Work Incentives Improvement Act of 1999 Offers New Opportunities

DISABILITY ISSUES
Vol. 19 No. 4

Work Incentives Improvement Act of 1999 Offers New Opportunities

by Raymond Glazier, PhD

For years now, 76% of those of us with disabilities who were surveyed have been telling Harris pollsters that we want to work, while the national unemployment rate in our community has approached 75%. Some people in government were puzzled that 9 million of us working‑age adults with disabilities continued to live on inadequate Social Security benefit checks in this booming economy, with few people ever leaving the SSA disability roles to return to work. Disability activists have been trying to tell them, “It’s the health insurance, stupid!” Medicare eligibility for persons with disabilities has been tied to not working, and Medicaid tied to poverty status, which isn’t hard to qualify for when a Social Security check is your only income.

Finally, we’re beginning to be heard. House of Representatives 1180, the Ticket to Work and Work Incentives Improvement Act o 1999 (WIIA) was signed into law by President Clinton on December 17^th. As Ted Kennedy noted in a statement about the bill he co‑sponsored in the Senate, “The estimated cost of this new program would be recouped if only 70,000 people leave the disability benefit roles.” That is well below one percent of all current SSI/SSDI (Supplemental Security Income/Social Security Disability Insurance) recipients.

A White House press release about the signing summarized succinctly the major provisions of the WIIA:

“Most significantly, H.R. 1180:

v Expands states’ ability to provide a Medicaid ”buy‑in” to individuals with disabilities who return to work. (See our comments on the Massachusetts CommonHealth program in the last issue, Massachusetts is Ahead of the Game.)

v Creates a new Medicaid demonstration to assess the effectiveness of providing Medicaid coverage to people whose condition has not yet deteriorated enough to prevent work, but who need health care to prevent or forestall that level of deterioration. This provision will allow states to help those individuals with diseases such as muscular dystrophy, Parkinson’s Disease, diabetes, and HIV.

v Lengthens from 4 years to 8 1/2 years the period for which Social Security disability beneficiaries who return to work can continue to receive reduced‑cost Medicare coverage.

v Provides grants to states to design and administer infrastructures to provide services that support working individuals with disabilities.

v Provides Social Security disability beneficiaries a choice of providers for employment‑related services.

v Authorizes the Social Security Administration to test new and innovative ways to enable individuals with disabilities to return to work and make economic independence a reality.

v Enables individuals with disabilities to reestablish eligibility for Social Security disability benefits on an expedited basis if their attempts to return to work prove to be unsuccessful. These individuals will be able to request reinstatement of benefits without having to file a new disability benefits application — thereby reducing the risk of returning to work.”

However, note that the WIIA does not require states to implement a Medicaid buy‑in like CommonHealth, in which working persons with disabilities can purchase that broad Medicaid coverage by paying monthly premiums on a sliding scale. It simply makes it easier for the states to do that, if they choose. The WIIA provision for state grants to improve support services for working persons with disabilities (worksite personal assistance services? job coaches for persons with chronic mental illness?) also relies on the 50 states for innovative thinking and new programs. Obviously there will be great variation in the states’ approaches, levels of commitment to solutions, and the degrees of success their efforts experience.

The “Ticket to Work” part of the bill encourages private vocational rehabilitation service providers, including everyone from non‑profit organizations like Morgan Memorial/ Goodwill to for‑profit job training firms to become more aggressively entrepreneurial. It offers these service providers a percentage of the disability benefit cost savings for each person with a disability placed in gainful employment as after‑the‑fact payment for the vocational rehabilitation services provided to make that person employable. On the face of it, this just sounds like “the American way in action.” But, in order for providers to provide services in anticipation of substantial future returns, they will want to be totally sure they can “rehabilitate” and place each consumer. This will probably encourage “creaming,” a gaming of the system in which only the least disabled persons with the greatest work potential, the easiest to “rehabilitate” (and the least needy), will receive services under “Ticket to Work.”

This sort of creaming was a trend in the publicly funded vocational rehabilitation (VR) system until the Rehabilitation Act was rewritten to mandate that persons with severe disability be the first priority. Since most state VR systems have more consumers than they can serve with available dollars, many are operating under an “order of selection” process that gives preference to those persons the state defines as having severe disabilities. Those with lesser disabilities will now, at least in theory, have a shot at private services through “Ticket to Work,” as the incentives are reversed for the private sector. If “Ticket to Work” works at all, it is a potential bonanza for the private providers who figure out how to play the game.

In the political tango that resulted in the ultimate passage of the WIIA, many tangentially related (or outrightly unrelated) provisions got written into the bill, in addition to the inclusion of “Ticket to Work.” WIIA extends through 2001 tax incentive measures that:

v Encourage employers to pay for their workers’ continuing education.

v Help disadvantaged people, including welfare recipients, find jobs.

v Encourage businesses to clean up polluted “brownfields.”

v Stimulate low‑ and no‑emission production of power.

v Assist first‑time home buyers in purchasing a home in the District of Columbia.

Thus we in the disability community are not the only beneficiaries of the WIIA’s passage.

However, we will certainly be held accountable for its success in fostering employment of persons with disabilities. If the prospect of losing Medicare and/or Medicaid health coverage has been holding you hostage, spruce up your resume and prepare to hunt for a job. Of course, it will take months to years before the detailed regulations get written to implement fully the WIIA’s health care and other provisions. And we all know that “the devil is in the details.” So, despite the rhetoric, be advised to bide your time and look before you leap.

To inform you better about workplace acceptance and accommodations, Cornell University’s Program on Employment and Disability has recently published two reports based on telephone surveys of employers: The ADA at Work: Implementation of the Employment Provisions of the Americans with Disabilities Act (with the Society for Human Resources Management), which reports on what private employers say they are doing, and its government counterpart, Disability Employment Policies and Practices in U.S. Federal Government Agencies.

You can check out these, and many other ADA/employment titles for both employers and us folks, at their website: http://www.ilr.cornell.edu/ped

Ray Glazier is a founding Trustee of the Information Center, a wheelchair user, and a disability policy researcher at Abt Associates Inc. in Cambridge, Massachusetts.