1. How the new Ticket to Work Rules may provide new funding to Employment Programs Iowa Partners December 19, 2006

2. 2 What will be covered? Why you should care. The current Ticket Program and why it failed. The new “proposed” Ticket Program and why it may succeed. How much funding can states expect from the new program. What are the implications for MIG Projects

3. 3 Why should you care? State and federal funding for vocational services are either flat or being cut VR and CRP programs will have to identify other sources of funding to maintain current capacity. No sources of funding for long term supports exist for some groups (TBI, borderline IQ, etc)

4. 4 The Ticket Program may be a new source of revenue to vocational programs

5. 5 The Current Ticket to Work Program Free market design, open to any providers to compete for consumer Tickets Designed to pay vocational providers for helping people get completely off benefits. Payment primarily based on outcome of zero benefits paid. Very little upfront payment for intermediate outcomes

6. 6 The Current Ticket to Work Program Eligible beneficiaries receive a Ticket to Work Must assign that Ticket to an participating vocational provider “Employment Network”. Beneficiary receives time limited protection from disability reviews Vocational provider only gets paid when beneficiary achieves outcome

7. Current Ticket Outcome-Milestone System OutcomePayment SSIPayment SSDI One Month Above SGA ($860) One payment of $173 One payment of $295 3 Months Above SGA ($860) One payment of $347One payment of $590 7 Months Above SGA ($860) One payment of $694One payment of $1,181 12 Months Above SGA ($860) One payment of $867One payment of $1,476 Zero Cash Benefits$173 per month for 34 months $295 per month for 34 months

8. 8 Current VR Cost Reimbursement System Pre-dates Ticket Program but blended into Ticket Program by SSA Only available to State VR programs VR program must have Ticket assignment VR receives reimbursement for costs, if beneficiary works nine months above SGA ($860 per month).

9. 9 Why did the Ticket fail nationally? Not enough upfront funding or funding total for Employment Networks Employment networks carried all the risk to provide services without any guarantee of being paid. Program set up State VR agencies and private providers in (unfair) competition. Even if Employment Networks helped people work, they may use SSA work incentives to keep benefits.

10. 10 Why is SSA changing the Ticket Program Participation by Employment Networks is very low. Very few beneficiaries are participating and most are being served through State VR agencies. Various groups and committees have proposed radical changes to make it work (Adequacy of Incentives Advisory Group, Ticket to Work Advisory Panel)

11. 11 Proposed Ticket to Work Regulations As of November 2006 proposed…but have been reviewed and approved SSA Commissioner, Office of Budget and Management….bottom line it is a done deal barring a catastrophic event. Rules will go into effect no more than 60 days after they are published.

12. 12 Key Changes in Ticket Program VR and EN Relationship SSA will allow Ticket assignment to State VR agencies for upfront services, then allow assignment to EN (CRP, supported employment provider) for long term follow up. VR gets reimbursed for funds spent on beneficiary if the beneficiary works nine months above SGA ($860). EN (supported employment provider) gets all milestone-outcome payments after VR case closure.

13. 13 Key Changes to Ticket Program New Milestone-Outcome Payments SSA will pay much more money for employment outcomes much earlier in process. Phase One: Four payments for earnings at $620 per month Phase Two: Eleven payments for earnings at $860 per month Phase Three: Thirty Six payments if the beneficiary is in zero payment status because of earnings

14. New Ticket Outcome-Milestone System Phase One Earnings Milestones Payment SSIPayment SSDI $310 for two weeks work $1,081 $620 for three months $1,081 $620 for six months $1,081 $620 for nine months $1,081 Total Phase 1 Milestones $4,324

15. 15 New Ticket Outcome-Milestone System Phase Two Phase Two Gross earnings $860 per month SSDI Milestone Payment $324 per month for eleven months SSI Milestone Payment $189 per month for eighteen months Total Phase Two Milestones $3,564

16. 16 New Ticket Outcome-Milestone System Phase Three Earnings above $860 per month and SSI/SSDI benefit at zero SSDI $324 per month for 36 months SSI $189 per month for 60 months

17. 17 Key Things to Note For Phase One and Phase Two milestones beneficiary can still be receiving benefits…no disincentive for encourage use of SSA work incentives If beneficiary goes directly to Phase Two or Phase Three EN receives a lump sum of of all unpaid milestones CRPs and Supported employment agencies will have to become Employment Networks to participate

18. 18 How VR and CRP/Supported Employment Partnership May Work VR funds initial upfront services through SE grants When VR closes case, Ticket is assigned to SE provider SE provider can bill any Milestone- Outcome payments after case closure. In most cases Phase One Milestone three onwards. VR bills for SSA reimbursement if beneficiary works nine months above SGA ($860 per month).

19. 19 Income Projections for VR Only Consumers Projections based on 21 VR consumers in one counselor caseload enrolled in 2003 and 2004 VR Reimbursements listed are actual Milestone-Outcome payments projected based on actual earnings. Estimates are conservative and do not take into account future payments

21. 21 Why the big increase? The lower milestone-outcome threshold VR would have received payment on 10 of 21 cases, instead of 3 under reimbursement. VR would have received more money under milestone outcome, than reimbursement for the three cases ($8,319 vs $22, 886) This data suggests VR should always select milestone-outcome for all cases. This needs to be researched with a larger sample

22. 22 Statewide Projections for Vermont VR and Partner Agencies Vermont VR contracts with 20 plus community providers VR provides upfront funding to providers Providers provide longer term supports funded through Medicaid and General Fund dollars

23. 23 Projected Ticket Income for Vermont Projections based on historical analysis of VR data from 2000 to 2005. Earnings data based on Unemployment Insurance data. Assumes an 80% acceptance rate of billing

24. Actual Payments Estimated Payments Actual and Estimated Ticket and Reimbursement Payments By Year (Estimated at 80% Ticket Acceptance Rate) Actual Payments by State Fiscal Year Estimated Payments by Calendar Year

25. 25 Cautionary Note Projections based on published regulations. Does not take into account potential administrative challenges SSA may still throw us a curve ball or two in how they interpret the published regulations

26. 26 What will have to happen for community providers to take advantage of this new funding? Providers and VR will have to develop new Ticket partnerships If provider agencies become ENS they will have to develop systems to collect and report earnings information to SSA. VR and ENs could partner around wage reporting and administration. To maximize earnings providers will have to support higher earnings for beneficiaries

27. 27 Potential Opportunities Providers could generate supplemental income they can use in anyway. Provides a potential source of funding for long term supports to underserved groups (consumers with TBI, autism, borderline IQ etc).

28. 28 What Can MIGS do? Raise awareness of opportunity with VR agency, community MH, developmental disabilities programs, CRPs etc. Pay for or provide training and TA to VR and CRPs. Pay for infrastructure to help states take advantage of this (i.e. State Ticket Administrators, data/billing systems, facilitate use of State Unemployment Insurance data for Ticket billing etc.)

29. 29 What Can MIGS do? Help coordinate with WIPA’s (BPAOs), SSA, Maximus etc to get information out. Support benefits counseling efforts in conjunction with Ticket utilization. Remember for Phase One and Phase Two payments beneficiaries can still be receiving cash benefits. Advocate State and Federal Medicaid policy that does not “punish” agencies for generating Ticket revenue. Ticket revenue should not be considered “double dipping”

30. 30 For more information… Call James Smith, Vermont Division of Vocational Rehabilitation at (802) 241-4480 or at james.smith@dail. state.vt.us