TN 1 (10-02)

A. Introduction

The Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170) was enacted on Dec. 17, 1999. The purpose of the new law is to:

• Provide health care and employment preparation and placement services to individuals with disabilities that will enable those individuals to reduce their dependence on cash benefit programs.

• 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.

• Provide individuals with disabilities the option of maintaining Medicare coverage while working.

• Establish a “Ticket to Work and Self-Sufficiency Program” (Ticket to Work program) that allows Social Security disability beneficiaries and disabled or blind SSI recipients to seek the employment services, vocational rehabilitation (VR) services, or other support services needed to obtain, regain, or maintain employment and reduce their dependence on cash benefit programs.

The provisions of the law become effective at various times, generally beginning one year after enactment. See a glossary of terms in DI 55001.995.

B. Description of P. L. 106-170 provisions

1. Ticket to Work and Self-Sufficiency Program

Beginning in 2002, eligible Social Security and Supplemental Security Income (SSI) disability and blind beneficiaries will receive a “ticket” they may use to obtain vocational rehabilitation, employment or other support services from an approved Employment Network (EN) or State Vocational Rehabilitation agency (VR agency) of their choice. The Ticket to Work program is voluntary for beneficiaries and ENs. SSA will phase in the Program nationally over a three-year period, with it being fully operational by January 1, 2004.

During the phase in period only eligible individuals identified as living in locations where SSA has phased in the Ticket to Work program will receive tickets (see DI 55002.005C.8.). However, if an individual who has been issued a ticket moves to a “non-ticket” state, he/she may continue to use that ticket with an EN, if available.

a. The first phase of ticket distribution

In early 2002, tickets were distributed to eligible beneficiaries in the following 13 States: Arizona, Colorado, Delaware, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont and Wisconsin.

b. The second phase of ticket distribution

Beginning later in 2002, tickets are being distributed to eligible beneficiaries in the District of Columbia and the following 20 States: Alaska, Arkansas, Connecticut, Georgia, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, South Dakota, Tennessee, and Virginia.

c. The third phase of ticket distribution

In 2003, tickets will be distributed in the following 17 States and territories: Alabama, California, Hawaii, Idaho, Maine, Maryland, Minnesota, Nebraska, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Utah, Washington, West Virginia, Wyoming, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands.

2. Expanded availability of health care services

Beginning on October 1, 2000, the law expanded Medicaid and Medicare coverage to more people with disabilities who work.

a. Medicaid changes

States may provide Medicaid coverage to more people who are still working. Under P. L. 106-170, States also may permit working individuals with income above 250 percent of the federal poverty level to purchase Medicaid coverage. This provision creates an experiment in which medical assistance will be provided to workers with impairments who are not too disabled to work.

In addition, a Medicaid Infrastructure Grant program is available to support the State efforts to increase employment options for people with disabilities. To find out if these provisions are available in your State, call the State Medicaid Office in your area or go to http://www.ssa.gov/work.

You can also access the following web site for more information:
http://cms.hhs.gov/twwiia/

b. Medicare changes

The law also expanded Medicare coverage to people with disabilities who work. It extended part A premium-free coverage for four and-a-half years beyond the prior limit (4 years) for most Social Security disability beneficiaries who work. This is a total of 8 and 1/2 years including the trial work period. Medicare now continues for at least 93 months after the end of the trial work period. (For more information on Medicare continuation, see HI 00801.146, HI 00801.170 and HI 00820.025.)

3. Expedited reinstatement of benefits

Effective January 1, 2001, when an individual's Social Security or SSI disability/blindness benefits have ended because of work activity, the individual can request reinstatement of benefits, including Medicare and Medicaid, if applicable, without filing a new application. The basic criteria for expedited reinstatement are:

• The individual must be unable to work because of his/her medical condition.

• The individual's impairment(s) must be the same or related to the impairment(s) that was the basis for the individual's previous disability benefits.

• The individual must file the request for reinstatement with Social Security within 60 months from the month his/her benefits are terminated, but this time period may be extended for good cause.

In addition, the individual may receive provisional benefits - as well as Medicare or Medicaid - for up to six months while his/her case is being reviewed. If the individual is found not disabled, the benefits generally would not be considered an overpayment. (For more information on expedited reinstatement, see DI 13050.001, DI 28057.000, HI 00801.164, and HI 00801.165.)

4. Deferral of medical continuing disability reviews (CDR)

a. Section [Comment: The provision referenced below is found in section 1148(I) of the Social Security Act, which was added, along with many other things, by section 101(a) of P.L. 106-170.]

Effective January 1, 2001, an individual who is "using a ticket" will not be subject to medical continuing disability reviews (see DI 55025.001). Cash benefits may be subject to termination if earnings are above the substantial gainful activity level.

b. Section 111 of P. L. 106-170

Effective Jan. 1, 2002, Social Security disability beneficiaries who have been receiving benefits for at least 24 months will not be medically reviewed solely because of work activity. However, regularly scheduled medical reviews can still be performed unless the beneficiary is using a ticket and, again, benefits can be terminated if earnings are above the substantial gainful activity (SGA) limits. Remember that Section 111 applies to all States, not just “Ticket” States. (See DI 13010.010).

5. Ticket to Work and Work Incentives Advisory Panel

The law established a Ticket to Work and Work Incentives Advisory Panel within Social Security, composed of 12 members appointed by the President and Congress. The panel advises the Commissioner and reports to Congress on implementation of the Ticket to Work program. At least one-half of the panel members are individuals with disabilities or representatives of individuals with disabilities, with consideration given to current or former Social Security disabled or blind beneficiaries. (See http://ssa.gov/work/panel for more information on the Advisory panel.)

6. Work incentives Outreach Program

The law directs SSA to establish a community-based work incentives planning and assistance program (BPAO) to provide disabled beneficiaries with information to make informed choices about employment. SSA has established a program of cooperative agreements and contracts to provide benefits planning and assistance to all SSA disability beneficiaries, including information about the availability of protection and advocacy services (see DI 55001.005B). These individuals employed by the BPAO organizations are called Benefit Specialists (see DI 55001.005C).

The law also directs SSA to establish a corps of work-incentives specialists within SSA to provide timely and accurate information about SSA's employment support programs to beneficiaries with disabilities who want to work.

7. Protection and Advocacy (P & A)

The law authorizes Social Security to make payments to protection and advocacy systems established in each state to provide information, advice and other services to disability beneficiaries (see DI 55001.005B).

8. Demonstration projects and studies

The law provides Social Security disability insurance program demonstrating authority for five years. In addition, the law requires Social Security to conduct a demonstration project to test reducing Social Security disability insurance benefits by $1 for each $2 that a beneficiary earns over a certain amount. The implementation date for this demonstration will be announced.

C. Description of the Ticket To Work program

1. How will SSA administer the program?

The law requires that SSA contract with one or more organizations in the private or public sector for service as a Program Manager (PM) to help SSA administer the Ticket to Work program and manage Employment Networks (EN). Most questions about the Ticket to Work program should be referred to the PM (see DI 55005.001). SSA has contracted with MAXIMUS to be the PM.

2. What is an employment network?

Under the Ticket to Work program, an EN is any qualified private or public entity that enters into an agreement with SSA to provide rehabilitation, employment or support services to an eligible beneficiary with a disability or blindness. (See DI 55010.001 for more information.). A State Vocational Rehabilitation agency (State VR agency) may participate as an EN (see DI 55060.005C).

3. What is a ticket?

A ticket is a document which SSA may issue to disabled beneficiaries for participation in the Ticket to Work program (see DI 55002.020B and DI 55099.001). The ticket provides evidence of SSA's agreement to pay an Employment Network to which a beneficiary's ticket is assigned, in accordance with the regulations governing payment under the Ticket to Work program.

4. Who is eligible to receive a ticket?

In general, only an individual who is age 18 or older and has not attained age 65 is eligible for a ticket. Also, the individual must be either:

• a title II disability beneficiary (i.e., a disabled worker, a disabled widow(er), a disabled surviving divorced spouse, or a childhood disability beneficiary); or

• a title XVI recipient eligible for SSI benefits based on disability or blindness.

See DI 55002.005C for information on the exceptions to these criteria for ticket eligibility.

5. What does an individual do with a ticket?

Participation in the Ticket to Work Program is voluntary for the beneficiary and the EN. A beneficiary who chooses to participate in the Program may take the ticket to any EN or the State VR agency. An EN has the right to select whom it will serve based on both its assessments of the needs of the individual and its ability to help the beneficiary.

6. What happens when an individual takes a ticket to an EN or the State VR agency?

The EN or VR agency will verify ticket eligibility through the PM (see DI 55005.001A.3.e). The ticket holder and the EN or the State VR agency will discuss employment options, goals and a plan of services to attain these goals. If the beneficiary and the EN or VR agency agree to work together, they both will develop and sign an employment plan (see DI 55020.001).

7. How does an EN get paid?

An EN does not get paid for specific services. We will pay the EN when a beneficiary achieves certain outcomes based on employment (see DI 55060.005A). ENs cannot request or receive compensation from the beneficiary for the EN's services.

8. How does a State VR agency get paid?

On a case-by-case basis, a State VR agency has the option of being paid under the existing State VR agency traditional reimbursement program (see DI 13510.001) or as an EN under its selected EN payment system (see DI 55060.005C).