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Volume 1 , Issue 2 Date: Autumn, 2000 Topic: Legal Issues in Disability

The Ticket To Work and Work Incentives Improvement Act of 1999

by Raymond A. Cebula, Esq.

On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999 into law. This Act represents the most significant “return to work” development since the implementation of the SSI work incentive program some 20 years ago. Popularly referred to as the “Ticket to Work” program, it applies to both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients. The Social Security Administration (SSA) will administer the program.

The disability community and advocates spent two exhausting years working towards passage of the Ticket to Work program. It will hopefully prove to be a significant means of securing vocational rehabilitation services for disabled individuals wanting to return to work, or entering the work force for the first time.

The express purposes of the Act are:
    • to provide health care, employment preparation, and placement services to SSDI and SSI recipients;
    • to encourage States to expand Medicaid availability for SSI recipients who work;
    • to expand Medicare availability to SSDI recipients who work; and,
    • to establish a “ticket ” that will allow an SSDI or SSI recipient with a disability to obtain necessary services and supports to obtain and retain employment and reduce dependency on cash benefits.

    The new law does not change the existing work incentive programs that are available to SSDI and SSI recipients. The trial work period, extended period of eligibility and existing Medicare coverage provisions are, and will continue to be, available to SSDI recipients who wish to return to work. SSI recipients will still be able to participate in the 1619(a) work incentive program and to benefit from the 1619(b) extended Medicaid coverage. Employment subsidies and impairment related work expenses are still available to all Social Security recipients with disabilities who choose to enter the work force.

    This article addresses the most significant sections of the Ticket to Work program. It also discusses concerns about potential problems in how the program will work.


    Under this provision of the new Act, a recipient of SSDI and SSI benefits with a disability will be provided a ticket. This ticket will allow that person to obtain employment services, vocational rehabilitation services, or other support services from any public or private vocational rehabilitation provider that is willing to provide services to that recipient. The ticket will be available in some states beginning January 1, 2001 and will be available nationwide in 2004. At this time, no one is certain about how to obtain a ticket. It is likely that a person will have to affirmatively request a ticket.

    The ticket will explain SSA’s commitment to pay for all services provided in order to assist in the recipient’s return to work effort. Each participating individual will develop an “individual work plan” with the rehabilitation service provider that will set forth the planned employment goal, as well as the services and/or supports necessary to attain that goal and how the supports and/or services will be obtained.

    Elimination of Work Disincentives

    SSA will periodically review a recipient’s claim while he is receiving disability benefits, to ensure that he continues to meet the program’s disability criteria. The new Act provides that, as of January 1, 2002, no continuing disability review can be based upon the work activity of a recipient with a disability. Work activity may not be used as evidence that the recipient is not disabled. However, all recipients will be subject to the regularly scheduled, medical continuing disability review process. This means that a recipient who is working cannot be found “not disabled” simply because he is working and earning wages, even if his earnings exceed the Substantial Gainful Activity level.

    Expedited Reinstatement of Benefits

    All SSDI and SSI recipients with disabilities who return to work but then are forced to stop work activity because of their medical impairments may take advantage of an expedited reinstatement of benefits process beginning on January 1, 2001. Reinstatement requires an application and requires that the worker stop working due to the same impairment that gave rise to the disability, or one that is substantially related to that impairment. These expedited benefits are to be paid immediately upon application. They will be considered “provisional benefits” for up to five (5) months. It is assumed that SSA will have processed the reinstatement application during this five (5) month period.

    If the recipient is not eligible for reinstatement, the reinstatement application will be treated as a new application for disability benefits. The five (5) months of provisional benefits will not be considered an overpayment and the date of the application for reinstatement will be considered the date of a new “initial” application for benefits.

    Expanded Medicaid Benefits

    States will have the option of expanding Medicaid coverage to allow for “buy-in” programs for SSI recipients with disabilities who return to work after October 1, 2000. Options to cover up to 450% of the poverty level exist for each State. SSI recipients must work at least 40 hours per month and continue to suffer from a severe impairment. Each state must take legislative or regulatory action in order to take advantage of the Medicaid expansion options. For more information concerning your state, contact the state agency that administers the Medicaid program to learn what options are available or are being considered.

    Expanded Medicare Benefits

    As of October 1, 2000, a 4 ½ year extension of Medicare coverage will be available to
    SSDI recipients who work. This extension allows for a total period of 7 years and 9 months of
    Medicare coverage after completing a Trial Work Period.

    This Medicare extension will apply to all SSDI recipients who are working and who meet the criteria listed below. It is NOT necessary to be a holder of a ticket in order to benefit from the Medicare extension.

    The Medicare extension is available to SSDI recipients who work and who:
      • still have a disabling impairment that meets SSA standards;
      • have coverage under Medicare Part A;
      • started to work after beginning to receive disability insurance benefits;
      • are still within the Trial Work Period; or
      • are still within the Extended Period of Eligibility, or
      • have current Medicare coverage that is not due to terminate until after 9/30/00.

      As long as the recipient remains “disabled” for social security purposes, Medicare coverage will be available for a continuous period of 7 years, 9 months AFTER the completion of a Trial Work Period.

      Important to holders of Medigap policies is a provision allowing a policy holder to suspend coverage if employer-provided health benefits meets her needs. Should employment cease, re-enrollment in the Medigap can occur even if the employment termination takes place outside of the policy’s enrollment window.


      The Ticket to Work and Work Incentives Improvement Act of 1999 will be implemented over time. Full implementation will not occur until 2004. The ticket, the extended Medicare coverage, and the Medicaid buy-ins will all be phased in according to the specific language of the law. Please refer to the sections above to determine when the various sections of the law will be implemented.

      In fact, even after the ticket becomes available in your area, a recipient will have the option of using the ticket or the existing work incentive programs. The use of the ticket is completely voluntary on the recipient’s part, as are all other existing work incentives. Careful counseling and planning is the best route to determine the best option for a recipient’s needs.

      Benefits Counselors will be available to discuss return to work planning. SSA is in the process of awarding grants to organizations that will provide counseling services to any recipient wishing to discuss a return to work. These Counselors will be able to provide information concerning the effect of work and earnings on disability benefits and on the various state and federal work incentive programs. They will have information available about health coverage plans and their suitability to meet the needs of each recipient. They will explain the effect of earnings on other public benefits such as food stamps and subsidized housing. They will also be able to explain the availability of legal services to assist if disputes arise while using a ticket or engaging in work activity. SSA will be able to provide a list of counselors who are available to discuss return to work issues.


      Advocates remain concerned that rehabilitation providers will “skim” the surface of the disability community by accepting and providing services to those recipients who need lesser levels of service and less expensive services. Problems with reimbursement mechanisms may severely limit the ability of smaller rehabilitation providers to provide needed services to individuals with complex and/or expensive service rehabilitation requirements. The actual number of participating and available providers remains a question.

      Social Security workers have historically been under trained and under informed about the existing work incentive programs, much to the detriment of recipients desiring to use the programs. Poor attention to wage reports has caused significant difficulties for working recipients. SSA must act to insure that its internal systems are able to quickly and appropriately deal with the vast quantities of critical information that will result from the use of the Ticket to Work program.

      While this expansive Act is a welcome addition to the current array of work incentive programs available to disabled SSDI and SSI beneficiaries, the total impact must be carefully monitored to insure that all recipients are assured access to the critical services needed to assist in their return to work. Social Security offices must work in a timely and time efficient manner to allow for benefits accounts to be adjusted to reflect work activity and wages. Recipients must have access to accurate information concerning the effect of work on their entire benefits package, including benefits not provided by SSA. Only in this way will SSDI and SSI recipients who want to work gain the confidence that they need to enter the work place with security.

      Ray Cebula

      Raymond A. Cebula, Esq., is a Senior Staff Attorney at the Disability Law Center in Boston, Massachusetts. Recognized as a national expert in Social Security law, Mr. Cebula provides technical assistance and advice to other attorneys and legal workers nationally. He was awarded a Regional Huber Smith Fellowship upon his graduation from the Franklin Pierce Law Center. Prior to his current position, he specialized in poverty law in Legal Services offices in Iowa and Massachusetts. He also serves as a Clinical Instructor at Harvard Law School and has written extensively on Social Security issues.

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