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In This ISSUE:

1) Ticket to Work Annual Report to Congress
2) Washington State DSHS Medical Assistance Agency...

1) Ticket to Work Annual Report to Congress The full report can be found at: http://www.ssa.gov/work/panel/panel_documents/annual_report2004.html
Stephan L. Smart, CEO of SL Start in Washington State has participated on the Ticket to work Advisory Council that prepared the report. Some concerns identified in the report are lists in the following excerpts:

Implementation Issues
The Panel has received regular updates on implementation from SSA and CMS officials and has invited a variety of field professionals, constituents, and other experts to share their knowledge and opinions. During 2003, the Panel also provided Social Security beneficiaries, employment services providers, advocates, and grantees with extensive opportunities for public input. SSA updates, expert briefings, research, and ongoing public comment from beneficiaries, advocates, employment service providers, field experts, and grantees have raised a number of serious implementation and policy issues. The Panel has studied and prioritized these issues and will next discuss them in detail.

EN payment issues: The most significant problem contributing to low EN participation is the payment system. We see this as the most urgent issue requiring attention. According to a recent evaluation of the Ticket Program, EN's face significant difficulties with program implementation because of problems with the EN payment structure (Thornton et al., 2004). The evaluation team interviewed eight of the most successful EN's, determined by numbers of tickets assigned and payments received. All of them said that they were losing money on the Ticket Program. Despite the fact that all of these EN's had thriving, well-thought-out programs and had experienced some success in placing beneficiaries in employment, the situation looked fairly bleak. The evaluators conclude that the problem is so serious that many of these EN's will not be able to continue as providers unless circumstances change dramatically. On the basis of public testimony, the Panel believes that the dire situation faced by these EN's reflects that of most EN's enrolled in the Ticket Program.
In February 2004, the Panel issued a Ticket Program report to Congress and the Commissioner titled The Crisis in EN Participation: A Blueprint for Action, which presented specific analysis and recommendations on important and timely issues. (See appendix D for the Executive Summary of this report.) The following section, based on the report, highlights three fundamental problems that discourage the active participation of many providers.

Financial risk : Three aspects of the payment system appear to impose significant risk on providers. First, it requires EN's themselves to provide the capital to serve beneficiaries, while simultaneously requiring them to wait a relatively long time before they can recoup their costs. Most service models offered by EN's entail more intensive services early on (e.g., during the first year) and less intensive services over time. Second, the current payment system requires providers to wait 60 or more months to recoup full payment, introducing significant risk because, over time, more and more factors outside the provider's control will affect the likelihood of the beneficiary's employment (e.g., changes in health status, living arrangements, and labor market dynamics). The payment system, which involves equal outcome payments over time, does not recognize this increased risk to providers. Third, the risk is not equitably shared between EN's and SSA. EN's receive only 40 percent of the average expected savings to SSA but bear nearly all of the costs associated with generating those savings.

Payment for all work outcomes: During the past 20 years, Congress has adopted several work incentives that enable SSI beneficiaries to retain Social Security and medical benefits while working. For example, the $1 for $2 income benefit offset enables people to receive benefits while earning a monthly net income of almost $1,200. Many SSI beneficiaries must retain some level of benefits to live independently in the community, either because they will never earn enough to be self-supporting or because they use Medicaid funds for personal assistance services or adaptive equipment that they cannot obtain through private insurance. Beneficiaries who use these work incentives may remain on cash benefits longer than they would have without the incentives, or they may never entirely leave the benefit rolls. Because EN's are paid in full only when the beneficiary receives zero cash benefits, they face a higher risk of not receiving payment for the services they provide and, consequently, are less likely to serve SSI beneficiaries at all. The Panel has heard testimony repeatedly to this effect. In addition, the eight EN's interviewed in the Ticket Program evaluation (Thornton et al., 2004) agreed that they deserved some payment for the work they had done to get SSI recipients back to work, even though those recipients were still receiving cash benefits.
The Panel raised this issue in its Year Two and Year Three Annual Interim Reports to the President and Congress. Beneficiaries who reduce their dependence on SSI not only reduce costs for the program, but also return a portion of their earnings in taxes and FICA (Federal Insurance Contributions Act) payments. EN's should have incentives to work with all beneficiaries who have some earnings potential, regardless of whether they can earn enough to completely leave the benefit rolls. One solution is for SSA to develop a payment schedule for EN's that helps beneficiaries find employment and reduces but does not eliminate their SSI payment.

Lower payments for SSI recipients : The lower payment to EN's for serving SSI-only recipients relative to SSDI beneficiaries is problematic for several reasons. First, it is widely accepted that SSI-only recipients, on average, will be more difficult to place in long-term employment than SSDI beneficiaries. The combination of limited work histories, low skill levels, and severe physical and/or cognitive impairments makes SSI-only recipients more difficult to serve. Because of this fact and because EN payments for SSI-only recipients are lower relative to those for SSDI beneficiaries, SSA has created a strong incentive for EN's not to serve SSI recipients. The EN payment system neither recognizes that there are immediate savings to the SSI program when a recipient goes to work even at relatively low levels of wages nor rewards EN's accordingly for partial success. Reforming the EN payment system to provide payments earlier in the process and to ensure adequate funding so EN's are willing to serve a wide range of beneficiaries who want to work has been recommended by the Panel in its past three annual reports. The Panel continues to believe that it is imperative for SSA to move quickly to enhance the payment system to make it more attractive to EN's To delay further will significantly jeopardize the success of the Ticket Program and the credibility of the Commissioner's commitment to support return-to-work efforts.
Additional impacting factors and recommendations to Congress are defined in the full Annual Report

Readers are invited to send information about new resources on secondary education, transition from school, services and supports for adults with disabilities to connectingpoint@projectcore.org . Approved information will then be posted. Additional questions or comments can be sent to
the Project Coordinator at coordinator@projectcore.org .
While The Connecting Point is not a discussion group, additional questions and discussions can be posted at bulletinboard@projectcore.org .
The CORE Project is funded by the Department of Education Rehabilitation
Services Administration.
The CORE Project (In Washington State)
Phone- 1-800-5-PARENT
Phone- 1-509-928-1522
Fax 1-509-928-1522
Web site www.projectcore.org

CORE Project
PMB 175
1324 N. Liberty Lake Rd
Liberty Lake, WA 99019
( A Project of Washington PAVE)

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