1. Ticket to Work Program Partnership Plus in Virginia

2. Course Objectives Content: Describe the Ticket to Work program Identify three purposes of the Ticket to Work and Work Incentives Improvement Act Discuss the benefits to beneficiaries who participate in the program Review partnership plus in Virginia Application: Identify resources to aid you in referring clients Implement benefits discussion during the intake process 2

3. Ticket to Work Program Ticket - Signifies eligibility to participate o Age 18 through 64 o Currently receiving SSI and/or SSDI Participation o Access to services/supports to enter employment and work towards financial independence o Voluntary and free o Benefits of beneficiary participation Protection from medical CDRs Expedited Reinstatement of Benefits (EXR) 3

4. Virginia Statistics Eligible Ticket Holders307,910 In-use with VR5,040 Assigned to ENs1,093 ENs in Virginia 25 Percentage of ENs who are VR vendors 76% Percentage of ENs who are Workforce 20% 4

5. 2016 SGA Levels TWP - $810 per month SGA level for 2016: Non ‐ blind ‐‐‐ $1130 per month Blind ‐‐‐ $1820 per month Quarter of coverage level for 2016: $1,260.00

6. Ticket to Work and Work Incentives Improvement Act Signed into law by President Clinton in 1999 Purposes o Encourage states to enable beneficiaries to purchase necessary Medicaid coverage o Provide continuing Medicare coverage while employed o Establish the Ticket to Work and Self-Sufficiency program 6

7. Beneficiary Participation Access to employment-related services and support increased choices Access to more service providers o Approved ENs o State Vocational Rehabilitation (VR) agencies o Partnership Plus Protection from medical Continuing Disability Reviews (CDR) 7

8. Ticket to Work Service Provider Roles Social Security expects approved ENs to: Increase the number of beneficiaries entering workforce Assist beneficiaries in becoming economically self- supporting Provide the community with access to a pool of qualified applicants and workers with disabilities 8

9. Payments to Employment Networks An outcome-based program Payments are: o Based on beneficiary milestones and outcomes o Associated with work and earnings the beneficiary achieves after the ticket is assigned to the EN ENs must choose between two payment systems o Outcome Payment System o Outcome/Milestone Payment System EN can change its elected payment system once a calendar year (not done often) ENs can split payments 9

10. Key Partners in the Ticket Program Social Security Administration (Social Security) Ticket Program Manager (TPM) VR Partnership Plus Employment Networks Work Incentives Planning and Assistance (WIPA) 10

11. Social Security Oversees the Ticket to Work program Publishes and updates governing regulations Final authority on all policy decisions Determines which beneficiaries are Ticket- eligible Approves requests to become Employment Networks www.socialsecurity.gov/work/ 11

12. Ticket Program Manager Oversees the day-to-day operations of the Ticket program Maintains list of approved ENs Provides orientation, training and support for ENs Administers Ticket program processes o Individual Work Plan (IWP) o Ticket assignment/unassignment process o Payment processes 12

13. Provides support to beneficiaries Markets the Ticket program and Social Security work incentives to beneficiaries Administers a call center Conducts online Work Incentive Seminar Events Offers outreach materials that ENs can use Has a social media presence 13 Ticket Program Manager (continued)

14. Work Incentives Planning and Assistance (WIPA) Projects Supports working beneficiaries to make a successful transition to financial self-support WIPA services are free WIPA staff can answer questions about how work and earnings will affect a beneficiary’s federal, state and local benefits Find the WIPA in your area at: www.chooseworkttw.net www.chooseworkttw.net 14

15. VADARS PP ENs VA is considered a best practice state for Partnership Plus and TtW Employment Networks Administrative Employment Networks CILs, Workforce Centers, CSBs, CRPs and ESOs 15

16. Work Incentives Specialist Advocates Work Incentives Specialist Advocate (WISA) with credentials through Cornell University or certification as a Community Work Incentive Coordinator through VCU. Fee for service vendor with DARS 11 services can be authorized on behalf of a DARS client WISA’s provide a safety net to support a client’s choice to go to work 16

17. Virginia Department for Aging and Rehabilitative Services made the decision to train staff as WISAs embedded within Ticket to Work Partnership Plus Employment Networks. Created an anchor service for clients to tap into future services post VR closure as needed through the Ticket to Work Program. These services have been customized to maximize VR outcomes. Interested stakeholders all have access to the same information.

18. Partnership Plus (PPlus): What is it? A functional definition “... the two programs provide a continuum of services— VR agencies provide more intensive, up-front services to help beneficiaries enter or return to work, while employment networks under the Ticket to Work program can provide longer-term supports to help beneficiaries stay at work.” Government Accountability Office (GAO) report on Employment for People with Disabilities (June 2012) 18

19. SVRA – Intensive up-front services leading to employment Beneficiary – Obtains employment; SVRA case is closed following a minimum of 90 days of employment; the Ticket is available for assignment to an EN EN – Develops IWP before or within 90 days after SVRA case closure to provide long-term job retention and career advancement supports PPlus post SVRA: supports planning prior to case closure PPlus SVRA referral at case closure: EN assigns the Ticket Referral 19 Partnership Plus: SVRA to EN Best Practice

20. SVRA and EN PPlus common customers (RSA published data) State Vocational Rehabilitation Agencies (SVRAs) serve 300,000+ SSI and SSDI beneficiaries annually 65,677 exited in employed status in 12-month period ending 9/30/14 (FFY14) 20

21. SVRA employed beneficiaries eligible for PPlus referral at closure in FFY14 65,677 SSI, SSDI and dual eligible SSI/DI beneficiaries were closed employed in FFY14 12,549 closed working > 35 hours a week at SGA 6,161 SSDI beneficiaries 5,180 SSI beneficiaries 1,208 SSI and SSDI dual eligible beneficiaries 21

22. Referring a client Do the services the EN offers match the beneficiary‘s service needs? Does the beneficiary have a previous work history or a history of prior earnings? Is the beneficiary likely to achieve Trial Work (TWL) or SGA level earnings? Is the beneficiary interested in becoming self- supporting? How much education has the beneficiary completed? What skills or areas of expertise does the beneficiary have? 22

23. Other Considerations Limitations Past Employment Issues Strengths and Competencies Fears Housing Childcare Medication Transportation 23

24. The Choice Group Ticket to Work (TTW) Became an Employment Network (EN) in February 2009 One of the original 6 Partnership Plus organizations in Virginia Over 60 job coaches located throughout VA Have served over 150 Ticket holders to date

25. TTW Services Eligibility SSI/SSDI beneficiaries Between the ages of 18 – 64 Stated goal of transitioning off cash benefits ● ● ● ● ● ● Currently receiving cash benefits, OR Not receiving cash benefits due to earnings (but within 3 months of no cash benefits )

26. TTW Services Different Criteria  DARS can serve a beneficiary who wants to earn less than SGA ($1130 in 2016)  Employment Networks (ENs) are prohibited from serving beneficiaries whose goal is to supplement their SSI/SSDI cash benefits.

27. The Choice Group Currently 9 WISAs on staff, located strategically throughout the state One WISA was recently credentialed as a Community Work Incentives “Partner” (CWIC) Manager serves on the Board of the National Employment Network Association (NENA) Cross-trained (WISA and TTW) Dedicated WISA/TTW Program Specialist

28. The Choice Group Ticket to Work Unique opportunity to serve beneficiaries Collaboration with DARS, DBVI, CSBs, CILs, WIPAs o Referrals in both directions Partnership Plus o All Counselors involved o Access to clients for WISA services Administrative EN agreements Suitability – 60 employees are approved Established networks in communities we serve Employer recognition increases advocacy

29. WISA Services Purpose :  To help clients understand the effects of earned countable income on their federal and state benefits, and their eligibility for work incentives.  To help implement work incentives.  To help DARS achieve successful closures.

30. WISA Services Outcomes Everyone on the same page Proactive – not reactive Not IF there will be changes, but WHEN Client can focus on work

31. WISA Interaction with DSS Medicaid Identify applicable eligibility so we can explain effects of earned income SSI, Waiver, QMB, SMLB, QI, etc. Assist with 1619(b) Assist with Medicaid Works 31

32. WISA Services Initial Service (starting place for all WISA services)  WorkWORLD Benefits Analysis  Benefits Planning Query (BPQY) (with the latest enhancements DARS can now obtain BPQYs directly from SSA Baltimore by secure email, and provide them with referrals)

33. WISA Services Work Incentives (authorized as needed after WorkWORLD)  Part 1 Plan to Achieve Self-Support (PASS)  Part 2 Plan to Achieve Self-Support (PASS)  Impairment Related Work Expense (IRWE)  Medicaid While Working (1619b)  Student Earned Income Exclusion (SEIE)  Subsidy or Special Conditions

34. WISA Services Work Incentives continued (authorized as needed after WorkWORLD)  Medicaid Works (Medicaid Buy-In)  Blind Work Expense (BWE)  Overpayment (Assistance with appeal and/or payment plan)  Individual Development Account (IDA) More to come!!

35. 1634 States Affects 34 states – Virginia is not one of them The state asks SSA to make Medicaid eligibility determinations Medicaid is provided to all recipients of federally- administered State Supplementary Payments (SSPs) Medicaid-based Work Incentives are automatic 35

36. 209(b) States The state uses at least one eligibility criterion more restrictive than the SSI program Successful implementation of Medicaid-based Work Incentives requires active and diligent communication between beneficiary, SSA and DSS. 36

37. 209(b) States Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, Virginia 37

38. 1619(b) Medicaid Protection for Working Individuals Allows beneficiary to continue to receive Medicaid, even without receiving a cash benefit, as long as they meet the following criteria: Still have a disability; Need the Medicaid coverage to pay expenses that allow beneficiary to work; Accumulate no more than $2000 in resources; Earn less than $35,118 gross per year. 38

39. 1619(b) continued Maintains an active SSA account – even without cash benefits for more than 12 months Allows a beneficiary to return to SSI cash benefits if financially eligible 39

40. 1619(b) - Medicaid Use Test To be eligible for 1619(b), an individual must depend on Medicaid coverage to continue working. An individual depends on Medicaid coverage if he/she: Used Medicaid coverage within the past 12 months; or Expects to use Medicaid coverage in the next 12 months; or Would be unable to pay unexpected medical bills in the next 12 months without Medicaid coverage. 40

41. Medicaid Works Allows beneficiaries to continue receiving Medicaid after resources exceed $2000 Enrollees can have earnings up to $75,000 and resources up to $35,118 There are no restrictions on how funds are to be spent After approval, income and resources of spouse or family do not affect beneficiary 41

42. Medicaid Works Should be registered while receiving Medicaid under SSI, including under 1619(b). If beneficiary waits to apply until Medicaid has ended, the eligibility criteria will NOT be met. In combination with 1619(b) can provide seamless transition from Social Security program. 42

43. Medicare Savings Plans Qualified Medicare Beneficiary (QMB) QMB income & resource limits in 2016: Individual monthly income limit*: $1,010 Married couple monthly income limit* $1,355 Individual resource limit: $7,280 Married couple resource limit: $10,930 Program helps pay for: Part A premiums Part B premiums Deductibles, coinsurance, and copayments 43

44. Medicare Savings Plans Specified Low-Income Medicare Beneficiary (SLMB) SLMB income & resource limits in 2016: Individual monthly income limit*: $1,208 Married couple monthly income limit*: $1,622 Individual resource limit: $7,280 Married couple resource limit: $10,930 Program helps pay for: Part B premiums only 44

45. Medicare Savings Plans Qualifying Individual (QI) QI income & resource limits in 2016: Individual monthly income limit*: $1,357 Married couple monthly income limit*: $1,823 Individual resource limit: $7,280 Married couple resource limit: $10,930 Program helps pay for: Part B premiums only Renewal Beneficiary must reapply annually 45

46. Medicare Savings Plans Qualified Disabled and Working Individuals(QDWI) The QDWI program helps pay the Part A premium. You may qualify if any of these apply to you: You're a working disabled person under 65 You lost your premium-free Part A when you went back to work You aren't getting medical assistance from your state You meet the income and resource limits required by your state 46

47. Medicare Savings Plans Qualified Disabled and Working Individuals (QDWI) QDWI income & resource limits in 2016: Individual monthly income limit*: $4,045 Married couple monthly income limit: $5,425 Individual resource limit: $4,000 Married couple resource limit: $6,000 Program helps pay for: Part A premiums only 47

48. WISA/TTW Services Example #1: TCG provides services to Joe (DARS client) Joe was recently hired as a Porter at a local hospital. He is a SSI beneficiary. He will earn well over $1600 per month. The DARS Counselor plans to close the case at the end of May.

49. WISA/TTW Services Example #2: DARS has helped Mary obtain employment as an Administrative Assistant at a law firm. TCG was not involved in the placement. Mary is an SSDI beneficiary. She will earn $2400 per month to start and plans to continue with her employment after her Trial Work Period ends. Mary is unsure when and how her cash and health benefits will change.

50. WISA/TTW Services Example #3: Fred is on the waiting list at DARS due to Order of Selection. He started receiving SSDI benefits in 2013 after a back surgery related to his CP, but is now ready to return to work and was released by his doctor in late 2014. He has an MBA and has worked successfully in government positions as an Accountant and Analyst. He needs help identifying opportunities and negotiating accommodations. Section 503 is new to him.

51. Individual Work Plan (IWP) A living document developed in partnership with the beneficiary. Identifies beneficiary’s employment goal(s). Spells out the services and ongoing employment supports the EN will provide to assist the beneficiary in achieving and maintaining that goal. Serves as the administrative tool by which the beneficiary assigns her/his Ticket to an EN/SVR. Learn more by visiting: https://yourtickettowork.com/web/ttw/individual-work- plan https://yourtickettowork.com/web/ttw/individual-work- plan 51

52. Questions 52 David Leon VADARS Ticket to Work Coordinator David.Leon@dars.virginia.gov www.vadars.org Jonathan May WISA/TtW Coordinator Jonathan.May@thechoicegroup.com www.thechoicegroup.com

53. How to Stay Informed and other Resources https://yourtickettowork.com/web/ttw/calendar- of-eventshttps://yourtickettowork.com/web/ttw/calendar- of-events https://www.chooseworkttw.net/webinar/ http://www.realeconomicimpact.org/resources/w ebinarshttp://www.realeconomicimpact.org/resources/w ebinars http://nenaticket.org/ http://www.nabwis.org/ 53