1. Work Incentives in Virginia A system geared toward an outcome of self-sufficiency

2. Virginia’s Approach This presentation will demonstrate Virginia’s successful outcome based approach to employment and self sufficiency for clients on SSI/SSDI. Medicaid Works and 1619B will be highlighted

3. Positive Employment Outcomes Virginia finds that the combination of WorkWORLD and Work Incentives Specialists (WISAs) leads to positive employment outcomes.

4. Dual Strategies Our approach uses dual strategies. WorkWORLD, which calculates and uses both federal and state work incentives and eligibility calculations to provide an accurate analysis and side by side “what ifs;” And WISAs (work incentive specialist advocates) that work with the client to create an analysis that shows current and future actions.

5. WW Addresses Issues of Trust It is Person Centered planning that allows people to dream about where they might be in 5 years. Clients can understand what will happen to their benefits when they go to work and ultimately reach self sufficiency.

6. Virginia Department for Aging and Rehabilitative Services made the decision to train staff as WISAs embedded within Ticket to Work partnership plus Employment Networks. Created an anchor service for clients to tap into future services post VR closure as needed through the Ticket to Work Program.

7. What is a WISA Work Incentive Specialist Advocate (WISA)with credentials through Cornell University or certification as a community work incentive coordinator through VCU. Fee for service vendor with DARS 10 services can be authorized on behalf of a DARS client WISA’s provide a safety net to support a client’s choice to go to work

8. WISA program in Virginia the beginning Work Incentive Specialist Advocate program began in Virginia in 2006 Initially funded through the Medicaid Infrastructure Grant Goal was to create a safety net to support an individuals choice to go to work DARS would pay for outcomes not advice

9. Evidence of VR Success Virginia has identified that counselors who utilize work incentives with their consumers have an 75% successful closure rates as compared to 41% for the same population when no work incentives are used. Data includes over1,300 cases closed to the agency

10. Capacity building the numbers SFY 2011 51 authorized services through 8 service providers SFY 2012 114 services 7 providers SFY 2013 330 services 17 providers SFY 2014 818 services 27 providers(34 staff) SFY 2015 YTD 2,700 + services 28 providers(75 staff)

11. Specific Work Incentive Services WorkWORLD Analysis Benefit Planning Query (BPQY) Student Earned Income Exclusion 1619(b) Medicaid Works Individual Development Accounts Plan to Achieve Self Support Impairment Related Work Expense Subsidy Blind Work Expense Overpayments

12. Continuous Improvements Work Incentive Specialist position WorkWORLD is now web based Work Incentive Manual Additional trainings developed

13. Expectations for the future # of authorizations will continue to increase Success rates will remain consistent More organizations will add WISAs to their staff Additional opportunities for WISA’s to vend these services to other agencies

14. Medicaid Infrastructure Grant and Medicaid Buy-In Authorized under the Balanced Budget Act of 1997 and the Ticket to Work and Work Incentives Improvement Act of 1999

15. Medicaid Infrastructure Grant and Medicaid Buy-In Support people with disabilities in securing and sustaining competitive employment in an integrated setting by targeting improvements to the Medicaid program

16. Eligibility Requirements: Disabled 16 through 64 years of age Meet all requirements of Medicaid group with income ≤ 80% of poverty ($785/month, $9,420/year in 2016)  Important note: SSI beneficiaries are considered income eligible, but must meet resource limit of $2,000 ($3,000 if couple) Employed or have letter from employer Virginia’s Medicaid Buy-In Program MEDICAID WORKS Overview

17. “Disabled” Requirement Current enrollment in SSI or SSDI programs Finding of disability for Medicaid by the Disability Determination Services (DDS) unit

18. Must be “Employed” or “Working” Competitive employment in an integrated setting Compensation at or above minimum wage Payroll taxes withheld (documentation req.) If self-employed, earnings documentation of IRS filings, quarterly estimated taxes, business records or business plan

19. Complete the MEDICAID WORKS Agreement Establish “Work Incentive” (WIN) account(s) –Deposit all earned income and resources Submit payment of a premium, if required –Monthly premium continues to be waived –If implemented, on a sliding scale Additional Eligibility Requirements

20. Recommend contacting the Work Incentive Planning and Assistance (WIPA) project Community Work Incentive Coordinators (CWICs) provide benefits planning services WorkWORLD Before Enrollment

21. Earned income in WIN account of up to 200% of Federal Poverty Level ($34,543 in 2015) –Medicaid/SSI methodology for countable income –Assistance unit of one –Gross earnings of up to $75,000 Upon Enrollment

22. Resources from earnings in WIN account up to annual SSI threshold for Virginia ($35,118 in 2016) –Exclude amounts in IRS-approved accounts Upon Enrollment

23. Safety net –Allow 6 months continued coverage if unemployed due to unavoidable employment interruptions

24. 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

25. Upon Enrollment Safety net (continued) –Amounts in IRS-approved accounts established as WIN accounts disregarded in all future Medicaid determinations

26. 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.

27. Enrollee Demographics MEDICAID WORKS Program As of March 2016, 54 workers with disabilities enrolled. –Age range: 20 to 64 –Gender: 21 Female and 24 Male –Hourly wage range: $7.25 to $20.00 –Average Hours: over 20 weekly (range 16 to 40) –Enrollment by DSS agency localities: Central – 5, Eastern – 20, Northern – 10, Western – 4 and Piedmont – 6

28. Continued Medicaid Eligibility (Section 1619(B)) 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.

29. 1619 B SSA 2 step process SSA Role

30. 1619 B DSS The second step in determining if a 1619 (b) eligible individual is able to continue their Medicaid coverage is managed by DSS

31. 1619 B

32. 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.

33. WorkWORLD Demonstration

34. Division of Rehabilitative Services Virginia Dept for Aging and Rehabilitative Services www.vadars.org 800-552-5019 (voice) 800-464-9950 (TTY) David.Leon@dars.virginia.govDavid.Leon@dars.virginia.gov Ticket to Work Coordinator (804) 662-7151 Contact us