Vermont Work Incentive Initiative

1. Vermont Work Incentive Initiative Peter Baird MaryAlice Mowry Vermont Division of Vocational Rehabilitation

2. Background • 1994 Appropriations Bill mandates a report for Governor and General Assembly on barriers to work or persons with disabilities • Report due January 1997 • Literature review, SSA, other states • 17 focus groups with consumers, providers, employers

3. Findings: Social Security and the Need for Reform • People on SSI and SSDI Want to Work and Can Find Employment • The Work Incentives for SSDI and SSI Beneficiaries Actually Act as Disincentives • Beneficiaries Have Incentives To Purposely Restrict Their Earnings To Stay On Benefits, especially Health Benefits • The System Can Be Reformed To Everyone’s Benefit

4. Principle Strategies • Ongoing Health Care Coverage After Employment • Work Incentive, Counseling and Assistance • SSI and SSDI Waivers • Early Intervention

5. Demographics on SSA Population in VR • 33% of All People Served in VR System Are SSI or SSDI Beneficiaries • 34% of All Successful Rehabilitations are SSI or SSDI Beneficiaries

6. Employment Over Time For All VR Closures and SSDI/SSI Closures

7. Earnings of All VR Closures and SSDI/SSI Closures

8. Project Development • 1997 Report to the Governor and the General Assembly on Work Disincentives submitted • 1997 Eight-State meeting with Senator Jeffords’ (VT) office; HCFA; SSA; and GWU Intergovernmental Policy Project • 1998 RWJ BHS Application • 1998 SSA Grant Application

9. Project Development (cont.) • Consumer-Directed Steering Committee (VCIL, DD Council, VCDR, VR Consumers) • VR-SSA-DDS Manager Meetings • VR-SSA-DDS Staff Meetings • VR-DSW Meetings (Health Care) • VR As Lead Agency

10. Primary Ways to Improve Work Incentives for SSDI and SSI Beneficiaries • Earlier Intervention: Improved Disability Determination Services and Employee Assistance Programs • Improved Counseling and Education: Better Training For VR Counselors, Creation of Peer Project and Benefits Counseling Program • Health Care for SSDI Beneficiaries (Medicaid Buy-In)

11. Research Questions • Is lack of health care insurance or under-insurance a significant barrier to employment for people on SSDI and SSI? • What are broader program costs and savings related to our program interventions? • What types of benefits counseling, information and assistance would be part of a successful program?

12. Early Intervention • Earlier DDS Referrals • More DDS Referrals • Result: 5 times increase in number of referrals, and 8 times increase in number of people entering VR through DDS

13. Improved Benefits Counseling • Benefits Counselors in VR, work also with Community Mental Health Centers • State-wide coverage • Funded by SSA Cooperative Agreement funds, with plans to fund long term by existing VR system if proven effective

14. Medicaid Eligibility for “Working Disabled” • Proposed by Dept of Social Welfare on Sept 10th • Effective date January 1, 2000 • Allows working disabled persons to be eligible for Medicaid even when their earnings would make them otherwise ineligible

15. What Will Working Disabled Persons Pay for this Coverage? • Below 185% of FPL: no fee • From 185% to 225% of FPL: $12 • From 226% to 250% of FPL: $25 • exception when person has other health insurance, then only $12 185% of FPL for an individual is $1271/month, 225% of FPL for an individual is $1545/month

16. May a Working Disabled Person Save Money Without Losing Eligibility? • YES! • All earnings from a job, or all non-liquid items purchased from earnings, are disregarded • This will encourage people with disability to save money for their future independence

17. How Did This Medicaid Program Become Enacted ? • Primary Group to Promote Program: DVR • Initial Discussions: A limited Medicaid waiver for VR consumers only • Balanced Budget Act of 1997: easier path • Little disagreement on policy (seen as continuation of Welfare reform and sensible in healthy economy) • Main concern: cost

18. Fiscal Analysis Several Assumptions: • Most people applying for this Medicaid option will already be on Medicaid • Those most interested in this option currently need and receive Medicaid • Vermont has very generous Medicaid program for low-income residents • Sample of 500 SSDI beneficiaries in VR: 90% already receiving Medicaid. This is a good sample to use because they are SSDI beneficiaries who are working or considering work.

19. Fiscal Analysis (cont) • Numbers applying will be limited • Work requirement restricts numbers of applicants • Costs will be relatively low • Many applicants receiving Medicare or already on Medicaid • No personal assistance services in Vermont Medicaid • Mental Health costs are capitated in VT • Survey of 500 SSDI beneficiaries receiving VR services shows that annual Medicaid cost per applicant is $4200 (60% of this is pharmaceuticals)

20. VT Work Incentive Initiative: Goals 1) Enhance consumer quality of life through improved employment and health outcomes. 2) Empowerment of SSDI and SSI beneficiaries seeking employment. 3) Demonstrate the different effects that health care and cash assistance have on a person’s decision to seek and retain employment. 4) Education and data for consumers, advocates, and state and health providers on work incentives and employment. 5) Data for Medicaid to analyze buy-in, and other options in future. 6) Data for possible changes in federal law regarding SSA work incentives.

21. Informed Consent and Consumer Choice • Benefits Counseling for all eligible VR and Mental Health Consumers • Medicaid buy-in for eligible consumers, available state-wide • Peer counseling for targeted populations • Goal: more knowledgeable, informed consumers with real choices regarding employment

22. Vermont Work Incentive Initiative • Medicaid for • Working Disabled • Allows working consumers who meet SSA definition of disability to purchase affordable Medicaid coverage • Allows consumers to earn livable wages, save money, and maintain health coverage • ------------------------------------------ • Other Initiatives: • SSDI Waiver – In Development • SSI Waiver – In Development • Peer Counseling. • Begun in Southern VT with Targeted Populations • Benefits Counseling • Six Benefits Counselors and Lead Counselor • Work within VR and Mental Health Centers • Provide Accurate, Reliable Information to Allow Consumers to Make Informed Choices • ---------------------------------- • IPS Model in Mental Health Centers (MHC) • Improve Vocational Outcomes in Mental Health Centers Through IPS • Subcontract with NH Psychiatric Research Center