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Teleconference Transcript

Transcript of NCSET teleconference call held on June 27 , 2002


"Ticket to Work" and Transition: Making the Connection

Presented by:

Thomas P. Golden
Program on Employment and Disability, Cornell University

Robert "Bobby" Silverstein
Center for the Study and Advancement of Disability Policy


MS. LEUCHOVIUS: Well, on behalf of NCSET, I want to welcome you to today's teleconference on "Ticket to Work" and Transition: Making the Connection. This is Deborah Leuchovius, and I work at PACER Center in Minneapolis, Minnesota. I coordinate our national technical assistance activities in the area of transition and vocational rehabilitation. PACER is a partner with the Center and working with the Center to provide information and technical assistance on transition topics to parent centers around the country.

I am excited about today's topic. I invited our speakers here today because we're hearing more and more about the Ticket to Work, and that it has big implications for many of the youth that we work with. At the same time, I think that many very sophisticated parent advocates feel they still don't have a grasp of what it's all about. And so, we're glad to provide you with this opportunity to introduce you to the Ticket to Work and Work Incentive Improvement Act.

I want to introduce our two distinguished speakers. Bobby Silverstein is joining us again. He's the Director of the Center for the Study and Advancement of Disability Policy. Bobby has over 25 years of experience providing policy analysis, research, and technical assistance to policy makers, and was a principal advisor to Senator Tom Harkin on disability issues from 1987 to 1997, playing a crucial role in disability policy legislation, including the Americans With Disabilities Act.

Thomas Golden is a faculty member at Cornell University's program on employment and disability in Ithaca, New York. He directs several initiatives focusing on training and organizational development related to systems change and employment of people with disabilities. He is currently serving as a member of the Social Security Administration's Ticket to Work and Work Incentive Advisory Panel.

Before I turn it over to our two guests, I want to go over a couple of logistical points. First of all, we ask individuals to press their mute button while our speakers are presenting at the beginning of this conference and hold your questions until their presentations are over. We have 40 minutes of presentation, and I'll play the role of a timekeeper and then we'll turn it over to questions from the listening audience. Without any further ado then, I shall turn it over to you, Bobby, who's going to provide us with a description and introduction to Ticket to Work.

MR. SILVERSTEIN: Thank you, Deborah.

Let me start by saying that all of the information that I'm about to share with you is on a policy brief that you can access. I think there's probably a link through the PACER Center, but if you'd like to get it directly, it's http://www.communityinclusion.org. And on the cover page under "New at ICI" is a policy brief describing the final regulations implementing the Ticket to Work and Self-Sufficiency Program, which we will refer to as the Ticket to Work Program.

What I'm going to try to do in 10 minutes or less is to give you an overview of this new Ticket to Work Program and identify some of the key words and phrases that we will be using throughout this audio conference.

First of all, let's start with the Ticket to Work and Work Incentives Improvement Act of 1999 which was signed into law by President Clinton on December 17th, 1999. We sometimes refer to this as TWWIIA. The overall legislation had three basic purposes. The first purpose was to encourage states to adopt what we call a Medicaid Buy-In Program and that would be for working disabled persons who might not (because of resources or income) otherwise qualify for Medicaid to provide them with the opportunity to buy-in to the Medicaid program. And this is important, particularly for those who need things like prescription drug coverage or personal assistance services.

The second purpose was to include an option of maintaining Medicare coverage while still working, and extend the Medicare coverage for those on SSDI.

And the third purpose, basically, was to establish a new return to work ticket program that would allow individuals with disabilities to seek the services they need to obtain and retain employment. And the full title of this is the Ticket to Work and Self-Sufficiency Program. We're going to refer to it throughout the discussion as the Ticket to Work Program.

Before we talk about the major provisions included in the Ticket to Work Program, it's very important to understand the work related programs in existence prior to the enactment of the Ticket program. Basically, there were two programs administered by the Social Security Administration. The first program required prompt referral of folks applying for or on SSI or SSDI prompt referral to state vocational rehabilitation programs. These state voc rehab agencies would get paid by the Social Security Administration if and only if a beneficiary was earning more than what's called SGA (Substantial Gainful Activity), which for this year is at $780 a month if they were earning more than this level for a continuous period of at least nine months. If that happened, the voc rehab agency would be reimbursed for the services. Whatever the reasonable cost was for providing the services, voc rehab would get reimbursed if the individual worked above SGA for nine continuous months.

The second program is called the Alternate Participant Program. Some people also refer to this as the Alternate Provider Program. Under this program, the beneficiary would be first referred to voc rehab; but, if voc rehab declined to serve the individual, then a public or private agency such as a community rehab provider, for example, could serve that person, and they would be reimbursed based on the same cost reimbursement approach that I described for voc rehab agencies.

Major changes that were made in the Ticket to Work Program. For example, the prompt referral provision to voc rehab was repealed and in its place is the Ticket to Work Program. That's a major change that was made in the legislation.

Let's now provide an overview of this new Ticket to Work Program. The major purpose of the program was to expand the universe of service providers and therefore enhance the range of choices available to SSI and SSDI beneficiaries who were interested in finding, entering, and retaining self-supporting employment. A related purpose is to reduce or eliminate dependency on cash benefits. But the major purpose, again, was to expand the universe of service providers. No longer, theoretically, is an individual required to go to state voc rehab first.

So, Congress wanted to expand the universe of providers and expand the choice available to individuals with disabilities receiving benefits. This program is being phased into operation over a several year period. The first phase of states are already beginning to implement the program. It began February 1, 2002. Another phase of states will be coming in the end of the year and then the third set shortly thereafter. If anybody's interested in knowing the status of their state, we can certainly provide that, or again, it's available in this policy brief.

Under this new Ticket to Work Program, there's an entitlement to a ticket and this ticket is issued by the Commissioner to SSDI and SSI beneficiaries for participation in the program. Basically, the ticket entitles a service provider, which we'll call an employment network, to be paid under certain circumstances, which we'll describe shortly.

Now, who's eligible for a ticket? Basically, all SSI and SSDI disability cash beneficiaries age 18 to 64 are eligible. However, there are three very important exceptions to this general rule, two of which are of particular importance to all of you who are participating in this conference call.

First, the ticket is not applicable to beneficiaries who have the kind of impairments that are expected to improve, and for whom the Social Security Administration has not yet conducted at least one what's called a Continuing Disability Review that is a review to determine if you're still disabled and still eligible for benefits.

The second group of beneficiaries who are not eligible for a ticket are those how have not attained the age of 18. In other words, any child with a disability who is under 18 is not eligible for a Ticket.

And the third group is those who were receiving SSI benefits prior to attaining the age of 18 under the child disability standard for children, and who have subsequently become 18 but for whom the Social Security Administration has not yet conducted a re-determination of eligibility under the adult standard. In other words, a child who was receiving SSI under the child standard, turns 18, and at that point, Social Security Administration has to re-determine whether that child is still eligible, but use the adult instead of the child standard. And if such re-determination has not been yet made, that individual is not eligible for a ticket.

Now, participation in this Ticket to Work Program is totally voluntary. The ticket may be used by the individual to obtain vocational rehabilitation services, employment services, or any other kind of services that might help that individual attain self-supporting employment. Now, the individual may assign the ticket to what is called an employment network, which we'll talk about a little more shortly, or may assign it to the state voc rehab agency. Under the rules, the individual can retrieve his or her ticket any time and reassign it to some other entity if that person so chooses.

Now, what are some of the advantages of participating in the ticket program? One of the major ones is that the the individual would not be subject to what is called a Continuing Disability Review, a CDR. These are the kind of reviews that the Social Security Administration conduct to determine whether an individual is or is not still disabled, and therefore eligible for benefits. If the person is "using" a ticket, SSA will suspend medical reviews to determine whether the individual's medical condition has improved. They will suspend those kind of reviews.

Now, what does it mean to be using a ticket? Under the regulations, to be using a ticket means that the individual is making timely progress toward self-sufficiency, and there are special rules for determining what constitutes timely progress. The first two years, it's basically preparation, and the years thereafter they have to show increased work over a 12-month period. Now, this program is managed not by the Social Security Administration, but by an entity called MAXIMUS.

Now again, who are the key entities here? They are employment networks. These are the people who will actually provide the services to facilitate getting a job for beneficiaries. These employment networks could be state agencies like voc rehab or the Mental Retardation/ Developmental Disabled agency or Medicaid agency, or they could be any of the following: a local agency like a one-stop or public school, a community college or a university, a community rehab provider or an employer, and non-traditional providers, such as family or friends, but it does not include the individual. The individual may not be an employment network. But these employment networks must apply to MAXIMUS and fill out what's called a Request for a Proposal and meet certain minimum qualification standards. Employment networks must develop what's called an Individual Work Plan in partnership between the service provider and the beneficiary.

Now, the major question is, how do these entities get paid? They get paid under one of two different systems of payment. One is called the Outcome Payment System, and the other is called the Outcome Milestone Payment System. Under the Outcome Payment System, you get paid if and only if the beneficiary does not receive benefits due to work and earnings. In other words, these entities get paid on a monthly basis, but they get paid if and only if for that month the beneficiary is not entitled to any cash payments. Under the Outcome Milestone Payment System, an employment network receives up to four payments of specified amounts for reaching certain milestones and the remaining payments are made consistent with this Outcome Payment System.

I'm going to stop there in terms of an overview, but the key words again here that we talked about is the program's purpose, which is to expand the universe of providers. There's a ticket which you're eligible for. If you are using a ticket and making progress, there's a suspension of these CDRs, Continue Disability Reviews. We have a program manager who is from? MAXIMUS. We have employment networks who are service providers. We have participation by voc rehab agencies. The employment networks must provide individual work plans, and there are two payment systems. And I'll stop there.

MS. LEUCHOVIUS: Thanks, Bobby. I'd like to turn it over to Tom now, who's going to talk about what this means for families.

MR. GOLDEN: I think from the point of view of a transition aged youth or their family, or even the secondary education community that youth might be engaged in, I think the Ticket to Work Program does represent some unique opportunities, especially in regard to expanding and enhancing transition planning services and supports for youth with disabilities who meet that eligibility criteria that Bobby so articulately talked about earlier. For that small group of transition-aged youth that are eligible for a ticket, there is potential to access services and supports under the Ticket to Work program. As a family member or as a student yourself, or potentially even a secondary educator or supporter of a student with a disability, I want to talk to you about how to go through a systematic process for identifying the impact, if you will, and the potential for participating in this program.

I want to start out by going back to the Individuals with Disabilities Education Act, because there is really a refined niche of students that are going to be impacted by this. While the Ticket to Work and Work Incentives Advisory Panel very clearly in their Preliminary Advice Report to the Social Security Administration, the President and Congress would have liked to have seen tickets go to all transition-aged youth as it's defined under the Individual with Disabilities Education Act. The final regulations that were promulgated excluded those youth that would be 16, 17, and 18 years old, unless they were 18 and had met SSA's adult disability criteria. Under IDEA, they're defining transition services as a coordinated set of activities for students with a disability that are designed with an outcome-oriented process. I think therein lies a key to how the ticket may hold some potentials, because transition is intended to be an outcome-oriented process as well, much like the ticket. Both of these systems are really to promote movement from school to post-school activities that can include post-secondary education, vocational training, integrated employment or supported employment, continuing in adult ed., adult services, independent living, or community participation.

I think it's important to understand some other variables that are impacting whether or not the ticket holds potential for a student or potentially the secondary school that they're involved in. When you look at that transition definition that's under the Individual with Disabilities Education Act and other school reform efforts that are currently taking place, school districts are under increasing pressure to improve the academic achievement of students both with and without disabilities. In the face of these pressures though, additional resources could provide an important financial incentive for those school districts to support their provision of an outcome-oriented process leading toward life after school. The Ticket to Work is really the first completely outcomes-based payment system that schools can participate in for a small niche of students that Bobby had talked about earlier.

So, with that basis and the fact that I do think there is some alignment between the Ticket to Work and the transitions provisions of the Individuals with Disabilities Act, I want to talk about how this potential supplemental funding source for 18 to 21-year-old students could impact them and talk to you a little bit more about some interplay between the Ticket to Work and some of the existing work incentive provisions that Bobby had also mentioned.

In starting out, I think that families and students considering participation in the Ticket to Work Program really need to consider answering several important questions in their attempt to determine how this program can best meet their needs. That really begins with: identifying whether the individual is going to be eligible for the ticket program, both from a procedural as well as from a functional perspective. When I talk about a procedural definition, or a procedural perspective, I'm talking here about whether they meet the eligibility criteria as outlined in the regulation. Have they met the adult disability criteria? If it's a student who's not yet gone through their age 18 re-determination as Bobby had talked about, that's an important element in the transition planning process that needs to be planned for. How we can integrate within each student's individualized education program or their transition plan, specific objectives that really support that student and that family in having the information they need to provide to the Social Security Administration to meet that adult disability criteria so they can gain access to the ticket program?

Another piece under that procedural definition is understanding what most practitioners have come to call "Section 301." This is a provision of the Social Security Act providing ongoing benefits to students who have been determined to have medically recovered during their age 18 re-determination and are participating in an approved vocational rehabilitations program. If engaged in a vocational rehabilitation program, their benefits could continue until the point at which the vocational rehabilitation program is completed. That's another important kind of milestone in the planning process that educators and families and students need to be aware of the importance of potentially connecting to vocational rehabilitation, employment sources and/or other supports early in the hopes that being connected is going to provide them that protection under Section 301 that's going to entitle them to a ticket later on. The SSA has yet to bring this protection into alignment with the Ticket to Work Act.

The second piece that I think is important is at what point the student is in the actual transitioning planning process. You know, there are probably a lot of different parents here who have a lot of kids at different points in their lives. There are three really distinct categories of employment awareness that we're seeing in transition aged youth. One is that student who has a limited or no idea of what it is they're interested in pursuing in relationship to employment. The second is that child who maybe has an idea about what they want to do, but there's really no formal plan that's guiding that employment path, if you will. And then finally is that student who has clearly articulated employment goals, and they actually do have a formal plan or something that's integrated within their individualized education program that is being implemented that has them on their road to employment. Depending on where your student or the student that you're supporting or engaged with is in regard to their employment awareness, their employment development really speaks to the ease at which they're going to move through the Ticket to Work Program, and also gives them some ideas as to what type of employment networks they need to connect with that can best meet their unique employment needs.

The third area that I'm going to talk about is what I would call the four basic pillars to employment. When I talk about those, I'm talking about understanding the student's unique interests, their preferences, abilities, and support needs, and what that tells you about what it is they want to achieve in their life. Second is the impact of their employment choices on their financial well-being and independence. And I think Bobby's going to talk a little bit later about benefits planning assistance and outreach. It's a critical support to help with that second pillar and understanding how work is going to impact their financial well-being later on. Third are individual service provider capacities. Who are the employment networks that are out there, and how are they situated to meet the unique needs that we talked about under the first pillar? And then finally, given all of that and given what we know about the student's individualized education program or their individualized transition plan, what are the elements of an individualized work plan that would clearly outline their preferred employment indicators, their goals, and their objectives, so that we have this student on their path or on their way to a successful adult outcome.

When we talk about supporting a student and considering their interests and preferences, one of the reasons this is so important, is that we need to begin to develop a profile of where is it that the student wants to go? What's their preferred career field of interest? What types of environments do they prefer to work in? What are their valued employment indicators; for example, the pace of work or the pay, the schedule, benefits, their hours, co-worker interactions, et cetera? And then, what's the work culture like potentially that they're interested in working in? Having an idea up front and early on in a child's education program of what these interests and preferences are, really will support an employment network later on in making sure that the student is matched effectively to a job that they're going to have a high level of satisfaction with. One of the things that Bobby didn't have the time to talk about, because we only gave him 10 minutes up front, is the fact that this is a voluntary program and as such, it's also market driven, which means quality assurance is the responsibility of the customer. And so, it's important up front that we really identify these employment indicators, because at any point in the Ticket to Work Program that beneficiary, or that student, if you will, has the right to pull their ticket and deposit it with another employment network if they feel their needs are not being met. So, it's important students be self-determined and know and understand where it is they want to go.

When we talk about their abilities and support needs, we're really talking here about the specific skill sets and abilities that the individual has. What are their support needs that go beyond their disability? What support needs does the person have that are specifically related to their disabilities and the types of services and supports that have proven effective in the past? That's all critical information that schools and families and students can share with employment networks to help them in crafting a quality individualized work plan that will lead to their success later on.

That second pillar I talked about the impact of work chances on a student's financial well-being. This is the most critical. I think that we would be remiss if we were to sit here and gloat about how wonderful the Ticket to Work Program is without making sure that we build in safeguards for students that ensure that we are not going to have them be worse off by participating in a program like this. And as Bobby said early on, he really talked about this as an outcome-based system. For the most part, unless it's a Milestone Payment, a provider's not going to get paid unless that student or beneficiary is not receiving a cash benefit. And what that means is that person's only source of income is going to be their earnings.

So, what's really important is understanding up front the financial impact of work on this child's benefit status. That's a critical step in helping that child and that family make an informed decision about whether or not the child's going to go work, or whether they're going to participate in this program. How will their current future benefits received be impacted by their earnings? How will their employment impact the rest of their family? What safety nets exist for this person in regard to financial well-being? And what levels of income must the person generate to offset the loss of their benefits? That's probably the most important piece of information we can assist a transition-aged youth in understanding and their family in understanding is what is the level of income we're talking about to offset the loss of this person's benefits by participating in the program? Because if we take that important step up front, what we've done is we've painted a picture of the student's preferred employment outlook, but we've also attached to that what we know the student needs to earn if the child's going to be successful.

That third pillar, real quickly, is just about really supporting the employment network selection process. And I've talked to a lot of family members, and this is a real tough one, because in the past, families and students have had real limited access and limited choices about who they get their services and supports from. The real intent of this program was to expand the universe of potential providers that families can access and beneficiaries can access to receive their vocational rehabilitation, their employment services, and/or other supports they need. And so, when we talk about support in the employment network selection process, that's complex. That's an important area that we need to explore, because we need to assist beneficiaries in looking at the options that exist there, providing them with tools and supports to assist them in weighing employment networks that are out there and available to them, and supporting them in understanding the factors that they should be weighing (for example, staff qualifications of the employment network, service delivery characteristics, and outcome data). How effective is this employment network in working with other individuals with the same disability, or students who have had similar kinds of transition services provided? What does their customer satisfaction data say?

Ultimately, who the employment network is, is the consumer or student's choice. They choose and decide which one they're going to use. And so, when we talk about evaluating the employment network options that are out there Bobby gave you the Web site for MAXIMUS. If you don't have access online to them at yourtickettowork.com, you can call them tollfree, at 866-968-7842, to get a list of the employment networks that serve your local geographic area. Keep in mind when you're looking at them, what their staff's qualifications are. What are some other general considerations we need to make in regard to quality assurance? What are some of the service delivery characteristics as well as program outcome measures?

And you know, I think just in closing before I turn it back to Deborah, I think an important thing to remember is that this isn't as simple as just participating in the Ticket to Work Program. What further refines whether or not the Ticket to Work Program is going to be a program that really best meets the needs of your child or the student that you're supporting, is interaction with other programs that they're involved in. For example, many students that I have worked with because of their disability may not be interested in working at certain levels in employment, or don't have the ability to work at a certain level of employment.

For example, for a child receiving SSI as an adult in school is entitled to the Student-Earned Income Exclusion. This work incentive allows a student can set aside $5,340 of their earned income that's not counted against them. And that's an income which when you factor that into the equation of how long it's going to take an employment network to get paid, a student would have to earn on average of about $1,400 a month to offset this Student-Earned Income Exclusion before an employment network's going to get paid. So, there's lots of other unintended consequences between program interactions with other work incentives administered by the Social Security Administration or other federal and state benefits. It's very important to make sure that a family and a student is connected to the supports that they need to understand these program interactions.

I'm going to stop there and turn it back to Deborah and just hope that Bobby is going to take some time to talk about the role of the benefits planning, assistance and outreach project.

MS. LEUCHOVIUS: Thank you, Tom. And I am going to turn it right back to Bobby, so he can give his perspective and offer some additional information on what this means for families.

MR. SILVERSTEIN: OK. Hi. My watch says it's quarter to and we did start a little late. So, I'm going to abbreviate my comments so we have plenty of time for questions.

The major point that I would like to make is some folks may think this Ticket is the best thing since sliced bread and say, "Just do it, this is a great opportunity." Other folks may say that this whole Ticket program is a joke, because providers are afraid that they're never going to get paid, or they're not going to get paid enough to make it worthwhile, and some have said if you have a bankruptcy wish, you'll participate. Those are the extremes in terms of the comments. My urging to all of you, whether you are a young person, a school system, or an employment network, is to really look at this closer.

And Thomas has some materials, I have some materials, MAXIMUS has some materials to really look at this carefully. And then focus try to work with benefits counselors in your state. There are a number of federal programs supporting benefit counselors. There are a select number of experts in your state. If you're a parent-training and information center, it is absolutely critical in my opinion to touch base with these folks and to find out who they are and work with them because this is, as Thomas said, a very complicated issue. And if you participate, you may think that these CDRs are suspended, but they may be only under certain circumstances. Finding an employment network that is willing to accept an individual may be a very difficult task, because they understand that they're looking for the cream of the cream of the cream of those on benefits to serve and they may not be willing to provide expensive ongoing services. But, individual providers may be willing to do so if they partner with an MR/DD or mental health agency or a Medicaid agency or even partner with voc rehab. There may be ways of doing that. And as I briefly mentioned, family members may become employment networks if they meet certain state criteria. The individual cannot be an employment network but a family or friends can be. I'll stop there.

MS. LEUCHOVIUS: Thanks, Bobby. I really appreciate your conscientious eye on the clock. My watch actually says 2:45 and that leaves us with 15 minutes for questions and answers and I'm just going to let someone jump in there and ask the first question.

MS. JOHNSON: This is Jane from PACER Center, and I have a question about how a school could become part of the employer's network and receive payment to provide clear outcomes for students who fall under the category of qualifying for a Ticket to Work? Anybody want to take that one?

MR. GOLDEN: Well, I could take it. We've been working, in fact, with a small rural school district in western New York and they run a program called "Access" which is a program based at a post-secondary education institution, a collaborative of the local school district, what's called the Board of Cooperative Education Services as well as the local independent living center and the post-secondary institution. The program is for 18 to 21 year olds. It provides a good illustration I believe there's around 11 percent of the kids in this program that are potential ticket recipients upon the initial analysis that was done. As the Access Program looked at becoming an employment network, it was really a collaborative approach. It was the local school district, the post-secondary education institution as well as that adult service provider, the independent living center working together.

The way that they initially looked at cutting the pie as an employment network, was to look at the Milestone Outcome Payment System. The Access program is a program that allows a student to participate in post-secondary education while completing their GED as well, but at the same time, also working. The way they're looking at it currently is, in the Milestone Outcome Payment System, the school takes the milestone payments during the initial 18 to 21-year period, and then at age 21, those students are phased over to the adult service provider, taking the primary role and getting the student into full-time employment. Then they pull the Outcome payments once the student has completed their participation in the program and met the employment criteria for getting an Outcome Payment System. Now, they've not, I believe, signed up as an employment network yet, but they've been looking at how this might work and how might it be mutually beneficial to all parties?

That's one example. I don't know if you have another, Bobby?

MS. LARIZZO: As both a private and a non-private employment company, how would you get paid in the initial phase of this when you're still just reviewing the case to see if they would be even an appropriate candidate for the services. How would we be reimbursed? I thought I heard that you don't get paid until they are making a certain level of income.

MR. SILVERSTEIN: There are two payment systems. One is called the Outcome Payment System, where you get absolutely nothing until the individual is no longer receiving any cash benefits whatsoever. The second system is the Outcome Milestone Payment System, where you can get certain payments for certain milestones, and there are four milestones under which you can get paid. The first milestone requires that there be one calendar month where earnings must be more than $780.

So, if for one month earnings are more than $780, you can get milestone one. Milestone two kicks in if you have three calendar months within a 12-month period, where earnings are above $780. Milestone three kicks in if there are seven calendar months within the 12-month period where earning are over $780. And milestone four kicks in if there are 12 calendar months within a 15-month period where earnings are over a $780. And so, the way this translates is to get milestone one, if you have a student who is no longer a student, and is 18 or over who under the adult standard they're eligible for SSI, you get $162 if you achieve milestone one, an additional $324 for milestone two, $648 for milestone three, and $811 if the individual achieves milestone four or a total of a possible $1,945 in milestones. These milestones are then subtracted from the payment that you would otherwise receive under the Outcome Payment System when that person is totally off the rolls.

MS. LEUCHOVIUS: Bobby, this is Deborah. Why would anybody choose not to do the Outcome Milestone Payment and opt for just the Outcome Payment?

MR. SILVERSTEIN: Well, because some people believe and again this is a cash flow issue—that $2,000 before they are totally off the rolls is better than nothing. A number of employment networks would also say that for somebody with a significant disability who needs ongoing services and supports, and given various issues some people have, their disability allows them to work sometime and not other times, other work disincentives, fear of losing healthcare, particularly if a state does not have a Medicaid Buy-In program some of them are saying this just doesn't make sense from a economic point of view.

From my point of view, this would make sense for those who could also get money from the Medicaid agency or MR/DD or mental health agency, who will put the money up front and then say to a community rehab provider, "Hey, we'll give you the money up front under certain conditions, if you meet certain other kinds of milestones that we might identify, and then you can keep this money under the ticket program for ongoing services and supports." So, I think in partnership, employment networks might be interested. I think employers might be very interested. If they were otherwise going to hire an individual, they have nothing to lose.

MR. GOLDEN: I think one area where you may see an employment network select the pure outcome payment system is when they have had extensive experience placing individuals into jobs that totally offset their benefits from the beginning, for example, a SSI recipient over age 18 who's participating in school. If they're placing an individual into a job over $1,500 a month, it's probably going to benefit them more, and they will pull down a larger payment under the Outcome Payment System than they would if they had selected the Milestone Outcome Payment System.

So, I think another factor for employment networks is what is their experience in placing individuals in high yield earning jobs? I think you're going to see in some of those cases, they're going to take the Outcome Payment System versus the Milestone, because you're getting 40 percent of the savings to the Social Security Administration over that five-year period versus 34 percent, which is what you're getting under the Milestone.

MS. MARROW: Yes, we're wondering what's going to happen with the consumers that are more difficult to serve. Who's going to pick up these people in the community in terms of providing the diagnostic services necessary to even make a decision as to whether or not they're employable?

MR. SILVERSTEIN: Well, again, I just think that employment networks that have thought this through are not likely to serve many folks with significant disabilities. And so, that this program in theory is available, but in reality may not be. So, that leaves the MR/DD, mental health agency, and it leaves state voc rehab.

MS. MARROW: So, are you saying that state voc rehab will continue to work with the clientele that we're getting from them?

MR. SILVERSTEIN: Absolutely.

MR. ROSE: Yes, this is Nick Rose from the New York State Developmental Disabilities Planning Council. We are getting inquiries from parents who are interested in becoming employment networks. Assuming they are otherwise qualified or could develop a circle of support or a micro-board, who would be the best contact source for parents to get more information to develop their role as an employment network?

MR. GOLDEN: I think there are a couple of contacts. If they want to go to the big cheese right off, they would just contact MAXIMUS directly. I think MAXIMUS has an intense interest right now in trying to develop the more non-traditional providers. Which is what I would see that family member or micro-board more representative of. The other thing though that they could look to is many states have established statewide work incentive support centers that could provide support to parents to guide them through understanding before they go to MAXIMUS a little more about the Ticket to Work Program, or they could contact their local benefits planning assistance and outreach projects for some more education or information materials on the program, if they want to do a little bit more book learning before they actually make a decision and contact MAXIMUS.

MR. HALONA: Yeah, hi. Bobby, this is Bill Halona. One of the things I'm interested in is that this 18 to 20 to 21-year-old population is a group of people who most people have left prior to 8/19. But also they're the people who stay in schools through age 21, and typically have more severe disabilities. Many of these families have not been eligible for SSI because of their own personal incomes. I understand that at age 18, there is a transfer where it's the individual income rather than the family income that is taken into account for eligibility. Would you think that the schools should play a role in assisting families of children 18 and older to connect with the SSI if they're considered potentially eligible?

MR. SILVERSTEIN: I just think there's a responsibility of public agencies to provide all information to people as to what their rights and responsibilities are. And if they are entitled to SSI, people should be informed that that is an option. School systems should be careful, though, to make sure that the information provided is accurate, and that if they encourage or discourage something, they should know and understand the consequences, so that if there is counseling of not receiving benefits or not applying, people that counseling better be careful and comprehensive so that they the family and the individual knows that there may not only be consequences in terms of cash benefits, but in many states, if you're SSI, you're automatically eligible for Medicaid and that means that the individual if they don't apply for SSI, may not, in fact, be eligible for Medicaid it would depend. So, my answer is, yes, but make sure it's knowledgeable information. And to me, it shouldn't be encouraged or discouraged. The role of the school system is to facilitate the dissemination of information.

MR. GOLDEN: This is Thomas. I would agree, Bobby. I think I might go one step further and say I think the law has built in intentionally the whole notion of transition services from community providers and I do not think it is the role of the school district to facilitate a child's application for SSI. However, I do think the law is very clear, that under the transitions services piece, that a school district could refer a child to an adult provider or community provider to provide them with that support, and that might be a benefits plan and assistance and outreach project. And I would think that that would be a stellar collaboration between a school district and a community provider that can provide quality, topnotch information to the student and their family.

MS. LEUCHOVIUS: Thank you very much. I want to say how much I have learned from the two of you in one hour. It's been more than what I've been able to glean over the last couple of months, probably. So, thank you so much.

I also want to let callers know that there will be a transcript of this call available on the NCSET Web site, which you can get to by going to http://www.ncset.org. And that will get you where you want to go.

Also, I wanted to let you know that there are several resources available on the Web site. They're currently available on the Center's Web site under the announcement of today's teleconference. So, at the end of the information that's provided about today's teleconference, there is a category called "supplemental materials" that identify articles that Bobby and Tom thought might be helpful for you. Also, there is a list of these benefit provider programs in every state. That could be helpful for you, as well.

I want to let you know that the next teleconference sponsored by the National Center will be on Tuesday, July 30th, at 1:00 p.m., an hour earlier than today's conference. The title is "Employer Champions, Success Stories on Engaging Youth with Disabilities in the Workplace." And there will be three speakers, all employers who represent diverse industries and programs, and we'll be talking about how they have integrated youth into their workplace.

End of Teleconference


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