The Work Incentives Improvement Act of 1999 (S. 331)   

June 18, 1999 Summary Prepared by:
Sallie Rhodes, National Protection and Advocacy Systems
Washington, DC


The Work Incentives Improvement Act of 1999 (WIIA, S. 331) was adopted by the
Senate on June 16, 1999, by a roll call vote of 99-0. Although Senator
Harkin was not able to vote because he was out of the country, he made a
statement in the Congressional Record on June 17, expressing his support of
the bill.


S. 331 represents a comprehensive approach to addressing numerous barriers to
gainful employment faced by individuals with disabilities who are recipients
of Social Security disability benefits, i.e., Social Security Disability
Insurance (SSDI), Supplemental Security Income (SSI), Medicare, and
Medicaid. Approximately eight million people receive such benefits.

The bill contains three components: health care reforms, a program for
increased choice in employment service providers and work incentive reforms
which significantly upgrade the way Social Security handles the work attempts
of its customers.

New state options in Medicaid coverage and continued Medicare coverage for
certain working individuals address the biggest disincentive to employment
for individuals with disabilities who are recipients of Social Security
disability benefits, i.e., the need for continued access to health insurance.
S. 331 expands Medicaid options for States by creating two new optional
eligibility categories which would allow states to offer Medicaid coverage to
workers with disabilities. Participating states may require cost-sharing on
a sliding scale fee up to the full premium cost within certain guidelines.

Building on a coverage option enacted in the Balanced Budget Act of 1997,
states may offer a Medicaid buy-in to people with disabilities who earn above
250% of poverty.

States may cover individuals who continue to have a severe medically
impairment but lose eligibility for SSI or SSDI because of a medical

A third Medicaid program, a health care demonstration project, will allow
access to Medicaid services to a worker with a medically determinable
diagnosis likely to make them eligible for SSI/SSDI without such health care
services at their disposal.

In addition, provisions for continuing Medicare coverage, during a six-year
trial program, would permit SSDI beneficiaries to continue to receive
Medicare coverage. Currently, beneficiaries who return to work must pay Part
A premiums after a three year extended period of eligibility.

The bill calls for three GAO reports to look at both the Medicaid and
Medicare provisions. GAO is to submit reports that examine the extent to
which higher health care costs deter the employment of individuals with
disabilities, how states are implementing these provisions, and the costs and
effectiveness of the programs.
A program of Infrastructure Grants would make funds available to states to
support the design, establishment, and operation of infrastructures to
support working individuals with disabilities.

The "Ticket to Work and Self-Sufficiency Program" enhances the range of
choices available to Social Security disabilities beneficiaries when they are
seeking vocational rehabilitation and employment services because they want
to work, return to work, or upgrade their skills and employment status. If
the individual goes to work and achieves substantial earnings, the vocational
rehabilitation (VR) or employment services provider would be reimbursed based
on a portion of benefits saved.

By removing work disincentives, S. 331 would encourage SSDI and SSI
beneficiaries to return to work by providing assurance that cash benefits
would remain available if employment proves unsuccessful. Specifically,
these provisions prohibit using employment as the sole basis for scheduling a
continuing disability review and would expedite eligibility redeterminations
for individuals who had received SSDI but lost them due to work, but who need
to return to disability benefits.

With the inclusion of the Work Incentives Outreach and Assistance Programs,
the bill addresses directly the ever critical and often forgotten issue of
ensuring that individuals targeted by Social Security programs have access to
timely and accurate information about the existence of work incentives
programs, how participation in such programs will affect their benefit
status, and how to make sure that they are not negatively impacted by their
participation in such programs.

With the inclusion of funding for protection and advocacy services, S. 331
provides an assurance that beneficiaries of SSDI/SSI who are accessing the
programs and services provided for under this bill will have access to
assistance and advocacy services if they experience difficulties in their
relationships with service providers and program representatives. Such
access is particularly important given the targeted population for the
programs and services in this bill (i.e., individuals with severe
disabilities), the new way of seeking vocational rehabilitation, employment
supports and services, work incentives and other support needs provided for
in this bill, and the extreme complexity of negotiating the Social Security

The required $2 for $1 demonstration program will provide valuable
information as to whether removing the cash cliff faced by SSDI recipients
whose earnings exceed $500 a month, i.e., the Social Security
Administration's assigned value for "substantial gainful activity" (SGA),
will provide an incentive for these individuals to return to work. (NOTE:
SGA increases to $700 a month effective July 1, 1999.)

1.    Added details to GAO studies with regard to: (1) who (types of
disabilities) takes advantage of the Medicaid expansion provisions; (2) their
income levels; (3) their actual medical costs; and (4) their use of private
insurance. Benefits: Federal and State governments and private insurers will
have access to important information that could shape the creation of
appropriate private health care options for workers with

2.    Added a provision requiring States to charge 100% of the Medicaid
premium to individuals who have an adjusted gross income over $75,000. This
amount must be indexed each year. There is nothing that prevents the use of
State monies to supplement these premiums; the protection only applies to the
federal funds. States may charge a sliding scale fee up to 100% of premium
costs for individuals with earned income over 250% of poverty; however, if
you earn between 250% and 450%, your premium cost may not be more than 7.5%
of your adjusted gross earned income. (Earned income includes the exclusion
of the disregards established under current law.)

3.    Reduced the period of Medicare continuation to 6 years (originally was
10 years). The "grandfather" clause remains, i.e., if enrolled in the
Medicare program in WIIA and the program is not extended, the worker would
receive Medicare for life as long as the person remains disabled.

4.    Made the authorization of the Ticket to Work Program permanent;
changed the composition of the Work Incentives Advisory Panel and the
appointment process; and made the Work Incentives Planning and Assistance
Program and the Protection and Advocacy Program a 5-year authorization,
rather than permanent.

5.    Struck the foreign tax credit carryover provision and other offsets
from the bill. (The Unanimous Consent from June 15 states that it is out of
order for the Senate to consider any conference report on this bill that does
not offset the bill's spending.)

6. Advisory Panel: All panel members must still be subject matter experts.
Past or present consumers must make up 50% of the panel, that is, six of the
twelve members must be past or present consumers of services. The original
ratio was seven consumers and five did not have to be consumers. The Panel
is now selected by bipartisan members of the Congress, not the Commissioner
of Social Security.

In addition, the following changes were made in conjunction with changes made
during the markup of the House companion bill (H.R. 1180). When H.R. 1180
was marked-up by the House Commerce Committee's Subcommittee on Health and
the Environment the following changes were made which are now included in S.

    Limits eligibility for Medicaid Buy-in for working disabled to ages 16
to 65.

    Allows reinstatement of MediGap coverage for those who need to leave
work and return to Disability Insurance.

NOTE WELL: Several people not up on all the details have commented recently:
"The health care in WIIA was cut to six years." The Medicare program only in
S. 331 was cut to 6 years. It is very helpful to point out at this time that
each provision in WIIA has separate time lines or no time lines, depending on
the provision.