1. 1 29 th Annual NYAPRS Conference: Making the Ticket Work for You

2. TRACK: PROS WORKSHOP: 135 Presenters Joshua Carpenter, M.S.Ed., C.R.C., Clubhouse of Suffolk, Ronkonkoma NY Jason Vandewater, LMSW, Federation of Organizations, West Babylon NY Kelly Stengel, MPH, NYAPRS, Albany NY Oscar Jiménez, MPH, NYAPRS, Albany NY 2

3. Our Program for Today Ticket-to-Work Program At A Glance: –What is the Ticket –to-Work –Purpose of the Ticket-to-Work Program Provider’s Perspective: –Clubhouse of Suffolk –Federation of Organizations Resources for Employment Networks 3

4. 4 What is the Ticket to Work?

5. Ticket-to-Work Program: 101 What is the goal of the program? –Help people with disabilities get jobs and become more self-sufficient What is it the Ticket? –Similar to a voucher that allows people with disabilities to purchase employment services and supports Who can a Ticket Holder purchase services from? –An Employment Network (EN): Agency or program pre- approved by Social Security to take Tickets 5

6. Ticket-to-Work Program: 101 cont’d How much money is each Ticket worth? –Up to $23,000 (up to $5,100 the first 9 months) Who does the Ticket belong to? –The Ticket belongs to the person with a disability (“Ticket Holder”), not the provider nor the government –The Ticket Holder can choose the Employment Network she/he likes best, and switch at any point in time 6

7. 7 2011 MILESTONE-OUTCOME PAYMENT METHOD Payment TypeBeneficiary Earnings Required After Ticket Assignment SSDI Ticket- Holder SSI Ticket-Holder Milestone 1 Milestone 2 Milestone 3 Milestone 4 $360/ month x 1 month $720/ month x 3 months within 6 months $720/ month x 6 months within 12 months $720/ month x 9 months within 18 months $1279 Total for Phase 1$5,116 Outcome Phase Earnings sufficient for “zero cash benefit” status Up to 36 payments of $384/ month Up to 60 payments of $221/ month Total of Outcome Payments Available$13,824$13,260 Total of Milestones + Outcome Payments$23,164$22,354 Phase 2 Phase 1 MilestonesGross earnings at or over $1,000(non- blind)/month (SGA) Gross earnings at or over $1,640 (blind)/month (SGA) Up to 11 payments of $382/ month Up to 18 payments of $221/ month Total for Phase 2$4,224$3,978 Total Phase 1 + 2 Milestones Payments $9,340 $9,094 2011 Payments At A Glance

8. TypeTicket Holder EarningsEN Payment for SSDI EN Payment for SSI Phase 1 Milestone 1$360/ two weeks within 1 month $1,279 Milestone 2$720/mo for 3 months within 6 months (cumulative) $1,279 Milestone 3$720/mo for 6 months within 12 months (cumulative) $1,279 Milestone 4$720/mo for 9 months within 18 months (cumulative) $1,279 Total Potential Phase I Milestone Payments$5,116 2011 Rates Milestone-Outcome Payment System: Phase 1 Milestones 8

9. Type Ticket Holder Earnings EN Payment for SSDI EN Payment for SSI Phase 2Gross > SGA ($1000/non-blind; $1,640 for blind) $384/mo. (up to 11 mos.) $221/mo. (up to 18 mos.) Total Phase 2 Payments $4,224$3,978 Total Potential Ticket Payments Phases 1 and 2 $9,340$9,094 2011 Rates Milestone-Outcome Payment System: Phase 2 Payments 9

10. Milestone-Outcome Payment System: Outcome Payments Type Ticket Holder Earnings EN Payment for SSDI EN Payment for SSI Outcome PhaseNet > SGA ($1000/non-blind; $1,640 /blind) AND 0 cash benefit $384/mo. for up to 36 months $221/mo. for up to 60 months Total Outcome Phase Payments $13,824$13,260 Total Potential Ticket Payments $23,164$22,254 2011 Rates 10

11. 11 2011 MILESTONE-OUTCOME PAYMENT METHOD Payment TypeBeneficiary Earnings Required After Ticket Assignment SSDI Ticket- Holder SSI Ticket-Holder Milestone 1 Milestone 2 Milestone 3 Milestone 4 $360/ month x 1 month $720/ month x 3 months within 6 months $720/ month x 6 months within 12 months $720/ month x 9 months within 18 months $1279 Total for Phase 1$5,116 Outcome Phase Earnings sufficient for “zero cash benefit” status Up to 36 payments of $384/ month Up to 60 payments of $221/ month Total of Outcome Payments Available$13,824$13,260 Total of Milestones + Outcome Payments$23,164$22,354 Phase 2 Phase 1 MilestonesGross earnings at or over $1,000(non- blind)/month (SGA) Gross earnings at or over $1,640 (blind)/month (SGA) Up to 11 payments of $382/ month Up to 18 payments of $221/ month Total for Phase 2$4,224$3,978 Total Phase 1 + 2 Milestones Payments $9,340 $9,094 2011 Payments At A Glance

12. 1.When an individual has an ACCES-VR case OPEN, the Ticket is considered “in use” and it cannot be assigned to an EN 2.After VR case is formally closed, then the beneficiary can assign Ticket to an EN 3.If the VR case is closed successfully, then Phase One payments are NOT available 4.If the VR case is NOT closed successfully, then ALL Ticket payments may still be available 12 Partnership Plus at a Glance

13. Types of EN business models –Independent –Collaborative –Single administrator –State level strategies 13

14. Independent ENs 14 This example shows a collaborative web allowing for referral and mentoring efforts amongst separate EN’s ACCES-VR provides information about all EN options when closing a case Each EN completes a separate application to operate as an independent EN

15. Collaborative Agreement Strategy ACESS- VR Partnership Plus Advantages: Sharing of information & resources, staffing and community outreach Specific Advantage of collaboration with One- Stop: Access to database of potential Ticket holders who wish to return to work 15 ACCES-VR

16. Single Administrator EN Strategy 16 ACCES-VR Partnership Plus Contracted for Ticket Administration/ Outreach / Reporting Provide direct service to Ticket holders / Follow-up supports / data collection

17. State Level Strategy 17 Policy / Outreach / Reporting/Administration ACCES-VR Partnership Plus Contracted for Ticket Administration Provide direct service to Ticket holders / Follow-up supports / data collection

18. Provider’s Perspectives: Lessons and Challenges in Utilizing the Ticket- to- Work Program 18

19. Clubhouse of Suffolk - EN Current status of Tickets assigned – 28 total assignments 9 currently employed (4 @ TWL, i.e. triggering Phase 1 Milestones) 12 in job placement phase, 7 in job readiness development 5 payment requests thus far, with several expected in coming months Potential revenue look-back – 3 years since TTW regulations changed (July 2008) – Had tickets started being assigned then, potential revenue to date: $214,200 (approximately), based on past employment data at our 2 sites - Ronkonkoma & Riverhead (Synergy Center) 19

20. Clubhouse of Suffolk – EN (cont’d) Strategy for targeting Ticket holders – Target current and incoming PROS members first: 48 seeking employment at this time who are also eligible Ticket holders. – 4-6 calls per month from community ticket holders (about half do not have a psychiatric disability, provide referral) – Market Clubhouse Ticket to Work Services at Behavioral Health Trade Show (Mental Illness Awareness Day, October 2011) – Referral CD / Collaboration w/ Community ENs 20

21. Clubhouse of Suffolk – EN (cont’d) Lessons learned – Be selective in WHO you choose to assign and WHEN – ALWAYS check Ticket status with MAXIMUS (1 st meeting/contact, before IWP) Challenges and opportunities – Staffing / Expertise (Benefits counseling/planning paramount) – Everything must be submitted in paper format at this time – Integration into existing Electronic Health Record (EHR) – Expand into Clubhouse Case Management? (Future) 21

22. Clubhouse of Suffolk : New EN Requirements Impact on service delivery – More documentation (but not much) & better organization – Better, more comprehensive services, more qualified employees providing services – Complements and is in accordance w/ COS’s mission Affect on organizational structure – Differentiation and designation of staff w/ specific TTW related duties (counseling, billing, intakes, recordkeeping, etc.) and who has access to TTW-specific information. What have the changes meant for the Clubhouse of Suffolk: Not that much! – More structure, clarity of EN expectations, more solid service delivery. 22

23. Resources and Tools for Employment Networks and Ticket Holders 23

24. Resources and Tools for ENs and Ticket Holders Decision Tree Tool for Assigning Tickets YourTickettoWork.com SSA’s Technical Assistance and Support Center (TASC) Chooseworkttw.net 24

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26. YourTickettoWork.com Social Security Administration’s (SSA) website to provide information to ENs, VR agencies, and potential ENs For ENs – Has forms related to contract maintenance, Ticket assignments, and payments For potential ENs – Has information about program requirements and applying to become and EN 26

27. YourTickettoWork.com Resources for ENs Individualized Work Plan (IWP) 18 Month Prior Earning Look-Back Worksheet Payment Request Form Certification of Services Statement 2011 Payment at a Glance 27

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31. YourTickettoWork.com Resources for Potential ENs Information on Ticket to Work Basics Information and Tutorials Related to: – Outreach – Ticket Assignment – Requesting a Beneficiary CD – The Partnership Plus Program – Timely Progress Review 31

32. Technical Assistance and Support Center (TASC) Established to address technical assistance needs of Employment Networks Goal is to improve trainings and internal processes, increase Ticket assignments and payments, and increase access to sustained employment for Ticket Holders. 32

33. Technical Assistance and Support Center (TASC) (Cont.) Each Social Security region has a TASC Team lead by a Senior Account Manager TASC can support organizations by: – Answer questions regarding the EN application, completing IWPs, and submitting payment requests – Helping to incorporating TtW into their current business models – Facilitating the development of effective making strategies 33

34. Contacting Technical Assistance and Support Center (TASC) Current ENs: Michael Yozzi Senior Account Manager, Region 2 703.336.8008; Toll Free: 866.949.3687 ext. 8008 Fax: 703.893.4149 MichaelYozzi@maximus.com MichaelYozzi@maximus.com Prospective ENs: Joel Middleton Account Manager, Region 2 703.336.8108; Toll Free: 866.949.3687 ext. 8108 Fax: 703.893.4149 JoelMiddleton@maximus.com JoelMiddleton@maximus.com 34

35. Chooseworkttw.net Resources for Ticket Holders A website created for Social Security beneficiaries with disabilities who want to work Chooseworkttw.net This site has: – Videos of success stories – Information about the Ticket to Work Program – Work Incentive Seminar Event (WISE) information – Ticket to Work program documents 35

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37. Questions about future trainings and technical assistance? 37 Kelly Stengel, MPH NYAPRS Assistant Director of Community and Economic Development 8-436-0008, ext. 33 kellys@nyaprs.org Oscar Jimenez, MPH NYAPRS Director of Community and Economic Development 518-436-0008, ext. 21 oscarj@nyaprs.org

38. New York Makes Work Pay is a Comprehensive Employment System Medicaid Infrastructure Grant (Contract No. #1QACMS030318) from the U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services to the Office of Mental Health on behalf of New York State. It is a joint effort of the Burton Blatt Institute at Syracuse University and the Employment and Disability Institute at Cornell University with the collaborative support of the Employment Committee of the New York State Most Integrated Setting Coordinating Council to develop pathways and remove obstacles to employment for New Yorkers with disabilities. 38 New York Makes Work Pay Partnering Organizations