VA DARS, Ticket to Work Partnership Plus, 1619B and Medicaid Works

October 17,2017 VASWP

Services Staff Training Day

David Leon

Ticket to Work Coordinator, VA DARS

David.Leon@dars.Virginia.gov

Jonathan May

Ticket to Work/WISA supervisor, The Choice Group

jonathan.may@thechoicegroup.com

Christian Wiscovitch, VR Counselor, DARS

Christian.Wiscovitch@dars.Virginia.gov

Reggie Herndon, EN Specialist, LACIL

ReggieH@lacil.org

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Presenters

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Poverty and Disability

* Reference: Department of Health and Human Services (January 2017) | https://aspe.hhs.gov/poverty-guidelines

2017 Poverty Guidelines for the 48 Contiguous States and the District of Columbia

Persons in Family/Household Poverty Guideline

(For families/households with more than 8 persons, add $4,180 for each additional person)

1 $12,060

2 $16,240

3 $20,420

4 $24,600

5 $28,780

6 $32,960

7 $37,140

8 $41,320

Utilizing the Ticket to Work and Partnership Plus creates

additional resources for SVRA clients and service providers.

People with disabilities are considerably more likely to

experience poverty relative to those without disabilities.

The Ticket to Work program is a path out of poverty!

Additional resources for VR, EN and Clients.

Work Incentives are available to protect critical health

benefits

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Why is this Important?

Vocational Rehabilitation Overview and Points of

contact for each DSS office

Functional Definition of Ticket to Work and Partnership

Plus

Virginia Model

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Objectives

V R Counselor

Division of Rehabilitative Services

October 17th,2017

Virginia’s federally mandated Vocational Rehabilitation (VR) program

Assists individuals with disabilities to prepare for, enter, and maintain employment

Focus is on EMPLOYMENT

Participation is VOLUNTARY

An expert in disability and career counseling

Determines eligibility for DRS services

Identifies barriers to competitive employment

Helps develop employment goal

Develops Individualized Plan for Employment (IPE) with

steps to achieve student’s employment goal

Referral

Intake

Eligibility

Order of Selection*

Individualized Plan for Employment (IPE)

Services

Closure

Post Employment Services

* When a state does not have sufficient funds to meet the needs of all

individuals seeking services, a plan must be initiated to serve those clients with the most need first.

Determines eligibility for DRS services

Identifies barriers to competitive employment

Helps develop employment goal

Develops Individualized Plan for Employment (IPE)

with steps to achieve consumer’s employment goal

Implements plan and co-ordinates services to help

consumer prepare for, find, and

maintain employment

Eligible to work in the US

Documented disability

Barrier to employment caused by disability

Be able to benefit from services

Require services to prepare for, enter and engage in or retain employment

Mobility

Self Direction

Self Care

Interpersonal Skills

Communication

Work Tolerance

Work Skills

Modifications or accommodations

Effective communication skills

Organizational skills

Assistance needed to get from place to place

Training or supervision to obtain/maintain work skills

Work stamina

Work habits

Adaptive/assistive technology

Money management

Medication management

Self-care capability

Ability to plan and initiate activities

Problem solving skills

Interactions and relationships with others

Self advocacy skills

Developed after DRS eligibility is established

Created collaboratively with Client, family, service

providers, and DRS Counselor

Parallel to the student’s IEP (for Transition

students)

Focuses on the goal of employment

Outlines steps needed for employment goal

Plans for necessary services and funding

Eligible clients must complete financial needs

process

Some services can be provided without regard to

financial need

Some services involve financial participation on

the part of the student and family

If the consumer is recipient of SSI or SSDI, there

is no financial needs test and they

automatically qualify for all services

Counseling and guidance

Assessment

Career exploration

Benefits Analysis through WISA

Job readiness skills

Job seeking and placement

On-the-Job Training, Unpaid Work Experiences

Disability awareness counseling

Follow-along services after job placement

Higher education

Vocational/technical training

Durable medical equipment or other goods

Assistive Technology (A.T.)

Therapeutic Intervention

Job Coaching

Campus located in Fishersville, VA

PERT program for high school youth

Life Skills Training Program

Vocational Evaluations

Therapeutic Evaluations

Vocational Training Programs

Driver Evaluation and Training (including modified)

Physical Therapy, Speech Therapy, Occupational

Therapy

Successfully closed 4060 cases

Average hourly earnings of $10.24

For 2017… 18902 Current Open Cases

Consumer referred from DSS Lynchburg

Receiving TANF and struggling to find

employment

Provided Counseling and Guidance, Employment

Services, Job Placement, Interview Preparation,

and resume services.

Employed through Sodexo at Liberty University

earning $9.00 per hour

Stable in employment and working for over a full

year.

DARS Contacts

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What is Ticket to Work?

Ticket to work is a program designed to assist beneficiaries go to work and get off of the federal benefit roles.

Ticket holder’s are individuals receiving SSI or SSDI and between the ages of 18 and 64.

VADARS is currently working with almost 7,000 ticket holders.

Commonwealth of Virginia –over 315,000 beneficiaries.

https://www.ssa.gov/work/tickettracker.html

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A mechanism for sequential provision of services

Office of Vocational Rehabilitation (OVR) > Employment

Network (EN)

EN > OVR > EN

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What is Partnership Plus?

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How Partnership Plus Works

Virginia Model

Partnership Plus and Administrative EN Models

Fee for Service Work Incentive Services

Work Incentive Specialist Advocates (WISA)

WorkWORLD for the Web

Work Incentive Specialist Position and Manual

National Employment Network Association (NENA) and National Association of Benefits and Work Incentives Specialists (NABWIS) membership and participation

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Ticket to Work in Virginia

Ticket to Work Coordinator

Formalized Partnership Plus agreement

Benchmark Retention payments

21 current agreements

12 Administrative EN agreements

FFY 2015: Over $930,000 to our partners around the state though Ticket to Work funding

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Who Participates in the Ticket to Work program in Virginia?

Workforce Development Boards

Centers for Independent Living

Employment Service Organizations

Community Service Boards

Private nonprofit and for-profit Organizations

Community Rehabilitation Programs

DSS?

Ticket to Work Strategies

Present at DSS conferences to build collaborative relationships

• This has led to an increased referral stream for appropriate clients ……….

Co-present at specialty meetings, staff meetings, district meetings, statewide and national conferences.

Conduct quarterly meetings with Partnership Plus stakeholders

Current Initiatives to make the Ticket program Stronger

Work Incentive Manual – contract added

State Specific trainings developed

WorkWORLD Enhancements

Financial Competency

Motivational Interviewing

Potential Ongoing Support Services

Career Planning and Advancement

Advocacy Assistance

Understanding and accessing SSA Work Incentives

Budgeting & Financial wellness coaching

Help arranging for support services such as transportation or medication

Other services that will help maintain job

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Lynchburg Area Center for Independent Living Became an EN in 2011

Currently serving 87 TtW clients

Member of NENA

2 WISAs on staff

Participates in partnership Plus with DARS

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LACIL – Core Services

Peer Counseling

Independent Living Skills Training

System and Individual Advocacy

Transition

Information and Referral

• Additional services available through the LACIL Employment Network

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The Choice Group

Currently 13 WISAs on staff, located strategically throughout the state

One WISA credentialed as a Community partner Work Incentive Coordinator (CpWIC)

Manager serves on the Board of the National Employment Network Association (NENA)

Cross-trained (WISA and TTW)

Dedicated WISA/TTW Program Specialist

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The Choice Group Became an Employment Network (EN) in

February 2009

One of the original 6 Partnership Plus organizations in Virginia

Over 75 job coaches located throughout VA

Have served over 200 Ticket holders to date

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The Choice Group

Ticket to Work

Unique opportunity to serve beneficiaries

Collaboration with DARS, DBVI, CSBs, CILs, WIPAs

o Referrals in both directions

Partnership Plus

o All Counselors involved

o Access to clients for WISA services

Administrative EN agreements

Suitability

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TTW interaction with DSS

Medicaid

• Identify applicable eligibility so we can explain effects of earned income

○ SSI, Waiver, QMB, SMLB, QI, etc.

• Assist with 1619(b)

• Assist with Medicaid Works

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1619(b) Medicaid Protection for Working Individuals

Allows beneficiary to continue to receive Medicaid, even without receiving a cash benefit, as long as they meet the following criteria:

Still have a disability;

Need the Medicaid coverage to pay expenses that allow beneficiary to work;

Accumulate no more than $2000 in resources;

Earn less than $35,684 gross per year.

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1619(b) continued

Maintains an active SSA account – even without cash benefits for more than 12 months

Allows a beneficiary to return to SSI cash benefits if financially eligible

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1619(b) continued

Have been eligible for an SSI cash payment for at least 1 month;

Still meet the disability requirement; and

Still meet all other non-disability SSI requirements; and

Need Medicaid benefits to continue to work; and

Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services.

1619 B

MEDICAID WORKS Virginia’s Medicaid Buy-In Program Eligibility Requirements

• Disabled

• 16 through 64 years of age

• Meet all requirements of the “ABD with Income ≤ 80% of the Federal Poverty Level” covered group

• Income limit $804/month, $9,648/year in 2017

○ Only income of applicant is counted

○ SSI beneficiaries are considered income eligible

• Resource limit $2,000 for individual, $3,000 for couple

○ SSI beneficiaries do not have resource test for Medicaid unless they

have countable real property ( i.e. that is excluded for SSI)

• Employed or have offer of employment letter

Disabled for Medicaid Works Purposes Means:

Current enrollment in SSI or SSDI programs,

Finding of disability by the Social Security Administration

(SSA) that has not been reversed, or

Finding of disability for Medicaid by the Disability

Determination Services (DDS) Unit

Sign the MEDICAID WORKS Agreement

Establish Work Incentive (WIN) account(s)

• Deposit all earned income and resources from earnings

Submit payment of a premium, if required

• Monthly premium continues to be waived

• If implemented, on a sliding scale

Additional Eligibility Requirements

DARS or Ticket to Work Employment Network

Recommend contacting a Work Incentive Specialist

Advocate (WISA)

WorkWORLD

Before Enrollment

• For earnings accumulated after enrollment in MEDICAID WORKS, up to $35,684 in 2017 is disregarded if deposited and retained in a WIN account.

Also excluded when placed in WIN account:

• Increases in Social Security benefits due to participation

in MW

• SSA Cost of Living Adjustments (COLAs)

• Unemployment Compensation received when participant

loses job through no fault of his or her own.

Upon Enrollment

Upon Enrollment

Resources accumulated while in MEDICAID WORKS and held in IRS approved retirement accounts, medical savings accounts and other similar State-approved accounts are excluded.

• Other resources evaluated with regular ABD Medicaid rules

• Resource assistance unit = 1

Upon Enrollment

Safety net

• Allow 6 months continued coverage if

unemployed due to unavoidable employment

interruptions

Upon Enrollment

Safety net (continued)

• Resources in WIN account disregarded in evaluation

for other covered groups

○ If eligible and enrolled in another group, enrollee

has one year to dispose of excess resources

Upon Enrollment

Safety net (continued)

• Amounts in IRS-approved accounts established as

WIN accounts disregarded in all future Medicaid

determinations

Alternative Benefits Package

Added Personal Assistance Services in June 2008

• Service eligibility requirements same as for waivers

• Process to access same as for waivers

• In-home and in the workplace

• Workplace supports are not provided if:

○ provided by the Department of Rehabilitative Services, under IDEA, or

○ they are an employer's responsibility under the Americans with Disabilities Act or Section 504 of the Rehabilitation Act.

Relationship Between Medicaid Works and 1619(B)

Medicaid Works offers higher income and resource limits, but more stringent eligibility criteria if not on SSI.

1619(B) has lower limits, but offers a “link” to the SSI system that Medicaid Works does not provide.

MEDICAID WORKS (MW) Enrollee Demographics

As of April 2017, 42 workers with disabilities enrolled.

• Age range: 20 to 64 years

• Gender: 18 Female and 24 Male

• Hourly wage range: $7.25/hr. to $20.00/hr.

• Average number of hours worked: over 20 weekly (range 16 to 40)

Enrollment by DSS regions:

• Central 8

• Eastern 16

• Northern 10

• Piedmont 3

• Western 5

Meet Client X

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Meet client Q

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Questions

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Contact Information

David Leon

David.leon@dars.virginia.gov

Jonathan May

jonathan.may@thechoicegroup.com

Christian Wiscovitch

Christian.Wiscovitch@dars.Virginia.gov

Reggie Herndon

ReggieH@lacil.org

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