Wisconsin
Pathways to Independence
Program Summary
Enhancing the Wisconsin
workforce through more reliable health and support systems for people with
disabilities.
The Problem: The U.S. General Accounting Office has calculated that less
than 1% of SSI or SSDI beneficiaries leave those programs each year as a result of paid
employment. Of those who leave, about 1/3 return within 3 years.
More than 6.6 million Americans have a permanent disability and receive income support
from the Social Security Trust Fund (SSDI) or Supplemental Security Income (SSI).
Social Security Administration reported that the total number of
persons receiving either a Social Security payment, a federally
administered SSI payment or both was 49,635,881. Federally
administered payments totaled nearly $2.7 billion in December 2000: $2.4
billion in federal SSI payments, and $293 million in state supplements.
The average federally administered payment was $379. The aged averaged
$300, disabled and blind, $398.
In Wisconsin, 84,887 persons--9,771 aged, and 75,116 disabled and
blind--received federally administered SSI payments in December 2000. A
total of 16,957 recipients were aged 65 or older, 53,618 between 18 and
64, and 14,312 under 18.
Most people with disabilities want to work. Employers are increasingly interested in
employing people with disabilities. Advances in technology offer employment hope even for
those with the most severe disabilities.
Removal of the
following problems could
significantly increase the employment of people with disabilities.
Loss of Health and Long Term Care Coverage:
The potential loss of Medicaid
and Medicare is cited by SSI and SSDI beneficiaries as one of the most important barriers
to paid employment. Earnings in excess of $780/month for more than 9 months jeopardize
such coverage. Because people with significant disabilities rely on the health care system
for their ability to live, employment that jeopardizes health care is perceived as
life-threatening. What is required is a simple guarantee of continued
health coverage.
Falling Off the Eligibility Cliffs: The "All or Nothing"
approach to cash assistance and health coverage is another barrier. SSDI checks are
eliminated entirely when an individual earns more than $780/month in any random nine
months over the most recent 5-year period. In addition, each federal program acts
independently to reduce benefits as earnings increase. For example, HUD rent subsidies are
reduced 30% for each dollar earned. SSI is reduced 50%. Food stamps are reduced by 25%.
The cumulative effect of benefit reductions, increased taxes and work expenses can mean
that the cost of working approaches or exceeds total earnings. What is required is a
gradual and coordinated reduction of benefits which will guarantee that "work
pays."
Fragmented and Inadequate Supports: People with disabilities often depend
on many different public programs. Such programs are uncoordinated and sometimes act at
cross-purposes. People with disabilities are unusually reliant upon dependable support
systems in order to work: transportation systems which match a job schedule; reliable
personal attendant care for people in wheelchairs; computers; vocational training;
worksite accommodations; timely medication management; mental health assistance.
There
exist no programs which can "pull all the pieces together." There is no program
which can intercede quickly when there are breakdowns.
Implications for Action: Since almost no beneficiaries leave SSI/SSDI as
a result of paid employment, there would be virtually no cost to the state and
federal
governments to continue the Medicaid/Medicare coverage of current beneficiaries if they
can secure paid employment. This would remove the impediment which people with severe
disabilities fear most. If employment rates increase it would cost little to
remove the current "cliffs" in cash assistance in SSI, SSDI, and HUD programs.
The Wisconsin Department of Health and Family Services and the Department of
Workforce Development are working jointly to create a powerful initiative to increase
employment on the part of people with significant disabilities.
The Key Concepts Are:
A. Simplified Access to Comprehensive Help:
Participants are able to
consult with a single team which can offer coordinated access to all professionals and
programs that may assist them in achieving their employment goals. These local
Comprehensive
Assistance Networks mobilize all available vocational, educational, health and
supportive services. Each organization works with the local vocational rehabilitation
district to assure needed training, worksite accommodations and adaptive aids. The
organization recruits employers to match abilities of the individual with the
employers’ requirements. The goal is to break down the barriers between isolated
health, long term care, vocational, educational, and cash assistance programs so that all
services can be aligned in support of vocational goals. Greater coordination as well as
new flexibility in funding among all support programs will reduce fragmentation.
Current Status: With assistance from the Robert Wood Johnson Foundation, local
pilot tests have confirmed the value of team-based comprehensive approaches for both
persons with physical disabilities and people with mental illness. Research associated
with these efforts indicates a strong potential for benefits to the individual and for
public financial savings. With assistance from the Social Security Administration, a
request for proposals was issued in December 1998 to expand this concept.
Presently, twenty Pathways Provider sites offer services.B. Remove Employment
Barriers: In
Pathways to Independence we seek
to remove systemic barriers to employment which result from public policy. The plan is to
incorporate the following features:
In addition, the Pathways Medicaid Purchase Plan has been designed to
provide access to health care on the part of people without current Medicaid coverage but
who meet the SSI disability test. The Purchase Plan has been available since
March 2000.
Gradual Reduction of Cash Assistance: Replace the "all or nothing
cliff" in eligibility for SSDI payments in favor of a sliding scale. Coordinate the
benefit reductions of other federal and state programs so that a reasonable amount of
discretionary net income remains, and "work pays."
Current Status: An SSI waiver was granted in January 2001. An
SSDI waiver was submitted in June 2000. SSA has not acted on the
request as of yet.
Research: A strong research design will document demonstration results for
the three target groups. Analysis of comparison or control groups, together with
comprehensive tracking of changes in public costs, will enable us to assess the potential
impact of any larger-scale public policy changes.Building on Experience:
Essential elements of this demonstration
have already been pre-tested in Wisconsin with help from the Robert Wood Johnson
Foundation. The Vocational Futures Planning model developed through RWJ-F assistance
has assisted many people with significant physical disabilities to become employed.
However, the successes are fragile. The experiences of such people indicate that without
removal of key employment barriers described earlier, successes achieved so far will be
hard to replicate or sustain.
In his 1998 "State of the State" address then Governor Tommy G.
Thompson urged a speedy solution: "We are wasting too much talent by allowing legitimate fears over health
care to keep people with disabilities out of the workforce. Give them their freedom by
protecting their health."
Last Revised: July 14, 2010 |
