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Promoting Employment for Persons with Disabilities: Are the New Incentives Sufficient?

Promoting Employment for Persons with Disabilities: Are the New Incentives Sufficient?. % of Males Age 25-64 Employed by Disability Status. % of Females Age 25-64 Employed by Disability Status. Key Features of Social Insurance Coverage of Disabilities.

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Promoting Employment for Persons with Disabilities: Are the New Incentives Sufficient?

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  1. Promoting Employment for Persons with Disabilities: Are the New Incentives Sufficient?

  2. % of Males Age 25-64 Employed by Disability Status

  3. % of Females Age 25-64 Employed by Disability Status

  4. Key Features of Social Insurance Coverage of Disabilities • Who should be eligible and what disabilities should be covered? • What should the level of benefits be? • For people receiving benefits, how should their benefits be affected if they earn income? • What provision should be made for vocational rehabilitation/return-to-work services for beneficiaries? • What cash or in-kind subsidies or incentives should be used to encourage beneficiaries to work?

  5. Eligibility Provisions • SSI • Means-tested: > $600 other income/month • > $2000 financial assets • SSDI • > $20,000 in earnings before becoming disabled

  6. Coverage • Disabilities expected to last 12 months or longer that preclude substantial work. • Substantial defined as earning above the Substantial Gainful Activity (SGA) level of $830 per month. • Evidence of disability includes medical documentation and absence of earnings. • Partial disabilities or functional impairments that do not preclude SGA are not covered.

  7. Cash Benefits • SSI - $579 per month (+ supplements of up to $150 per month in some states) • SSDI - Based on pre-disability earnings, ranges from about $200 to $2000 per month, averaging ≈ $800.

  8. In-Kind Benefits • Health Insurance • SSI recipients covered by Medicaid • SSDI recipients covered by Medicare • Other Low-Income Assistance • Food stamps • Housing subsidies

  9. Effects of Earnings on Cash Benefits • SSI - Each $1 of earnings > $85 per month reduces cash benefits by $0.50 • SSDI - Earnings > the SGA triggers a re-review and possible loss of benefits • SSDI - Earnings > $590 in 9 months over a 5-year period results in re-review and possible loss of benefits.

  10. SSI/SSDI Work Incentive Provisions • Plans to Achieve Self-Support (PASS) (SSI) • Deduction of work expenses related to blindness or impairments from earnings(SSI/SSDI) • Continued benefits (Sec. 1619a) or Medicaid coverage (Sec. 1619b) for earnings above SGA (SSI) • Trial Work Period (SSDI) • Extended Medicare Coverage (SSDI) • Extended Period of Eligibility (SSDI)

  11. Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) • Established a new set of administrative and payment arrangements for providing VR services to beneficiaries (the TTW program). • Expanded legislative authority and provided for grants to states to implement Medicaid “buy-in” insurance programs. • Extended Medicare eligibility for beneficiaries who work their way off the SSDI benefit rolls. • Prohibit continuing disability reviews for beneficiaries making timely progress in their rehab programs to self-support.

  12. Activity in Old vs. New Payment Systems

  13. EN Strategies to Make TTW Participation Feasible • 1. Access other funding streams to subsidize services to beneficiaries. • 2. Screening And selection to find low-cost beneficiaries with good prospects for increasing earnings. • 3. Offer minimal services.

  14. Medicaid Buy-In Authorities • 1997 BBA • Increased previous Federal limits on income and assets of eligible Medicaid enrollees • Authorized states to charge a sliding scale of premiums • 1999 TWWIIA • Limited state programs to persons aged 16-64 with disabilities • Completely removed Federal limits on income and assets of Medicaid enrollees

  15. Per Cent Increase in Buy-In Enrollments, 2003 to 2004, by Implementation Year and Authority

  16. Changes in TTW Outcome Payments • Increase the Level of EN Payments Relative to Cash Benefit Reductions • Pay ENs for Partial Outcomes • SSI beneficiaries who reduce their cash benefits but do not leave the rolls • Make Higher EN Payments at Earlier Time Points • Extend the Time Period of Outcome Payments

  17. Direct SSA Payments for EN Services • Early Intervention VR/RTW Services • Transition Programs • High Up-Front Costs (e.g., special equipment) • EN Capacity-Building Grants

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