A DISABILITY SYSTEM FOR THE 21ST CENTURY

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A DISABILITY SYSTEM FOR THE 21ST CENTURY

• SOCIAL SECURITY ADVISORY BOARD

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SOCIAL SECURITY ADVISORY BOARD

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

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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
  

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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

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TRENDS Persons with Disabilities
2005
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FUTURE TRENDS
2025
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FUTURE PUBLIC POLICY

• Strength of workforce based on ones ability to
  participate not ones inability
  
• Public disability policy should better focus on
  assisting workers to remain in the workforce.

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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
  

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DISABILITY PARADOX

• Is It Social Securitys Definition of
  Disability?
  
• OR
• Is SSA Targeting Persons with Disabilities At The
  Wrong Time?
  

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A DISABILITY SYSTEM for the 21ST 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
  

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A DISABILITY SYSTEM for the 21ST CENTURY

• Developed a 21st 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

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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
  

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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
  

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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

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CONCEPTUAL MODEL for ADULTS
Adult Model
Little or no work history
Substantial work history
Triage assessment
SSDI/SSI

• Transition program
• develop work Rx
• coordinate supports

Exit to employment
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PROFILE OF SSI YOUTH

• Less than half of SSI youth graduate from
  secondary school
  
• 60 of SSI youth ages 19-23 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
  

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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
  

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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

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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
  

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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
  

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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
  

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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
  

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A DISABILITY SYSTEM for the 21ST CENTURY

• the Nations 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 21st century
  demands a system that fulfills the goals of the
  ADA and we believe that the time is now to
  explore alternatives.