Return to Work Incentive

Biggest change in HIV benefits since passage of the Ryan White Act in 1990

by Tom Mcormack

The Ticket to Work and Work Incentives Improvement Act of 1999 finally

passed Congress and was signed by President Clinton on December 17, 1999. The

bill has numerous, complex provisions affecting SSDI, SSI, Medicare,

Medicaid, return-to-work and vocational rehabilitation services for

disabled persons.

It offers states a set of interrelated options for enhanced Medicaid

coverage of disabled persons who work. It limits---but does not fully

eliminate---the threat of being found "no longer disabled" for those

patients in remission who are work ready or are already actually working.

AIDS agencies and even businesses can now get federal funding for

return-to-work, benefits counseling and vocational rehabilitation services.

Previously, clients could only get these services from state vocational

rehabilitation departments. .

Most notably, states which already chose to give Medicaid to middle-income,

working disabled persons under the 1997 Balanced Budget Act* can now raise

their income and asset eligibility levels even higher and they can also

cover of "ex-disabled" working persons---those with still-serious

impairments who "flunk" Social Security Continuing Disability Reviews

(CDRs) while working. In addition many---but not all---states can get

demonstration grants to give Medicaid to "pre-disabled" working

persons---those with serious impairments that would advance to full

disability without Medicaid treatment.

Beginning October 1, 2000, the bill also gives 4.5 years of additional

premium-free Part A Medicare coverage (after the 9 month Trial Work Period

and 36 month Extended Period of Eligibility, during which Part A is ALREADY

free under current law) for those who've returned to work. Thereafter-just

as before---those who are still disabled can continue their Medicare

coverage INDEFINITELY.**

The bill also lightens---but doesn't completely end---the threat of CDRs

ending medical as well as cash benefits for those found to have " medically

improved" enough to no longer be "disabled". Working in itself can't be

used as evidence of medical improvement; those actually working can't be

given "routine" CDRs and those who do flunk CDRs due to working can apply

to be immediately reinstated for benefits for up to 6 months while Social

Security decides if they really have stopped being disabled after all. But,

basically, medical improvements can still bring an end to SSDI, SSI,

Medicare and Medicaid, except in the above-mentioned narrow instances.

Finally, the bill allows disabled SSDI and SSI recipients to receive their

vocational rehabilitation, related counseling and job-readiness services

from qualified private sector and nonprofit providers as well as state

vocational rehabilitation agencies. Numerous technical strings are

attached, of course---but this should prove to be a lucrative new source

for funding portions of the case management/benefits advocacy budgets of

many AIDS service organizations.

Because bill provisions are so very complex---and each is to be effective

on different dates in the coming years-no one should rely on a brief

summary for major decisions. A more detailed bill summary is available---as

is a longer explanation, "Returning To Work and Keeping Medicare and

Medicaid" by emailing tomxix@ix.netcom.com,

*Alaska, California, Iowa, Massachusetts, Minnesota, Nebraska, Oregon,

South Carolina, Vermont and Wisconsin already cover middle-income working

disabled persons who are not yet on---or have gone off-SSDI. All other

states can do so as well if they so choose.

**Once SSDI checks stop, Medicare Part B can be continued by paying the

$45.50 monthly premium oneself. Those who can't afford this can get the

welfare office to do so for them by applying at the welfare office for the

SLIM/QI program if their earnings are under $1939 monthly. Once "free" Part

A Medicare ends (after 45 months back at work presently and after 99 months

back at work beginning October 1, 2000) the Part A premium [either $166 or

$301 monthly] must be paid; those who can't afford that can apply to have

the QWDI program do so with monthly earnings under $2832.