A DISABILITY SYSTEM FOR THE 21 ST CENTURY SOCIAL SECURITY ADVISORY BOARD

Social Security Advisory Board 2 SOCIAL SECURITY ADVISORY BOARD A Disability System for the 21 st Century Cornell/AAPD Policy Forum Hon. Dorcas R. Hardy Board Member Former Commissioner of Social Security January 12, 2007

Social Security Advisory Board 3 SOCIAL SECURITY ADVISORY BOARD Established in 1994 as an independent, bipartisan Board 12 years of studies kept leading us back to the disability programs and the need to modernize Disability system is disjointed and uncoordinated Align more closely with the Americans with Disabilities Act SSDI and SSI should be options of last resort – not the only option

Social Security Advisory Board 4 TRENDS: DISABILITY BENEFICIARIES AND EXPENDITURES 2002 Federal/State program costs: $276 billion or 2.7% GDP Last 15 years: Working-age population 18% SSDI beneficiaries 117% SSI recipients 66% Long-range SSDI costs 38%

Social Security Advisory Board 5 TRENDS: Persons with Disabilities 2005

Social Security Advisory Board 6 FUTURE TRENDS 2025

Social Security Advisory Board 7 FUTURE PUBLIC POLICY Strength of workforce based on one’s ability to participate not one’s inability Public disability policy should better focus on assisting workers to remain in the workforce.

Social Security Advisory Board 8 SSDI and SSI TODAY All or nothing definition Unable to engage in SGA due to impairment which results in death or lasts at least 12 months Beneficiaries have significant limitations and bleak employment outlook Efforts focus on returning to work after proving inability to work

Social Security Advisory Board 9 DISABILITY PARADOX Is It Social Security’s Definition of Disability? OR Is SSA Targeting Persons with Disabilities At The Wrong Time?

Social Security Advisory Board 10 A DISABILITY SYSTEM for the 21 ST CENTURY Invited an expert panel to assist SSAB: Richard Burkhauser, Cornell University Marty Ford, Disability Policy Collaboration, The Arc/UCP Allen Heinemann, Rehabilitation Institute of Chicago Andy Imparato, American Association of People with Disabilities Ken Mitchell, UnumProvident Held public hearings and roundtable discussions around the country

Social Security Advisory Board 11 A DISABILITY SYSTEM for the 21 ST CENTURY Developed a 21 st century vision that: – Supports individuals and maximizes employment outcomes – Facilitates a culture of ability to work – Addresses dynamic nature of disability and impact on work – Coordinates and integrates services

Social Security Advisory Board 12 CONCEPTUAL MODEL for ADULTS Assumptions: Not a barrier to permanent disability benefits Timely intervention is critical Triage, assessment, and work Rx available before applying for SSDI/SSI

Social Security Advisory Board 13 CONCEPTUAL MODEL for ADULTS The Process: Establish a “front-end” that coordinates and integrates RTW assessment and service: a single point of entry Focused and ongoing case management Multidimensional evaluation using nationwide network of public and private providers

Social Security Advisory Board 14 CONCEPTUAL MODEL for ADULTS The Process: Development of tailored work prescription that includes: Income maintenance Medical treatment Rehabilitation, counseling, and training Administration: external to SSA

Social Security Advisory Board 15 CONCEPTUAL MODEL for ADULTS Triage assessment SSDI/SSI Exit to employment Substantial work history Little or no work history Adult Model Transition program develop work Rx coordinate supports

Social Security Advisory Board 16 PROFILE OF SSI YOUTH Less than half of SSI youth graduate from secondary school 60% of SSI youth ages are not working, in school, or attending vocational training Post age 18 redetermination: 50% are not working, in school, or in a training program On or off SSI: income just above the poverty line

Social Security Advisory Board 17 INTEGRATED MODEL for SSI YOUTH Assumptions: Early, comprehensive, functional assessment Expectations of independence, self-support, and community inclusion Continuing guidance and coordinated access to services and supports

Social Security Advisory Board 18 INTEGRATED MODEL for SSI YOUTH Life-progression plan – not another IEP element – Multidisciplinary assessments leading to dynamic educational and support program Participation is voluntary; not linked to special education Continue to receive SSI and Medicaid Incentives to participate: differential program rules Administration: external to SSA

Social Security Advisory Board 19 POLICY CHALLENGES Make work pay Access to health care Job preparation trust funds Refocus criteria for age-18 redetermination Address disincentives to work: create system-wide buy-in programs

Social Security Advisory Board 20 MAKE WORK PAY Create more effective incentives to make work pay – Wider availability of short-term benefits – Revise work, earnings, and asset rules – Earned income tax credit for people with disabilities – Tax sheltered savings to encourage asset accumulation that supports work efforts – New tax credits for employers with strong RTW programs

Social Security Advisory Board 21 ACCESS TO HEALTH CARE Any system change must address health insurance coverage. COBRA is available for some, but can be very costly. Expand access through public programs based on cost-sharing Establish lifetime certification for health coverage for those with lifelong conditions Explore public/private partnership to provide health coverage

Social Security Advisory Board 22 OPPORTUNITY: STATE SHORT-TERM DISABILITY PROGRAMS Pre-test concept of an alternate coordinated path for adults with disabilities Partner with the short-term programs that exist in CA, HI, NJ, NY, RI, and Puerto Rico. Add “upfront” assessment that leads to rehabilitation, and training. State pays usual benefits; public/private partnership provides wrap- around program Measure outcomes and determine cost-effectiveness of an integrated disability system

Social Security Advisory Board 23 A DISABILITY SYSTEM for the 21 ST CENTURY … the Nation’s proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living, and economic self-sufficiency … Americans with Disabilities Act Social Security disability programs are vital supports that must continue Urge policymakers to revisit a definition of disability that emphasizes inabilities rather than abilities There is no magic answer, but the 21 st century demands a system that fulfills the goals of the ADA and we believe that the time is now to explore alternatives.