Supported Employment: An Underutilized Vehicle to Recovery MARYLAND DEPARTMENT OF HEALTH Supported Employment: An Underutilized Vehicle to Recovery Stacy Seymore, COTA/L, CPRP Director, Employment Services — Behavioral Health Administration

Learning Objectives Participants will learn about the impact of work in recovery Participants will learn about Supported Employment services, eligibility, and how to access them Participants will gain greater understanding of the collaborative systems in Maryland supporting individuals to return to competitive employment in the community

Why Work? Expand social network Reduce symptoms Engage in meaningful activities Improve self esteem Increase financial independence Achieve other goals

Barriers to Employment Fear of failure Intermittent work history Anticipated loss of benefits Unfamiliarity with available supports

Safety Nets and Work Incentive Disclaimer: There are more safety nets and work incentives available to individuals than can possibly be covered within the time constraints of this training. Each individual’s situation is unique For this purpose, we have highlighted a few that you may find especially helpful Behavioral Health Administration (BHA) offers full day Making Employment Work Training free for you and your family members and Maryland has a plethora of certified benefits counselors which serve as experts in this area

SSI and SSDI Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI)

Employment Earnings Impact The very basics: SSI: The more money you make, the smaller the check you receive Title II/SSDI: All-or-nothing based on the length of time that you work earning over substantial gainful activity ($1,180 for 2018)

Trial Work Period During a trial work period, a beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled Social Security does not consider work performed during the trial work period as showing that the disability has ended until services have been performed in at least nine months (not necessarily consecutive) in a rolling 60-month period During this time, a Title II beneficiary can try out working and make as much as they can to see if they can sustain it without impacting the cash payment

Continuation of Medicare Benefits If a person loses a Title II benefit (includes SSDI) due to work, he/she retains Medicare for at least 93 months (seven years and nine months) after the end of the Trial Work Period

SSI Provides supplemental income to adults with low income who are age 65 or older or are blind or have a disability Is a needs-based program for which the individual must have limited resources and income to qualify Provides individuals with Medicaid

SSI Financial Eligibility The most SSI any one person can be eligible for is $750 per month (for 2018) The amount of SSI an individual qualifies for each month is affected by the amount of income he or she receives The Social Security Administration (SSA) looks at two different types of income when calculating SSI payments: Countable Unearned Income Countable Earned Income

Continued Medicaid Coverage If an individual loses an SSI cash benefit due to earned income, he/she can retain his/her Medicaid through the 1619(b) rule. The threshold in Maryland is $40,365 per year for 2018

Expedited Reinstatement If benefits ended due to work earnings, the beneficiary can request reinstatement without having to do a new application. While eligibility is determined, an individual can receive provisional benefits for up to six months. Provisional benefits include Medicare/Medicaid coverage. These provisional cash payments do not typically have to be re-paid if the request for reinstatement is denied.

EID Program The Employed Individuals with Disabilities (EID) program allows eligible Marylanders with disabilities to pay a small fee and receive health care coverage EID provides full fee-for-service Medicaid coverage for those with other health insurance or Medicare. Monthly premiums range from $0-$55

Intent of Supported Employment Supported Employment services are individualized and provided to assist eligible individuals to choose, obtain, maintain, or advance within competitive employment, in a community-integrated work environment, consistent with their interests, preferences, and skills.

PBHS Eligibility for Medicaid Recipients A person is automatically eligible if she or he: Has full Maryland Medicaid (not Qualified Medicare Beneficiary (QMB) or Specified Low Income Medicare Beneficiary (SLMB) ), Has a diagnosis covered by the Public Behavioral Health System (PBHS) Lives in Maryland voluntarily with intent to stay permanently Is a U.S. citizen or certain lawfully admitted aliens

Supported Employment Eligibility Once an individual meets financial eligibility for the PBHS (either through Medicaid or Uninsured Eligibility), he/she must then meet Medical Necessity criteria for supported employment. Medical Necessity is determined based on: Diagnosis Functional Limitations Clinical Risk

Supported Employment Eligibility Priority population diagnosis: Schizophrenia Spectrum Disorder Major Affective Disorder Other Psychotic Disorder Borderline or Schizotypal Personality Disorder

Supported Employment Eligibility Impaired role functioning for at least two years, including the inability to maintain independent employment and at least two of the following: Social behavior that results in interventions by the mental health system Inability, due to cognitive disorganization, to procure financial assistance to support living in the community Severe inability to establish or maintain a personal support system Need for assistance with basic living skills

Supported Employment Eligibility Work history has been non-existent, interrupted, or intermittent due to a significant psychiatric impairment Desire to attain competitive employment in the community, and Require supported employment services to choose, to obtain, to maintain, or to advance within competitive employment

Braided Services PrePlacement- BHA Job Development- DORS Placement- Job Coaching- Extended Supports-

Pre-Placement Services include: Vocational assessment Referral to the Division of Rehabilitation Services (DORS) Entitlements counseling Discussion of the risks and benefits of disability disclosure and informed choice Development of the Individual Vocational Plan (IVP)

Job Development Services include: Individualized job search Resume writing Application assistance Interview practice Advocacy

Job Placement Job placement includes assisting individuals in negotiating with the employer a mutually acceptable job offer and advocating for the terms and conditions of employment, to include any reasonable accommodations and adaptations requested by the individual Agency-sponsored and set-aside placements will not be eligible for supported employment supports

Job Coaching Job coaching services are intensive level supports designed to help the individual learn to perform job tasks to the employer’s specifications and to develop the interpersonal skills necessary to assume the employee role and to be accepted as a full-status employee at the job site and in related community-based settings Job coaching may also be used as a preventative intervention to assist the individual in preserving the job placement, resolving employment crises, and in stabilizing the employment situation for continuing employment

Job Coaching Includes: Support for new employee orientation Employer education and advocacy (if individual has disclosed) On the job skills training Identification of necessary accommodations and compensatory strategies Job analysis and environmental assessment Vocational counseling Mobility skills training

Extended Support Extended Support services include proactive employment advocacy, supportive counseling, and ancillary support services, at or away from the job site, to assist the individual in maintaining continuous, uninterrupted, competitive employment and to develop an employment-related support system.

Extended Support Service overview: Supports which assist an individual to maintain and/or advance in competitive employment Services encourage the use of natural supports Services are not time-limited Service provision should occur in the community

Getting Connected Anyone can make a referral for Supported Employment: Psychiatrist Therapist Local Behavioral Health Authority Family member or friend Individual seeking services

Supported Employment Resources Core Service Agency (CSA)/Local Behavioral Health Authority (LBHA): Familiar with eligibility for services and providers in your community BHA: Responsible for state-level policy, resources, and service eligibility information Division of Rehabilitation Services: State Vocational Rehabilitation Agency offering additional employment supports as well as the ability to fund additional resources which may assist an individual to obtain and maintain successful employment

Additional Resources Maryland Employment Network www.ticket2workmd.org Maryland Benefits Counseling Network www.mdbenefitscounseling.org

Questions Stacy Seymore, Director, Employment Services stacy.seymore2@maryland.gov