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  CMS Home > Medicaid > Ticket to Work - Work Incentives Improvement Act (TWWIIA) > Overview


Welcome to the informational web site for the CMS "Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA)." This landmark legislation modernizes the employment services system for people with disabilities and makes it possible for millions of Americans with disabilities to no longer have to choose between taking a job and having health care. CMS will be providing information to states, beneficiaries and advocacy groups on an ongoing basis concerning implementation of this important legislation. For more information on TWWIIA you can also reference the Social Security Administration (Please see link below "Social Security Administration Work Programs").

The four sections of the Act that provide health care support for people with disabilities who work are:

  • Medicaid Buy-In. Section 201 of TWWIIA governs the provision of health care services to workers with severe disabilities by establishing a Medicaid state plan buy-In optional eligibility groups. As of 2008, more than 90,000 individuals in 40 States were covered under this new eligibility group.
  • Extended Medicare Coverage. Section 202 extends the period of premium free Medicare Part A coverage and requires consumer protection for some individuals with Medigap coverage. Individuals receiving Social Security Disability Insurance who elect to work above threshold levels (substantial gainful activity) can maintain their Medicare coverage for eight and a half years after they return to work.
  • Medicaid Infrastructure Grants. Section 203 provides grants to States to develop state infrastructures to support working individuals with disabilities. As of 2008, over 40 States and the District of Columbia are participating in this program.
  • Demonstration to Maintain Independence and employment. Section 204 provides health care coverage to individuals with potentially disabling conditions who work testing the hypothesis that the provision of health care and related supports will prolong independence and employment and reduce dependency on disability income support programs.
TWWIIA Fact Sheet [PDF 13 KB]
Related Links Inside CMS

Real Choice Systems Change Grants
Related Links Outside CMSExternal Linking Policy

Ticket To Work and Work Incentives Improvement Act of 1999

President's New Freedom Initiative

Home & Community Based Service resources (HCBS.org)

MIG-Research Assistance to States

Social Security Administration Work Programs


Page Last Modified: 10/16/2008 11:06:25 AM
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