a disability system for the 21 st century social security advisory board
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A DISABILITY SYSTEM FOR THE 21ST CENTURY
SOCIAL SECURITY ADVISORY BOARD
Social Security Advisory Board
www.ssab.gov2
SOCIAL SECURITY ADVISORY BOARD
A Disability System for the 21st Century
Cornell/AAPD Policy Forum
Hon. Dorcas R. HardyBoard Member
Former Commissioner of Social Security
January 12, 2007
Social Security Advisory Board
www.ssab.gov3
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
www.ssab.gov4
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
www.ssab.gov5
TRENDS: Persons with Disabilities
2005
Social Security Advisory Board
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FUTURE TRENDS
2025
Social Security Advisory Board
www.ssab.gov7
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
www.ssab.gov8
SSDI and SSI TODAY
All or nothing definitionUnable 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
www.ssab.gov9
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
www.ssab.gov10
A DISABILITY SYSTEM for the 21ST CENTURY
Invited an expert panel to assist SSAB:
Richard Burkhauser, Cornell UniversityMarty Ford, Disability Policy Collaboration, The Arc/UCPAllen Heinemann, Rehabilitation Institute of ChicagoAndy Imparato, American Association of People with DisabilitiesKen Mitchell, UnumProvident
Held public hearings and roundtable discussions around the country
Social Security Advisory Board
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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
Social Security Advisory Board
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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
Social Security Advisory Board
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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
Social Security Advisory Board
www.ssab.gov14
CONCEPTUAL MODEL for ADULTS
The Process:
Development of tailored work prescriptionthat includes:
Income maintenance Medical treatment Rehabilitation, counseling, and training
Administration: external to SSA
Social Security Advisory Board
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CONCEPTUAL MODEL for ADULTS
Triageassessment
SSDI/SSI
Exit to employment
Substantial work
history
Little or noworkhistory
Adult Model
Transition program• develop work Rx • coordinate supports
Social Security Advisory Board
www.ssab.gov16
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
Social Security Advisory Board
www.ssab.gov17
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
www.ssab.gov18
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
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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
Social Security Advisory Board
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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
Social Security Advisory Board
www.ssab.gov21
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
www.ssab.gov22
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
www.ssab.gov23
A DISABILITY SYSTEM for the 21ST 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 21st century demands a system that fulfills the goals of the ADA and we believe that the time is now to explore alternatives.