REMOVING BARRIERS TO WORK:
Action Proposals for the 105th Congress and Beyond
September 24, 1997
National Council on Disability
1331 F Street, NW, Suite 1050
Washington, DC 20004-1107
(202) 272-2004 Voice
(202) 272-2074 TTY
(202) 272-2022 Fax
http://www.ncd.gov
The views contained in this report do not necessarily
represent those of the Administration, as this document has not
been subjected to the A-19 Executive Branch review process.
LETTER OF TRANSMITTAL
September 24, 1997
The President
The White House
Washington, DC 20500
Dear Mr. President:
On behalf of the members of the National Council
on Disability (NCD), I submit this special report, Removing Barriers
to Work: Action Proposals for the 105th Congress and Beyond,
which focuses on the barriers to employment encountered by millions
of individuals and on proposals that would eliminate or reduce those
barriers.
The action proposals in this report represent what
NCD sees as an emerging consensus in the disability community about
the kinds of reforms needed to remove the major barriers preventing
Supplemental Security Income recipients and Social Security Disability
Insurance beneficiaries from becoming more self-sufficient through
employment. These proposals are fully in line with your desire to
"invest in the education and training of our people" and to "tackle
the tough issue of entitlement reform . . . [by making] tough choices
to strengthen and protect Medicare and Social Security over the
long run." The proposals reflect the emerging bipartisan emphasis
on personal responsibility by removing some of the complex and burdensome
federal requirements that prevent many people with disabilities
from taking charge of their own lives and becoming employed.
Social Security programs can be transformed from
a lifelong entitlement into an investment in employment potential
for thousands of individuals. With your help, Mr. President, these
NCD proposals, which are a cost effective investment, will enable
many people to fulfill the dream of the Americans with Disabilities
Act.
We look forward to working with you as we seek to
empower individuals with disabilities to achieve economic self-sufficiency,
independent living, and inclusion and integration into all aspects
of society.
Sincerely,
Marca Bristo
Chairperson
(The same letter of transmittal was sent to the President
Pro Tempore of the U.S. Senate and the Speaker of the U.S. House
of Representatives.)
NCD MEMBERS AND STAFF
Members
Marca Bristo, chairperson
Kate P. Wolters, vice chairperson
Yerker Andersson, Ph.D.
Dave N. Brown
John D. Kemp
Audrey McCrimon
Gina McDonald
Bonnie O'Day, Ph.D.
Lilliam Rangel Pollo
Debra Robinson
Shirley W. Ryan
Michael B. Unhjem
Rae E. Unzicker
Hughey Walker
Ela Yazzie-King
Staff
Ethel D. Briggs, executive director
Speed Davis, executive assistant to the chairperson
Andrew J. Imparato, general counsel and policy director
Mark S. Quigley, public affairs specialist and editor
Billie Jean Keith, program specialist
Jamal Mazrui, program specialist
Brenda Bratton, executive secretary
Stacey S. Brown, staff assistant
Janice Mack, administrative officer
ACKNOWLEDGMENT
The National Council on Disability wishes to express
its appreciation to David J. Ruth, associate director, Employment
Support Institute, School of Business, Virginia Commonwealth University,
Richmond, Virginia, for his assistance in drafting this report.
TABLE OF CONTENTS
Executive Summary
Introduction
Barriers and Action Proposals
Barrier: Many People Would Be Worse
Off Financially If They Worked and Earned to Their Potential Than
If They Did Not Work
Action Proposal 1: Provide Medical
Coverage for Workers With Disabilities
Action Proposal 2: Replace the DI
"Income Cliff" With Gradual Benefit Reductions
Action Proposal 3: Ensure That People
Do Not Lose Eligibility Because They Work
Action Proposal 4: Compensate for
Disability-Related Work Expenses
Action Proposal 5: Remove Marriage
Penalties
Action Proposal 6: Waive No-Fault
Overpayments
Action Proposal 7: Raise Resource
Limits
Action Proposal 8: Increase SSA Accountability
to Stakeholders
Barrier: People With Disabilities
Cannot Choose Their Own Vocational Rehabilitation Program
Action Proposal 9: Provide Immediate
Access to Employment Counseling
Action Proposal 10: Increase Access
to and Choice Among Service Providers by Instituting a "Ticket"
or "Voucher" Program
Action Proposal 11: Provide Access
to Information About Providers
Action Proposal 12: Provide Access
to Investment Funding
Action Proposal 13: Eliminate the
Scholarship Penalty
Barrier: People With Disabilities
Lack Employment Opportunities
Action Proposal 14: Reimburse Employers
for Disability Expenses
Action Proposal 15: Institute a Tax
Credit for Disability/Diversity Training
One Proposal Not Endorsed
In Conclusion
Appendix: Mission of the National Council
on Disability
EXECUTIVE SUMMARY
This report by the National Council on Disability
(NCD), an independent federal agency, focuses on the barriers to
employment encountered by millions of individuals and on proposals
that would eliminate or reduce those barriers.
More than 3.5 million people ages 16 to 64 who have
disabilities receive Supplemental Security Income (SSI) benefits.
Only 2.32 percent of these people are working and earning more than
$500 per month, the earnings threshold for determining whether benefits
will continue. Of the more than 4 million beneficiaries of Social
Security Disability Insurance (DI), only 0.33 percent earn more
than $500 per month after their 12 months of trial work and grace
periods. Research and copious anecdotal evidence both demonstrate
that many more SSI recipients and DI beneficiaries want to work;
and with appropriate support, they are capable of working above
the $500-per-month earning level.
The action proposals in this report represent what
NCD sees as an emerging consensus in the disability community about
the kinds of reforms needed to remove the major barriers preventing
SSI recipients and DI beneficiaries from becoming more self-sufficient
through employment. These proposals are fully in line with President
Clinton's desire to "invest in the education and training of our
people" and to "tackle the tough issue of entitlement reform [by
making] tough choices to strengthen and protect Medicare and Social
Security over the long run." The proposals reflect the emerging
bipartisan emphasis on personal responsibility by removing some
of the complex and burdensome federal requirements that prevent
many people with disabilities from taking charge of their own lives
and becoming employed.
Social Security programs can be transformed from
a lifelong entitlement into an investment in employment potential
for thousands of individuals. These NCD proposals are a cost effective
investment that will enable many people to fulfill the dream of
the Americans with Disabilities Act.
The proposals are the culmination of an intensive
campaign to hear from consumers, advocates, and grassroots disability
leaders, a campaign that began with the 1996 NCD national policy
summit that produced the landmark report, Achieving Independence.
Consumers and advocates expanded upon the employment recommendations
from that report during a 2½-day working conference in 1997. The
40 conference participants--most of whom are or have been SSI recipients
or DI beneficiaries and all of whom are very knowledgeable about
disability employment issues--identified barriers to employment
facing individuals with disabilities and generated a series of proposals
for overcoming those barriers. To find out what the rest of the
disability community thought of the proposals, NCD took oral and
written testimony from hundreds of individuals with disabilities,
their families, and advocates through a series of 13 hearings around
the country.
The disability community identified the following
major barriers and the reforms needed to reduce them.
BARRIER: MANY PEOPLE WOULD BE WORSE OFF FINANCIALLY
IF THEY WORKED AND EARNED TO THEIR POTENTIAL THAN IF THEY DID NOT
WORK
People fear most of all losing the medical benefits
that can literally spell the difference between life and death.
They fear a sudden loss of cash benefits when they earn a mere $500
per month--earnings too low to make up for the lost medical coverage
or to pay for their disability-related work expenses, such as wheelchairs
and personal assistants. According to Maynard Bostrom from Minnesota,
"Now, you either stay under $500 or get a position that pays high
enough to make it worth it," which the Employment Support Institute
at Virginia Commonwealth University estimates to be more than $24,000
per year.
Many other people fear that if they work, the Social
Security Administration (SSA) will declare them no longer disabled
and therefore ineligible for further benefits, even though they
have had no medical improvement. This fear is especially acute for
those with conditions that are recurrent or relapsing, such as multiple
sclerosis or long-term mental illness. They are afraid to take the
risk if the probability of relapse or recurrence is high.
Finally, consumers fear the complexity and the apparent
capriciousness of the rules that deny or allow them to keep some
of their benefits while working. According to the National Academy
of Social Insurance, SSA overpays approximately 75 percent of the
beneficiaries who earn between $600 and $1,000 per month. Because
of staff shortages and lack of training or incentives, SSA itself
seems unable to explain and administer these complex rules adequately.
All these fears are exacerbated for people who have
or who want to have spouses and children. Consumers denounced the
complexity and unfairness of counting a family member's income when
determining benefits under SSI.
The action proposals to the 105th Congress to address
these fears are summarized below.
PROPOSALS TO MAKE WORK PAY
Provide Medical Coverage for Workers
With Disabilities
Congress should require States to provide Medicaid
coverage like that currently available to SSI recipients to all
DI beneficiaries who earn more than $500 per month. All DI beneficiaries
and SSI recipients who earn more than threshold amounts set by the
States would have to pay a fee (on a sliding scale) to keep their
Medicaid coverage.
Replace the DI "Income Cliff" With Gradual Benefit
Reductions
Congress should establish similar rules for SSI and
DI that would give full benefits to those earning less than $500
per month and would reduce cash benefits by $50 for each $100 of
earnings above that level. This would eliminate the "income cliff"
faced by many DI beneficiaries who would see their disposable income
plummet if they earned $500 or more per month.
Ensure That People Do Not Lose Eligibility Because
They Work
Individuals whose SSI or DI cash benefits have stopped
because of their earnings--but who have not medically recovered
from their disabilities--should remain eligible for future benefits
in the event that their earning ability declines. People with permanent
disabilities should not have to repeat the arduous eligibility determination
process every time their disabilities prevent them from working.
Congress should ensure that continuing disability
reviews (CDRs) are carried out on schedule (every 3 or 7 years,
depending on the disability) and are not triggered by an individual's
engaging in work activity. Currently, individuals who work receive
what they say are "intimidating and threatening" letters telling
them that a CDR is being scheduled to see whether they have "recovered"
from their disability. Instead, workers should get letters congratulating
them for becoming employed and informing them about the work incentives
they may find useful.
Compensate for Disability-Related Work Expenses
Congress should establish a tax credit that would
reimburse individuals earning less than $50,000 per year for 75
percent of their disability-related work expenses. Individuals should
get this refund even if they do not owe income taxes, either in
a lump-sum check from the Internal Revenue Service or as an addition
to each paycheck.
Remove Marriage Penalties
Congress should ensure that Social Security benefits
are based on individual earnings and income. SSA should not penalize
beneficiaries for being married or for being disabled adult children
of disabled, retired, or deceased beneficiaries.
Waive No-Fault Overpayments
Congress should instruct SSA to collect SSI or DI
overpayments only in cases of consumer fraud, failure to report
changes in income, or intentional misrepresentation of income. Overpayment
waivers should be granted routinely and quickly when SSA has made
overpayments and the SSI recipient or DI beneficiary is not at fault.
Raise Resource Limits
Congress should raise the resource limits for SSI
eligibility from $2,000 to $5,000 and exempt Super IRAs, qualified
plans, and medical savings accounts from this resource limitation.
These plans allow tax-favored savings for education, medical emergencies,
or retirement and should not affect SSI eligibility.
BARRIER: PEOPLE WITH DISABILITIES CANNOT CHOOSE THEIR
OWN VOCATIONAL REHABILITATION PROGRAM
Consumers feel that they have insufficient access
to and choice of the services and supports they need to prepare
for, gain, and maintain employment or self-employment. Most SSI
and DI applicants are never offered rehabilitation services. Those
who receive the offer have only one choice in rehabilitation providers
(the State vocational rehabilitation agency) and must wait for long
periods to receive services.
Some individuals' disabilities will always prevent
them from earning more than $500 per month. There are many more
individuals, however, who could earn a significant amount and be
much more (if not completely) financially self-sufficient. They
could do so if the financial disincentives identified above were
reduced and if they had access to and information to make choices
about training programs, employment counseling, adaptive equipment
and transportation, and, in some cases, resources needed to start
their own businesses.
PROPOSALS TO INCREASE ACCESS AND CHOICE
Institute a "Ticket" or "Voucher" Program
Congress should create a "ticket" or "voucher" program
that enables SSI recipients and DI beneficiaries to select and buy
services leading to employment. Individuals should be allowed to
choose from a wide array of service providers, including educational
institutions, training facilities, job-coaching services, and assistive
technology.
The tickets should be financed from the savings to
taxpayers that result from individuals going to work and thus leaving
the Social Security rolls. The tickets should provide sufficient
reward to service providers to be an incentive for them to participate
in the program.
Provide Access to Investment Funding
The Plan for Achieving Self-Support (PASS)--or a
PASS-like program--which allows consumers to invest in training,
equipment, or other assets needed for employment, should be retained,
simplified, and made available to both SSI recipients and DI beneficiaries.
Eliminate the Scholarship Penalty
Congress should direct SSA to exclude all scholarship
and fellowship income in determining both initial eligibility for
SSI and cash benefit amounts for SSI and DI.
BARRIER: PEOPLE WITH DISABILITIES LACK EMPLOYMENT OPPORTUNITIES
People with disabilities face a daunting challenge
when they try to find employment. They must not only overcome the
limitations imposed by their disabilities, but also compete with
recent high school and college graduates, the victims of industry
downsizing and relocations, and all the welfare recipients who now
must go to work.
Furthermore, many employers are reluctant to hire
a person with a disability. Employers fear increased health insurance
costs; the need to provide reasonable but possibly expensive accommodations;
and the perceived need to deal with adverse reactions by customers,
coworkers, and supervisors who might be uncomfortable around people
with disabilities.
Employers' first fear, that they could face increased
health insurance costs, would be alleviated by NCD's proposal for
a Medicaid buy-in with wrap-around coverage. The other fears and
the competitive realities are addressed by the next proposals.
PROPOSALS TO INCREASE EMPLOYER INCENTIVES
Reimburse Employers for Disability Expenses
Congress should institute a tax credit to reimburse
employers for the expenses involved in providing employees with
sign language interpreters, print materials in alternative formats,
on-the-job personal assistance, extraordinary training, job coaches,
and other accommodations that are not funded by other sources.
Institute a Tax Credit for Disability/Diversity
Training
Congress should enact tax credits for employers that
conduct disability/diversity training for all personnel within the
organization. The credit should be available only for 1 year after
its establishment. This brief availability period would encourage
employers to move quickly toward supporting disability awareness
and a new focus on employing individuals with disabilities. The
training should be conducted by professional trainers with disabilities.
IN CONCLUSION
Over the past 15 months, NCD heard countless individuals
with disabilities say that they want very much to work and that
they would do so but for the barriers encountered when they tried.
Those barriers and the action proposals designed to reduce those
barriers are detailed in the report that follows. The findings and
proposals are supported with testimony, explanations, and analyses
using WorkWORLD software.(1)
NCD calls on Congress to take a hard look at what
people with disabilities believe would allow them to work, earn
to their potential, and contribute more fully to their communities
and to society at large.
INTRODUCTION
This report by the National Council on Disability
(NCD), an independent federal agency, addresses the employment of
people with disabilities and their experiences in trying to prepare
for, gain, and maintain employment or self-employment. The report
discusses the barriers encountered by a particular segment of the
disability community: those who are receiving or who are eligible
to receive benefits through the Disability Insurance (DI) and Supplemental
Security Income (SSI) programs of the Social Security Administration
(SSA). The report then presents NCD's proposals for eliminating
or reducing those barriers, based on the input from the disability
community.
More than 3.5 million people ages 16 to 64 who have
disabilities receive SSI benefits. Only 2.32 percent of these people
are working and earning more than $500 per month,(2)
the earnings threshold for determining whether benefits will continue.
Of the more than 4 million beneficiaries of DI, only 0.33 percent
earn more than $500 per month once their 12 months of trial work
and grace periods have expired.(3)
Both research and copious anecdotal evidence demonstrate that many
more SSI recipients and DI beneficiaries want to work; and with
appropriate support, they are capable of working above the $500-per-month
earning level.(4)
The action proposals in this report represent what
NCD sees as an emerging consensus in the disability community about
the kinds of reforms needed to remove the major barriers preventing
SSI recipients and DI beneficiaries from becoming more self-sufficient
through employment. These proposals are fully in line with President
Clinton's desire to "invest in the education and training of our
people" and to "tackle the tough issue of entitlement reform [by
making] tough choices to strengthen and protect Medicare and Social
Security over the long run." (5)
The proposals reflect the emerging bipartisan emphasis on personal
responsibility by removing some of the complex and burdensome federal
requirements that prevent many people with disabilities from taking
charge of their own lives and becoming employed.
Social Security programs can be transformed from
a lifelong entitlement into an investment in employment potential
for thousands of individuals. These NCD proposals will enable many
people to fulfill the dream of the Americans With Disabilities Act
(ADA), while helping to balance the budget by saving taxpayers billions
of dollars.
The NCD proposals are the culmination of an intensive
campaign to hear from consumers, advocates, and grassroots disability
leaders, a campaign that began with the 1996 NCD national policy
summit that produced the landmark report, Achieving Independence.(6)
Consumers and advocates expanded upon the employment recommendations
from that report during a 2½-day working conference held in Houston
in February 1997. The consumers and advocates who met in Houston--most
of whom are or have been SSI recipients or DI beneficiaries and
all of whom are very knowledgeable about disability employment issues--identified
barriers to employment facing individuals with disabilities and
generated a series of proposals for overcoming those barriers. (The
participants in the Houston conference were aided in crafting many
of the proposals by WorkWORLD, decision support software developed
and facilitated by staff from Virginia Commonwealth University's
Employment Support Institute (ESI). Included in this report are
WorkWORLD analyses that demonstrate the impact of many of the proposals
on individuals who go to work.)
NCD then disseminated those proposals widely, including
posting them on the World Wide Web, and held a series of 13 hearings
around the country to find out what the rest of the disability community
thought of the proposals. NCD took oral and written testimony from
hundreds of individuals with disabilities, their families, and numerous
advocacy and service provider organizations. In publicizing and
conducting theses hearings, NCD made a special effort to ensure
that underrepresented communities--such as Hispanics, African Americans,
and Native Americans--had a chance to review and comment on the
proposals. For example, one hearing was held in Spanish. NCD also
ensured that a wide range of disabilities were represented.
The testimony included statements from policy experts,
leaders of local and national disability organizations, and many
grassroots individuals who had their own stories to tell. The overall
intent of these hearings and proposals was perhaps best summed up
by a 14-year-old with Down syndrome who said,
When I grow up, I want to be a firefighter. If
there is a house on fire, I will help to squirt out the fire.
I want to live in my own apartment. I will need a job to pay for
the apartment. I will need a job to pay for food and clothes.
Rules about working should be easy. Rules should help me get a
job. (Tiffany Zimenoff, Boulder, Colorado)
Rules should not be barriers to employment. Rules
should help Tiffany and others get jobs. The current rules governing
DI and SSI benefits often do not help. The following section of
this report describes the major barriers to employment identified
by people with disabilities and their advocates--explaining why
so few people with disabilities go to work and lessen their dependence
on DI and SSI benefits--and offers proposals for change.
BARRIERS AND ACTION PROPOSALS
Barrier: Many People Would Be Worse Off Financially
If They Worked and Earned to Their Potential Than If They Did Not
Work
People fear, most of all, losing the medical benefits
that can literally spell the difference between life and death.
They fear a sudden loss of cash benefits when they earn a mere $500
per month--earnings too low to make up for the lost medical coverage
or to pay for their disability-related work expenses, such as wheelchairs
and personal assistants. Many people also fear being denied medical
benefits in the private sector because of preexisting conditions.
According to Maynard Bostrom from Minnesota, "Now, you either stay
under $500 or get a position that pays high enough to make it worth
it," which the Employment Support Institute at Virginia Commonwealth
University estimates to be more than $24,000 per year.
An individual with a chronic respiratory condition
said,
Giving up SSI, SSDI, food stamps, and
perhaps rent subsidy is a risk worth taking. Giving up health
coverage is actually life-threatening. (D.C. Brown, Seaford,
Delaware)
Many people also fear losing their cash benefits
at earning levels too low to make up for the benefit loss. A supported
employee of a Vermont Wendy's who lost her job because she could
not work enough hours commented,
It is always said that there are incentives
for us to go to work, but in reality there can be consequences
to work, such as loss of some benefits or risk of losing them
if your employer even asks you to stay an extra hour. I feel their
incentives are not really fair! I feel if there was less threat
of losing benefits, etc., that you would see a lot more people
willing to return to work with the help of Supported Employment.
I would love to find a job and not be afraid of losing my benefits.
(Lisa Fairbrother, Newport, Vermont)
Lisa could not work as many hours as her employer
wanted because doing so would have caused her to lose her DI and
Medicare benefits. She obviously wants very much to work, but the
current structure of the DI program is the biggest barrier to her
employment.
A man from Cloquet, Minnesota, who had sustained
a back injury was helped by his vocational rehabilitation (VR) agency
to return to college and become a licensed facility administrator.
He said that he then could not find a job making enough money to
compensate for losing his DI benefits. He has been offered and encouraged
to accept assistant-level jobs at $12,000 per year, but he cannot
afford to do so because he would lose his DI benefits and be much
worse off financially. The higher-paying jobs, unfortunately, always
demand the experience he cannot afford to get.
Many individuals also fear that their disability-related
work expenses will so deplete their earnings that they will not
be able to afford to work. The current impairment-related work expense
(IRWE) provisions will reimburse SSI recipients who earn between
$65 and $1,053 per month for up to 50 percent of the costs of their
disability-related expenses.(7)
Most individuals think that the variable IRWE reimbursement rate
is both too low and too confusing. Although they would prefer that
100 percent of their disability-related work expenses be reimbursed,
most of those who testified regarding the work-expense tax credit
agreed that a straightforward 75 percent reimbursement would be
far better than the current variable system.
Many others fear that if they work, SSA will declare
them no longer disabled and therefore ineligible to restart their
benefits without going through a new, lengthy, tedious application
process if their earning ability should decline. This fear is especially
acute for those with conditions that are recurrent or relapsing,
such as multiple sclerosis or long-term mental illness. They are
afraid to take the risk if the probability of relapse or recurrence
is high.
For DI beneficiaries, this fear is realized if they
earn more than $500 per month for even 1 month after they have completed
their extended period of eligibility.
For SSI recipients, the first fear of losing eligibility
arises from the fact that their earnings now trigger a continuing
disability review (CDR). They say that many of their friends have
been found through CDRs to have "recovered" from their disabilities,
even though those friends are still using wheelchairs, respirators,
and personal assistants to survive. The second fear of SSI recipients
is that their earnings may exceed the thresholds for Medicaid eligibility,
which vary from State to State and can even be set individually.
In Arizona, for example, the 1996 threshold for household income
was only $12,300 per year.
The president of the Vermont Psychiatric Survivors
said,
Work activity should not trigger a CDR. Many
consumers are frightened beyond words about a CDR and often will
cease all work activity and pull away from their rehabilitation
plan. (Phil Wolf, Newport, Vermont)
Many of these fears are exacerbated for people who
have or who want to have spouses and children. Consumers denounced
the complexity and unfairness of counting a family member's income
when determining benefits under SSI.
One couple, for example, spoke about the "marriage
penalty" that caused one of them to lose Medicaid:
Many members of the disability community
who want to marry believe that the threat of loss of Medicaid
benefits, without the existence of universal health coverage,
is a choice between love and death, life and loneliness. (Barbara
Waxman Fiduccia and Daniel Fiduccia, Cupertino, California)
When Barbara and Daniel married, they were both receiving
SSI and Medicaid. When he got a job, he retained his Medicaid through
the SSI 1619b provisions; but she lost hers because deemed income
made her ineligible for SSI and Medicaid. The action proposal below
concerning the elimination of the marriage penalty addresses this
problem.
Finally, a majority of the consumers who testified
said they fear the complexity and the apparent capriciousness of
the rules that deny them or allow them to keep some of their benefits
while working. They said that SSA seems unable, because of lack
of staff or training or incentives, to adequately administer these
complex rules. One hearing participant, for example, cited the National
Academy of Social Insurance finding that 75 percent of all recipients
earning between $600 and $1,000 a month were charged with overpayments
in the 12 months prior to September 1994.(8)
The director of services for the Northwest AIDS Foundations
wrote that
The complicated payment structure of the
Social Security Administration (SSA) must be changed. Many of
our clients who return to work receive overpayments from the SSA
and must either return the money or attempt to have the overpayments
waived. This is a costly system that discourages many individuals
from considering returning to work. (Brian Giddens, Seattle,
Washington)
An obviously distraught individual wrote,
The real tragedy is that these stupid
and too often serious errors, this gross negligence on the part
of SSA, has cost me (at times) a decent place to live and needed
medical and dental care--I may lose my back teeth as a direct
result of this plus the current bungling of Medicare. . . . Now,
after 20 years of permanent disability and all I've been through,
SSA is trying to prove that I've "medically improved." I've been
harassed, harangued, badgered, and adversely affected by what
I, and a good attorney, would perceive as "intentional infliction
of emotional distress"; my medicals will demonstrate posttraumatic
stress syndrome, for sure! I wouldn't wish what I've been through
with SSA on my worst enemy. Too many of these bureaucrats have
set themselves up as demigods! (Sten Nilsson, New York)
A benefits advocate said,
The use of all work incentive programs
must become less bureaucratic and bogged down in voluminous regulations.
People are afraid to use these programs because they are so hard
to use and understand. People are also scared to death of getting
hit with a huge overpayment because of the Social Security practice
of continuing to pay benefits after they are scheduled to discontinue
and other slow bookkeeping practices. By the time people get overpayment
notices, these overpayments have become unmanageable. (Unidentified,
Topeka, Kansas)
The following action proposals to the 105th Congress
and beyond address these fears and barriers.
Action Proposal 1: Provide Medical
Coverage for Workers With Disabilities
Congress should require States to provide Medicaid
coverage (under 1619b) to all SSI recipients and DI beneficiaries
who, as individuals, have earnings below their State or individual
thresholds. Medicaid should cover long-term services such as personal
assistance, assistive technology, housing modification, and medical
supplies. For DI beneficiaries covered by Medicare and those who
can access health insurance through their employers, Medicaid
should provide wrap-around coverage for those services and costs
not covered by Medicare or the employer's insurance.
Congress should establish a Medicare buy-in program
that would allow DI beneficiaries whose individual earnings exceed
$15,000 per year to purchase Medicare coverage on a sliding scale
tied to earnings.
Congress should require States to establish a Medicaid
buy-in program (called 1619c) for all SSI recipients and DI beneficiaries
whose earnings exceed the State or individual threshold. The buy-in
should be based on a sliding scale tied to an individual's earnings.
The buy-in should be less costly for those who receive wrap-around
coverage and need only to supplement Medicare or their employers'
insurance.
Loss of Medicaid or lack of access to adequate health
insurance is the number one concern of people with disabilities
who want to work. Consumers and advocates across the country said
that they would work if they had access to Medicaid that covered
not only their immediate needs but also such long-term services
as personal assistance, assistive technology, housing modification,
and medical supplies. Covered services should specifically include
assistive services and technology needed by people with visual impairments.
(See the testimony from Kansas under Action Proposal 2 for more
on this point.) Medicaid wrap-around policies should be available
for those who have Medicare or who can access insurance through
their employers. These wrap-around policies would cover those costs
normally covered under Medicaid but not under Medicare or the employer's
insurance. If people with disabilities cannot get this coverage,
more than one person said, then they actually fear for their lives.
Action Proposal 2: Replace the DI
"Income Cliff" With Gradual Benefit Reductions
Congress should establish similar rules for SSI
and DI that would give full benefits to those earning less than
$500 per month and would reduce cash benefits by $50 for each
$100 of earnings above that level--with adjustments in benefit
levels made quarterly instead of monthly. This provision would
replace the current trial work period provision.
Individuals eligible for the $1,000 blind SGA (substantial
gainful activity) amount could choose to remain under current
rules or switch to the $500 earned-income exclusion and $50/$100
reduction. For those receiving additional DI amounts for dependent
children, the $50/$100 reduction would apply to the total amount
of DI received, including the dependent allowance.
The $500-per-month earnings level should be adjusted
annually to reflect changes in the Consumer Price Index (CPI).
Although many believe that this $500-per-month earnings
level bears no real relation to significant earnings capacity, most
accept it as an arbitrary starting point for a rationally determined
reduction in support to individuals with disabilities who are able
to earn significant incomes. A few hearing participants railed against
the $500 level; but from their testimony it was apparent that they
were thinking of it as an all-or-nothing trigger (as is currently
the case with DI after the trial work period) rather than as an
earned-income exclusion in determining a gradual benefit reduction.
Figure 1 shows the results of a WorkWORLD analysis(9)
of the effects of current policies compared with the effects of
the first two action proposals on the net income(10)
of an individual receiving the average DI benefit of $704 per month.(11)
The graph plots gross earnings, from $0 to $33,000
a year in $3,000 increments, versus net income. At each $3,000 increment,
a dark bar shows the DI beneficiary's net income under current policies;
and a lighter bar shows the individual's net income under the action
proposals.
[Figure 1 not available.]
Figure 1 - This graph shows the effect of the net
income of a person who receives $704 a month in Disability Income
benefits if he or she goes to work under current policies and
under the NCD action proposals for Medicaid/Medicare coverage
and gradual benefit reductions.
The dark bars show that at $0 and at $3,000 per year,
the current policies and the proposed policies yield the same net
income (a little less than $10,000 net income per year at $3,000
per year of earnings). At $6,000 per year of earnings, however,
an individual under current policies who has used up the trial work
period would face a net income drop of $5,700 to $3,800 a year.
Under the NCD proposals, the individual's income would rise to $12,200
per year.
Both the dark and the light bars show that at earnings
between $6,000 and $15,000 per year, an individual would see net
income rise under both the current policies and the proposed policies.
At earnings of $15,000 per year, however, the individual laboring
under current policies would realize $4,500 per year less in net
income than the individual working under the proposed policies.
The black bars also show that between $15,000 and
$18,000 in earnings, there is another income cliff or drop in net
income under current policies. This smaller cliff is caused by the
current Medicare buy-in provision that allows an individual to purchase
Medicare at $332 per month. The proposed buy-in, on the other hand,
keeps the net income curve moving upward because the cost of purchasing
Medicare coverage would be on a sliding scale instead of the current
all-or-nothing basis.
Caveats Concerning Individuals Who Are Blind
Some individuals with visual impairments strongly
suggested at the hearings that earnings reductions should begin
at a DI beneficiary's current SGA amount. SGA for blind DI beneficiaries
is $1,000 per month versus $500 per month for those with other disabilities.
An individual from Kansas gave the following rationale for the SGA
difference:
The idea that all disabled people who
receive SSDI should have the same substantial gainful activity
level assumes that the benefits and covered costs of being disabled,
or costs of attempting to live independently as a disabled person,
are the same or enjoy the same third party coverage, across the
board and across all disability groups. This simply is not true.
. . . Readers for blind people allowing them
to handle their business independently; sighted guide services,
if needed to travel in unfamiliar areas; shopping assistance;
environmental descriptive services; etc., however, are not covered
for persons who are blind under Title XIX or any other source.
(Michael Byington, Topeka, Kansas)
NCD believes that full funding of assistive services
and technologies should be provided under Action Proposal 1 for
Medicaid and Medicare coverage, including services and equipment
that would help people with visual impairments. NCD also believes
that these services can be covered under the tax proposals described
under Action Proposal 4.
NCD fully supports a "hold harmless" provision that
would allow people with visual impairments to choose whether to
receive their benefits under the current DI rules or the proposed
gradual reduction of benefits. The following analysis of these options
with WorkWORLD software, depicted in Figure 2, demonstrates that
the current rules would be preferable for individuals with visual
impairments in only a very narrow range of circumstances.
Figure 2 shows what an individual's net income would
be when the individual is unemployed and when he or she has increasing
earnings levels under current rules compared with what it would
be under the action proposals in this report. The analysis is for
a DI beneficiary receiving the average DI benefit of $704 per month
who qualifies for the blind SGA amount of $1,000 per month.
Figure 2 shows that blind DI beneficiaries who earn
between $6,000 and $12,000 a year would be somewhat better off under
the current rules. Those earning $8,600, for example, would have
a net income of $14,070 under current rules and $12,870 under the
proposed changes; and if they have no prospect of earning $12,000
per year, they would be better off under the current rules. If,
however, they have a chance to earn $12,000 or more, they would
be much better off with the proposed rules. Blind DI beneficiaries
earning $12,000, for example, would have net incomes of $8,202 under
current rules, but they would have $13,605 under this action proposal.
[Figure 2 not available.]
Figure 2 - This graph shows that, among blind persons,
only those who earn between $6,000 and $12,000 a year are better
off with current policies. (This analysis assumes that the person
has no work expenses.)
SSA Administrative Cost Savings
Another aspect of Action Proposal 2 (Replace the
DI "Income Cliff" With Gradual Benefit Reductions) that deserves
more than passing comment is the fact that it would radically decrease
both SSA's administrative expenses and the incidence of over- and
underpayments. First, this proposal would reduce the administrative
burden by having both the DI and SSI programs ignore earnings of
less than $500 per month, eliminating the need to make earnings
adjustments for more than 45 percent of SSI recipients. Second,
it would require adjustments only for large changes in income, because
the adjustments would be made only for changes in earnings of $100
per month or more. Third, making changes quarterly instead of monthly
would require check adjustments only 4 times a year instead of 12.
Currently, very small changes in earnings (changes that can occur,
for example, because there are five paychecks in a month instead
of four or because an employer asks a worker to work a few hours
of overtime in a given month) require SSA to alter the SSI benefit
amount. The relatively larger increments required for benefit changes
under the proposal would mean that SSA would not have to make monthly
adjustments for those workers who are in relatively stable situations
but who happen to be paid weekly or to have small overtime opportunities.
Dependent Benefits
Before holding these hearings, NCD had not realized
how important the benefits received by dependents of DI beneficiaries
are in the employment equation. However, many individuals indicated
that a critical element in their employment decision was the fact
that if they went to work they would lose not only their own benefits,
but also the benefits for their dependent children. The recommendation
to gradually reduce workers' benefits commensurate with earnings
was good, they said; but if their children's benefits were lost,
then they would be in desperate straits.
A number of people recommended that dependent benefits
not be affected by employment. These benefits, they said, should
depend only on eligibility; and eligibility should not be affected
by work activity. Many others, however, felt that although dependent
benefits were important, they should decrease with increased earnings
just as primary benefits would under this action proposal. Therefore,
NCD proposes that dependent benefits be lumped in with primary benefits
when determining the $50/$100 decrease in benefits due to earnings.
Index the Earned-Income Exclusion
Finally, NCD recommends that the earned-income exclusion
amount, $500 per month, be indexed to the CPI. This would acknowledge
that people with disabilities are working within the same economic
system, with the same inflationary realities, that all Americans
have to deal with. It also would gradually bring the $500 threshold
closer to the current $1,000 SGA for blind individuals and increasingly
narrow the number of individuals who would be forced to choose between
current and proposed rules.
Action Proposal 3: Ensure That People
Do Not Lose Eligibility Because They Work
Individuals whose SSI or DI cash benefits have
stopped because of their earnings--but who have not medically
recovered from their disability--should remain eligible for future
benefits in the event that their earning ability declines.
Congress should ensure that CDRs are carried out
on schedule (every 3 or 7 years, depending on the disability)
and are not triggered by work activity.
Enacting this proposal would drastically reduce one
of the major fears discouraging those who could earn significant
amounts of money (and thus pay significant taxes) from doing so.
Making continued eligibility contingent only on medical recovery,
not earnings, would reduce individuals' concerns that they might
not be able to work in the future. Under the current system, if
they lose their job after losing eligibility for SSI or DI benefits
because they had been earning, they would be without earnings and
benefits while again going through the grueling application process.
This fear is especially strong among those who have episodic disabilities,
such as mental illness, and degenerative disabilities, such as multiple
sclerosis and arthritis.
The New York Times recently published the
story of a Manhattan physician who had lost his DI eligibility because
he "worked 3 months too long."(12)
Dr. Luis Kaplan had lost one leg to cancer in 1990. Although qualified
for DI and Medicare benefits, he was able to resume his practice
after rehabilitation by getting around on crutches. Unfortunately,
after 4 years and 3 months of working, Dr. Kaplan found that arthritis
in his arms prevented him from continuing. His DI benefits of $1,235
per month were restarted and continued for the next 2 years, until
SSA realized that Dr. Kaplan had worked 3 months past his extended
period of eligibility. SSA informed Dr. Kaplan that he no longer
had Medicare, that he would no longer receive his monthly DI check,
and that he owed SSA $24,813.90 in benefits he had mistakenly received.
Dr. Kaplan told the reporter that he could not believe that a man
with arthritis and an amputated leg would lose his eligibility because
he tried too long to keep working.
Enacting the second part of this action proposal
would mean that SSA would carry out CDRs in accordance with the
schedule appropriate for the disability type (every 3 years for
disabilities where medical improvement is possible and every 7 years
when medical improvement is not expected). SSA should not schedule
additional CDRs simply because an individual goes to work. Removing
the earnings trigger for CDRs would mean that SSA could, as one
hearing participant suggested, send new workers a letter of congratulations
rather than a warning that they could lose their benefits.
Action Proposal 4: Compensate for
Disability-Related Work Expenses
Congress should establish a disability work expense
(DWE) tax credit that would reimburse 75 percent of an individual's
disability-related work expenses. The reimbursement could not
exceed the individual's gross earnings and would be capped at
expenses of $15,000 per year. The credit would begin phasing out
at earnings of $50,000 per year and be completely phased out at
$75,000.
This tax credit would be refundable, meaning that
those who owe no taxes could still receive it as a refund. The
credit could be received either in installments in each paycheck--if
an individual files the appropriate tax form with the employer--or
in quarterly or yearly refunds from the Internal Revenue Service
(IRS).
The current tax deduction for impairment-related
work expenses should be retained to cover expenses not reimbursed
by the above credit. Both the credit and the deduction should
cover expenses related to preparing for and traveling to and from
work, as well as expenses incurred at work.
The DWE tax credit would replace the current impairment-related
work expense (IRWE) work incentive with a straightforward 75 percent
reimbursement for disability-related work expenses. The current
IRWE not only is complex, but also has different effects in the
two Social Security disability programs. In both programs, the work
expense amount is subtracted from gross earnings before determining
the effect of earnings on benefits. In the DI program, the effect
is to keep the whole DI check coming if gross earnings minus work
expenses are less than $500 per month. In the SSI program, the effect
varies with the circumstances. Both the rate of reimbursement and
the total amount of reimbursement depend on the amounts of earned
and unearned income a person has, as well as the work expense amount.
Under the current IRWE rules, for example, an SSI
recipient earning $65 per month with $100 in IRWEs gets no reimbursement.
A recipient earning $300 per month would get $50 as an IRWE reimbursement.
That same person, however, would get only $11 in IRWE reimbursement
if he or she happened to be a dual SSI-DI beneficiary getting $425
per month of DI. In fact, that $11 would be the whole SSI check.
(These calculations were made with WorkWORLD software. The typical
SSI recipient could hardly be expected to be able to predict such
effects without the benefit of the software.)
In contrast, the DWE tax refund would be very predictable.
It would be 75 percent of the disability-related work expense or
the earnings amount, whichever is lower. In the above example, then,
the person earning $65 per month with $100 in work expenses (about
the cost of monthly paratransit services in many places) would get
a DWE tax refund of $65 per month. The person earning $300 per month
would get a tax refund of $75 per month, whether he or she was an
SSI recipient only or a dual SSI-DI beneficiary.
Workers could choose how they receive the work expense
reimbursement. They could file a form with their employer estimating
the cost of the work expense, and the employer would subtract the
refund from the taxes to be deducted and add the rest of the reimbursement,
if any, to the paycheck. Alternatively, they could receive their
refund directly from IRS, either in a lump sum at the end of the
year or in quarterly payments if they file quarterly estimated taxes.
(NCD believes that workers who do not want to self-disclose to employers
must be allowed the option of filing and receiving quarterly refunds,
and this alternative must be explicitly provided in the tax credit
legislation.)
Although not everyone who testified concerning the
DWE tax credit proposal agreed that bringing IRS into the picture
was a good idea, NCD agrees with those who pointed out that dealing
with IRS is "normalizing," since all working people must do so.
(Even low-income earners must file with IRS if they want to receive
the earned income tax credit, another refundable tax credit.) Dealing
with IRS also is less demeaning most of the time, since it is the
worker who would estimate and claim the work expense, not a claims
representative. Individuals would have more control of the process
because they could file an estimate of their expenses ahead of time
and then file an amendment if the expenses changed significantly.
Finally, low-cost, expert tax advice is readily available, while
expert advice on SSI and DI claims can be much harder to find.
Perhaps the most important reason NCD is proposing
a DWE tax credit in lieu of the IRWE incentive is that in many circumstances,
the tax credit removes a financial barrier to employment that is
inflicted by IRWE. A WorkWORLD analysis, for example, shows the
effects of an IRWE versus a DWE tax credit for a dual SSI-DI beneficiary
who has high work expenses. Figure 3 shows what happens to an SSI
recipient who receives $450 in DI each month and who has $400 per
month in disability-related work expenses.(13)
The graph compares the effects of (1) current policies, including
using IRWE to cover the $400 in work expenses; (2) the NCD proposals,
but retaining IRWE; and (3) the NCD proposals with the DWE tax credit
proposal.
Figure 3 shows that at earnings of $3,000 per year,
the worker would see a drop in net income of about $1,800 under
both the current policy and the NCD-IRWE option. With the DWE tax
credit, however, the NCD proposals result in an increase in net
income of $1,000.
Both under current policies and under an NCD-IRWE
alternative, individuals earning $6,000 per year would have only
about $1,000 more in net income than when unemployed. With the NCD-DWE
proposal, however, net income would go up about $4,500. At each
higher increment of earnings, individuals do better with the DWE
tax credit proposal than if NCD retained IRWE as the method of compensating
for work expenses.
[Figure 3 not available.]
Figure 3 - This graph compares net income under
current policies and impairment-related work expense and disability
work expense tax credits. (The person is a Social Security Income
recipient who also receives $450 per month in Disability Income
and has disability-related work expenses of $400 a month when
employed.)
Action Proposal 5: Remove Marriage
Penalties
Congress should ensure that Social Security benefits
are based on individual earnings and income. SSA should not penalize
beneficiaries for being married or for being disabled adult children
of disabled, retired, or deceased beneficiaries.
Some of the most troubling and bizarre stories told
during the hearings involved what beneficiaries and recipients call
"the marriage penalty." (See examples of their testimony in the
introduction to this section.) People who can barely survive on
their current benefits find that if they marry, and often if they
gain employment after they marry, they risk their very survival.
The simple remedy that many suggested--which NCD agrees with--is
that SSA treat individuals as individuals and discontinue the complicated
provisions that treat the income of spouses as income of beneficiaries
and cut off disabled adult children who marry.
Action Proposal 6: Waive No-Fault
Overpayments
Congress should instruct SSA to collect SSI or
DI overpayments only when an individual fails to report a change
in income, intentionally misrepresents income or earnings information,
or otherwise engages in fraud. Overpayment waivers should be granted
quickly and routinely when SSA has made overpayments and the SSI
recipient or DI beneficiary is not at fault.
A large number of individuals who testified at NCD
hearings told their "overpayment" stories. These stories are no
doubt widely circulated among the disability community, and they
serve to discourage even the most ambitious from going to work and
taking the overpayment risk. Many of the stories were of overpayments
that resulted from SSA mistakes. Enacting this proposal would put
the responsibility for those mistakes where it belongs.
NCD also believes that a number of the other action
proposals will result in a drastic reduction in overpayments and
overpayment mistakes. Raising the earned-income exclusion for SSI
recipients from $65 to $500, for example, would eliminate the need
to change the benefit levels for nearly half of those SSI recipients
who are currently working.
Raising the earnings increment that results in benefit
reductions from $1 to $100 should also reduce the overpayment problem,
because the monthly changes due to weekly pay periods and small
overtime amounts should be eliminated. Making changes in income
reportable quarterly instead of monthly should also result in a
large reduction in the number of overpayment mistakes that are made.
Probably most important of the other action proposals
that affect overpayments is the elimination of the complicated and
difficult-to-administer trial work period (TWP) for DI beneficiaries,
along with its all-or-nothing provisions and its 5-year rolling
time period. (TWP would be eliminated if Action Proposal 2 were
enacted. That is the proposal to replace the DI income cliff with
an immediate $50/$100 reduction of cash benefits.) Many of those
who testified had learned that they owed SSA thousands of dollars
because their TWP had been incorrectly calculated, and the error
was discovered long after the fact.
Finally, ensuring that individuals who have not medically
recovered retain their eligibility, thus eliminating DI's extended
period of eligibility, would eliminate cases such as that of Dr.
Luis Kaplan, the physician who owed almost $25,000 because SSA did
not realize for 2 years that he had worked 3 months past his deadline.
This action proposal deals with the residual overpayments
that are still made. Individuals should not have to reimburse overpayments
unless the individuals are at fault. Individuals would still be
responsible for reporting any income changes in a timely fashion,
and they would have to pay back overpayments that result from their
own failures to keep SSA correctly informed of their earnings and
income.
Action Proposal 7: Raise Resource
Limits
Congress should raise the resource limits for SSI
eligibility from $2,000 to $5,000 and exempt Super IRAs, qualified
plans, and medical savings accounts from this resource limitation.
These plans allow tax-favored savings for education, medical emergencies,
or retirement and should not affect SSI eligibility.
Even the proposed limit of $5,000 was thought too
low by many who testified. They said that such limits keep them
in poverty because the limits prevent them from saving in order
to move, to start a business, or to have money for emergencies.
NCD agrees that even the $5,000 resource limits prevent individuals
from saving for business ventures and many emergencies, but the
Plan for Achieving Self-Support (PASS) proposal (below) should adequately
deal with the need for business startup funds. Action Proposal 1
would provide that resource limits not be imposed for Medicaid and
Medicare coverage and buy-ins, the number one concern of those who
testified.
Action Proposal 8: Increase SSA Accountability
to Stakeholders
Congress should establish an oversight group composed
of stakeholders outside of SSA, including employers, service providers,
and at least 51 percent consumers (beneficiaries, recipients, and
a limited number of family members). This group would be federally
funded, independent of SSA, and authorized by Congress to recommend
employment-related regulations and to monitor their implementation.
This proposal addresses the concerns of all those
who testified that they have found SSA to be unresponsive to their
needs. This oversight group would not replace the current appeal
system for individual complaints; rather, it would deal with the
larger issues of regulatory and policy matters. This group, for
example, would deal with the current problems with the PASS program
that were raised so frequently during the hearings.
Barrier: People With Disabilities
Cannot Choose Their Own Vocational Rehabilitation Program
When individuals apply for SSI or DI benefits, they
are required first to prove that their disabilities prevent them
from earning more than $500 per month. They then must wait a long
time for services to help them become employed, and most never receive
an offer for such services. Those who are offered vocational services
have few choices in the services they can access and have little
information upon which to base their choices.
An individual from Alaska submitted as testimony
a May 1997 paper by George Washington University's Allen Jensen
summarizing the efforts of a number of States to institute work
incentive reforms.(14) One of
the two most common reform measures was to provide referrals to
vocational services as early as possible in the disability application
process. (The other most common measure was to ensure medical insurance
coverage.) An individual at the Seattle hearing cited a report by
the General Accounting Office (GAO) saying that an early return
to work was crucial to employment success. Waiting months for a
vocational referral, he said, was ridiculous.
Several participants at the Albuquerque hearing,
especially those from the Navajo and Hopi tribes, spoke about the
limited number of services available in their communities. Service
providers, one said, can come from as far away as 200 miles. The
participants favored the provision of vouchers, believing that consumer
choice and vouchers would ensure that more services would become
available in their communities by encouraging local community members
and agencies to become involved in service provision. The participants
preferred a system of local service providers to reliance on professionals
from larger communities. Essentially the same message about service
availability, and the possibility that vouchers could improve that
availability, came from an inner-city resident of Baltimore. Finally,
a number of consumers at the Minnesota hearings emphasized their
need for choice among service providers. A ticket or voucher system
could give them that choice.
The head of the disability supports unit of a State
Department of Human Services said,
Lack of choice in providers and employment
service is a second barrier to employment. [Fear of losing benefits
and of having overpayments was the first barrier.] Consumers receiving
inadequate service have no recourse for the selection of another
provider unless they are willing and able to purchase the services
themselves. Funding should be opened up for competition to allow
consumers to purchase the supports needed from quality, appropriate
providers.
Some Houston conference participants and a few hearing
participants said that there are some individuals whose disabilities
will always prevent them from earning more than $500 per month.
They warned that any reforms should not jeopardize the supports
needed by such individuals. Other participants, while not disputing
that those who cannot work should be protected from harm, commented
that there are many more individuals with disabilities who could
earn a significant amount and be much more (if not completely) financially
self-sufficient. They could do so if the fears identified above
were reduced and if they had access to and information to make choices
about training programs, employment counseling, adaptive equipment
and transportation, and, in many cases, resources needed to start
their own businesses. The action proposals for the DWE tax credit
would help individuals pay for employment services, but NCD has
heard from the disability community that other remedies also are
needed.
A few hearing participants extolled SSA's PASS for
allowing the purchase of services and equipment, transportation,
and business investments that enabled them to become more self-sufficient.
Most, however, focused either on difficulties with PASS or on recent
changes in SSA's administration of the program. A few examples of
the testimony follow:
These plans are arcane, difficult to use,
and [it is hard to] find Social Security personnel who know what
to do with them, and [the plans] only work for people saving for
large capital investments. (Nancy Becker Kennedy, Los Angeles
California)
In March of '94, I was approved for a
PASS for school and to start my own at-home business. Several
months ago I got a letter in the mail saying that I owe them $1,800
in back pay. I have asked for an appeal. I don't get that kind
of money to be deducted from my Social Security. I can barely
pay my living quarters. . . . I applied for another PASS to help
me get the equipment to help me start the home business. I was
turned down. I lost my car which I got for part of the PASS to
help me get the business started and to get back and forth to
school. . . . I used to be self-supported. I would like
to be like that again. (Aleph Wright, address unknown)
I work with hundreds of claimants each year.
The PASS rules were changed subversively without review of Congress
and without input from people with disabilities. The new rules
seem to provide disincentives rather than incentives for people
to try to return to work. My experience, since the regulations
have been changed, is that no clients I have worked with have
had a PASS approved. (Richard St. Denis, attorney with the
Center for Disabilities, Boulder, Colorado)
The PASS program as recreated unilaterally by
SSA will work for no one. . . . The SSA changes that [we] find
most outrageous are as follows:
- PASS use only for entry-level jobs (which
means no one with a severe disability can ever get off the dole)
- No using PASS money for payments (long delays
in even starting to work)
- Cannot save for van unless you can drive it
yourself (just plain idiotic and probably a policy violation
of 504 and the ADA)
- Unannounced moratoriums on PASS plans, leaving
many broke and bankrupt as they were in the middle of a plan."
(Julie Reiskin, executive director of the Colorado Cross Disability
Coalition)
PASS is the only useful tool and must
be fixed immediately. Get rid of restriction to entry-level jobs.
In the GAO study, people said they purchased cars, computers,
and small businesses; and SSA took these three things out of PASS
plans. These things work. The excitement of PASS plans was not
engendered by any other system. VR has not been effective in helping
people start small businesses either and will not help with cars
or computers. PASS regulations need to be revised to reflect the
program before the [recent] revisions. (Anonymous)
Following are the action proposals to the 105th Congress
and beyond to address these needs.
Action
Proposal 9: Provide Immediate Access to Employment Counseling
Congress should designate a portion of the savings
to the Social Security Trust Fund to establish grant-funded employment
counseling services nationwide and ensure that all SSI and DI
applicants are immediately referred to such services when they
make initial application to SSA for disability benefits.
Employment counselors would (1) explain to applicants
how to use the work incentives associated with SSI, DI, and other
benefits; (2) inform applicants of the vocational training and other
supports available to them through vocational rehabilitation (VR)
agencies and other organizations; and (3) help applicants navigate
through the bureaucratic maze so that they can make full use of
the work incentives and employment services.
Some participants at the Houston conference and a
few of those who testified during the hearings thought that the
employment counselors should be SSA employees housed at SSA field
offices. However, most of those who addressed this issue stressed
that such counselors should be part of organizations that have expertise
in the employment area and that they should be independent of the
local SSA offices.
Action Proposal 10: Increase Access
to and Choice Among Service Providers by Instituting a "Ticket" or
"Voucher" Program
Congress should create a "ticket" or "voucher"
program that enables most SSI recipients and DI beneficiaries
to select and buy services leading to employment. Individuals
should be allowed to choose from a wide array of service providers,
including educational institutions, training facilities, job-coaching
services, and assistive technology. The tickets should be financed
from the savings to taxpayers that result from individuals going
to work, thus leaving the benefit rolls. The tickets should provide
sufficient reward to service providers to be an incentive for
them to participate in the program. Advance payments should be
made for milestones such as the completion of a training program,
job placement, and a period of time on the job. Services covered
by any voucher proposal should include the purchase of technology
or equipment, tuition for college or vocational school, or other
training and support needed to work. SSI recipients and DI beneficiaries
should control the allocation of those vouchers.
The director of a head injury support group in Mississippi
said that providers need financial incentives to train and find
jobs for people with head injuries. She agreed with the concept
that providers should be paid for successes. The Social Security
coordinator for a State VR agency said that any ticket or voucher
should be available for the State VR agencies as well as private
providers. This action proposal would not limit payments to private
providers.
Although there was much consumer support for the
ticket or voucher idea, that support was neither unequivocal nor
universal. One consumer from Minnesota, for example, expressed dissatisfaction
with VR services and said, "I wish you would give me the money you're
spending on me so that I could decide what I want to do." Another
suggested that "giving money to private providers is just giving
money to people who are not disabled" and should not be a priority.
A California consumer said,
I'm afraid that I must also take issue with
the "voucher" system under which people can choose from a number
of public and private agencies. Although this idea sounds good
on its face, it will result in a two-tiered system, in which the
least disabled, best educated, and most effectively advocated
people will be creamed by the private facilities and the most
disabled and hardest to rehabilitate will be ghettoized with the
state VR Agency. (Roger Petersen, member, Board of Directors,
California Council of the Blind)
Some providers of services also had their doubts.
The director of rehabilitation services for a Minnesota agency,
for example, said she had the following concerns:
a) When an agency is being asked to accept
a difficult-to-place person, it would be even more reluctant to
accept this person when chances are payment wouldn't be forthcoming;
b) While, happily, the beneficiary may choose
to go on to school or seek other training after the initial rehabilitation
training, it would delay payment to the agency providing the initial
training. Most agencies could not afford to wait for payment;
and
c) After successful rehabilitation, the beneficiary
may either refuse to work or cannot work due to a circumstance
not related to the initial rehabilitation. Does the agency providing
the service still get paid? Consumer choice is important and necessary,
but it shouldn't be at the expense of the agency providing the
training."
Despite these caveats and concerns, NCD believes
that the provision of more employment services and more choice among
services, especially when the services can be tied to success and
funded from savings to the system, is very important to consumers
who want and need employment services. Under the current system,
State VR agencies are reimbursed by SSA for "successfully rehabilitating"
only about 6,000 people per year of the millions of individuals
on the SSI and DI rolls; and the majority of those successes are
actually placements into sheltered employment or into unpaid homemaker
positions.(15)
The concern that private service providers might
cream off the "the least disabled, best educated, and most effectively
advocated people" and not take the risk of working with people who
have severe disabilities is offset by other testimony and research
evidence, NCD believes. Service providers have found that motivation
to work, not severity of disability, is the most important factor
in predicting job placement success.(16)
It is much easier to place a highly motivated individual with severe
cerebral palsy than an individual with lower back pain who wants
to retire on disability. Creaming highly motivated individuals is
a good place to start.
NCD recognizes that some service providers may not
choose to take the risks outlined in the testimony by the Minnesota
director of rehabilitation services. NCD believes, though, that
a voucher program offers fewer risks and more worthwhile rewards
for success than alternative programs that have been proposed or
are currently being implemented. SSA, for example, is currently
implementing its Alternate Provider Program, in which private providers
of employment services can be reimbursed for the costs of successfully
helping individuals that the State VR system chooses not to serve.
That program may not sufficiently reward providers, however, because
it pays them only enough to cover the costs of their successes.
The costs of serving those individuals who do not find and maintain
employment must somehow be borne by the provider. The possible rewards,
many providers say, do not compensate for the risks.
NCD recommends that a payment system be devised that
rewards providers sufficiently that they will take risks by serving
individuals with severe disabilities who want to work. Such a payment
system, NCD believes, would overcome the resistance to the ticket
proposal that surfaced in some of the testimony. Even if some agencies
do not avail themselves of this funding to the extent that some
advocates would hope, NCD believes that the chance to increase service
availability and choice is worth the risk.
Action
Proposal 11: Provide Access to Information About Providers
Congress should establish, with enabling legislation
if necessary, a grant program that would fund independent evaluations
of rehabilitation providers around the country. The evaluations
should be based primarily on outcome measures such as number and
type of placements, wages, types of disabilities served, and consumer
response, thereby providing users with consumer-based information
to aid in their decision making. The funding should also provide
for the local dissemination of the information.
One advocate from a California Independent Living
Resource Center agreed that
Consumer choice is a key element . . .
however, informed choice is not a list of providers, but a report
comparing providers on items such as services offered, languages
spoken, percentage of participants completing a program, placement
rates and wage level, etc.
On the other hand, another California consumer-advocate
warned against establishing yet another accreditation program, especially
a program that on the local level might make one of a number of
rival agencies (the one winning the grant) the judge of quality
in that area. Taking this warning into account, NCD recommends that
two types of information be gathered: (1) purely factual outcome
data and (2) aggregated survey responses of SSI recipients and DI
beneficiaries who use vouchers. The information would not duplicate
the kinds of process and documentation data collected through standard
accreditation evaluation techniques such as document reviews and
staff interviews. The disseminated information would truly be consumer
based.
Action Proposal 12: Provide Access
to Investment Funding
The Plan for Achieving Self-Support (PASS)--or
a PASS-like program--which allows consumers to invest in training,
equipment, or other assets needed for employment, should be retained,
simplified, and made available to both SSI recipients and DI beneficiaries.
A redesigned program should restore at least the
original flexibility of PASS, lessen the degree of micromanagement
by SSA, and simplify documentation procedures.
Hearing participants commented that the tax credit
for work-related expenses was not enough. People need up-front investment
money to get assistive technology, training, and equipment to start
small businesses. However, there were few positive suggestions about
how the PASS program should be redesigned to be useful to more than
a small minority of SSI recipients and DI beneficiaries, other than
recommending that the recent changes in the PASS program be rolled
back. NCD recommends, therefore, that the oversight group proposed
in Action Proposal 8 develop guidelines for revamping PASS.
Action Proposal 13: Eliminate the
Scholarship Penalty
Congress should direct SSA to exclude all scholarship
and fellowship income in determining both initial eligibility
for SSI and cash benefit amounts for SSI and DI.
One hearing participant told of having to turn down
a scholarship and forgo an educational opportunity in order to remain
eligible for SSI and Medicaid coverage. A number of advocates also
spoke of the absurdity of penalizing people who have earned opportunities
for educational advancement. Currently, a scholarship covering $500
per month in living expenses would result in a loss of both SSI
and Medicaid because such money is treated as unearned income and
would not therefore qualify an individual for 1619a benefits above
the SGA level. A lesser scholarship would reduce the SSI check dollar
for dollar. SSI recipients should be encouraged, not discouraged,
from seeking scholarships and furthering their education. Doing
away with this penalty seems to be, in the words of one participant,
a "no-brainer."
Barrier: People With Disabilities
Lack Employment Opportunities
People with disabilities face a daunting challenge
when they try to find employment. They must not only overcome the
limitations imposed by their disabilities, but also compete with
recent high school and college graduates, the victims of industry
downsizing and relocations, and all the welfare recipients who now
must go to work.
Furthermore, many employers are reluctant to hire
a person with a disability. Employers fear increased health insurance
costs, the need to provide reasonable but possibly expensive accommodations,
and the perceived need to deal with adverse reactions by customers,
coworkers, and supervisors who might be uncomfortable around people
with disabilities.
Employers' first fear, that they could face increased
health insurance costs, would be alleviated by NCD's proposal for
a Medicaid buy-in with wrap-around coverage. The following testimony
and proposals address the other fears and competitive realities.
Two California consumers said,
Employers need to be encouraged to hire both
mentally and physically disabled people, accommodate them, and
pay them a living wage, with the support and encouragement of
the Government. (Ana Harris)
I believe that without active advocacy
and incentives to encourage employers to hire people like me,
opportunities will be slim. (Bertha E. Johnson)
Another consumer said,
Small employers should get federal funds
to accommodate needs of disabled workers. This should include
small access modifications, assistive technology, special computers,
personal assistants, brailling, interpreters, etc. (Julie
Reiskin, Colorado)
Following are the action proposals to the 105th Congress
to address these needs.
Action Proposal 14: Reimburse Employers
for Disability Expenses
Congress should institute a tax credit to reimburse
employers for the expenses involved in providing employees with
sign language interpreters, print materials in alternative formats,
on-the-job personal assistance, extraordinary training, job coaches,
and other accommodations that are not funded by other sources.
ADA specifies that many of these costs are reasonable
expenses that individual employers should bear. According to hearing
participants, employers do not agree that they should have to pay
for these accommodations. Consequently, potential employers find
ways to avoid hiring people who need such accommodations. NCD believes
that to level the playing field for job applicants with disabilities,
tax credits should be available to employers that bear accommodation
expenses.
Action Proposal 15: Institute a Tax
Credit for Disability/Diversity Training
Congress should enact tax credits for employers
that conduct disability/diversity training for all personnel within
the organization. The credit should be available only for 1 year
after its establishment.
Many of the consumers at the Houston conference advocated
for disability/diversity training for employers and their employees,
conducted by professionals with disabilities. The consumers contended
that such training could open employment doors for many with disabilities.
It could help people get past the awkwardness and embarrassment
they feel when they are around people with disabilities, the consumers
said, by teaching them "disability etiquette" and by allowing them
to find humor in overcoming their initial discomfort. Disability/diversity
training could help people see those with disabilities as just one
more part of an increasingly diverse workforce.
NCD believes that making this tax credit available
for only 1 year would encourage employers to move quickly toward
supporting disability awareness and a new focus on employing individuals
with disabilities.
One Proposal Not Endorsed
The final form of many of the action proposals was
substantially influenced by testimony given during the 13 hearings
held around the country. NCD has decided not to endorse one proposal
that had been included in the recommendations circulated before
the hearings because of various objections raised by hearing participants.
Rejected Action Proposal: Create an Employer FICA Exemption
Currently, employers are obligated to pay 7.65 percent
of each employee's wages as a FICA contribution to Social Security
and Medicare. Congress should create a FICA tax exemption for employers
of employees with disabilities. During the 1st employment year,
the employer could keep 50 percent of that FICA obligation. During
the 2nd and 3rd years, the employer could keep 75 percent and 100
percent, respectively.
The idea behind the increasing exemption over the
first 3 years was to use the tax exemption to encourage employers
to keep employees until their training and experience made it economically
unwise to replace them with new employees. The proposal provided
that the exemption would not be available for employees with hidden
disabilities unless the employee chose to self-disclose the disability.
The original proposal suggested that an employee could use the FICA
exemption as a bargaining chip with a potential employer.
The proposal for a FICA tax exemption proved to be
very controversial at some of the hearings. Some people saw the
FICA tax break as an unconscionable bribe, while others said that
it would be a great tool to counter discrimination. Here is some
of the testimony.
The idea of providing employers with some monetary
benefits for hiring us flies in the face of how Americans see
themselves these days. . . . A tax break, to the best of my understanding,
would represent a bribe to both. . . . A tax break implies that
the disabled person is not up to the job before proof to the contrary.
(Jon Crowder, Berkeley, California)
I do not want my disability to be used
as a tax break for employers to save money; I want to be hired
for me. (Heidi Myhre, Minnesota}
By offering employer incentives, many
people who are afraid to hire a person with a disability will
realize some legitimate returns on their employees. This works
on attitude through the pocketbook. I like it. (Cheryl, personal
assistant services coordinator at the Access Center of San Diego)
We noted with concern the recommendation that
persons with disabilities use their willingness to disclose their
disability (and thus qualify their employer for additional tax
breaks) as a "bargaining chip" in their negotiations with employers.
Our current research suggests that the issue of disclosure--particularly
for people with psychiatric disabilities--is so fraught with tension
and ambivalence that such a recommendation is inappropriate, and
we would strongly urge NCD to remove that item from its document.
(Richard Baron, director of Matrix Institute, Philadelphia)
Several Albuquerque participants expressed concern
over the lack of employment opportunities and economic development
in rural areas and on reservations. Employers, they said, need incentives
to hire people with disabilities for the long term. One person thought
the tax credit for hiring someone with a disability should last
for 5 rather than 3 years. Another participant suggested that tax
credits be given to employers for providing vocational rehabilitation,
job coaches, and other support services.
After reviewing all this testimony, NCD concluded
that the arguments for including an employer incentive such as the
FICA exemption do not outweigh the concerns about "bribery" and
self-disclosure, especially because the benefit to employers would
be quite small except for very high-paying jobs. (The benefit to
an employer of a full-time worker getting $5 per hour would be less
than $400 the 1st year and $800 the 3rd year.) NCD therefore does
not recommend the FICA exemption.
IN CONCLUSION
NCD firmly believes that hundreds of thousands of
the millions of working-age SSI recipients and DI beneficiaries
want to go to work and would do so except for the many barriers
that still exist, despite the enactment of ADA.
Some of the barriers are financial. The action proposals
dealing with health insurance and the SSA work incentives will,
NCD believes, overcome the barriers that currently make it more
advantageous financially to remain unemployed than to get a job.
Some of the barriers involve an employment service
system that offers neither choice to consumers nor sufficient rewards
to service providers. The NCD proposals would give consumers a choice
of service providers that would readily accept the risk of helping
individuals with severe disabilities. It also would give consumers
access to funding for education, assistive technology, and business
investments that could help them gain economic self-sufficiency
and personal dignity.
Finally, some of the barriers concern employment
opportunities. The proposals would allow employers to claim tax
credits for the extra expenses they might incur in hiring someone
with a disability. The proposals also would give employers an incentive
to support training that might make it easier for them and their
employees to integrate individuals with disabilities into their
organizations.
In recent congressional testimony, GAO emphasized
the need to take a holistic approach in dealing with return-to-work
reforms. Citing a number of earlier studies, GAO said that to be
effective, SSA must "develop a comprehensive, integrated, return-to-work
strategy that includes (1) intervening earlier, (2) providing return-to-work
supports and assistance, and (3) structuring benefits to encourage
work."(17) NCD believes that
the proposals incorporated in this report more than meet GAO's requirements.
They not only would provide for intervening early, providing supports,
and restructuring benefits, but they also would deal with employer
reluctance and the need for some consumers to start their own businesses.
NCD issues a challenge to the 105th Congress to tap
into the potential provided by people who have disabilities. America's
citizens with disabilities want very much to contribute to their
country's continued preeminence in the world of nations. They have
the talents and the capabilities to do so; and if the proposals
presented in this report are enacted, they undoubtedly will.
APPENDIX
MISSION OF THE NATIONAL COUNCIL ON DISABILITY
Overview and Purpose
NCD is an independent federal agency led by 15 members
appointed by the President of the United States and confirmed by
the U.S. Senate.
The overall purpose of NCD is to promote policies,
programs, practices, and procedures that guarantee equal opportunity
for all individuals with disabilities, regardless of the nature
or severity of the disability; and to empower individuals with disabilities
to achieve economic self-sufficiency, independent living, and inclusion
and integration into all aspects of society.
Specific Duties
The current statutory mandate of NCD includes the
following:
- Reviewing and evaluating, on a continuing basis,
policies, programs, practices, and procedures concerning individuals
with disabilities conducted or assisted by federal departments
and agencies, including programs established or assisted under
the Rehabilitation Act of 1973, as amended, or under the Developmental
Disabilities Assistance and Bill of Rights Act; as well as all
statutes and regulations pertaining to federal programs that assist
such individuals with disabilities, in order to assess the effectiveness
of such policies, programs, practices, procedures, statutes, and
regulations in meeting the needs of individuals with disabilities.
- Reviewing and evaluating, on a continuing basis,
new and emerging disability policy issues affecting individuals
with disabilities at the federal, state, and local levels, and
in the private sector, including the need for and coordination
of adult services, access to personal assistance services, school
reform efforts and the impact of such efforts on individuals with
disabilities, access to health care, and policies that operate
as disincentives for individuals to seek and retain employment.
- Making recommendations to the President, the Congress,
the Secretary of Education, the Director of the National Institute
on Disability and Rehabilitation Research, and other officials
of federal agencies, respecting ways to better promote equal opportunity,
economic self-sufficiency, independent living, and inclusion and
integration into all aspects of society for Americans with disabilities.
- Providing the Congress, on a continuing basis,
advice, recommendations, legislative proposals, and any additional
information that the Council or the Congress deems appropriate.
- Gathering information about the implementation,
effectiveness, and impact of the Americans with Disabilities Act
of 1990 (42 U.S.C. 12101 et seq.).
- Advising the President, the Congress, the Commissioner
of the Rehabilitation Services Administration, the Assistant Secretary
for Special Education and Rehabilitative Services within the Department
of Education, and the Director of the National Institute on Disability
and Rehabilitation Research on the development of the programs
to be carried out under the Rehabilitation Act of 1973, as amended.
- Providing advice to the Commissioner with respect
to the policies and conduct of the Rehabilitation Services Administration.
- Making recommendations to the Director of the
National Institute on Disability and Rehabilitation Research on
ways to improve research, service, administration, and the collection,
dissemination, and implementation of research findings affecting
persons with disabilities.
- Providing advice regarding priorities for the
activities of the Interagency Disability Coordinating Council
and reviewing the recommendations of this Council for legislative
and administrative changes to ensure that such recommendations
are consistent with the purposes of the Council to promote the
full integration, independence, and productivity of individuals
with disabilities;
- Preparing and submitting to the President and
the Congress an annual report titled National Disability Policy:
A Progress Report.
- Preparing and submitting to the Congress and the
President an annual report containing a summary of the activities
and accomplishments of the Council.
International
In 1995, NCD was designated by the Department of
State to be the official contact point with the U.S. government
for disability issues. Specifically, NCD interacts with the special
rapporteur of United Nations Commission for Social Development on
disability matters.
Consumers Served and Current Activities
While many government agencies deal with issues and
programs affecting people with disabilities, NCD is the only federal
agency charged with addressing, analyzing, and making recommendations
on issues of public policy that affect people with disabilities
regardless of age, disability type, perceived employment potential,
economic need, specific functional ability, status as a veteran,
or other individual circumstance. NCD recognizes its unique opportunity
to facilitate independent living, community integration, and employment
opportunities for people with disabilities by ensuring an informed
and coordinated approach to addressing the concerns of persons with
disabilities and eliminating barriers to their active participation
in community and family life.
NCD plays a major role in developing disability policy
in America. In fact, it was NCD that originally proposed what eventually
became ADA. NCD's present list of key issues includes improving
personal assistance services, promoting health care reform, including
students with disabilities in high-quality programs in typical neighborhood
schools, promoting equal employment and community housing opportunities,
monitoring the implementation of ADA, improving assistive technology,
and ensuring that persons with disabilities who are members of minority
groups fully participate in society.
Statutory History
NCD was initially established in 1978 as an advisory
board within the Department of Education (Public Law 95-602). The
Rehabilitation Act Amendments of 1984 (Public Law 98-221) transformed
NCD into an independent agency.
1 WorkWORLD is decision
support software developed by the Employment Support Institute at
Virginia Commonwealth University's School of Business. It helps
analyze and illustrate the financial effects of alternative policy
options.
2 Social Security
Administration, Office of Research, Evaluation, and Statistics,
Division of SSI Statistics and Analysis. Quarterly Report on
SSI Disabled Workers and Work Incentive Provisions. June 1997.
3 Data from an April
1996 analysis by the SSA Office of Disability for individuals under
age 59.
4 See the
1994 N.O.D./Harris Survey of Americans With Disabilities
conducted by Louis Harris and Associates for the National Organization
on Disability; and Supported Employment Research: Expanding Competitive
Employment Opportunities for Persons With Significant Disabilities,
edited by P. Wehman, J. Kregel, and M. West (Richmond, VA: Rehabilitation
Research and Training Center, Virginia Commonwealth University,
1997).
5 Quotations
are from President Clinton's opening remarks at his press conference
held on August 6, 1997.
6 The NCD report's
full title is Achieving Independence: The Challenge for the 21st
Century--A Decade of Progress in Disability Policy--Setting an Agenda
for the Future. (July 26, 1996).
7 The actual reimbursement
level depends on the gross earnings level and can range from no
reimbursement at earnings of $65 per month to 50 percent reimbursement
at earnings of $1,053 per month, for expenses up to $968 per month
or $11,616 per year. Above the $1,053-per-month earnings level,
the percentage of reimbursement declines at a rate dependent on
the amount of expenses claimed.
8 NCD found this
citation to be correct. It is on page 159 of Balancing Security
and Opportunity: The Challenge of Disability Income Policy (Washington,
DC: National Academy of Social Insurance, 1996). The data come from
SSA's Office of Supplemental Security Income and they show that
60 percent of all individuals earning more than $65 per month in
that period (95,600 individuals) were charged with overpayments.
9 The results
are shown in graphic format. This report also fully describes the
significant results so that those readers who have access only to
the text will have all of the relevant information.
10 "Net
income" in this simple case is an individual's earnings, plus DI
benefits, minus taxes paid and buy-in amounts. In a later look at
the work expense proposal, WorkWORLD will also subtract work expenses.
11 Tables showing
the numbers behind all the WorkWORLD graphs are available from ESI.
E-mail David Ruth at druth@vcu.edu with fax number or call 804-828-1992.
12 Esther
B. Fein. "What Is Disabled? He Thought He Knew: Doctor Finds That
Working Too Long Costs Him Social Security Payments." New York
Times. Tuesday, August 12, 1997 (Late Edition, Final).
13 Such a person
might be someone with a traumatic brain injury (TBI) who was injured
after a few years of working and who now needs 10 hours per month
of ongoing job-coaching services to maintain employment. In many
States, funding for such ongoing services are not available to people
with TBI.
14 Allen
Jensen's paper, "Summaries of State Profiles of State's Initiatives
to Develop Projects to Reduce Work Disincentives for Persons With
Disabilities," was written under contract with SSA.
15 More detailed
statistics are available in tables on pages 102 and 106 of Balancing
Security and Opportunity (National Academy of Social Insurance,
1996).
16 See, for example,
a number of the research articles in Life Beyond the Classroom:
Transition Strategies for Young People With Disabilities, edited
by P. Wehman (Baltimore, MD: Paul H. Brookes Publishing Co., 1996).
17 Testimony before
the Subcommittee on Social Security, Committee on Ways and Means,
House of Representatives, July 23, 1997. Social Security Disability:
Improving Return-to-Work Outcomes Important, but Trade-offs and
Challenges Exist. GAO/T-HEHS-97-186.
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