporating many of the federal Act's goals. Going to the Source: Involvement of and Feedback from People with Disabilities The CA Work Incentives Initiative staff holds regular focus groups with consumers to ask what employment and health care challenges they face and what they think should be done to address the problems inherent in the system. These focus groups help the staff to pinpoint the real-life implications of policy implementation. Employers and TWWIIA The Act's health-care provisions-which enable people with disabilities to retain Medicare for longer periods of time and/or to buy-in to Medicaid--make it possible for employers to reach out to a previously untapped pool of employees, who would previously not have been able to consider going to work because it would have meant loss of health insurance. Project staff have held roundtables with employers to gather their feedback and concerns early in the process of state policy development. Participating large and small employers indicated a strong interest in continued involvement with the project. Program Evaluation Several methods are in use or under development to evaluate the project. Lead project staff meet regularly to monitor progress in activities and to assess the need for changes in implementation activities. The project staff is currently working with California Endowment staff and external evaluation experts to develop outcome measures related to changes in systems that help break down barrier to care. These measures will evaluate the project's success in 1) promoting effective implementation of the Work Incentives Act based on how well it meets the linked health insurance and employment needs of the target population and 2) identifying and training people with disabilities in leadership and policy development skills. The evaluation measures will be consistent with the over-riding project goal of involving people with disabilities in all phases of the project. An important aspect will be the development of a feedback loop whereby evaluation data gathered from affected people with disabilities will be utilized to keep the project focused on its original goal of consumer involvement. The Disability Funders Network The Disability Funders Network (DFN), an affinity group affiliated with the Council on Foundations, was funded by The California Endowment to educate California grantmakers about the Work Incentives Act and to facilitate public/private-funding partnerships demonstrating the legislation's potential to integrate California's systems of health and work supports for peoples with disabilities. During its first year of operation, the DFN project focused on the educational component - working with Grantmakers in Health to 1) inform funders about the legislation and how it interacts with their funding missions and 2) establishing communication links and partnerships between foundations and the Social Security Administration, appropriate state agencies, employers and the disability community. Methods used to educate and inform included workshops, articles, reports, conferences, and individual meetings with grantmakers. The second year of the project will focus on facilitating projects demonstrating the role of private funding in enhancing California's implementation of the Act's health-coverage and employment provisions. In addition, DFN will work on facilitating foundation support in order to build public awareness to alert all stakeholders (including people with disabilities, employers, agency officials, health insurance professionals, and employment and health-related organizations) about the opportunities created by the Work Incentives Act. End For more information contact: Jeanne Argoff, Ph.D. Executive Director Disability Funders Network 2529 Kirklyn Street Falls Church, VA 22043 Tel: (703) 560-0099 Fax: (703) 560-1151 E-mail: njargoff@aol.com The California Work Group on Work Incentives and Health Care CWG PUBLIC POLICY RECOMMENDATIONS To implement new state and federal law for workers with disabilities The California Work Group on Work Incentives and Health Care CWG PUBLIC POLICY RECOMMENDATIONS To implement new state and federal law for workers with disabilities May, 2000 The Ticket to Work and Work Incentives Improvement Act of 1999 Signing Ceremony ~ FDR Memorial December 17, 1999 "But now it's our turn. We have to make it work in the lives of real people. I have instructed Health, Labor and SSA to take immediate action to implement this legislation, to team up with the states, advocates, businesses and others who are crucial to make this bill work." --President William Jefferson Clinton The California Work Group on Work Incentives and Health Care CWG May, 2000 PRINCIPLES, GUIDELINES, STRATEGY and RECOMMENDATIONS To Implement New State and Federal Law For Workers with Disabilities Table of Contents Table of Contents Statement Objectives Principles and Guidelines Background and Strategy Critical Decisions, Needed Partnerships Public Policy Recommendations Outline Public Policy Recommendations Addenda Contact Information Endorsements to Date The California Work Group on Work Incentives and Health Care CWG May, 2000 PRINCIPLES, GUIDELINES, STRATEGY and RECOMMENDATIONS To Implement New State and Federal Law For Workers with Disabilities Statement Objectives Formed in March 2000, the California Work Group on Work Incentives and Health Care (the CWG) is an open, accessible statewide network of consumers, advocates and community-based organizations. Our participants have different disabilities and diverse ethnic and cultural backgrounds. The CWG is developing a consensus-based California agenda for implementation of new state and federal employment and health care law for workers with disabilities, which includes but is not limited to Social Security Disability Program beneficiaries. The complexities of state and federal public programs on work and disability have become barriers to employment. Because of new state and federal law, the CWG strongly believes we now have the opportunity to remove those barriers. This document contains principles, guidelines and recommendations designed as tools for use with the disability community and our work with policy makers and government agencies. The CWG seeks to protect and enhance financial and health support needed when work is not an option. We will provide mechanisms for critical feedback and dialogue with consumers affected by the implementation of legislation under review. _____________________ PRINCIPLES AND GUIDELINES 1. Do no harm. Public policy and program implementation and outcomes shall do no harm to people with disabilities and/or to other family members. 2. Health care and other interconnected public program reform must take place simultaneously to reduce rates of unemployment and underemployment for Californians with disabilities. 3. Informed choice and empowerment. Informed choice and empowerment refers to a consumer's ability to understand and use programs successfully because the programs are designed to enable consumers to navigate them competently and without fear. Program design must be accessible, synchronized with other public policy and programs, and understandable to agency staff, consumers of services and others. This is mandatory to ensure successful employment outcomes and to decrease administrative costs. The concept of consumer empowerment, as applied to public programs, refers to programs which allow for self-determination, self-advocacy, and active participation in the decision making process at the individual and systems levels. 4. Health care coverage - Recognize needs of consumers. Seamless, uninterrupted access to health care coverage from public and private sectors enhances the continued ability to work. Temporary, part-time and self-employment profiles are common examples of uneven earned income levels for workers with disabilities. Some persons with disabilities are unable to work at all. The health care programs must be designed for these profiles. Those who consider them too risky will not use health care buy-in programs. Design Examples To Support Seamless Coverage: 1. A "Presumptive Eligibility" mechanism within the Medi-Cal eligibility process to enable workers with disabilities to accept unexpected new employment opportunities and retain affordable Medi-Cal services. 2. Develop consumer options to encourage timely premium payments and maintenance of ongoing participation, such as an employer payroll deduction or automatic checking account debiting from a worker's bank account. 3. "Easy Back On" provisions that do no harm, for workers to return to other categorically needy Medi-Cal groups. Flexibility Premium payment schedule design must suit the work patterns of the eligible person. (Self-employed workers can receive lump sum and unscheduled income for work performed over several months.) 5. Establishment of partnerships. California's Work Incentives and Health Care Initiative must be developed, implemented, and evaluated by a partnership consisting of representatives from cross disability coalitions, employers, appropriate executive agencies and members of the legislature. 6. Outcomes and performance. California's Work Incentives and Health Care Initiative must document outcomes and performance by supporting data collection and research and evaluation activities. _______________________ BACKGROUND AND STRATEGY Current California Law California is one of a growing number of states providing better access to Medicaid (Medi-Cal in California) for workers with disabilities. Assemblywoman Carole Migden authored the successful AB 155, signed by Governor Gray Davis last fall, which establishes our current 250% Working Disabled Program. The authority for this program comes from the federal Balanced Budget Act of 1997, Section 4733. The 250% Working Disabled Program contains new and long sought after provisions for workers with disabilities who use Medi-Cal services. California 250% Working Disabled Program * New Provisions: * The individual's disability income (for example, SSI, or SSDI) is disregarded for eligibility purposes. * All resources in the form of employer or individual retirement arrangements authorized by the Internal Revenue Service are exempted for eligibility purposes. * Current earnings at time of application, known as Substantial Gainful Activity (SGA), are not a consideration in determining whether disability exists. Employed adults with disabilities can be eligible for the 250% Working Disabled Program as long as they meet Social Security's medical rules for disability. * An eligible applicant does not have to be a present or former SSI/SSP recipient. The Workforce Investment Act of 1998 - WIA The Ticket to Work and Work Incentives Improvement Act of 1999 - TWWIIA Since the passage of the federal Balanced Budget Act of 1997 and the historic AB 155, or 250% Working Disabled Program, a seachange of new law has given rise to hope that the complex web of existing work incentive law and regulations can be transformed into a workable, interconnected system of employment incentives for adults with disabilities. Since 1998, employment focused reform for working age adults with disabilities has now been enacted into Medicare, Medicaid, the Social Security Supplemental Security Income Program (SSI), the Social Security Disability Insurance Program (SSDI), and within the federal Departments of Labor and Education. WIA (1998) is a redesign of major federal public employment programs for employers and workers with and without disabilities. Employment training and related services will be centered in accessible community One Stop Centers with program accessibility for workers with disabilities. The Act is being implemented this year utilizing a state wide policy making Workforce Investment Board (SWIB) in conjunction with locally autonomous Local Workforce Investment Boards (LWIBs). TWWIIA (1999) increases opportunities for states to limit barriers to employment for persons with disabilities by improving access to health care coverage available under Medicare and Medicaid. TWWIIA also established the Ticket to Work and Self-sufficiency program that will allow Social Security disability beneficiaries (SSI and SSDI) to seek employment training and placement services needed to obtain and retain employment from a wider pool of providers. This Act begins a redesign of public long-term disability programs so that they reflect the new paradigm of disability that focuses on equality of opportunity, full participation, independent living, and economic self-sufficiency for persons with disabilities. The Act is designed to keep pace with medical and other technological advances and the changing dynamics of the new workplace. The Act's provisions are voluntary and grounded in the principles of informed choice and empowerment TWWIIA and WIA are interconnected in several ways. As federally funded programs, they are required to serve employers and job seekers with disabilities. The WIA One Stop Centers, for services to employers and job seekers, may also choose to provide employment services for Social Security beneficiaries in the Ticket program found in TWWIIA. The interconnections in TWWIIA and WIA may have the net result of a marked increase in the choice and quality of employment services for all Californians in ways that are now under development in the implementation and regulatory phases of the two Acts. Recent California Developments Assemblywoman Carole Migden has introduced a new bill this year, AB 1955, to implement certain provisions of the Ticket to Work and Work Incentive Improvement Act (TWWIIA) for workers with disabilities. As currently written, AB 1955 requires that California: 1. Apply for TWWIIA infrastructure grants for the design and support of health care and other new programs for workers with disabilities, and requires California to; 2. Seek participation in a demonstration project to provide Medi-Cal services to current workers with potentially severe disabilities. Regarding the Workforce Investment Act (WIA), the California state wide and local Workforce Investment Boards (SWIB and LWIBs) have been meeting to implement key provisions of WIA by July 1, 2000. We have the new Medi-Cal buy-in for workers with disabilities (the 250% Working Disabled Program), and a new state TWWIIA based bill, AB 1955, pending in the California Assembly. We have two interconnected federal Acts focused on employment to implement in California. Critical Decisions, Needed Partnerships Cross disability state wide coalitions on employment have been emerging in recent years in close to twenty states. These coalitions are working with state and federal entities to remove public program barriers to employment for people with disabilities. The community of people with disabilities and their advocates is the group most familiar with existing benefit programs and with program barriers to employment. The disability community has been instrumental in the design and passage of TWWIIA. Participants in the California Work Group on Work Incentives and Health Care are most willing to work with policy makers and agencies responsible for implementation of work incentive programs, and we expect them to work with us. The continued participation and contributions of the disability community are essential to the successful implementation of work incentives and other employment supports in California. CWG participants and others in the disability community are now meeting with county staff, Medi-Cal services staff in Sacramento, Health Care Finance Administration (HCFA) and Social Security staff, and state policy makers. More people with disabilities are being appointed to Local Workforce Investment Boards (LWIBS). Based on our outlined principles and guidelines, CWG participants request progress on our objectives, as follows: 1. CWG participants and other consumers and groups should be able to work closely with county and California Department of Health Services staff implementing AB 155, the 250% Working Disabled Program. 2. The California Department of Health Services should provide appropriate regulations, resources, training and community outreach to successfully implement AB 155, the 250% Working Disabled Program. 3. Policy makers should improve and enhance AB 1955, the California TWWIIA initiative in the Assembly, by amendment and inclusion of the following recommendations. These recommendations will bring to California the needed provisions available in TWWIIA that we fought so hard for, together with the California legislature in 1999. CWG participants affirm our intentions to foster public education, dialogue and cooperation on this agenda between government and diverse consumer, community and business stakeholders. PUBLIC POLICY RECOMMENDATIONS To improve and enhance AB 1955, The California TWWIIA initiative in the Assembly I. and II. Provide Health Care for Workers with Disabilities - Medi-Cal (Relevant TWWIIA Section is in Italics.) Include TWWIIA Medi-Cal Buy-In #1, The Earnings Buy-In and Buy-In #2, The Medical Improvement Buy-In TWWIIA Sec. 201. Expanding State options under the medicaid program for workers with disabilities. III. Health Care Demonstration Project: Provide Ongoing Medi-Cal Services for Certain Workers with Disabilities CWG supports this provision in AB 1955, pending now in the California Assembly. TWWIIA Sec. 204. Demonstration of coverage under the medicaid program of workers with potentially severe disabilities. IV. Apply for TWWIIA Infrastructure Grants CWG supports this provision in AB 1955, pending now in the California Assembly. A grant to support Medi-Cal buy-in training for county welfare workers shall be given priority in the application. TWWIIA Sec. 203. Grants to develop and establish State infrastructures to support working individuals with disabilities. V. New Health Care Coverage Choices shall do no harm and shall support work attempts and financial independence. California use of Waivers and Demonstration Projects in Medi-Cal buy-in programs. CWG strongly supports making provisions of Waiver Programs and Social Security Demonstration Projects available to all participants of TWWIIA Medi-Cal buy-ins #1 and #2. TWWIIA Sec. 301. Extension of disability insurance program demonstration project authority. TWWIIA Sec. 302. Demonstration projects providing for reductions in disability insurance benefits based on earnings. VI. Community Programs for Workers with Disabilities A California Work Incentives Planning and Assistance Program Grants, cooperative agreements, or contracts to provide benefits planning and assistance (including information on the availability of protection and advocacy services) to individuals with disabilities and outreach to individuals with disabilities who are potentially eligible for work incentive programs. TWWIIA Sec. 121. Work incentives outreach program. TWWIIA Sec. 122. State grants for work incentives assistance to disabled beneficiaries. VII. Maximize Choice in Employment Services - One Stop Centers Recommendations for the California One Stop Centers and their utility for employers and workers with disabilities. VIII. Provision for Research/Data Collection The CWG suggests building an ongoing data collection and research component to track Medi-Cal services for workers with disabilities. _______________________ PUBLIC POLICY RECOMMENDATIONS I. Provide Health Care for Workers with Disabilities Medi-Cal Include TWWIIA Medicaid Buy-In #1 - The Earnings Buy-In The new federal law allows a state Medicaid buy-in option (Medi-Cal in CA) for workers with disabilities who earn over 250% of the federal poverty level. States may set their own income and resource limits and charge a premium for access to Medicaid services for workers with disabilities. Participant eligibility and sliding scale premium payment amounts shall be determined using the earned income of the eligible worker with a disability. Other family income is exempt. PREMIUMS DUE: For a person with earnings below 200% of poverty, Medi-Cal is premium free. Monthly premiums will be 7.5% of earnings above 200% of poverty. PREMIUM SCHEDULE: Premiums shall be payable monthly, quarterly or annually at the option of the eligible person. Other PREMIUMS: Extend current Medi-Cal law to allow a deduction from Medi-Cal buy-in premiums for consumer payments to other health care policies. Above $75,000.00 a year in adjusted gross income as defined in Section 62 of the Internal Revenue Code of 1986, affordable premiums will be granted to eligible high cost Medi-Cal buy-in participants, exempting them from paying the full 100% premium as described in TWWIIA. II. Provide Health Care for Social Security Beneficiaries who "medically improve." Medi-Cal Include TWWIIA Medicaid Buy-in #2 -- The Medical Improvement Buy-In Medicaid buy-in option for workers with disabilities who lose eligibility for Social Security benefits due to medical improvement but continue to have severe medically-determinable disabilities. Participant eligibility and sliding scale premium payment amounts shall be determined using the earned income of the eligible worker with a disability. Other family income is exempt. DEFINITION OF EMPLOYED PERSON: "is engaged in a work effort that meets substantial and reasonable threshold criteria for hours of work, wages, or other measures, as defined by the State and approved by the Secretary." of the US Department of Health and Human Services. TWWIIA: Title II, Sec. 201, (a), "(2). "(B) PREMIUMS DUE: For a person with earnings below 200% of poverty, Medi-Cal is premium free. Monthly premiums will be 7.5% of earnings above 200% of poverty. PREMIUM SCHEDULE: Premiums shall be payable monthly, quarterly or annually depending on the choice of the eligible person. Other PREMIUMS: Extend current Medi-Cal law to allow a deduction from Medi-Cal buy-in premiums for consumer payments to other Health care policies. Above $75,000.00 a year in adjusted gross income as defined in Section 62 of the Internal Revenue Code of 1986, affordable premiums will be granted to eligible high cost Medi-Cal buy-in participants, exempting them from paying the full 100% premium as described in TWWIIA. III. Health Care Demonstration Project: Provide Ongoing Medi-Cal Services for Certain Workers with Disabilities A TWWIIA time-limited Medicaid buy-in demonstration program allowing states to extend Medicaid to certain workers who have a disability that, without ongoing health care, would become severe enough to qualify them for Social Security disability benefits. Federally funded at 250 million over six years. CWG supports this provision which is in AB 1955 now, pending in the California Assembly. IV. Apply for TWWIIA Infrastructure Grants Grants to states to develop and establish infrastructures to support working individuals with disabilities, for those states that provide personal assistance services (PAS) in their Medicaid state plan to the extent necessary to enable individuals with disabilities to remain employed. Funds may be used to set up Medicaid buy-ins, demonstrations and programs for workers with disabilities. Federally funded at 150 million over five years. CWG supports this provision which is in AB 1955 now, pending in the California Assembly. A grant to support Medi-Cal buy-in training for county welfare workers shall be given priority in the application. V. New Health Care Coverage Choices shall do no harm and shall support work attempts and financial independence. TWWIIA reauthorizes the demonstration project authority for the Social Security Disability Insurance (SSDI) Program. The Act also requires Social Security to conduct specific demonstration projects which gradually reduce cash benefit amounts for working SSDI beneficiaries as earnings gradually increase for them, the so-called "2 for 1 Demonstration Project." Most workers switch jobs and have periods of unemployment. The success and utility of health care programs for workers in TWWIIA is interconnected with redesign of the "cash cliff" of the SSDI program and with redesign of other cash benefit and eligibility provisions. California Medi-Cal buy-in program design must integrate with these non-health care related provisions so that use of a program does no harm to participant or other family member. AB 1955, as amended, should build on the excellent base provisions cited above in our current 250% Working Disabled Program. Proposed non health care provision to promote financial independence: Allowance for $20,000 ceiling in liquid assets, checking, savings accounts, etc. State waivers can also allow certain exemptions for Medi-Cal buy-in participants. CWG strongly supports making provisions of Waiver Programs and Social Security Demonstration Projects available to all participants of TWWIIA Medi-Cal buy-ins #1 and #2. Proposed Examples of California Medi-Cal Buy-In Program Waiver Provisions * "Easy Back On" provision(s) that do no harm for a worker to return to eligibility for other Medi-Cal programs for the categorically needy, SSI, or SSDI, with protections for financial gains made in assets and resources. * Suspension of Social Security and Medi-Cal Continuing Disability (Medical) Reviews, commonly referred to as 'CDRs,' for Medi-Cal buy-in participants. "2 for 1" Demonstration Project in California The state of California will use its best efforts to effect a statewide "2 for 1" Social Security Administration Demonstration Project for California SSDI beneficiaries who work. NOTE: The California Work Incentives Planning and Assistance Program shall provide workers with the needed information and procedures for these provisions. VI. Community Programs for Workers with Disabilities California Work Incentives Planning and Assistance Program California shall establish a state funded Work Incentives Planning and Assistance Program for Medi-Cal buy-in participants, Social Security disability beneficiaries and others. The program will award grants, cooperative agreements, or contracts to provide benefits planning and assistance (including information on the availability of protection and advocacy services) to individuals with disabilities and outreach to individuals with disabilities who are potentially eligible for work incentive programs. The California program will supplement community based programs of the Social Security Work Incentives Planning and Assistance Program and coordinate information and activities with One Stop Center services. VII. Maximize Choice in Employment Services - One Stop Centers A. TWWIIA contains the Ticket program, a new payment mechanism for rehabilitation and employment services provided to Social Security disability beneficiaries. California One Stop Centers shall meet the criteria needed to participate in the Social Security Ticket program for rehabilitation and employment services. B. The state of California shall direct the Governor and the State Workforce Investment Board to seek targeted Department of Labor funding now available to ensure that One Stop Centers provide physical and program access to employers and job seekers with disabilities. C. The state of California shall mandate that physical and program access to One Stop Centers for employers and job seekers with disabilities takes place concurrently with implementation of all other Workforce Investment Act (WIA) provisions. D. One Stop Center counselor staff shall have the prerequisite training and resources to advise SSI and SSDI beneficiaries on the implications of work for such individuals, to include referral expertise to appropriate work incentives planners. E. The Governor shall be required to appoint persons with disabilities to the state wide WIA Board (SWIB), as well as to direct that local elected officials appoint persons with disabilities (who do not represent government agencies) to local Workforce Investment Boards (LWIBs). F. As a component of program access, the Governor shall require all appointees to State and local Workforce investment Boards to participate in disability sensitivity awareness training provided by qualified persons with disabilities (who could be actual SWIB or LWIB Board members.) G. The State of California shall direct Workforce Investment Boards to schedule regular reviews of their One Stop Centers to determine if physical and program access is available to persons with disabilities. VIII. Provision for Research/Data Collection The Medicaid health care demonstration project in TWWIIA, Section 204, contains a component for research and data collection to assist in the assessment that will be used to continue the program beyond the statute's demonstration authority. Over the course of this long initiative, consumers and community groups were repeatedly confronted with government and policy maker objections which stated: "You don't have the data to support your policy." The CWG suggests building an ongoing data collection and research component to track Medi-Cal services for workers with disabilities. _______________________ ADDENDA COST, COST SAVINGS AND OFFSETS With respect to state Medi-Cal programs, we are keenly aware of the complex cost and offset issues inherent in the design of these programs. A Medicaid buy-in design has been broken down by Tom Hamilton at the federal Health Care Finance Administration (HCFA) into three elements; Program Design, Program Cost and Offsets, and Program Administration. Design and Administration elements can increase and decrease cost. Other state Medicaid initiative participants, staff at HCFA, community policy analysts and others who are deeply committed to the TWWIIA initiative are studying how to design affordable, yet attractive and usable Medicaid programs, for consumers of services who cannot work without them. Program savings and cost offsets which have been identified include tax revenues from workers with disabilities, program premiums paid, savings to SSI/SSP expenditures, and Medi-Cal services savings when the Medi-Cal buy-in eligible person is eligible for private health care and/or Medicare. We know that cost is a critical policy making factor in designing and implementing new Medi-Cal law. We are in proactive dialogue with many of the California and national experts working cooperatively on these issues and designs. THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT of 1996 (HIPAA) provides access to employer sponsored health insurance without a pre-existing condition waiting period for Medi-Cal recipients and Medicare beneficiaries if enrolled in those public programs for a period prior to the start of employment. HIPAA and, in California law, AB 1672, assure immediate access to employer-sponsored health insurance for Medi-Cal recipients and Medicare beneficiaries. These laws allow prior and existing Medi-Cal and/or Medicare coverage to be "credited" and thereby reduce month for month a private health insurance pre-existing condition exclusionary period. Exclusion periods range from 6 months to 1 year. HIPAA allows this crediting coverage as long as the gap in between coverage does not exceed 63 days. HIPAA and AB 1672 can be major employment supports. HIPAA provisions can also spread the costs of health care more equitably between public and private providers, which is an important public policy goal sought by many stakeholders. However, the medical services that many use to enable them to enter the workforce are not available in the private market. Medi-Cal can become a secondary payer, and a "wrap-around" policy for an employee, when health care coverage is offered by the employer. Many Medi-Cal recipients do not have the luxury of missing their public health care coverage for a month. Further, many adults with disabilities are self-employed or would like to be self-employed. We again stress that buy-in programs will not be attractive to those who consider them too risky for their health care needs. OTHER CURRENT STATE LEGISLATIVE INITIATIVES New York Assembly Bill A.10159, introduced March 20, 2000, pending TWWIIA based Medicaid buy-ins and other provisions Summary at: http://www.csh.org/alerts/finfo_57.html [from: www.csh.org] Connecticut Work Incentives Bill Approved by Human Services Committee and the Appropriations Committee General Assembly Raised Bill No. 5778 February Session, 2000 LCO No. 2105 "An Act Providing Work Incentives For Persons With Disabilities" TWWIIA and WIA RESOURCES One Stop Website for TWWIIA and WIA grant information: http://www.wdsc.org/disability/ "Bobby Approved" Text Version Included www.ssa.gov/work Health Care Finance Administration (HCFA) TWWIIA Website: http://www.hcfa.gov/medicaid/twwiia/twwiiahp.htm Department of Labor Work Incentives Grants, May, 2000, go to: http://www.wdsc.org/sga/sga/work_incentives_sga.html www.calwia.org MAKING NEW FEDERAL EMPLOYMENT PROGRAMS WORK February, 2000 Authored by: CORPORATION FOR SUPPORTIVE HOUSING For copies, please contact: Christina Garcia, Program Officer, Employment, Phone: 510-251-1910, ext. 210 Email: christina.garcia@csh.org 1330 Broadway, Suite 601, Oakland, CA 94612 _______________________ The California Work Group on Work Incentives and Health Care CWG For information or to join the CWG, please contact: Bryon R. MacDonald Public Policy Advocate World Institute on Disability 510 16th Street, Suite 100 Oakland, CA 94612 Direct Phone: 510-251-4304 Fax: 510- 763-4109 TTY/TDD 510-208-9493 WID Receptionist: 510-763-4100 Email: bryon@WID.org bryosemite@aol.com end DRAFT42 - 6/15/00 Endorsement to date for these Public Policy Recommendations June 15, 2000 AIDS Legal Referral Panel, San Francisco California Foundation for Independent Living Centers The Hawkins Center of Law and Support Services for People with Disabilities, Richmond HIV/AIDS Return to Work Initiative - San Francisco Department of Public Health Organization of Area Boards on Developmental Disabilities Positive Resource Center, San Francisco The Trade Winds Foundation World Institute on Disability, Oakland JANUARY 26, 2001 DRAFT NEW OPTIONS FOR CALIFORNIA WORKERS WITH DISABILITIES THE TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT OF 1999 -- TWWIIA THE WORKFORCE INVESTMENT ACT OF 1998 - WIA JANUARY 2001 OUTLINE DRAFT for "THE WORKFORCE INCLUSION ACT" For California Workers with Disabilities DEDICATED TO PRESIDENT FRANKLIN DELANO ROOSEVELT He did it all from his wheelchair. JANUARY 2001 OUTLINE DRAFT for "THE WORKFORCE INCLUSION ACT" For California Workers with Disabilities DEDICATED TO PRESIDENT FRANKLIN DELANO ROOSEVELT Introduction This January outline for CA legislation builds consensus on TWWIIA and WIA related provisions we want in legislation. We welcome your comments and input. 90% of these provisions or goals can be found in the California Work Group (CWG) May 2000 Policy Statement. To request a copy, email Casey@WID.org. Policy makers and community groups alike across this country agree on one premise. TWWIIA and WIA, separate or together, cannot work without proactive partnerships, between state agencies and between those agencies partnering with community based organizations, a process and plan that the Health Care Financing Administration (HCFA) is now calling "Comprehensive Coordination." This legislative framework presumes consensus on that premise. IMPORTANT TWWIIA NOTE ABOUT TWO GRANTS 1. The HCFA TWWIIA Demonstration to Maintain Independence and Employment for current workers with disabilities was re-released in late October. The applications for this project (from a state Medicaid agency) are due back to HCFA April 30, 2001. From HCFA: "Please note that if all of the funding is committed as a result of the applications received in April 2001 there will never be another opportunity to apply for this demonstration." If you have any questions please contact Joe Razes, HCFA project manager, at (410) 786-6126, EMAIL: Jrazes@hcfa.gov 2. The next HCFA TWWIIA Infrastructure Grant request for applications has just been announced in the Federal Register January 11, 2001, by HCFA. Letters of intent are due March 15 and applications submitted by May 21, 2001. See http://www.hcfa.gov/medicaid/twwiia/twwiiahp.htm The Workforce Inclusion Act PART ONE LEGISLATIVE INTENT AND FINDINGS PART TWO ACCESS TO HEALTH CARE FOR WORKERS WITH DISABILITIES PART THREE THE OFFICE OF WORKFORCE INCLUSION Who, What, and by When? PART FOUR INFRASTRUCTURE AND BENEFITS PLANNING GRANTS PART FIVE FUNDING SOURCES PART ONE LEGISLATIVE INTENT AND FINDINGS The people of the State of California do enact as follows: Section 1. (a) Legislative Abstract and Intent - Problem and Solution Statement MITCH Intent Legislative findings will show that California and the nation have begun a new journey to include people with disabilities in the workforce. California now has new health care and workforce investment systems with the potential to include people with disabilities in the workforce. The intent of the Workforce Inclusion Act is to enhance and complete the health care program available to California workers with disabilities. The Workforce Inclusion Act will coordinate improved health care services with infrastructure redesigns to bring adults with disabilities into gainful employment at a rate that is as close as possible to that of the general adult population; and to support adults with disabilities who move from total dependency on public assistance to employment, with services and planning available to sustain that employment. The removal of health care as a major barrier to employment for people with disabilities is strongly supported by the business community, especially small employers who create the majority of new jobs in California. Implementation of the Workforce Inclusion Act is the most cost effective strategy for the State of California. [Concept Paper for the Legislation - Develop soon. Problem Statement Solutions Necessary for CA to be in step with TWWIIA Implementation and increased utility of the WD program with its 5 year sunset.] (b) The Legislature finds and declares as follows: 1. All of California benefits when individuals with disabilities retain employment and self-employment. 2. Historically, federal programs for adults with disabilities have encouraged dependency on income supports and have created barriers to employment and economic self-sufficiency. Even in strong economic times, adults with disabilities have faced major barriers to achieve economic self-sufficiency, resulting in prolonged reliance upon income and other public assistance programs. 3. Recent state and national surveys find a steady and unacceptable 72% unemployment rate for adults with disabilities of working age. 4. To work and live independently in the community, people with disabilities must be able to navigate complicated state and federal public programs without the fear of penalty. Informed choice and empowerment refers to a consumer's ability to understand and use programs successfully because programs are designed to enable the consumers to navigate them competently and without fear. The concept of consumer empowerment, as applied to public programs, refers to programs which allow for self-determination, self-advocacy, and active participation in the decision making process at the individual and systems levels. 5. Work incentives and health care initiatives must be developed, implemented, and evaluated by a partnership consisting of representatives from cross disability coalitions, employers, appropriate executive agencies, and members of the legislature. 6. To work and live independently in the community, workers with disabilities must be able to have cash assets above $2,000 without losing vital Medi-Cal services. 7. Health care and other interconnected public program reform must take place simultaneously to reduce rates of unemployment and underemployment for Californians with disabilities. 8. Seamless, uninterrupted access to health care coverage from public and private sectors enhances the continued ability to work for persons with disabilities. 9. Program design must be accessible, synchronized with other public policy and programs, and understandable to agency staff, consumers of services and others. This is mandatory to ensure successful employment outcomes and to decrease administrative costs. 10. Individuals and a consortium of disability organizations have called for comprehensive; integrated workforce development services to meet the multiple system barriers they face in finding meaningful work. 11. Federal laws during the 1990's offered significant public policies and fiscal incentives designed to assist states to restructure workforce development programs into integrated workforce investment systems which will respond to the employment, training and education needs of its citizens. 12. Year 2000 research from Rutgers University uses current employment data to find that workers with disabilities are twice as likely to be in part time, temporary or self-employment profiles, requiring commensurate services to transition from cash benefit disability programs to work.1 13. The Balanced Budget Act of 1997 (H.R. 2015) provided Welfare-to-Work (WtW) funds for transitional assistance for recipients of the Temporary Assistance to Needy families (TANF) program through job creation, through wage subsidies, on-the-job training, job placement and post-employment services to transition hard-to-employ, public assistance recipients into full-time, permanent, unsubsidized employment. 14. California designated the Employment Development Department (EDD) as the state agency responsible for the WtW funds (Government Code Section 13070) and has allocated 85 percent of the federal grant funds on a formula basis to Local Workforce Investment Boards (LWIBs) in the local workforce investment areas throughout California and the balance of 15 percent in discretionary funds on a competitive basis to local entities. 15. Since 1998, employment-focused reforms for adults with disabilities in the workforce have been enacted into Medicare, Medicaid, the Social Security Supplemental Security Income Program (SSI), the Social Security Disability Insurance Program (SSDI), and within federal Departments of Labor and Education. 16. The federal Workforce Investment Act (WIA) Program (PL 105-220/1998) replaced its predecessor, the Job Training Partnership Act (JTPA) on July 1, 2000 with funding in 2001-02 to be provided through three programs: Adult Employment and Training, Youth Activities and Dislocated Workers. 17. WIA redesigns major federal public employment programs for employers and workers with and without disabilities and must be centered in accessible, community-based One Stop Centers. 18. California is implementing WIA through the California Workforce Investment Board (CWIB), which was authorized by Governor Gray Davis in Executive Order D-9-99 and consists of representatives of business, labor organizations, community-based organizations, schools and colleges, state agencies and local governments. 19. WIA requires CWIB and the Governor to develop a five-year Workforce Investment Plan, designate Local Workforce Investment Areas (LWIBs), establish Local Workforce Investment Boards, review Local Workforce Investment Area Plans, oversee local workforce education and training programs, negotiate performance standards with the Department of Labor and prepare an annual report. 20. The federal Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999 (Public Law 106-170) increased opportunities for states to remove and minimize barriers to employment for people with disabilities by improving access to health care coverage available under Medicare and Medicaid with all health care coverage provisions effective October 1, 2000. 21. TWWIIA allows a state Medicaid "buy-in" option for workers with disabilities who earn over 250 percent of the federal poverty level. States may set their own income and resource limits and may charge a premium for access to Medicaid services for such workers. 22. California's Legislature passed and Governor Davis approved AB 155 (Chapter 820, Statutes of 1999) October 8, 1999, to require the state Department of Health Services (DHS) to adopt the federal option under which any employed individual whose countable income, as determined in Welfare & Institutions Code Section 14007.9, does not exceed 250 percent of the federal poverty level and who is disabled shall be eligible for Medi-Cal benefits subject to the payment of sliding-scale premiums. 23. TWWIIA offers another "buy-in" option for workers with disabilities who lose eligibility for Social Security benefits due to medical improvement but continue to have severe medically-determinable disabilities. 24. SSDI beneficiaries will access a minimum of 8.5 years of no-cost Medicare Part A after work begins for as long as a worker remains disabled. 25. Beginning January 1, 2001, the Social Security Ticket to Work program (TTW) began a three-year phase-in period nationally, allowing SSI and SSDI beneficiaries to receive a "Ticket" from the Social Security Administration (SSA) which can be assigned for employment services to a wider pool of rehabilitation, employment or other support service providers. 26. State agencies participating in the Ticket to Work program of TWWIIA may enhance removing obstacles that people with disabilities face as they attempt to seek gainful employment and economic self-sufficiency. 27. TWWIIA's programs and consumer options are based upon public policies which respect the rights of consumers to control decisions related to health care, rehabilitation and employment within the framework of independent living principles and guidelines which include but are not limited to consumers' of such services having an array of choices to promote independence and financial stability. 28. The state Department of Rehabilitation (DOR) is a major partner in this area of public policy by assisting people with disabilities, particularly those with significant disabilities, in obtaining and retaining employment and maximizing their abilities to live independently in their communities. 29. DOR administers the Vocational Rehabilitation Services Program (VRSP) (Welfare & Institutions Code, Division 10, Section 19000 et seq.) to persons with disabilities through district and branch offices throughout the State and enters into a number of cooperative agreements with State and local agencies to assure specialized services (educational, mental health and welfare) are provided to target groups within this population. 30. The Long-Term Care Act of 2000 (Chapter 895, Statutes of 1999/AB 452), enacted legislation to improve the state-level administration of public, long-term care programs by the establishment of a Long Term Care Council (LTCC) as an interdepartmental, interagency council, to among other things, coordinate long-term care policy development and program operations within the California Health & Human Services Agency. 31. The California Health & Human Services Agency (CHHS) administers the State's health, social services, rehabilitation and employment programs through more than fifteen, major departments, boards, councils and centers with a total, combined budgets of over $ 58.3 billion in State and federal funds. 32. Existing and new state and federal work incentive and health care programs have complexity. Their application is individual and person centered. Turnover in direct services staff, the ever changing nature of regulatory procedures and their inherent complexity call for the infrastructure redesign found in the Workforce Inclusion Act. 33. It is an urgent finding from many California stakeholders that the California Department of Health Services (DHS) meet the application deadlines in April and May, 2001 for state application to the two TWWIIA health care grants. The grants can support the goals, and resources needed, to implement the Workforce Inclusion Act. The opportunity to participate in one of the two grants, the TWWIIA Demonstration to Maintain Independence and Employment, will be lost completely after April 30, 2001. PART TWO ACCESS TO HEALTH CARE FOR WORKERS WITH DISABILITIES FOR NEXT Discussions using JAN 22 draft: CWG Participants and Sherry Novick have electronic copies of INPUT FROM ALLEN JENSEN ON WHAT OTHER key STATES HAVE DONE/are doing ON RESOURCE LIMITS AND SPOUSAL INCOME ISSUES Section XYXY. Health Care Issues Amend the California Working Disabled Program -- WDP A Medi-Cal "Buy-In" Program for Workers with Disabilities The WDP, a public health care services program, acts as payer of last resort after Medicare and private or employer sponsored health care insurance. The program shall have discretion to pay other health care premiums. ASSETS AND RESOURCES OF PROGRAM PARTICIPANTS 1. Raise $2,000 asset limit to $25,000: cash, bank accounts, stocks, bonds etc., no restrictions on use. 2. Create an "Independence Account" Asset Exemption Category Allowable exemptions in this category for program eligibility and premium setting purposes: This applies to any non-loan financial product that a buy-in participant could access that is linked to work or Entrepreneurship Examples: Individual Development Accounts - IDA BRYON HAS TEMPLATE model LEGISLATION ON IDAs Abilities Fund products Business Equity Grants for down payment on business loans Social Security "PASS" plans Sherry knows CALWORKS MODEL on this type of exemption. 3. Eliminate the WDP buy-in earnings Limit. [CWG participants do not have a position justifying an earnings income limit lower than that allowed in TWWIIA.] 4. Exempt IRAs and other retirement programs for people who lose eligibility for the CWD program. Amend Welf. & Inst. Code § 14006(c), (as underlined below) the section governing what is an exempt asset under the medically needy programs, as follows: For purposes of determining eligibility under this part, resources shall be determined, defined, counted and valued in accordance with the federal law governing resources under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.). Resources exempt under Title XIX shall not be considered in determining eligibility. (1) A community spouse may retain nonexempt resources to the maximum extent permitted under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.). (2) Medically needy individuals and families may retain nonexempt resources to the extent permitted under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.). (3) In addition, the principle residence as defined in subdivision (b) shall be exempt. (4) In addition, for Medi-Cal applicants and recipients who are receiving earned income, resources in the form of employer or individual retirement arrangements authorized under the Internal Revenue Code shall be exempted as authorized by Section 1902(r)(2) of the Social Security Act (42 U.S.C. Sec. 1396a(r)). (5) In addition, Medi-Cal applicants and recipients who are disabled and who are not receiving earned income, resources in the form of employer or individual retirement arrangements authorized under the Internal Revenue Code shall be exempted for up to three years as authorized by Section 1902(r)(2) of the Social Security Act (42 U.S.C. Sec. 1396a(r)). [Explanation: Under comparability provisions in the federal Medicaid act, it is difficult to single out "former 250% working disabled". This would give a three-year window for retirement accounts (CT has life time exemption for their Independence Account and their Retirement Account exemptions in their state plan for prior workers in the their buy-in, source - Allen Jensen), - and additionally help people who are attempting to get from 62 early retirement to what is now 65-1/2 or 66 when Medicare would kick in.] ++++++++++++++++ WD PROGRAM ADMINISTRATION, ELIGIBILITY AND PREMIUMS 1. Transfer "buy-in" HCFA authority from Balanced Budget Act 1997 (BBA) to authority under TWWIIA, to build legal base for TWWIIA Medical Improvement Buy-In, to allow elimination of current earnings limit, and for other reasons. Technical amendment change. Allen Jensen discussions in progress, definition may not be needed at all. CWG POSITION: Use and adapt TWWIIA DEFINITION OF EMPLOYED PERSON if needed: "...is engaged in a work effort that meets substantial and reasonable threshold criteria for hours of work, wages, or other measures, as defined by the State and approved by the Secretary." of the US Department of Health and Human Services. TWWIIA: Title II, Sec. 201, (a), "(2). "(B) 2. Write "Easy Back On" provision to categorically needy Medi-Cal into this law. 2 NOTEs: Current state law mandates that the state must assess whether participants of any Medi-Cal program, who lose one program eligibility, are then eligible for other Medi-Cal programs. The state shall include provisions that "do no harm" for assets of ex-workers from the CWDP during grace period. See next provision, "grace period." Redetermination for the WD program is annual while, under current regulations, participant must report eligibility changes within 10 days of occurrence.......problematic. CA Kid health program models??? 3. Create a "Six Month Grace Period" Provision that Does No Harm. - A Minimum six month grace period for WD program eligibility after a work stoppage for those not in self-employment. Participants continue to pay premiums, retain assets, and secure new employment. Discussion Elements: "Grace Period" allowable after how many months in initial paid work that determined initial eligibility for the program? Dion says from month one, as in COBRA. DEVELOPMENT -- ATT: ALLEN JENSEN --MARILYN HOLLE ASKS?: Which STATES have gotten approvals for an extended grace period? We should look at their state plan amendment and state statute. One option which could help is to designating unemployment insurance and state disability insurance as earned income for the purposes of this program. That makes sense in that both programs are designed to provide temporary assistance between jobs. Break into two components: (Holle - this increases choice.) One protects assets gained from CWD program after work ends, second is the "grace period." Person may choose to leave CWD program and hope to protect assets returning to other needed Medi-Cal program. Holle included this language elsewhere. COBRA principles and standards should apply: "Make Work Pay" (Problem: Federal law, BBA and TWWIIA mandate work as a current requirement. Confer with Jensen, also Tom Hamilton of HCFA, thamilton@hcfa.gov 4. Draft specific self-employment rule in statute - ESSENTIAL. DEVELOPMENT: (Holle) - Following SSI self-employment rules should not be a problem because this option requires following SSI methodology. One caveat: under SSI self-employment averaging covers the time period when you are actively engaged in self-employment and does not spill over to moneys when you are not so engaged. For instance, if you were self-employed providing accounting services to 3 companies, the fact that in one month no one paid you would not affect your eligibility. However, if because you had a health set back you had to stop providing accounting services for several months, income averaging would not apply to embrace those months. Use of Tax ID Number, quarterly earnings reports as proof of eligibility in conjunction with existing annual redetermination for WD program. This SHOULD be easy, but not overlooked. [Margaret Lamb Dec. 7 committed to research and share SSI self-employment rules for "model" use(s).] 5. Initial Program Eligibility - No personal or household earnings or asset restrictions. Eligibility based on current medical SSA disability rules. Earnings are exempt. (At issue, the "marriage penalty.") 6. Premiums - CURRENT CWG Policy Position = Sliding scale premium payment amounts "shall be determined using the earned income of the eligible worker only." (At issue, the "marriage penalty." Maryland discussion, exempt some of spousal income.) 7. In determining premiums, family size matters as referenced in federal poverty level tables. Other household income is exempt. Household or family income and assets are a MAJOR Legislative DISCUSSION ITEM: For example, if spousal disposable income is high, there may be political/policy issues. DEVELOPMENT: Looking at only the income of the worker with a disability and disregarding the income of a spouse can be done under the flexible income and resources methodology provision of Section 1902(r)(2), 42 U.S.C. § 1396a(r)(2). 8. Delete or keep as a lesser priority: Establish a Presumptive Eligibility Status for applicants who are current Medi-Cal recipient, or SSI or SSDI beneficiary, who has proof of a job offer pending, or employment. (Marlene Ratner argues DHS must still determine financial eligibility.) 9. PREMIUMS DUE: For a person with earnings below 200% of poverty, Medi-Cal is premium free. Monthly premiums shall be no higher than 7.5% of earnings above 200% of poverty. (TWWIIA statutory premium limit for earnings between 250% and 450% of poverty.) In determining premiums, family size matters as referenced in federal poverty level tables. 10. PREMIUM SCHEDULE: Premiums shall be payable monthly, quarterly or annually at the option of the eligible person. (Serves self-employment profiles) - Set premium dollar amount for six month increments, review/adjust premium amount bi-annually. - Figuring out premium amounts for a six-month period and then adjusting upwards or downwards in the next six-month period is consistent with what is done under the medically needy share of cost program - See Section 12 in the Medi-Cal Eligibility Procedures Manual. 11. Reduce CWDP premiums by the amount equal to what the Medi-Cal recipient pays in premiums and deductibles (versus co-pays) for non-Working Disabled program health care premiums. [Page 11 #11 - Only premiums should reduce because Medi-Cal would cover deductibles and copays.] Amend Welf. & Inst. Code 14007.9(d) Individuals eligible for Medi-Cal benefits under this section shall be subject to the payment of premiums determined under this subdivision.The department shall establish sliding-scale premiums that are based on countable income, with a minimum premium of twenty dollars ($20) per month and a maximum premium of two hundred fifty dollars ($250) per month, and shall, by regulations, annually adjust the premiums (1) The amount of monthly premiums to be paid will be reduced by one twelfth the amount of premiums paid or payable per year for other health care coverage, but in no event to less than $20 a month. If the other health care coverage premium includes persons other than individuals eligible for Medi-Cal benefits under this section, the amount of the other health care premiums counted shall be the amount which would be paid or payable to cover only the individual or individuals eligible for Medi-Cal benefits under this section. (2) Prior to adjustment of any premiums pursuant to this subdivision, the department shall submit a report of proposed premium adjustments to the appropriate committees of the Legislature as part of the annual budget act process. Explanation: People should not be penalized for electing to pay for their own health insurance. Indeed they should be encouraged to pay keep their health benefit plans. 12. IHSS and Personal Assistance Services Provisions. [Page 12 #12 - I have looked at what actually appears in the state plan for personal care services and it just says in the home and does not include the additional part of 14132.95(a) which cover other locations authorized by the director. Therefore the state plan would have to be amended. Such an amendment would be a pretty pro forma procedure.] (1) Modify IHSS statute to specify that personal care services under IHSS shall be provided to individuals in or to the workplace. Remove the "attendant care at work" barrier to being able to participate in TWWIIA Medicaid options programs Amend Welf. & Inst. Code § 14132.95(a) as follows: (a) Personal care services when provided to a categorically needy person as defined in Section 14050.1 is a covered benefit to the extent federal financial participation is available if these services are (1) Provided (i) in the beneficiary's home; (ii) provided while the beneficiary is engaged in employment or educational or vocational training to the same extent as the covered services are provided in the home subject to federal approval; (iii) and in other locations as may be authorized by the director subject to federal approval. Explanation: M. Holle does not think federal approval is necessary to expressly extend personal care services to working folks. (2) For those receiving IHSS at home, or in or to the workplace, specify that payment of the Medi-Cal buy-in premium shall make the individual categorically eligible for IHSS and no further share of cost shall be required. Other than income and asset limits, retain current eligibility criteria for IHSS personal care services. 13. Repeal the 5 year sunset in current buy-in program. Retain current CWDP unearned income and asset disregards. PART THREE THE OFFICE OF WORKFORCE INCLUSION Or COMPARABLE STATE WIDE MECHANISM Who does What and by When? How often does it meet? Section 1000. Development of Comprehensive Working Strategies For Enhancing Employment Opportunities for Persons with Disabilities (a) Office of Workforce Inclusion or Comparable Mechanism. The (Governor) Secretary of Health and Human Services shall establish an Office or adopt a comparable state wide mechanism to create a sustainable, comprehensive working strategy to: (1) bring adults with disabilities into gainful employment at a rate that is as close as possible to that of the general adult population; (2) support the goals of equality of opportunity, full participation, independent living and economic-self-sufficiency for these individuals; and ensure that state government is a model employer of individuals with disabilities. (b) Mission of the State Level Office of Workforce Inclusion or Comparable Mechanism. The purpose of the Office or comparable mechanism is to increase the capacity of state programs to support the employment-related needs of individuals with disabilities by streamlining and expanding access to numerous health care, workforce investment and educational and other human resource services, activities, and programs. (c) Departments Included: The Office or comparable mechanism shall include, but not be limited to, the following departments within the Agency: Employment Development Department, Department of Health Services, Department of Aging, Department of Alcohol and Drug programs, Department of Developmental Services, Regional Centers, Health and Welfare Data Center, Department of Mental Health, Department of Rehabilitation and Department of Social Services. The Office or comparable mechanism shall also include other programs necessary to maximize the economic self-sufficiency of rural and urban individuals with disabilities such as Transportation, Housing, and.... (d) The Office of Workforce Inclusion shall monitor and enforce California implementation of Section 188, Title One, Workforce Investment Act. (e) Local Workforce Investment Board (LWIB) compliance and integration with employment supports for people with disabilities (1) The Secretary shall require a two part report for submission to Office of Workforce Inclusion or Comparable Mechanism: PART A: Compliance assessment(s) with date certain time lines for accessibility of local One Stops with Section 188 of Title I of WIA. Due Date:________________ PART B: Design and implementation strategies for qualifications needed to participate in TWWIIA Ticket to Work program for CA Social Security beneficiaries. Due Date, December 31, 2002 (e) Add Division 10 to the California Unemployment Insurance Code Division 10: Employment Assistance for Workers With Disabilities 18001. It is the purpose of this division to ensure that workforce preparation services provided through California's one stop centers, including information and services provided electronically, are accessible to employers and job seekers with disabilities; that appropriate services are provided to individuals with disabilities to enhance their employability; and that to achieve these ends, local workforce investment boards plan for and report on services to job seekers and employers with disabilities, including the implementation of the federal Ticket-to-Work program in their local workforce investment area. 18002. Under WIA all local workforce investment boards are required to establish at least one comprehensive one-stop career center in each local workforce investment area to provide: 1. An array of core services, including, but not limited to: * outreach, intake and orientation * initial assessments of skills, aptitudes, abilities and need for support services * program eligibility determination * information on the local, regional and national labor market * information on filing for unemployment insurance 2. Access to intensive services as needed, including, but not limited to: * comprehensive and specialized assessments of skill levels and service needs * development of individual employment plans * group counseling * individual counseling and career planning * case management for participants seeking training services under Section 18002 (3) * short-term prevocational services such as learning, communication, interview and other job seeking and work related skills to help prepare individuals for unsubsidized employment and training 3. Training services, including, but not limited to: * occupational skills training * on-the-job training * workplace training and cooperative education programs * private sector training programs * skills upgrade and retraining * entrepreneurial training * job readiness training * adult education and Literacy activities combined with training * customized training 18003. In order to ensure that one-stop career centers operated by local workforce investment boards meet the needs of workers and employers with disabilities, the Governor shall ensure that evaluations conducted pursuant to Sections 134 (a)(2)(B)(ii) and (v) of the federal WIA address how local one-stop centers plan to provide: 1. full access to workforce development services to their disabled community 2. assistive technology to ensure access to services 3. staff training on assessment and service strategies for job seekers and employers with disabilities 4. representation of the disability community in program planning and service delivery 5. for the development of regional employment networks in the local workforce investment area to participate in the Ticket to Work program and the role of the local board and one-stop centers in the Ticket program. 18004. The California Workforce Investment Board shall report to the Governor and the Legislature by December 31, 2002 on the status of one-stop services to the disabled and implementation of the Ticket to Work program in California. The Office of Workforce Inclusion shall direct Workforce Investment Boards to schedule regular performance reviews of their One Stop Centers to determine if physical and program access is available to persons with disabilities. One Stop Center counselor staff shall have the prerequisite training and resources to advise SSI and SSDI beneficiaries on the implications of work for such individuals, to include referral expertise to appropriate benefits planners. 18005. The Governor shall be required to appoint persons with disabilities to the state wide WIA Board (SWIB), as well as to direct that local elected officials appoint persons with disabilities (who do not represent government agencies) to local Workforce Investment Boards (LWIBs). PART FOUR INFRASTRUCTURE AND BENEFITS PLANNING GRANTS (f) Functions of the Office of Workforce Inclusion or Comparable Mechanism. The Office of Workforce Inclusion or comparable mechanism shall provide the necessary infrastructures for: (1) Sustained inter-department cross training and technical assistance services to Agency direct services staff and others to enhance employment opportunities for individuals with disabilities; (2) The use of information and financial management systems that link programs to one another and to other electronic networks that relate to subjects such as employment statistics, job vacancies, career planning, and workforce investment activities; (3) The use and promotion of customer service features such as intake and referral procedures, customer data bases, resource information, human services hotlines, and websites; (4) The expansion of cooperative efforts with employers, and establishment of cooperative efforts with entities of the Social Security Ticket to Work program, Social Security Benefits Planner programs and; (5) The expansion of current data collection, and research components tracking Medi-Cal and other state services for employed persons with disabilities; (6) The identification of staff roles, responsibilities, and available resources and specification of financial responsibility consistent with requirements of the respective federal or state laws; (7) The specifications of procedures for resolving disputes between and promoting model practices among departments; and, (8) Acting for the Secretary, design, implement, offer guidance and technical and research support of and for County Infrastructure Grants. (g) County Infrastructure Grants. (1)The Office of Workforce Inclusion shall design and establish a state wide system of grants to counties for the purpose of developing county-level comprehensive working strategies for enhancing employment opportunities for individuals with disabilities. (2)The mission of the grants shall be consistent with the mission of state level strategies describe in subsection (b) above; (3) The Secretary shall devise such policies governing such grants as he or she deems appropriate, including the appointment of a county wide lead agency. The lead agency may include state agencies such as state vocational rehabilitation that have county offices. The lead agency may contract or make other arrangements for administering the grant with nonprofit agencies such as centers for independent living and others. (h) Core Infrastructure Grant services: A. Comprehensive Benefits Planner and Outreach (BPO) programs on a county wide or multiple county wide basis. Such programs shall serve a cross disability range of consumers by arrangements as needed and approved by the Secretary. The Office of Workforce Inclusion shall award grants, or contracts to provide benefits planning and assistance (including information on the availability of protection and advocacy services) to individuals with disabilities and outreach to individuals with disabilities who are potentially eligible for work incentive programs. The California program may supplement community based programs of the Social Security Benefits Planning and Assistance Program (BPAO) and shall coordinate information and activities with One Stop Centers and others. Regional Centers, Department of Rehabilitation programs, One Stop Centers, Centers of Independent Living, TANF and other entities with work programs shall be required to coordinate and provide access to Benefits Planning and Outreach services for their consumers and programs. Benefits Planner programs shall have a base line of expertise with delivering direct services and with state and federal work incentive and health care programs; be provided technical assistance to perform the duties described through separate technical assistance training contracts to be awarded by the Secretary, and have access to ongoing web based technical assistance and training. The lead agency may contract or make other arrangements for administering the BPO programs with nonprofit agencies such as centers for independent living, Health Consumer Alliance programs and others. PLACE HOLDER FOR PROVISION LANGUAGE: = Replicate the SSA staff position of Social Security field office Employment Support Representative (ESR) in County welfare and Medi-Cal offices. This shall be an accessible, direct services staff person competent in the application of county and state work incentives. Note CA precedent: One CA DSS County Coordinator per County is now assigned to the current Medi-Cal Working Disabled buy-in program. (h) There is authorized to be appropriated such sums as may be necessary to award such grants to qualified Counties as they apply for County Infra-structure Grants. PART FIVE FUNDING SOURCES TWWIIA INFRASTRUCTURE GRANTS: 500K FOR TEN YEARS = 2.5 MILLION OVER TEN years, application due date MAY 21, 2001 GENERAL FUND [PROJECTED SAVINGS TO SSI/SSP] ----------------------------------- END JAN 26, 2001 DRAFT TO CONTRIBUTE YOUR INPUT OR COMMENTS CONTACT: Mitch Jeserich, Policy Analyst World Institute on Disability, 510 16th Street, Suite 100 Oakland, CA 94612, Phone: 510-251-4350, Fax: 510- 763-4109, TTY/TDD 510-208-9493, mitch@wid.org Bryon MacDonald, Public Policy Advocate World Institute on Disability Phone 510-251-4304 Bryosemite@aol.com TWWIIA News at: www.WID.org To subscribe to CA Work Incentives Update Listserv, contact: Casey McChesney, Program Associate World Institute on Disability Phone 510-251-4352 WEB RESOURCES US HEALTH CARE FINANCING ADIMINISTRATION TWWIIA Informational Website - What's New? State of Connecticut: First to adopt the TWWIIA Medicaid Buy-In Summary and Legislation http://www.dgne.com/terry/pres/index.html Comprehensive, Person-Centered State Work Incentive Initiatives A Resource Center for Developing and Implementing Medicaid Buy-in Programs and Related Employment Initiatives for Persons with Disabilities http://www.uiowa.edu/~lhpdc/work/index.html National Conference of State Legislators Ticket to Work: Medicaid Buy-In Options for Working People with Disabilities: by Julie Scales, NCSL, Donna Folkemer, NCSL, Allen Jensen, GWU http://www.ncsl.org/programs/health/Forum/tickettowork.htm TWWIIA NEWS at World Institute on Disability http://www.wid.org/ ONE STOP CENTERS AND THE WORKFORCE INVESTMENT ACT Institute for Community Inclusion Got a question about One-Stop Centers or the Workforce Investment Act? Want to share your experience in using a One-Stop Center? Do you have any tips for people with disabilities using One-Stop Centers? Post your comment or question on our message board. http://web1.tch.harvard.edu/ici/programs/wia.html The 250% CALIFORNIA WORKING DISABLED PROGRAM Question and Answer Sheet A guide for Medi-Cal beneficiaries about the new 250% California Working Disabled Program. A publication of The California Ticket to Work and Work Incentive Improvement Act Initiative. Mitch Jeserich Policy Analyst 510 16th Street, Suite 100 Oakland, CA 94612 mitch@wid.org (510) 251-4350 The 250% CALIFORNIA WORKING DISABLED PROGRAM QUESTION AND ANSWER SHEET 1. What is the 250% California Working Disabled Program (CWD)? The 250% California Working Disabled Program (CWD) is a new Medi-Cal program. Under this program workers with disabilities, who earn less than 250% of the Federal Poverty Level, can buy into Medi-Cal with monthly premium payments. 2. What does the CWD program consider to be "work"? "Work" is undefined. A disabled worker on the CWD program must provide proof of employment (e.g., pay stubs or written verification from the employer that verifies employment.) If you are self-employed, you will have to provide records (e.g., records and W-2 forms) to demonstrate employment. Also, for the independent contractor, verification may be provided with a 1099 IRS form as proof of income and employment. You are still considered to be working, under the CWD program, if you are receiving vacation or sick leave pay from your employer. 3. Who is eligible for the 250% California Working Disabled Program? Any working disabled person who meets the Social Security definition of disability, earns less than 250% of the federal poverty line, and has $2,000 or less of personal assets. Except for earnings, all applicants must continue to meet the Social Security definition of disability, and meet the non-financial requirements of the Medi-Cal program. Earnings due to work are not a consideration in determining whether disability exists. 4. What is the federal poverty line? Size of 48 Contiguous Family Unit States and D.C. Alaska Hawaii 1 $ 8,350 $10,430 $ 9,590 2 11,250 14,060 12,930 3 14,150 17,690 16,270 4 17,050 21,320 19,610 5 19,950 24,950 22,950 6 22,850 28,580 26,290 7 25,750 32,210 29,630 8 28,650 35,840 32,970 For each additional person, add 2,900 3,630 3,340 SOURCE: Federal Register, Vol. 65, No. 31, February 15, 2000, pp. 7555-7557. According to the chart, 250% the federal poverty line for a single individual in the year 2000 is $20,875, and for a family size of two is $28,125. (Note, you can calculate 250% of the federal poverty line by taking the income number equivalent to the family size and times that by 2.5) When considering a disabled worker's income, the CWD program uses the Social Security earned income rules. According to these rules, the first $65 of earnings, $20 from any source, plus one-half of the remaining income, are not counted. This means that half of one's earning are disregarded; thus a disabled worker can make up to approximately $42,000 a year and maintain eligibility for the CWD program. 5. If I buy into Medical through the CWD program, can I be eligible for In Home Supportive Services (IHSS)? Yes. Under the CWD program, you are eligible for IHSS if you meet the IHSS' eligibility requirements in the same way as all other Medi-Cal beneficiaries have to. Neither IHSS services nor the Personal Care Services Program (PCSP) services are covered outside of the home. This means that personal care services needed at the work-site are not covered at this time. 6. What if I am married? If you are married and spousal deeming applies, then 250% of the federal poverty line for two persons is used. 7. How do I get started into the CWD program? To buy into Medi-Cal through the CWD program, you should go to your county welfare office, or, if you currently receive Medi-Cal, you should talk to you Medi-Cal eligibility worker. Appendix I is a list of county coordinators for the CWD program. 8. Can I have a retirement fund? Yes. Any employer or individual retirement plan approved by the Internal Revenue Code is permissible under the CWD program. 9. What are the reporting requirements for the CWD program? There is an annual medical review for all recipients of any Medi-Cal program. However, there are no scheduled reporting requirements due to work. But you are required to report all changes (e.g., earnings, name/address changes) to your county eligibility worker within 10 days of the change. 10. Do I have to pay a premium payment? Yes. To buy into the CWD program you must pay a monthly premium. The premium amount is determined by your countable income. Premium payments range from a minimum of $20 a month to a maximum of $250 a month. Once you become eligible for the CWD program, you will be sent an invoice and postage-paid envelope for your premium payment. You will be mailed the premium payment invoice on the 23rd of each month, and the premium payments are due by the 10th of the following month. 11. Can my premium payments be increased or decreased? Yes. If you report an increase or a decrease in your countable income, the county will decide whether your premium payment should be adjusted. If the county increases your premium payments, the county must send you timely and adequate notice of action. If the county decreases your premium payments for the months that you have already paid the premium payment, your overpayment for those months will be credited to your following premium payments. 12. What if I fail to pay my premium payments? If the premium payments have not been received for two consecutive months, you will be sent a Notice of Action informing you of your termination from the CWD program. The Notice of Action will also inform you that you will be re-determined eligibility under other Medi-Cal programs. If you are discontinued from the CWD program for failure to pay full premiums for two consecutive months and you are off the program, you will have a 6-month penalty period. If you wish to reenroll into the program during the 6-month penalty period, you must pay the current premiums and pay the previous payments that went unpaid. If you wish to enroll after the 6-month penalty period, you will be considered a new applicant and must prepay the premium for the first month of your new eligibility. There is always an appeal process whenever a change in Medi-Cal eligibility takes place. If you wish to appeal your eligibility status, you should request the appeals process paperwork from your Medi-Cal eligibility worker. 13. If I stop working, when is the first month of my ineligibility for the CWD program? The month of ineligibility begins on the first day of the month following the month in which you have stopped working, unless there is a good cause for your work stoppage. If a good cause exists and you meet all other eligibility requirements, the county shall continue your eligibility into the CWD program for the next two months following the month in which you stopped working. A good cause includes such reasons as hospitalization, an inability to work that is directly related to the disability, a work-site closure, or a loss of current transportation and no other alternative means of transportation is available. 14. Can I qualify for the CWD program if I am an immigrant? Yes. Disabled immigrants who are potentially eligible for the CWD program include qualified immigrants and some immigrants who are Permanently Residing in the United States Under Color of Law (PRUCOL). Qualified Immigrants include * Lawful Permanent Residents. * Immigrants Granted Asylum under section 208 of the Immigration and Nationality Act (INA). * Refugees admitted to the United States under section 207 of the INA. * Immigrants paroled into the United States under INA section 212(d)(5) for at least one year. * An immigrant whose deportation is being withheld under section 243(h) of the INA. * An immigrant granted conditional entry under section 203(a)(7) of the INA. * An immigrant who is Cuban and Haitian Entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980. * Battered immigrants who meet the requirements for qualified alien status. APPENDIX 1 County Coordinators for the 250% Working Disabled Program ALAMEDA Joyce Cooper 510-267-9442 FAX (510) 267-9428 ALPINE Jackie Casey (530) 694-2235 FAX (530) 694-2252 AMADOR Kim Crippen (209) 223-6569 FAX (209) 223-6208 BUTTE Dianna George (530) 538-7398 FAX (530) 879-3468 CALAVERAS Connie McCain (209) 754-6447 FAX (209) 754-6543 COLUSA Beverly Binkier (530) 458-0264 FAX (530) 458-0492 CONTRA COSTA Sandra Baldwin (925) 313-1621 FAX (925) 313-1758 DEL NORTE Terry Keevil (707) 464-3191 FAX (707) 465-1783 ELDORADO Midge Mortensen (503) 642-7159 FAX (530) 626-9060 FRESNO Karen Sebilian (559) 253-9177 FAX (559) 253-9250 GLENN Becky Hansen (1) Loretta Carr (2) (530) 934-6514 FAX (530) 934-6521 HUMBOLDT Kathy Cauble (707) 445-7706 FAX (707) 441-5600 IMPERIAL Gary Andrews (760) 337-7408 FAX (760) 370-0492 INYO Darlene Landis (760) 872-1394 FAX (760) 872-1749 KERN Dawn Lewis (661) 631-6076 FAX (661) 327-4949 KINGS Pat Z. Reyes (559) 582-3211 Ext. 3204 FAX (559) 585-0346 LAKE Janice Hubbell (707) 995-4200 FAX (707) 995-4204 LASSEN Mary Polly (530) 251-8152 FAX (530) 251-8373 LOS ANGELES Carol Roach (562) 908-8308 FAX (562) 908-0530 MADERA Terri Cummins (559) 662-8364 FAX (559) 675-7983 MARIN John Paul (415) 499-6590 FAX (415) 499-6731 MARIPOSA Roxanne Kearney (209) 966-3609 FAX (209) 966-5943 MENDOCINO Joyce Johnson (707) 4637724 FAX (707) 463-7859 MERCED Lupe Rubalcava (209) 385-3000 Ext 5790 FAX (209) 383-6925 MODOC Pat Wood (530) 233-6501 FAX (530) 233-2136 MONO Julie Timerman (760) 934-3411 FAX (760) 924- 5431 MONTEREY Star Howard (831) 755-4407 FAX (831) 755-8476 NAPA Linda Abbey (707) 253-4106 FAX (707) 253-6095 NEVADA Michele Violette (530) 265-1632 FAX (530) 265- 7062 ORANGE Barbara Baranski (714) 541-7736 FAX (714) 245-6188 PLACER Linda Hertz (916) 784-6092 FAX (916) 784-6100 PLUMAS Virginia Ekonen (530) 283-6368 FAX (530) 283-6368 RIVERSIDE Sue de Jonckheere (909) 358-3992 FAX (909) 358-3990 SACRAMENTO Jennifer Sipe (916) 875-3731 FAX (916) 875-3591 SAN BENITO Roberta Johnson (831) 636-4180 FAX (831) 637-9754 SAN BERNARDINO Raquel Raden (909) 388-0279 FAX (909) 388-0281 SAN DIEGO Suzette St. Pierre (619) 515-6545 FAX (619) 515-6556 SANTA CRUZ Adella Ruvalcaba (831) 454-4163 FAX (831) 454-4092 SHASTA Penny Smith (530) 245-6318 FAX (530) 255-5288 SIERRA Lori Wright (916) 993-6720 (916) 993-6741 SISKIYOU Sam Nelson (530) 841-2767 FAX (530) 841-2791 SOLANO Diana Perez (707) 421-7805 FAX (707) 421-7237 SONOMA Kim Seamans (707) 565-5304 FAX (707) 527-2929 SAN FRANCISCO Dale Spink, Y 200 (415) 558-1951 FAX (415) 558-1841 SAN JOAQUIN Diane Luis (209) 468-1153 FAX (209) 468-1985 SAN LUIS OBISPO Pam Mettier (805) 781-1897 FAX (805) 781-1846 SAN MATEO Roxane Haynes (650) 595-7570 FAX (650) 595-7576 SANTA BARBARA Mysty Bonner (805) 737-7056 FAX (805) 737-7098 SANTA CLARA Mary Cardenas (408) 441-5590 FAX (408) 436-5493 STANISLAUS Ramona Ethier (209) 558-3684 FAX (209) 558-2558 SUTTER Denise Damm (530)-822-7230 Ext 218 FAX (530) 822-7212 TEHAMA Sue Proctor (530) 528-4095 FAX (530) 527-5410 TRINITY Marilyn Blackburn (530) 623-8236 FAX (530) 623-1250 TULARE Alex Cantu (559) 737-4660 EXT. 2106 FAX (559) 737-4694 TUOLUMNE Carol Peters (209) 533-5735 FAX (209) 533-5715 VENTURA Jennifer Enoch (805) 652-7522 FAX (805) 652-7845 YOLO Monica Perez (530) 661-2806 FAX (530) 661-2847 YUBA Carol Newsome (530) 749-6480 FAX (530) 749-6381 The Workforce Investment Act of 1998 The Workforce Investment Act of 1998 Goal The goal of the Act is to increase employment, retention, and earnings of participants, and in doing so, improve the quality of the workforce to sustain economic growth, enhance productivity and competitiveness, and reduce welfare. Key Principles • Streamlining services through better integration at the street level in the One-Stop delivery system. Programs and providers will co-locate, coordinate and integrate activities and information, so that the system as a whole is coherent and accessible for individuals and businesses alike. • Empowering individuals in several ways. First, eligible adults are given financial power to use Individual Training Accounts (ITA's) at qualified institutions. These ITA's supplement financial aid already available through other sources, or, if no other financial aid is available, they may pay for all the costs of training. Second, individuals are empowered with greater levels of information and guidance, through a system of consumer reports providing key information on the performance outcomes of training and education providers. Third, individuals are empowered through the advice, guidance, and support available through the One-Stop system, and the activities of One-Stop partners. • Universal access. Any individual will have access to the One-Stop system and to core employment-related services. Information about job vacancies, career options, student financial aid, relevant employment trends, and instruction on how to conduct a job search, write a resume, or interview with an employer is available to any job seeker in the U.S., or anyone who wants to advance his or her career. • Increased accountability. The goal of the Act is to increase employment, retention, and earnings of participants, and in doing so, improve the quality of the workforce to sustain economic growth, enhance productivity and competitiveness, and reduce welfare dependency. Consistent with this goal, the Act identifies core indicators of performance that State and local entities managing the workforce investment system must meet--or suffer sanctions. However, State and local entities exceeding the performance levels can receive incentive funds. Training providers and their programs also have to demonstrate successful performance to remain eligible to receive funds under the Act. And participants, with their ITA's, have the opportunity to make training choices based on program outcomes. To survive in the market, training providers must make accountability for performance and customer satisfaction a top priority. • Strong local role. Strong role for local workforce investment boards and the private sector, with local, business-led boards acting as "boards of directors,'' focusing on strategic planning, policy development and oversight of the local workforce investment system. Business and labor have an immediate and direct stake in the quality of the workforce investment system. Their active involvement is critical to the provision of essential data on what skills are in demand, what jobs are available, what career fields are expanding, and the identification and development of programs that best meet local employer needs. Highly successful private industry councils under JTPA exhibit these characteristics now. Under WIA, this will become the norm. • State and local flexibility. States and localities have increased flexibility, with significant authority reserved for the Governor and chief elected officials, to build on existing reforms in order to implement innovative and comprehensive workforce investment systems tailored to meet the particular needs of local and regional labor markets. • Improved youth programs linked more closely to local labor market needs and community youth programs and services, and with strong connections between academic and occupational learning. Youth programs include activities that promote youth development and citizenship, such as leadership development through voluntary community service opportunities; adult mentoring and followup; and targeted opportunities for youth living in high poverty areas. 9/98 2/99 12/99 Identify Issues Interim Regs Final Regs 12/98 4/99 7/99 Begin TA Early States Early States Submit Plans Early States Begin 4/99 As approved 7/00 Begin TA Non-Implem. States Additional States Begin All States Implem The Workforce Investment Act of 1998 Title I-Workforce Investment Systems Subtitle A-Workforce Investment Definitions Subtitle B-Statewide and Local Workforce Investment Systems • Chapter 1-State Provisions • Chapter 2-Local Provisions • Chapter 3-Workforce Investment Activities Providers • Chapter 4-Youth Activities • Chapter 5-Adult and Dislocated Worker Employment and Training Activities • Chapter 6-General Provisions • Subtitle C-Job Corps Subtitle D-National Programs Subtitle E-Administration Subtitle F-Repeals and Conforming Amendments Title II-Adult Education and Literacy Subtitle A-Adult Education and Literacy Programs • Chapter 1-Federal Provisions • Chapter 2-State Provisions • Chapter 3-Local Provisions • Chapter 4-General Provisions • Subtitle B-Repeals Title IIII-Workforce Investment-Related Activities Subtitle A-Wagner-Peyser Act Subtitle B-Linkages with Other Programs Subtitle C-Twenty-First Century Workforce Commission Subtitle D-Application of Civil Rights and Labor-management Laws to the Smithsonian Institution Title IV-Rehabilitation Act Amendments of 1998 Title V-General Provisions WORKFORCE INVESTMENT ACTIVITIES PROVIDERS ONE-STOP DELIVERY SYSTEMS REQUIRED PARTNERS • programs authorized under this title; • programs authorized under the Wagner-Peyser Act (29 U.S.C. 49 et seq.); • adult education and literacy activities authorized under title II; • programs authorized under title I of the Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.); • programs authorized under section 403(a)(5) of the Social Security Act (42 U.S.C. 603(a)(5)) (as added by section 5001 of the Balanced Budget Act of 1997); • activities authorized under title V of the Older Americans Act of 1965 (42 U.S.C. 3056 et seq.); • postsecondary vocational education activities authorized under the Carl D. Perkins Vocational and • Applied Technology Education Act (20 U.S.C. 2301 et seq.); • activities authorized under chapter 2 of title II of the Trade Act of 1974 (19 U.S.C. 2271 et seq.); • activities authorized under chapter 41 of title 38, United States Code; • employment and training activities carried out under the Community Services Block Grant Act (42 U.S.C. 901 et seq.); • employment and training activities carried out by the Department of Housing and Urban Development; and • programs authorized under State unemployment compensation laws (in accordance with applicable Federal law). ADDITIONAL PARTNERS • programs authorized under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.); • programs authorized under section 6(d)(4) of the Food Stamp Act of 1977 (7 U.S.C. 2015(d)(4)); • work programs authorized under section 6(o) of the Food Stamp Act of 1977 (7 U.S.C. 2015(o)); • programs authorized under the National and Community Service Act of 1990 (42 U.S.C. 12501 et seq.); and • other appropriate Federal, State, or local programs, including programs in the private sector. ONE-STOP OPERATORS • a postsecondary educational institution; • an employment service agency established under the Wagner-Peyser Act (29 U.S.C. 49 et seq.), on behalf of the local office of the agency; • a private, nonprofit organization (including a community-based organization); • a private for-profit entity; • a government agency; and • another interested organization or entity, which may include a local chamber of commerce or other business organization. ESTABLISHED ONE-STOP DELIVERY SYSTEM If a one-stop delivery system has been established in a local area prior to the date of enactment of this Act, the local board, the chief elected official, and the Governor involved may agree to certify an entity carrying out activities through the system as a one-stop operator for purposes of subsection (d), consistent with the requirements of subsection (b), of the memorandum of understanding, and of section 134(c). Designing and Managing the New System Several new features are included in the law to ensure the full involvement of business, labor, and community organizations in designing and ensuring the quality of the new workforce investment system. These include State and local workforce investment boards, local youth councils, and long-term State strategic planning. State and Local Workforce Investment Boards Each State will establish both State and local workforce investment boards. The State board will help the Governor develop a five-year strategic plan describing statewide workforce development activities, explaining how the requirements of the Act will be implemented, and outlining how special population groups will be served. The plan which must also include details about how local Employment Service/Job Service activities fit into the new service delivery structure must be submitted to the Secretary of Labor. The state board will advise the Governor on ways to develop the statewide workforce investment system and a statewide labor market information system. The state board will also help the Governor Local workforce investment boards, in partnership with local elected officials, will plan and oversee the local system. Local plans will be submitted for the Governor's approval. Local boards designate "One-Stop" operators and identify providers of training services, monitor system performance against established performance measures, negotiate local performance measures with the state board and the Governor, and help develop the labor market information system. Youth Councils Youth Councils will be established as a subgroup of the local board to develop parts of the local plan relating to youth, recommend providers of youth services, and coordinate local youth programs and initiatives. STATE WORKFORCE INVESTMENT BOARDS The Governor of a State shall establish a State workforce investment board to assist in the development of the State plan.* MEMBERSHIP The State Board shall include: (A) the Governor; (B) 2 members of each chamber of the State legislature, appointed by the appropriate presiding officers of each such chamber; and (C) representatives appointed by the Governor, who are-- (i) representatives of business in the State, who-- (I) are owners of businesses, chief executives or operating officers of businesses, and other business executives or employers with optimum policymaking or hiring authority, including members of local boards; (II) represent businesses with employment opportunities that reflect the employment opportunities of the State; and (III) are appointed from among individuals nominated by State business organizations and business trade associations; (ii) chief elected officials (representing both cities and counties, where appropriate); (iii) representatives of labor organizations, who have been nominated by State labor federations; (iv) representatives of individuals and organizations that have experience with respect to youth activities; (v) representatives of individuals and organizations that have experience and expertise in the delivery of workforce investment activities, including chief executive officers of community colleges and community-based organizations within the State; (vi)(I) the lead State agency officials with responsibility for the programs and activities that are carried out by one-stop partners; and (II) in any case in which no lead State agency official has responsibility for such a program, service, or activity, a representative in the State with expertise relating to such program, service, or activity; and (vii) such other representatives and State agency officials as the Governor may designate, such as the State agency officials responsible for economic development and juvenile justice programs in the State. AUTHORITY AND REGIONAL REPRESENTATION OF BOARD MEMBERS Members of the board that represent organizations, agencies, or other entities shall be individuals with optimum policymaking authority within the organizations, agencies, or entities. The members of the board shall represent diverse regions of the State, including urban, rural, and suburban areas. MAJORITY A majority of the members of the State Board shall be representatives described in paragraph (C)(i). (c) CHAIRMAN- The Governor shall select a chairperson for the State Board from among the representatives described in subsection(C)(i). *The above section of the Workforce Investment Act has been edited to improve the readability of this document. FUNCTIONS OF THE STATE BOARD The State Board shall assist the Governor in:* (1) development of the State plan; (2) development and continuous improvement of a statewide system of activities that are funded under this subtitle or carried out through a one-stop delivery system . . . that receives funds under this subtitle (referred to in this title as a `statewide workforce investment system'), including-- (A) development of linkages in order to assure coordination and nonduplication among the programs and activities; and (B) review of local plans; (3) commenting at least once annually on the measures taken pursuant to section the Carl D. Perkins Vocational and Applied Technology Education Act; (4) designation of local areas; (5) development of allocation formulas for the distribution of funds for adult employment and training activities and youth activities to local areas; (6) development and continuous improvement of comprehensive State performance measures, including State adjusted levels of performance, to assess the effectiveness of the workforce investment activities in the State; (7) preparation of the annual report to the Secretary; (8) development of the statewide employment statistics system described in the Wagner-Peyser Act; and (9) development of an application for an incentive grant. ALTERNATIVE ENTITY A State may use any State entity (including a State council, State workforce development board, combination of regional workforce development boards, or similar entity) that-- (A) was in existence on December 31, 1997; (B)(i) was established pursuant to the Job Training Partnership Act, as in effect on December 31, 1997; or (ii) is substantially similar to the State board described (above); and (C) includes representatives of business in the State and representatives of labor organizations in the State. *The above section of the Workforce Investment Act has been edited to improve the readability of this document. LOCAL WORKFORCE INVESTMENT BOARDS* There shall be established in each local area of a State, and certified by the Governor of the State, a local workforce investment board, to set policy for the portion of the statewide workforce investment system within the local area (referred to in this title as a `local workforce investment system'). MEMBERSHIP STATE CRITERIA The Governor of the State, in partnership with the State board, shall establish criteria for use by chief elected officials in the local areas for appointment of members of the local boards in such local areas. COMPOSITION Such criteria shall require, at a minimum, that the membership of each local board-- (A) shall include-- (i) representatives of business in the local area, who-- (I) are owners of businesses, chief executives or operating officers of businesses, and other business executives or employers with optimum policymaking or hiring authority; (II) represent businesses with employment opportunities that reflect the employment opportunities of the local area; and (III) are appointed from among individuals nominated by local business organizations and business trade associations; (ii) representatives of local educational entities, including representatives of local educational agencies, local school boards, entities providing adult education and literacy activities, and postsecondary educational institutions (including representatives of community colleges, where such entities exist), selected from among individuals nominated by regional or local educational agencies, institutions, or organizations representing such local educational entities; (iii) representatives of labor organizations (for a local area in which employees are represented by labor organizations), nominated by local labor federations, or (for a local area in which no employees are represented by such organizations), other representatives of employees; (iv) representatives of community-based organizations (including organizations representing individuals with disabilities and veterans, for a local area in which such organizations are present); (v) representatives of economic development agencies, including private sector economic development entities; and (vi) representatives of each of the one-stop partners; and (B) may include such other individuals or representatives of entities as the chief elected official in the local area may determine to be appropriate. AUTHORITY OF BOARD MEMBERS Members of the board that represent organizations, agencies, or other entities shall be individuals with optimum policymaking authority within the organizations, agencies, or entities. MAJORITY A majority of the members of the local board shall be representatives described in paragraph (A)(i). CHAIRPERSON The local board shall elect a chairperson for the local board from among the representatives described in paragraph (A)(i). APPOINTMENT AND CERTIFICATION OF BOARD (1) APPOINTMENT OF BOARD MEMBERS AND ASSIGNMENT OF RESPONSIBILITIES (A) IN GENERAL- The chief elected official in a local area is authorized to appoint the members of the local board for such area. (B) MULTIPLE UNITS OF LOCAL GOVERNMENT IN AREA- (i) IN GENERAL- In a case in which a local area includes more than 1 unit of general local government, the chief elected officials of such units may execute an agreement that specifies the respective roles of the individual chief elected officials-- (I) in the appointment of the members of the local board from the individuals nominated or recommended to be such members; and (II) in carrying out any other responsibilities assigned to such officials under this subtitle. (ii) LACK OF AGREEMENT- If, after a reasonable effort, the chief elected officials are unable to reach agreement as provided under clause (i), the Governor may appoint the members of the local board from individuals so nominated or recommended. (C) CONCENTRATED EMPLOYMENT PROGRAMS- In the case of a local area, the governing body of the concentrated employment program involved shall act in consultation with the chief elected official in the local area to appoint members of the local board, and to carry out any other responsibility relating to workforce investment activities assigned to such official under this Act. (2) CERTIFICATION (A) IN GENERAL- The Governor shall, once every 2 years, certify 1 local board for each local area in the State. (B) CRITERIA- Such certification shall be based on criteria established under subsection (b) and, for a second or subsequent certification, the extent to which the local board has ensured that workforce investment activities carried out in the local area have enabled the local area to meet the local performance measures. (C) FAILURE TO ACHIEVE CERTIFICATION- Failure of a local board to achieve certification shall result in reappointment and certification of another local board for the local area. (3) DECERTIFICATION (A) FRAUD, ABUSE, FAILURE TO CARRY OUT FUNCTIONS- Notwithstanding paragraph (2), the Governor may decertify a local board, at any time after providing notice and an opportunity for comment, for-- (i) fraud or abuse; or (ii) failure to carry out the functions specified for the local board in any of paragraphs (1) through (7) of subsection (d). (B) NONPERFORMANCE- Notwithstanding paragraph (2), the Governor may decertify a local board if a local area fails to meet the local performance measures for such local area for 2 consecutive program years (in accordance with section 136(h)). (C) PLAN- If the Governor decertifies a local board for a local area under subparagraph (A) or (B), the Governor may require that a new local board be appointed and certified for the local area pursuant to a reorganization plan developed by the Governor, in consultation with the chief elected official in the local area, and in accordance with the criteria established under subsection (b). (4) SINGLE STATE AREA (I)f a State indicates in the State plan that the State will be treated as a local area for purposes of the application of this title, the Governor may designate the State board to carry out any of the functions described in subsection (d). (d) FUNCTIONS OF LOCAL BOARD The functions of the local board shall include the following: (1) LOCAL PLAN Consistent with section 118, each local board, in partnership with the chief elected official for the local area involved, shall develop and submit a local plan to the Governor. (2) SELECTION OF OPERATORS AND PROVIDERS (A) SELECTION OF ONE-STOP OPERATORS- Consistent with section 121(d), the local board, with the agreement of the chief elected official-- (i) shall designate or certify one-stop operators; and (ii) may terminate for cause the eligibility of such operators. (B) SELECTION OF YOUTH PROVIDERS- (T)he local board shall identify eligible providers of youth activities in the local area by awarding grants or contracts on a competitive basis, based on the recommendations of the youth council. (C) IDENTIFICATION OF ELIGIBLE PROVIDERS OF TRAINING SERVICES- Consistent with section 122, the local board shall identify eligible providers of training services described in section 134(d)(4) in the local area. (D) IDENTIFICATION OF ELIGIBLE PROVIDERS OF INTENSIVE SERVICES- If the one-stop operator does not provide intensive services in a local area, the local board shall identify eligible providers of intensive services in the local area by awarding contracts. *The above section of the Workforce Investment Act has been edited to improve the readability of this document. YOUTH COUNCIL* (1) ESTABLISHMENT There shall be established, as a subgroup within each local board, a youth council appointed by the local board, in cooperation with the chief elected official for the local area. (2) MEMBERSHIP The membership of each youth council-- (A) shall include-- (i) members of the local board described in subparagraph (A) or (B) of subsection (b)(2) with special interest or expertise in youth policy; (ii) representatives of youth service agencies, including juvenile justice and local law enforcement agencies; (iii) representatives of local public housing authorities; (iv) parents of eligible youth seeking assistance under this subtitle; (v) individuals, including former participants, and representatives of organizations, that have experience relating to youth activities; and (vi) representatives of the Job Corps, as appropriate; and (B) may include such other individuals as the chairperson of the local board, in cooperation with the chief elected official, determines to be appropriate. (3) RELATIONSHIP TO LOCAL BOARD Members of the youth council who are not members of the local board described in subparagraphs (A) and (B) of subsection (b)(2) shall be voting members of the youth council and nonvoting members of the board. (4) DUTIES The duties of the youth council include-- (A) developing the portions of the local plan relating to eligible youth, as determined by the chairperson of the local board; (B) subject to the approval of the local board and consistent with section 123-- (i) recommending eligible providers of youth activities, to be awarded grants or contracts on a competitive basis by the local board to carry out the youth activities; and (ii) conducting oversight with respect to the eligible providers of youth activities, in the local area; (C) coordinating youth activities authorized under section 129 in the local area; and (D) other duties determined to be appropriate by the chairperson of the local board. ALTERNATIVE ENTITY (1) IN GENERAL- For purposes of complying with subsections (a), (b), and (c), and paragraphs (1) and (2) of subsection (h), a State may use any local entity (including a local council, regional workforce development board, or similar entity) that-- (A) is established to serve the local area (or the service delivery area that most closely corresponds to the local area); (B) is in existence on December 31, 1997; (C)(i) is established pursuant to section 102 of the Job Training Partnership Act, as in effect on December 31, 1997; or (ii) is substantially similar to the local board described in subsections (a), (b), and (c), and paragraphs (1) and (2) of subsection (h); and (D) includes-- (i) representatives of business in the local area; and (ii)(I) representatives of labor organizations (for a local area in which employees are represented by labor organizations), nominated by local labor federations; or (II) (for a local area in which no employees are represented by such organizations), other representatives of employees in the local area. *The above section of the Workforce Investment Act has been edited to improve the readability of this document. Workforce Investment Act Readiness Checklist This information is based on the readiness checklist developed by the State of Illinois. The checklist may be used by States and Locals as a tool for them to benchmark their progress as they implement the Workforce Investment Act. This readiness checklist is not all inclusive nor does it take the place of the Workforce Investment Act of 1998 or the WIA Planning Guidance. I. Statewide 5-Year Strategic Plan Content (some of the critical elements): • A description of the State Board and its role in fulfilling functions • State imposed requirements for the One-Stop Delivery system • State accountability system including any State performance measures. • Projected employment opportunities by occupation • Projected skills needed to obtain demand occupations • Economic Development needs of the State • Type and availability of Workforce Investment Activities in the State • Identification of local areas and process and criteria for designation • Criteria for appointment of members of local boards by LEOs • Detail plans required under Section 8 of the Wagner-Peyser Act • Procedures to assure coordination and non-duplication • Common data collection and reporting processes for programs and activities • Public comment process on the plan • State leverage of other private or Federal funds • Assurances of fiscal and fund accounting controls • Within State formula for adult, youth, and dislocated worker funds. • Actions that constitute a conflict of interest for State and local Board members • State assistance to develop a One-Stop delivery system • Description of appeal process for area designation • Adult and Dislocated Worker employment and training activities to be undertaken • The state rapid response unit and rapid response activities • Procedures used by local boards to identify eligible providers • How the state will meet the employment and training needs of the following customer segments: Dislocated Workers, Displaced Homemakers, Low Income Individuals, Public Assistance Recipients, and Individuals with multiple barriers to employment • Training and non-traditional occupations • Assurance that Veterans will be served • Description of Youth activities to be undertaken • Criteria for competitive procurement of youth services • Criteria to identify effective youth services • Coordination arrangements with Job Corps and other national programs • Coordination arrangements with the Youth Opportunity Grants II. Governance • Establish State Board • Work with Governor's Office to designate State Board • Establish Local Workforce Investment Area(s) • Identify areas entitled to automatic and temporary designation • Develop public comment procedures on proposed designations • Specify all LEO responsibilities under WIA for inclusion in LEO Agreements • Develop an application process for LEOs to apply for WIA designation • Appoint Local Workforce Investment Boards • Define criteria for LEO appointment of members of Local WIBS • Establish minimum public comment process on proposed appointments by LEOs • Develop criteria and procedures for initial certification of local Boards based on compositional requirements and job responsibilities of appointees (EXAMPLE: Optimum Policy Making Authority) • Define procedures for Governor's appointment of a WIB if no LEO agreement • Develop procedures for decertification of local WIBs for failure to carry out required functions or fraud • Plan and budget for 15% set-a-side for statewide activities • Obtain the input of the State WIB and Local Boards and LEOs on the scope of Statewide investment activities • Develop a budget for all required activities to be funded from the 15% reserve including state administrative activities; development and dissemination of list of Eligible Training Providers, the conduct of program evaluations, incentive awards to improve coordination and local performance, TA to assist local performers, establishment and operation of fiscal and management accountability systems, and establish and maintenance of the One-Stop delivery system • Develop a budget strategy for discretionary activities to be funded from the 15% reserve including providing technical assistance and capacity building; conduct research and demonstrations, and implement innovative incumbent worker programs, establish programs in empowerment zones and enterprise communities, implement innovative programs for displaced homemakers, implement non-traditional placement programs, support data collection concerning eligible training providers, and other locally authorized activities as needed • Establish State and Local rapid response procedures and services • Create procedures to develop state and local rapid response services • Clarify role of rapid response unit and funds in response to disasters • Develop a budget for all activities to be funded from the 25% dislocated worker reserve including rapid response unit functions, reserve funds to be allotted in response to mass layoffs, closings and disasters, and automated support of rapid response function III. Administrative Areas • Consult with LEOs regarding allocation formula prior to allocation of funds • Define allocation formula for local dislocated worker activities • Determine if the State will allocate any portion of youth or adult funds under the 30% discretionary provisions in Sections 127 or 132 • Distribute allocations to WIBs and LEOs IV. Establishing and Certifying the One-Stop Delivery System • Establish procedures for reaching agreement between the Governor, the WIBs and LEOs to designate new or existing One-Stop Operators • Clarify One-Stop Partners' legal obligation to support One-Stop system development costs and the ongoing costs of core services • Develop a model MOU for use by WIBs and the One-Stop partners regarding services to be offered through the One-Stop system • Define criteria for designating or certifying One-Stop operators • Define criteria for permitting local boards to provide core or intensive services • Develop policy regarding the waiver of the WIB training prohibition • Develop appropriate linkages with partnering agencies to ensure universal access through labor exchange functions (ES and AJB), UI claims and reemployment services • Make technology available to the local One-Stop Operators V. Development, Review and Approval of Local Plans • Develop Planning Instructions containing the format, content requirements, and forms for the Local WIA Plans • Operationally define programs and activities • Establish policies and procedures for 20% fund transfer across adult programs • Provide Employment Statistics to WIBs and LEOs to support planning • Specify minimum expenditure requirements for out-of-school youth • Provide the Governor's priority for use of limited adult training funds • Establish minimum requirements for public comment on local plans • Negotiate local outcome-oriented performance measures • Negotiate local performance measures of coordination and non-duplication • Develop procedures for submittal, review and state approval of local plans VI. Eligible Training Providers • Designate the appropriate State Agency to collect and disseminate performance information on Eligible Training Providers • While developing procedures for provider designation, obtain comments from WIBs, providers of training, business, organized labor, and interested members of the public • Secure Inter-Agency agreements to obtain relevant wage data regarding provider performance • Define policy and procedures to be used by WIBs to determine local adult and dislocated worker training providers "initially eligible" as WIA training providers • Develop minimum performance criteria for subsequent determinations. Include measures relating to all program participants and measures relating only to WIA participants including program completion rate, placements in unsubsidized employment, placements in training related jobs, wages at placement, six-month retention in employment, wages at six-month post placement, rates of licensure certification (where applicable), program costs, and other information required by the Governor. • Develop a methodology to allow local provider performance criteria to be adjusted based on economic, geographic, and demographic factors as well as characteristics of the population served • Negotiate interstate agreements to accept Eligible Training Provider lists from adjacent States • Develop procedures to remove providers from the list for submittal of inaccurate information or violation of the Act or Regulations • Develop separate criteria for One-The-Job Training and Customized Training Providers • Collect adult and dislocated worker training provider information submitted to local WIBs for later dissemination • Collect the list of eligible providers of Youth activities developed by the Local Board and Youth Council • Develop a strategy for the dissemination of the Provider Lists with performance information and distribute the list of Eligible Training Providers and providers of non-traditional training services through the One-Stop Delivery System • Establish an appeal procedure for providers denied approval by either the local board or the State designated agency • Provide minimum criteria for competitive procurement of Eligible Training Providers VII. Promulgate Participant Eligibility Policy. • Operationally define "core services" available to the general public • Operationally define "intensive services" • Clarify the role of traditional eligibility concepts ( for example, being economically disadvantaged or dislocated worker) in determining eligibility for adult training services • Operationally define new eligibility concepts limiting access to training services including: criteria to be determined "in need of training", criteria to demonstrate ability to "successfully participate in training", criteria to demonstrate occupational demand related to the training, documentation of efforts to obtain other financial assistance, inability to obtain employment through core services • Develop forms to support local eligibility determination VIII. Establishing the State Performance Accountability System • Operationally define and set standards for core performance measures for adults and youth ages 19-21 including entry into unsubsidized employment, employment retention for six months, earnings six month post termination, and attainment of recognized credentials • Operationally define and set standards for core performance measures for youth ages 14-18, including attainment of basic skills, attainment for work readiness and occupational skills, attainment of high school diploma or GED, and placement and retention and post-secondary education or advanced training • Develop indicators and set standards for measures of customer satisfaction for workers and employers • Determine if the State will promulgate any additional Governor's measures • Develop appropriate policy regarding the degree of WIB failure and the provision of technical assistance and application of sanctions • Develop incentive award strategies using 15% reserve funds for improving regional coordination, improving local coordination, and achievement of local performance measures • Negotiate with the Secretary of Labor regarding the acceptable level of performance on each national and optional state measure • Establish procedures to monitor progress against negotiated statewide performance goals vis-a-vis changes in economic conditions, service mix, and the population served in order to request a modification to the negotiated goals • Establish procedures to set local performance goals for each measure and adjust local performance expectations based on local economic conditions, service mix, and characteristics of the population served • IX. Reporting and Monitoring Capabilities • Define criteria for use by LEOs and WIBs for conducting oversight of One-Stop Centers • Define State reporting requirements regarding the activities carried out through the One-Stop Centers • Develop programmatic and fiscal monitoring instruments and procedures • Develop monitoring schedule • Develop monitoring and continuous improvement reports • Promulgate State programmatic and fiscal roles • Develop a plan to conduct program evaluation activities and develop a format for the annual report to the Secretary X. Development of a TAT Plan Supporting WIA Implementation • Provide training for LEOs regarding WIA responsibilities • Develop a training plan for WIBs and LEOs regarding requirements associated with the local One-Stop Memorandum of Understanding • Train local planners regarding plan requirements • Train local Boards regarding their role in the development and maintenance of the list of Eligible Training Providers • Develop a training plan for LEOs and WIBs regarding State and Federal performance management policy • Provide training for local staff on various procedures including intake, rapid response, etc. Six State Review State of Alaska Unified Plan Comprehensive Vision of A Workforce Investment System The vision for Alaska's Workforce Investment System is "building connections that put Alaskan's into good jobs." A good job is described as one that has adequate pay, benefits and career advancement opportunities that can sustain an individual and their family economically without reliance on public subsidy. (Self Sufficiency) This comprehensive vision will guide the workforce investment system. The system will provide employment education, training and support services to assure Alaska employers have a skilled workforce and Alaska workers have employment choices. The system will promote a healthy economy and strong communities by increasing employment opportunities through improved access to government, education and private sector activities that develop, strengthen, stimulate and diversify Alaska's economic base. Statewide Primary Workforce Development Goals • Strengthen the involvement of business, industry, and economic development to build Alaska's workforce. • Ensure access to quality employment education, training and employment services statewide, particularly to rural areas and for the economically disadvantaged. • Evaluate programs of the workforce investment system to optimize customer employability. • Advocate for Alaska's human resource investment programs and promote continuous improvement. • Promote the full integration of Alaskans with disabilities into all aspects of the workforce development system to put people with disabilities into good jobs. • Strengthen the involvement and ability of Alaska's Education system to develop Alaska's workforce. In order to achieve workforce investment system improvements over the five-year period, cross system measures will be used to gauge progress of the Plan. The measures will assist in understanding if the goals and strategies are effective in achieving the following broad results: ¦ Increasing the number of jobs held by Alaska residents. ¦ Reducing unemployment by economic region in Alaska. ¦ Decreasing welfare dependence by economic region in Alaska. ¦ Gaining income for Alaskans as compared to non-resident workers. ¦ Enhancing and increasing the supply of trained and credentialed workers for good jobs in demand. ¦ Retaining skilled workers in vital Alaskan industries. ¦ Gaining of skills and technical knowledge in Alaska's emerging and current workforce that meets the requirement of industry-based, nationally recognized skills standards. • Other Legislation and Initiatives In May of 1999 the Legislature passed House Bill 40, which was a major restructuring of several state departments. The bill abolished one department and transferred programs between agencies. Programs related to workforce development were consolidated into the Department of Labor. The department changed its name accordingly to the "Alaska Department of Labor and Workforce Development (AKDOL)." Three significant federal and state workforce reform initiatives that connect with all workforce development programs are also underway in Alaska: Alaska's School-to-Work (STW) initiative, implementation of Job Centers through the Alaska Job Center Network (AJCN), and welfare reform through the Alaska Temporary Assistance Program (ATAP). Legislation, departmental restructuring, and the Governor's Administrative Order resulted in bringing human resource investment issues forward in public policy. These combined efforts have launched serious concentration on building Alaskans' skills and knowledge to ensure a strong state economy in the years ahead. Economic Development and Challenges The slow, steady growth that has characterized Alaska's economy for the last decade is likely to continue for the immediate future. Employment growth will be focused primarily in the service, trade and transportation industry sectors. New jobs are anticipated to be created at a faster pace outside the Anchorage area and will likely be for lower pay than many of the jobs that have been lost in declining industries such as oil and wood products. Employment growth will be driven by a growing population, increasing tourism, and developing an economy that provides more services locally. This growth in the number of new jobs, coupled with normal turnover, will result in a variety of employment opportunities for the unemployed, underemployed and recent graduates of Alaska schools. The challenge for Alaska will be to prepare its labor force with the necessary skills to meet the needs of industry as it moves forward. The vast distances between community centers and the rich mix of cultures in Alaska add a complexity to delivery of services that are unimaginable in other states. There are many challenges that impact the ability to achieve the vision of connecting Alaskans with good jobs. Major Challenges for Alaska That Could Impact the System Flat federal and state funding for the workforce investment system. • Economic disasters, corporate mergers, plant closures. • Quality Schools Initiative and High School Exit exams. • Out migration of educated youth. • In migration of skilled and educated workers. • High welfare dependence and unemployment coupled with a shortage of sustainable jobs in many communities. • Low vocational and technical education investment statewide and regionally. • High demand for skilled workers who have passed nationally recognized, industry-based certification examinations.. • High job turnover in key industries and occupations. • People with multiple barriers to employment that inhibit successfully helping them. • No established statewide system for providers of Youth services. • Additional Major Challenges for Alaska ( Providing access to services in remote or rural areas where Alaska's workforce is widely dispersed throughout the 586,000 square miles of geographic area in the State creating difficult, often impractical or impossible, and costly service options. This challenge is partially addressed with the use of Internet technology to bridge the physical distances. ( Finding adequate resources such as personnel, technology and equipment, and establishing a unified and common communication systems for all agencies are limited by physical restrictions, regulatory requirements, and funding restrictions. ( Integrating and coordinating of all workforce development partners can be constrained by different funding sources and requirements creating a less effective and seamless delivery of services to customers. ( Developing policies and/or establishing consensus on program priorities can be a lengthy and cumbersome process, due to divergent geographic and economic issues statewide, diminishing the efforts for seamless delivery of services to customers. ( Dealing with dislocations in which the workers are widely dispersed throughout the State, and employed by a number of small businesses. ( Identifying eligible long term and at-risk participants whom are a part of the larger ATAP pool can be difficult. Caseloads are "sifted and sorted" repeatedly to identify WtW eligible participants, and then to determine whether they meet the more restrictive definition of long term, on whom 70% of WtW funds must be spent. ( Identifying non-custodial parents who are not a part of the ATAP system and motivating them to participate in services designed to help them access those services so that they can become self-sufficient and better support their children. • Alaska Specific Major Challenges ( Compensating for distance restrictions and limitations due to Alaska encompassing the largest land-mass with the most sparsely isolated populations in the United States ( Modifying services approaches to handle the fact that Alaska has one of the least developed rural-based infrastructures in the U.S., especially as it relates to real "job availability." There are few full-time positions in many rural areas. ( Providing services effectively in extremely small (less than 100) isolated communities (accessible by air only) where the customer desires to remain in the community (their home) but employment opportunities are minimal. ( Addressing the fact that rural Alaska has one of the highest welfare recipient rates. ( Addressing the fact that rural Alaska has the highest teen pregnancy rate per capita in the nation. These challenges will have some bearing on the ability of the state to meet the overall purpose of this plan. At this time it is unclear whether Alaska as a "small state" under the US Department of Labor WIA formula could lose 15% of it's WIA Title I funding, which is the major source for Alaska's public employment education and training effort. Reduced funding will limit service expansion and/or improvement. Consolidating workforce programs under the AKDOL, combined with implementing the Act, provide the state a new framework for improving the results of customers. Unique opportunities are provided by establishing strong and formal relationships with Alaska's Native WIA programs, improving the one-stop delivery system, joining economic development activities, and creating direct partnerships with all levels of education to achieve the plan goals. The key to reforming Alaska's workforce investment system has been coordination and collaboration. The Unified Plan continues and increases this coordination and collaboration. Each partner included in the plan will contribute to achieving the state's broad goals for developing Alaska's workforce while striving to meet and exceed their individual program and client performance outcomes. The states guiding strategies for the Unified Plan to achieve the broad goals which will change and improve the Workforce Investment system are: ( Provide flexibility to Local Workforce Investment Boards (LWIBs)in using program funds to cover unfunded mandated activity ( Reinforce the Alaska Job Center Network( AJCN) as the statewide one-stop system ( Use Baldridge Criteria and a Continuous Improvement process ( Incorporate regional planning within workforce investment areas ( Coordinate regional planning for rural Alaska with the Denali Commission ( Identify and use Best Practices and innovative strategies ( Continue efforts to reduce welfare dependence with particular emphasis on those persons termed hardest to serve ( Build a statewide standard system of voluntary skills for education and training in alignment with the Voluntary National System of Skill Standards being developed by the national Skills Standards Board.. ( Strengthen partnerships with Alaska Native employment and training organizations ( Expand access to services through technology for all citizens with an emphasis on rural Alaska ( Emphasize services for student success including high school completion, parent and employer involvement, and career pathways. ( Provide activities to support an information exchange for workforce investment, Youth programs, and service providers ( Build one statewide Vendor system focused on quality service and high performance. • State Of Arizona Unified Plan Executive Summary Arizona's current Workforce Investment System is being redesigned to encompass a myriad of state and federal employment and training programs and funding silos and align them with the economic development priorities of the State. These priorities are based on industry clusters which were first identified through a public-private, community-based process that resulted in Arizona's Strategic Plan for Economic Development to be implemented through the Governor's Strategic Partnership for Economic Development (GSPED). There are currently 11 industry clusters and seven related foundations which are the platform for economic development in Arizona. Even before the enactment of the Workforce Investment Act of 1998 (WIA), Arizona began developing Arizona's Workforce Development System Comprehensive Plan. The overriding purpose of the Comprehensive Plan is to enhance the economic growth and competitiveness of the State's industry clusters and develop the capacity of the foundations which support them. The Comprehensive Plan was developed to support "old" employment and training programs - which served their purposes well in the past - while transitioning to and creating "new" workforce investment systems - which will serve new purposes in the future. Goals that reinforce the new system include: · Enhancing existing and/or developing new training programs and service delivery systems to better meet industry's short, intermediate, and long-term needs; * Forecasting labor market demand by GSPED clusters and foundations at state and regional/county levels; * · Streamlining the access to and/or administration of workforce development programs; and · Providing a self-sustaining system of governance, management, and oversight for Arizona's Workforce Development System. First, this Strategic Five-Year Workforce Investment Plan proposes multiple ways to support the above goals of a statewide workforce investment system. The WIA requirements for a Youth Council provide an unprecedented opportunity to better meet the needs of both students and industry through coordination and collaboration. Also, both this WIA plan and the State's Comprehensive Plan provide opportunities, particularly with respect to adult and dislocated worker funds, to link populations "most-in-need" with occupations "most-in-demand." An enhanced Individual Training Account system guarantees customer choice and accountability of training providers and represents, in fact, a new approach for statewide service delivery. Second, the State's Comprehensive Plan addresses a unique state-level forecasting system to identify occupational demand by GSPED clusters and foundations at the state, regional, and county levels. The WIA allows the State to improve its Labor Market Information system to include cluster-based and sector-based forecasts of occupational demand, and information on all employment opportunities which can be incorporated into Arizona's One-Stop delivery system. In part, this means that all of Arizona's One-Stops can be fully linked with each other since information - currently unavailable - will be easily accessible at the county level and, therefore, improve what is now a weakness in the system. Third, the WIA assists the State to fulfill a goal to streamline the access to workforce development programs, primarily through its emphasis on the One-Stop delivery system. While Labor Market Information is part of the One-Stop initiative, clearly the WIA's focus, and hence Arizona's, on One-Stops serves to streamline access to services by employers and job seekers. One-Stop delivery systems create the "marketplace" where employers and job seekers meet to assess each other in terms of skill levels and compensation and provide the means for matching the two at the highest level possible. Finally, toward helping Arizona achieve its goal to develop a self-sustaining system of governance, the WIA requirements for Local Workforce Investment Boards, and Youth Councils, are significant. The move toward a more inclusive membership of Local Boards helps build programmatic linkages - including those with federal programs - that should serve to strengthen cooperation among service providers and leverage resources for the purposes of building both local and statewide systems. Arizona clearly has a vision of where it wants to be in the next five years. Fortunately, it has a track record of success to build upon in creating a workforce investment system. Salient accomplishments in the development of Arizona's system as it exists today are notable. · The "State's Readiness" for implementing the WIA is high in part because of the 11/2 year process dedicated toward developing Arizona's Workforce Development System Comprehensive Plan and its concomitant goals. · The Governor's designation of the Interagency WIA Team, which brings together three principal State agencies, has the State well-positioned to implement a smooth and orderly transition from JTPA and Wagner-Peyser to the new system embodied by the WIA. · The State's Individual Training Account (ITA) system represents another potential strength, particularly since the State has adapted a method and is working to take it "to scale." · Arizona has a strong record of methods and tools to provide Labor Market Information to State and local entities, including employment trends. · With a three-year track record, clearly Arizona has made progress in developing its One-Stop Career Center System. The framework for these centers is in place and collaboration among state and local providers is well-documented. · In terms of the system infrastructure, Local Workforce Investment Areas are being developed. A strength of these areas is that they are, in fact, the same as the former Service Delivery Areas, and therefore have the ability to build on their own track records of success and lessons learned. Preserving the continuity of these areas should prove to be an asset. Arizona's vision over the next five years is to prepare quality workers whose skills match those in demand created as a result of economic development. Arizona's former system, with its 34 separate funding streams and administrative entities, will no longer exist. A smaller, more efficient delivery system will be in place. Already because of the WIA, Arizona is moving from 34 separate funding streams and programs to 24 since the Act consolidates nine JTPA programs into three WIA programs and Arizona has incorporated the Individual Referral Certification Process as a cornerstone for an Individual Training Account system to be linked with the One-Stop Career Centers. To the extent that assessment drives performance, the rigorous performance management system required by the WIA is anticipated to "raise the stakes" in Arizona, since regression to the mean will no longer be acceptable. Arizona has the opportunity through negotiations with the 16 Local Workforce Investment Boards to set state-level standards to model what it expects from the Local Workforce Investment Areas. Realistic, but achievable, goals over time will be established to improve performance for the ultimate benefit of Arizona's citizens. State of Kansas United Plan Executive Summary The low unemployment rate in Kansas is expected to remain steady for at least the next five years. Many diverse jobs will be available offering high to low wages and requiring a variety of skills. To serve employers, job seekers and incumbent workers successfully, the Kansas workforce development system must evolve and become fully responsive to the needs of its customers. During the early and mid-1990s, Kansas leadership recognized that its system of job training and employment services did not address the needs of either the State's employers or its job seekers. A fragmented and confusing approach to service delivery resulted in duplication of services, a waste of scarce resources, and a lack of clear accountability for results. Furthermore, little coordination existed among the services provided to welfare recipients, outreach to needy families was inconsistent, and a lagging accountability process plagued the system. The challenges to developing the Kansas workforce development system are greater than simply consolidating employment and training programs. In 1998, Kansas received a five-year One-Stop implementation grant that began the evolution from a single-program, multiple-site delivery into a multiple-program, One-Stop service delivery system. Kansas is using the One-Stop implementation grant to transform service delivery from a programmatic-based approach to a service-based approach. Kansas will create an integrated, customer-friendly network of services with improved coordination, meaningful collaboration, and critical linkages among service providers. The Local Workforce Investment Boards (LWIBs) govern the resources provided by Title I of the Workforce Investment Act (WIA) and provide planning and oversight for the Wagner-Peyser Act. LWIBs will provide concerted planning and will coordinate efforts among employers and providers of education, training, employment, and support services. WIA provides the opportunity to further develop these collaborations and establish new ones. Fostering and maintaining coordination with a multitude of employment and training partners are key to aligning the One-Stop service delivery system with the Kansas vision of an integrated, effective workforce development system. By strengthening partnerships with employers and service providers, utilizing the latest technological tools and implementing a continuous improvement system, Kansas expects new levels of performance to be achieved. The evolution of the Kansas workforce development system will result in the following: * a Kansas One-Stop service delivery system that is the first call for employers, job seekers, and incumbent workers in search of services and information surrounding workforce issues; * a network of business-led LWIBs serving as a major force of influence for the Kansas workforce development system; and * an extensive list of eligible training providers offering competency-based courses developed with input from area employers. The Kansas Workforce Investment Partnership Council is the State's Workforce Investment Board (SWIB). This State Plan is built on the goals and recommendations of the SWIB and the strategic plans of the LWIBs. As Kansas prepares for full implementation of all elements of Title I of WIA in July 2000, it will continue to focus on and take appropriate steps to improve current efforts to determine customer satisfaction with the workforce development system and its services. Additionally, the State will enhance consumer information data and the procedures and processes necessary to share that information with customers relative to training providers, training opportunities, career paths, and earnings. Kansas will continue to focus on the employer community as a major customer of the One-Stop service delivery system to meet the employer's need for well-trained workers and their ongoing need for incumbent worker training. These efforts will enable the system to be even more responsive to workplace needs and to assist in supporting a strong, viable economy. The result will be a One-Stop service delivery system centered on accountability, customer satisfaction and continuous improvement. To ensure these services are meeting the needs of customers, Kansas will establish an outcome-based performance measurement system to include an assessment of customer satisfaction that will enhance accountability and support continuous improvement. While the Kansas system is not as fragmented, it is not yet fully integrated either. Many results have been realized but much more remains to be done. In the next five years, Kansas will move its One-Stop service delivery system of partnerships well beyond the customary coordination of programs and services. The following State Plan outlines this effort. I. Plan Development Process I.A. Describe the process for developing the State Plan (including a timeline) that ensures meaningful public comment. Include a description of the Governor's and the State Board's involvement in drafting, reviewing and commenting on the Plan. What actions did your State take to collaborate in the development of the State plan with local elected officials, local workforce boards and youth councils, the business community (including small businesses), labor organizations, educators, vocational rehabilitation agencies, and the other interested parties, such as service providers, welfare agencies, community-based organizations, transportation providers and advocates? (§§111(g), 112(b)(1), 112(b)(9).) ______________________________________________________________________ The following process was developed to ensure meaningful input into the State Plan from the Governor, the SWIB, chief elected officials, LWIBs, Youth Councils, the business community, labor organizations, education, vocational rehabilitation agencies, and the general public. A timeline describing significant events in the Kansas implementation process is contained in Attachment A. 1. Draft responses to the State Plan instructions were separated and distributed into a six-part "response series." The distribution and comment periods for each series were scheduled to allow sufficient time for review and comment. Each response series was: * distributed and reviewed by the Interagency Alliance for Planning and Policy Development, which represents various State agencies; * distributed and reviewed by a diverse group of individuals representing the universe of workforce development system stakeholders; and * posted on the Internet on the Kansas Department of Human Resources (KDHR) Web site http://entkdhr.ink.org/wia/ for public review and comment. 2. A subcommittee of the SWIB was appointed to review the series and all comments received. The subcommittee was comprised of individuals who represent organized labor organizations, education, vocational rehabilitation agencies, and the private sector. The subcommittee approved or rejected each response within the series. 3. After the subcommittee gave its final approval to the series of responses, the State Plan was developed and presented to the SWIB. 4. Following the SWIB's approval of the State Plan, a notice was published soliciting comments during a 30-day review period. At the same time, the Plan was distributed to all entities described in Item 2 above for review and comment, and was posted on the KDHR web site for public review and comment. 5. The SWIB reviewed all comments received prior to submitting the State Plan to the United States Department of Labor (USDOL). 6. All the meetings complied with the Kansas Open Meetings Act and were accessible to people with disabilities. I.B. Include all comments received (or a summary), and demonstrate how comments were considered in the plan development process. (§112(b)(9).) ______________________________________________________________________ The SWIB subcommittee, under the authority of and on behalf of the full SWIB, reviewed the public comments received to determine if what actions might be taken to modify or clarify responses in the State Plan. All comments were taken into consideration and a response letter was written to each person who commented on the Plan. The letter explained the review process and any action taken in response to the comment. When no action was taken to amend the Plan, appropriate feedback was given on an individual basis, as deemed necessary. A summary of the public comments and the action taken to address these comments is contained in Attachment H. II. State Vision and Goals II. A. What are the State's broad strategic economic and workforce development goals? The strategic economic and workforce development goals for Kansas are as follows: * Goal One - To develop a workforce development system where all employers, job seekers, and incumbent workers can conveniently access a network of information and services responsive to their individual needs. * Goal Two - To develop a state and local strategic planning, evaluation, and accountability system for the State's workforce development system programs and activities. * Goal Three - To assure all Kansans have access to the tools they need to develop literacy, basic education, and the workplace skills necessary for their educational and career advancement. * Goal Four - To provide access to training and education for all job seekers and workers to acquire the skills they need to meet the workplace requirements for long-term, sustaining employment in high-skill, high-wage occupational areas. * Goal Five - To assure all youth are prepared with the knowledge, skills, and behaviors necessary to make the transition from the education system into meaningful, challenging, and productive careers with high skills, high wages, and the opportunity for lifelong learning. State of Oregon Unified Plan Executive Summary Enclose a brief summary (e.g., two pages or less) of the State Plan that gives a general overview of the State's workforce investment system. This executive summary should include a discussion of your State's economic and workforce development goals, and how the statewide workforce investment system will support them. It should also include an overview of major accomplishments in the development of your system as it exists today; a brief description of the system as it looks today; a snapshot of how the system (including major partner involvement) will change over the five-year period; and a description of how performance will improve as a result. Oregon's WIA Transition Plan This document is a Transition Plan, not a full WIA Implementation Plan. By submitting a Transition Plan, Oregon is acknowledging that as a state it does not have all the necessary elements in place to implement the WIA. Full implementation is not expected in Oregon until July 1, 2000. However, there are certain aspects of the WIA that Oregon does have in place, and a timeline to make further progress towards full implementation. In addition, Oregon has one local workforce investment area that is ready to implement and is planning to lead the way for the rest of the state. Therefore Oregon is submitting this Transition Plan in order to: * Make it clear to ourselves, our statewide partners, and our Federal partners the status of WIA implementation in Oregon; * Allow Oregon to implement portions of the Act during the transition year, effecting an orderly transition to the WIA; and * Allow one local workforce investment area, Region 2, comprised of Multnomah, Washington and Tillamook Counties and the City of Portland, to proceed with full implementation of the WIA. Oregon's Workforce Vision Oregon's Workforce will be the best educated and trained in America by the year 2000 and equal to any in the world by 2010 The Oregon vision for workforce development was defined in an economic development strategy for the State called Oregon Shines. Oregon's economy has undergone a major transition from a natural resource-based economy to a diversified, internationally competitive economy, requiring a highly trained workforce skilled in information technologies, adaptive strategies, and high performance work organizations. Positioned on the Pacific Rim, the State is poised to capitalize on the growing trade with Asia and expanding opportunities in the global economy of the 21st century. This transformation of the state's economy is an opportunity for all Oregonians to improve their standard of living. Everyone counts. More high skilled jobs are being created than high skilled workers to fill them. Family wage jobs, in the quantity needed to move all Oregonians above the average national per capita income, are dependent upon significantly upgrading the skills and education of Oregonians. To meet the challenges of this new economy, all Oregonians must be included in a strategy to upgrade the existing workforce, to prepare and inspire those trapped in costly systems of welfare and corrections, and to educate and excite young people entering the workforce for the first time. A monumental task, it may be impossible without a significant shift from the way we have prepared the workforce in the past. It includes providing a full range of service: for the current workforce to get better jobs; for early intervention and rapid response services when workers are in danger of losing their jobs; for education and training to move the unemployed, under-employed or workers in transition into new jobs; and for preparing the emerging workforce. It also includes recognizing the necessity to respond to the needs of the individual as opposed to a "one size fits all" approach to service delivery. To meet the needs of employers and workers charting their destinies in this new economy, the workforce development system must re-examine roles, realign, and form new partnerships and incentives. This approach to workforce development must be grounded in skill sets, educational competencies and appropriate experiences needed by Oregon employers to compete in the 21st century. This means our basic institutions, including K-12 schools, education service districts, community colleges, higher education, local governments, training and placement agencies, and community based organizations, must focus on preparing all our citizens to participate in the new economy. Goals for Workforce This vision, to have the best educated and trained workforce in America and the world, is made operational through broad goals for workforce development and is carried out through Core Strategies and Action Plans tied to the Strategies. Each of these goals is designed to realize the vision. Emerging Workforce * To develop and implement higher standards of academic achievement for all students; * To demonstrate the relevance of education by better connecting school and work; * To decrease the overall high school dropout rate; and * To increase skills through postsecondary achievement. Transitional Workforce * To provide the skills necessary to obtain and maintain employment; and * To prepare workers for high skill, high wage jobs in current demand. Current Workforce * To ensure training and the opportunity for upward mobility for current workers. Economic Development * To maintain and increase the availability of a quality mix of jobs in all Oregon communities; and * To support Oregon businesses in competing in global markets. Governance (Program Efficiency) * To ensure efficient and effective provision of services State of Wisconsin Unified Plan Executive Summary Since submittal of the transition plan in March 1999, Wisconsin has worked toward WIA implementation building on past efforts. With the Job Center system well along in development here even before WIA was passed, we have used this year to enhance our local and statewide partnerships. While Wisconsin is not submitting a Unified Plan in the DOL structure, we believe we have already built the relationships with many partners needed to operate in a coordinated and cohesive manner. The new Council on Workforce Investment, with the enthusiastic support of Governor Tommy G. Thompson, is laying out its vision for Wisconsin, its businesses and workers over the next several years. Their deliberations and research in the coming months may cause some redirection of efforts and resources to best meet the needs of our State. At that time we will be able to produce clear economic and workforce development goals and a snapshot of how the system will look like in five years. Furthermore, once final performance measures have been determined with DOL, we will be able to describe the effected performance improvements anticipated from accomplishing these goals. Wisconsin is well suited to implement WIA given our Job Center system as a solid foundation to ensure optimum service delivery for the employer and job seeker customers along with the expanded partner entities. In addition, several years ago Wisconsin embarked on a mission to focus on our labor shortage issues that are a driving force in current changes to improve the workforce development system, and meet the economic needs of the state. The accomplishments of the state are highlighted in a snapshot of what our system looks like today: * 11 Workforce Development Areas (WDAs) that were established in 1998 were affirmed under WIA (this is a reduction from 17 under JTPA). * 11 new Workforce Development Boards were appointed by Chief Elected Officials to reflect the membership requirements of WIA. These new Boards reflect an increase in private sector participation and expansion of the number of program representatives on the boards. * 11 new Youth Councils were formed under the auspices of local WDBs. Youth Councils will include WDB members and other community leaders and will advise WDBs on meeting the needs of youth in their area. * The W-2 program (Wisconsin's national model for Welfare Reform also known as TANF and the Food Stamp E&T program) was made a mandatory WIA partner and as result is an active Job Center and WDB participant. * Statewide policy was adopted to use the option of continuing to utilize the "hold harmless" provision in determining local WDB funding formula in order to moderate rapid shifts in local WIA funds. * Statewide policy was issued on the role of WDBs in "Local Service Provision of Direct Service" which provides a strong direction that WDBs retain a "Strategic Direction Role" at the local level and refrain from directly operating programs. * Local Plans were developed by 11 WDBs to meet local workforce needs for implementation of WIA at the local level by July 1, 2000. * 43 sites have been designated by WDBs as comprehensive One-Stop Centers that will have the full array of workforce programs and services available to meet job seeker/worker and employer needs. Additional sites are being determined by WDBs and will be identified by the start of WIA operations. (The state has 78 "job centers" and WDBs have reassessed those based on the WIA "comprehensive" one-stop center model.) * A State Abbreviated Youth Plan was submitted to the Department of Labor for the early startup of WIA Youth programs beginning in May of 2000. * A new State Council on Workforce Investment was created to provide statewide direction and guidance on workforce issues. The Council greatly expanded the number of private sector representatives and has been charged by the Governor to address workforce issues in Wisconsin in the broadest terms. These accomplishments are due in large part to the extraordinary collaborative efforts of state agencies, local partners, Chief Elected Officials, Private Industry Councils, employers, labor, community-based organizations, education entities and numerous other organizations. To date, WIA implementation has involved a host of organizations and individuals. At the state level over 11 regional meetings have been conducted to disseminate information and receive feedback. A mailing list of over 1600 individuals has been used to notify recipients of WIA issues and a web page has been set up to allow access to WIA information. Over 80 presentations on WIA have been given to selected audiences throughout the state to provide background information and to encourage further involvement in the implementation process. State and local partner workgroups were convened in the summer of 1999 to identify a wide degree of program interests and concerns, and a formal review and comment process was used in making final statewide policy. At the local level, an equivalent number of meetings and discussion has been taking place in the WDAs to educate communities and get feedback on issues. Pathways to Independence Enhancing the Wisconsin Workforce Through More Reliable Health and Support Systems For People with Disabilities January 1999 The Problem: The U.S. General Accounting Office has calculated that less than 1% of SSI or SSDI beneficiaries leave those programs each year as a result of paid employment. Of those who leave, about 1/3 return within 3 years. More than 6.6 million Americans have a permanent disability and receive income support from the Social Security Trust Fund ("SSDI") or Supplemental Security Income ("SSI"). The federal government spent $36.6 billion dollars in the SSDI program in 1995, and $20.6 billion in SSI. Many states add their own funds to these federal SSI amounts to ensure an adequate financial safety net. Wisconsin adds approximately $127 million per year. The State has about 63,000 working-age SSI beneficiaries. Approximately 75,000 disabled workers receive SSDI in Wisconsin and an additional 30,000 worker-dependents receive SSDI. Most people with disabilities want to work. Employers are increasingly interested in employing people with disabilities. Advances in technology offer employment hope even for those with the most severe disabilities. Removal of the following problems could significantly increase the employment of people with disabilities. Implications for Action: Since almost no beneficiaries leave SSI/SSDI as a result of paid employment, it would be of virtually no cost to the State and Federal governments to continue the Medicaid/Medicare coverage of current beneficiaries if they can secure paid employment. This would remove the impediment which people with severe disabilities fear most. If employment rates increase it would also be of little cost to remove the current "cliffs" in cash assistance in SSI, SSDI, and HUD programs. Wisconsin Pathways to Independence The Wisconsin Department of Health and Family Services and the Department of Workforce Development are working jointly to create a powerful initiative to increase employment on the part of people with significant disabilities. Federal waivers and passage of some of the provisions in the federally-proposed Work Incentives Improvement Act would be necessary for Pathways to achieve its full potential. The key concepts are: A. Simplified Access to Comprehensive Help: Enrollees will be able to consult with a single team which can offer coordinated access to all professionals and programs that may assist them in achieving their employment goals. These local Comprehensive Assistance Networks mobilize all available vocational, educational, health and supportive services. Each organization works with the local vocational rehabilitation district to assure needed training, worksite accommodations and adaptive aids. The organization recruits employers to match abilities of the individual with the employers' requirements. The goal is to break down the barriers between isolated health, long term care, vocational, educational, and cash assistance programs so that all services can be aligned in support of vocational goals. Greater coordination as well as new flexibility in funding among all support programs will reduce fragmentation. Current Status: With assistance from the Robert Wood Johnson Foundation, local pilot tests have confirmed the value of team-based comprehensive approaches for both persons with physical disabilities and people with mental illness. Research associated with these efforts indicates a strong potential for benefits to the individual and for public financial savings. With assistance from the Social Security Administration, a request for proposals was issued in December 1998 to expand this concept. Over 70 public and private agencies have indicated their intent to submit a proposal to establish a local Comprehensive Assistance Network. Selections will be made in March 1999 for the initial 10 expansion sites.B. Remove Employment Barriers: In Pathways to Independence we seek to remove systemic barriers to employment which result from public policy. The plan is to incorporate the following features: Health/LTC Security: Guarantee continued Medicaid and/or Medicare coverage for up to1800 current SSI and SSDI beneficiaries in 15-20 sites who enroll in the work program over a five-year period. If enrollees secure employment paying over $500/ month, they would be assured of continued coverage regardless of earnings (and regardless of assets which result from earnings.) People with physical disabilities, mental illness, developmental disabilities, or HIV-AIDS would be included. Current Status: A Medicaid waiver will be submitted in March 1999 to add security and to simplify eligibility for people already receiving Medicaid, provided they become employed or increase their earnings. A Medicare waiver to extend Medicare beyond the current 39-month period will be submitted if the Social Security Administration's authority to grant waivers is restored by Congress. In addition, the Pathways Medicaid Purchase Plan has been designed to provide access to health care on the part of people without current Medicaid coverage but who meet the SSDI disability test. Governor Thompson's proposed budget for 1999-2001 contains legislation to permit people with significant disabilities to purchase Medicaid coverage if their net family incomes are less than 250% of the federal poverty level and they are employed or enroll in a work program. This would implement an important State option in the Balanced Budget Act passed by Congress in 1997. Gradual Reduction of Cash Assistance: Replace the "all or nothing cliff" in eligibility for SSDI payments in favor of a sliding scale. Coordinate the benefit reductions of other federal and state programs so that a reasonable amount of discretionary net income remains, and "work pays." Current Status: An SSI waiver will be submitted in February 1999. An SSDI waiver will be submitted if Congress restores the authority of the Social Security Administration to grant demonstration waivers. Research: A strong research design will document demonstration results for the three target groups. Analysis of comparison or control groups, together with comprehensive tracking of changes in public costs, will enable us to assess the potential impact of any larger-scale public policy changes. Building on Experience: Essential elements of this demonstration have already been pre-tested in Wisconsin with help from the Robert Wood Johnson Foundation. The Vocational Futures Planning model developed through such RWJ-F assistance has assisted many people with significant physical disabilities to become employed. However, the successes are fragile. The experiences of such people indicate that without removal of key employment barriers described earlier, successes achieved so far will be hard to replicate or sustain. One such successful person is Ken Adell. Ken has quadriplegia. Even though he can move only his head, Mr. Adell operates his computer with consummate skill. With help from adaptive aids, Ken excels in his job maintaining Internet sites and operating a toll-free telephone service. Ken earns about $27,000 per year. Not only has he worked off his SSDI payments, but he also contributes about $12,000 per year toward the cost of his medical care and pays over $2,000 per year in taxes. The problem is that in 14 months Ken's health coverage under Medicare is scheduled to expire. Ken does not have private health insurance. When his Medicare ends Ken will also lose his "disability status" and be ineligible to buy into Medicaid. Because Medicare and Medicaid pay for the health care he needs to live, Ken does not see a possibility for continued work if his Medicare coverage ends. Governor Tommy Thompson has committed his Administration to securing both the funds and federal waivers necessary for Pathways to Independence to be a success. In his 1998 "State of the State" address he urged a speedy solution: "We are wasting too much talent by allowing legitimate fears over health care to keep people with disabilities out of the workforce. Give them their freedom by protecting their health." Appendix WIA/TWWIIA Interviews _____________________________________ ___________________________ Respondant Date State WIA 1. Did the governor adopt the existing state and local JTPA boards rather than appointing new WIA boards? 2. How were the original appointments made to the state and local boards? 3. How have subsequent appointments to the board been completed? 4. How closely do the state's WIA local areas match the JTPA local areas? 5. How many full one stop centers are there in the state? How many satellites? 6. What training is provided to one stop center staff? What disability-specific training? 7. How is VR integrated into the one stop system? 8. How does a person with a disability move through the one-stop system? 9. What role does the ITA play in service access in the state? 10. When the state does not use the ITA, how do consumers access the WIA providers? 11. How much is the ITA worth in the state? How is its use coordinated with VR funding? 12. How is use of the Ticket-to-Work coordinated with use of the ITA? 13. How are youth services coordinated by the local and state boards? 14. What advantages are there for people with disabilities over JTPA TWWIIA 1. Is there a Medicaid (Medi-Cal in CA) buy-in for workers with disabilities? Is it authorized under the Balanced Budget Act of 1997 or TWWIIA? Briefly describe provisions. 2. If you have a state Medicaid buy-in, who knows about it, how many use it and how is it administered? Is it impossible, just hard, or easy to get sound information on it as it applies to an individual profile? Do consumers think the program is an improvement? How do consumers view this new program? 3. State TWWIIA coalitions. States with a buy-in got one because of a state community based coalition formed around that or similar goals. Do you have one? What entities move it forward? How many active participants? Does it have public or private funding? Please explain. 4. What level of expertise in your state coalition works with state agencies or legislators? Is this a learning experience or meetings with established relationships. Has the current status of your answer helped or hindered coalition objectives? 5. State agencies and state coalitions need technical assistance to move TWWIIA provisions forward. Do you have TA from traditional or non traditional sources? What are they? What web based support works best for you or your work in the areas of these questions? 6. What grants, if any, has the state Medicaid agency applied for available under TWWIIA? Please explain if and how these grants are helping, changing, or hindering progress underway? 7. The TWWIIA Infrastructure grant for Medicaid agencies requires making personal assistance services available outside the home to support work effort. What is the PAS status in your state in general and in this regard? 8. Many state are forming Olmstead coalitions with similar policy goals, inclusion, and players, state Medicaid agencies and state government. Does your state have one? Do the two coalition groups work with each other? At what level? Should they? 9. There are Benefits Planning and Outreach grants in TWWIIA for community based organizations or state entities. Who applied and who has them up and running by now? To what extent are they filling a need or is it too early to tell? Elaborate please. 10. Do you have a sense of what consumers know about TWWIIA, separate provisions of TWWIIA or state provisions related to TWWIIA such as the buy-in? How are they getting any state or federal information these days? Are there efforts to improve this situation? How? Who is doing this development work? 11. Medicare is NOW available to SSDI beneficiaries Part A free for 8.5 years after work begins. (TWWIIA provision in effect October, 2000). Do consumers know this or how to get information on this? 12. Website www.ssa/work Have you heard of this website? Comments? 13. TWWIIA has many provisions being implemented at state and federal levels with different schedules. Does the general public think the SSA Ticket to Work program is where everything comes together, where folks will get their health care too? (How can state, regional or local groups help with TWWIIA outreach? Should they?) 14. State VR. What role(s) are they playing now with TWWIIA? Do they have technical assistance available to the community on the VR and/or non VR aspects of TWWIIA? Available to One Stops? Should they? Do they/have worked with TWWIIA related projects with SSA? 15. Is the Ticket program in TWWIIA perceived as a threat or an opportunity with your state VR? Neither? Both? Why. Be specific. 16. Some advocates see positive connections between TWWIIA and the Workforce Investment Act. What is your view on this? What do you think people in the community think about these connections, if anything? The Workforce Investment Act of 1998 and The Ticket To Work And Work Incentives Improvement Act WEBSITE RESOURCES Comprehensive, Person-Centered State Work Incentive Initiatives http://www.uiowa.edu/~lhpdc/work/index.html Employment and Training Administration (DOL) http://www.doleta.gov/ First Gov for Workers http://workers.gov/ First Gov search Engine http://www.firstgov.gov/ HCFA Work Incentive Act Informational Website - What's New? http://www.hcfa.gov/medicaid/twwiia/whatsnew.htm Institute For Community Inclusion http://web1.tch.harvard.edu/ici/programs/wia.html Local WIArea Contacts http://www.naco.org/programs/social/work/getstate.cfm National Association of State Workforce Agencies http://www.icesa.org/ Neighborhood Legal Services, Inc. http://www.nls.org Official Executive Branch Web Sites http://lcweb.loc.gov/global/executive/fed.html Perform. Measures and Accountability http://www.wdsny.org/nyatep/sld001.htm Presidential Task Force On Employment Of Adults With Disabilities http://www.dol.gov/dol/_sec/public/programs/ptfead/main.htm Rehabilitation Research And Training Center (Rrtc) On Workforce Investment And Employment Policy For Persons With Disabilities http://www.comop.org/rrtc/rrtc.htm Social Security Administration "The Work Site" http://www.ssa.gov/work/ SS State Partnership Systems Change Initiative http://spiconnect.org/ Stakeholders http://www.usworkforce.org/resources/intergov.htm State Of Connecticut: Summary And Legislation http://www.dgne.com/terry/pres/index.html State WIA Contacts http://www.usworkforce.org/statecon.htm The California "Workforce Inclusion Act" www.leginfo.ca.gov The Law, Health Policy & Disability www,its.uiowa.edu/law The Workforce Investment Act of 1998 http://www.usworkforce.org/wialaw.txt Ticket To Work: Medicaid Buy-In Options For Working People With Disabilities http://www.ncsl.org/programs/health/forum/tickettowork.htm US Department of Labor (DOL) http://www.dol.gov/ Workforce Information Council http://www.workforceinfocouncil.org/ Work Incentive Act - Federal Grants And Other Resources Disability Online http://www.wdsc.org/disability/ Work Incentives News At World Institute On Disability http://www.wid.org/ Workforce Investment Act (DOL) http://www.usworkforce.org/ WIA Implementation Contact Inf. http://www.usworkforce.org/asp/team.asp WIA Regulations http://www.usworkforce.org/finalregs.htm WIA State Plans http://www.usworkforce.org/asp/planstatus.asp Worksupport.Com http://www.worksupport.com/ 1 Lisa Schur, Contingent Employment Among Workers with Disabilities - Barriers and Opportunities, Rutgers University, March 2000 ______________________________________________________________________________ ______ IL NET: TWWIIA/WIA Page iv ______________________________________________________________________________ ______ IL NET: TWWIIA/WIA Page 34 ______________________________________________________________________________ ______________________________________________ IL NET: TWWIIA/WIA Page 74 ______________________________________________________________________________ ______ IL NET: TWWIIA/WIA Page 129 ______________________________________________________________________________ ______ IL NET: TWWIIA/WIA Page 187