From: "Ryan, Millie" <>
To: 'Jim Gottstein' <>,
Cc:, walter majoros
         <>, Katsumi Kenaston <>,
        "Maltman, David" <>
Subject: RE: TWWIIA
Date: Tue, 27 Jun 2000 16:37:00 -0800
X-Mailer: Internet Mail Service (5.5.2448.0)

Hi Jim -

Sorry to be so late getting back to you.  I was out of town and am trying to
catch up on everything.  We recently held our second Think Tank on June 8-9
and discussed aspects of TWWIIA implementation, so hopefully I can provide
you with some of the group's thinking.  Kelly Behen and Richard Rainery
represented the Alaska Mental Health Board at the Think Tank.

In terms of the Ticket side of the Act, the Social Security Administration
plans to phase in states starting January 2001.  Duane French, the director
of the Division of Vocational Rehabilitation, would like to see Alaska be
one of the early implementers in January 2001.  Each year, more states will
be phased in until the Ticket is available nationally in January 2004.
During the Think Tank on June 8-9, it was recommended that the Division of
Vocational Rehabilitation convene a meeting of providers interested in being
an Employment Network to discuss strategies for meeting the desires and
needs of ticket holders, including sharing resources as appropriate.
However, the Social Security Administration has yet to issue any guidelines
for the establishment of Employment Networks.  SSA is in the process of
contracting for a Program Manager to oversee the implementation of the
Ticket side of the Act; once that happens, we should have a clearer picture
of how the Ticket will work.

In terms of the state's plans for implementing the Act, the Think Tank
further refined a set of action plans, many of which are directly related to
the Act. The general areas we covered included strategies to enlist employer
involvement, ensure health care coverage and address current disincentives
to employment, develop comprehensive service delivery approaches and address
the fears that many people have about going to work. 
Once we get the action plans typed up, I'll be happy to send you a copy.

In terms of the federal grants available, there are two grants available
through the Health Care Financing Administration and one through the Social
Security Administration.  In addition, the Department of Labor also has a
related request for proposals out now.

The first grant available from the Health Care Financing Administration is
to ensure access to health care through a Medicaid Buy-In Program and to
support State efforts to enhance their Medicaid programs to better meet the
needs of people with disabilities who are employed.  It cannot be used for
direct services; instead funds are intended to create system change that
will result in services and supports being made available through Medicaid
that enable people to go to work. 

Although Alaska has a Buy-In program now, it is not as liberal as some other
states in terms of resource and unearned income limits. The Think Tank came
up with an action plan to address some of the problems; however, we may need
to go back to the legislature and request changes. 

We have also identified some areas in general where changes to the Medicaid
program are needed (e.g. expansion of Personal Assistance Services, changes
in the role of eligibility workers, psychosocial rehabilitation) but need to
gather more specifics. We look forward to working with you and Katsumi to
further identify the specific needs of mental health consumers.  Then, we
will all need to work together to make sure needed policy changes happen
through amendments to the State Medicaid Plan.  The HCFA grant funds will
enable the state to make these changes. 

Either the State Medicaid Agency or another State Agency in partnership,
agreement and active participation of the State Medicaid Agency is eligible
to apply for these funds.  Since the Council has been leading systems change
efforts with a variety of partners, including the Division of Medical
Assistance, over the past few years with funds provided by the Trust and the
Rehabilitation Services Administration, the Division of Medical Assistance
would like the Council to apply for these funds.
HCFA also has funds available to allow states to extend the Medicaid Buy-In
program to people whose disability is not yet severe but will most likely
become so without medical assistance.  States can identify up to three
potentially severe physical or mental impairments.  Some of the target
groups discussed at a meeting I was at last week are diabetes, neurological
diseases, mental illnesses, HIV/AIDs, congestive heart failure and cancers.
Only the State Medicaid Agency can apply for these funds.  I don't know if
the Division of Medical Assistance plans to apply for these funds.  We have
a meeting scheduled later this week to talk about the HCFA grants, so I will
know more after that meeting.

The Social Security Administration has funds available for outreach and
benefits counseling.  The Center for Human Development at the University of
Alaska Anchorage is applying for these funds since the Think Tank wanted to
see a statewide program and the Center has distance delivery capacity.  Over
the past few months, a number of benefits counselors have been trained; the
Think Tank felt it was very important that we develop a means of providing
ongoing support and technical assistance to them and to other soon to be
trained persons so they give accurate information to consumers.  Think Tank
participants also discussed ways to outreach to consumer groups, service
providers and other groups in two ways: 1) basic benefits counseling
training for referral sources not interested in becoming benefits counseling
and 20 advanced training for people wanting to provide benefits counseling
services.  Another important aspect of the training will be teaching people
how to market the value of benefits counseling to potential funding sources.

The Department of Labor grants are intended to make the one-stop career
centers (in Alaska's case, the job centers) more useable and accessible by
people with disabilities.  We have been working in this area for the past
eight months through our Alaska Works grants. We have three resource
specialists working with the job centers in Anchorage, Juneau and Fairbanks;
eventually they will work with all the job centers in Alaska.  If Alaska
receives one of the Department of Labor grants, funds will be used to build
upon and complement existing activities and address the needs and
recommendations that we received from several consumer focus groups.  The
Division of Vocational Rehabilitation will be applying for these funds.

I know that I seem somewhat vague as to what we want to do with these
grants, but some smaller planning groups are meeting over the next few days
to flesh out the ideas generated at the Think Tank.  Hopefully, we will have
abstracts available in the next week or so that will better describe what we
want to do.  I'll be happy to forward the abstracts to you once we get them
put together.

In the meantime, if there are any ideas you all have I would appreciate
hearing from you.



        -----Original Message-----
        From:   Jim Gottstein []
        Sent:   Tuesday, June 20, 2000 8:11 AM
        Cc:; walter majoros; Katsumi
        Subject:        TWWIIA

        Dear Ms. Ryan,

        I am a member of the Alaska Mental Health Board and a member of the
        of Directors for the Alaska Mental Health Consumer Web,  One of my biggest issues is meaningful
employment of
        adult mental health consumers.  Katsumi Kenaston informs me that you
        the person within the DMHDD who is spearheading the TWWIIA effort on
        of the State.   I was wondering if there might be some information
that you
        could provide me and particularly for publication on the Alaska
        Health Consumer Web, that would inform consumers about (a) what they
        to do to utilize the TWWIA to help them get employment in Alaska,
(b) what
        the state's plans are for implementation of the Act, and (c) the
        efforts to access the federal grant funds that are available under
        Jim Gottstein, CEO
        Touch N' Go Systems
        406 G Street, Suite 210
        Anchorage,  Alaska  99501
        tel (907) 264-6333
        fax (907) 274-9493