WISE Ticket to Work Webinar
Understanding Ticket to Work: How to Help Your Clients and the People You Serve
April 24, 2019

Speakers: Stacey Plizga (Moderator); Raymond Cebula, Jayme Pendergraft & Greg Bell (Presenters)

STACEY>> Good afternoon, everyone, and welcome to today's Ticket to Work, "Understanding Ticket to Work: How to Help Your Clients and the People You Serve." 

My name is Stacey Plizga. I am a member of the Ticket to Work Team, and I will be your moderator for today's webinar. We are so glad that you are able to take the time to spend with us today to learn how you can make the most of the Ticket to Work program to help your clients and the people that you serve.

Let's get started by going over some of the functions of the webinar platform so you can interact and get the most out of the information that will be presented today. First, you can manage your own audio using the "Audio" option at the top of your screen. The "Audio" option is an icon that looks like microphone or a telephone. All attendees will be muted throughout today's webinar; thus, when you are presented with the option of joining the audio conference, choose "Listen Only, which appears at the bottom right in the Audio menu. Clicking "Listen Only" allows the sound to be broadcast through your computer speakers or your headphones.

If you are unable to connect to the audio with your computer or if you prefer to listen to the webinar by phone, you can dial 1-800-832-0736 and enter access code 4189148#. 

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Real-time caption is available and is displayed in the captioning pod, which is the box that appears below the slide that is your screen right now. You can also access captioning online by going to http://bit.ly/captions-APR19. This link can also be found in the Web Links pod under the title "Closed Captioning."

We are today to answer questions you have on the Ticket to Work program and serving your clients, so please send your questions into us at any time throughout today's webinar by typing them into the Q&A pod. We will direct a question to the appropriate speaker during the Q&A portion of our webinar, and we will address questions at two different points throughout today's presentation. So go ahead and send those questions in, and we will do our very best to answer as many of them as possible.

If you are listening by phone and you are not logged into the webinar, you may ask questions by sending an e-mail to Ticket to Work. The e-mail address is webinars@choosework.ssa.gov.

Another resource available that we think you'll find extremely helpful in connecting to the different resources mentioned is the Web Links pod, which you will find at the bottom right-hand side of your screen. This pod lists all the links to the resources presented during today's webinar. To access any of these resources, you will simply highlight the topic you are interested in that you would like to connect to and then select the "Browse To" button at the bottom of the pod. You will be taken to the website requested.

If you are listening by phone and not logged into the webinar or don't have access to the Web Links pod, you can e-mail Ticket to Work. The e-mail address is webinars@choosework.ssa.gov or reference the confirmation e-mail that you received for today's webinar for a list of available resources. 

Also, please note that SSA cannot guarantee and is not responsible for the accessibility of external websites.

Today's will be is being recorded, and a copy of it will be available within two weeks on the Choose Work website, which can be accessed at http://bit.ly/WISE/WISEarchives. This link, as well as others, can be found in that Web Links pod we just talked about in the bottom right-hand corner of your screen; and it is titled "WISE Webinar Archives." 

We hope that everyone has a great experience on our webinar today. However, if you run into any technical difficulties, please use the Q&A pod to send us a message; or you can send us an e-mail at the Ticket to Work e-mail address, which is webinars@choosework.ssa.gov. 

As mentioned earlier, my name is Stacey Plizga, and I am a member of the Ticket to Work Team. I am very excited to be here with all of you today as your moderator. We are delighted to have with us three speakers who will not only share information about Social Security's Ticket to Work program, but will also share information on how to help our clients and those you serve to assist them in their journey to financial independence.

Our first speaker, Ray Cebula, received his law degree from the Franklin Pierce Law Center. He spent 23 years working with legal services, providing direct representation to individuals with disabilities having legal issues with the SSA. He became part of Cornell University's Work Incentive Support Center in 2000 and in 2005 was brought on staff at ILR's Yang-Tan Institute on Employment and Disability, where he now serves as the program director of YTI Online, which is Cornell's Work Incentives Practitioner Credentialing program. While with YTI, he has provided training and technical assistance to youth transition demonstration projects, served as director of training and technical assistance for the New York State Medicaid Infrastructure grants, and continues to serve as a team member for the Technical Assistance Team of the National Training Center of CCU.

Our second speaker, Jayme Pendergraft, is the Outreach Manager for Social Security's Ticket Program. She oversees Ticket to Work program communication efforts including WISE webinars, social media, the Choose Work blog, and other outreach channels. She has supported the Ticket program for more than ten years and has dedicated her career to improving employment outcomes for people with disabilities. 

Our third speaker, Greg Bell, has 20 years of experience in the vocational rehabilitation field and is currently the Business Development Specialist for the Ticket to Work program. He started his career as a vocational services counselor working with individuals with developmental disabilities and mental illness and has collaborated with several agencies including the Department of Social Services, Virginia Darth, and One Stop. Mr. Bell has also served as the Senior Account Manager for TPM managing account specialists who provide technical assistance to ENs on the East Coast and Midwest.

We are excited to have these very knowledgeable speakers with us today to share their experiences and their expertise to assist you with helping your clients with their employment journey. 

Thank you all for joining us. Today's WISE webinar is for the people interested in learning how to talk with the people they serve about the Ticket to Work program. If you are someone who receives Social Security Disability benefits, we welcome you as well; but you may be more interested in taking a look at some of our archived webinars which are available online at http://fit.ly/WISE_OnDemand. 

We have a very informative session planned where our guest presenters will discuss how Social Security's Ticket to Work program can help the people that you serve and will answer questions that will help you to understand Social Security's Ticket to Work program, how you can connect to Ticket to Work service providers in your area; how you can share information about the program via some of your outreach and communication channels; like newsletters or social media; and finally, how to become an employment network.

It is my pleasure to introduce Ray Cebula, who will talk to us about Social Security Disability benefits and Ticket to Work.

Over to you, Ray. 

[Pause]

Ray, remember to take yourself off of mute; and you are up.

RAY>> Yes, thank you so much for that that (laughing). I was talking away having a grand old time here. I just want to say again I'm very, very happy to be here with you; and having been a fan of the Ticket to Work since President Clinton signed it and remaining a fan of the Ticket to Work. I think it's one of the best things that has happened to bring work incentives and the ability to work for our clients into the forefront. So I'm really happy because I also believe that VR counselors should be playing a major role in this, along with the ENs we have that are working so hard now; so we're talking to some great people hear who need to know and are in a great position to help.

Now, we are going to be talking about two different programs here just as a review quickly... Social Security Disability Insurance, which is an insurance program. It's the program that we all pay into with our FICA taxes and become insured for both disability purposes, should we need that, and retirement. I'm look forward to the retirement part myself pretty soon; it's been a long time. And then the SSI program, which is a poverty program. It's basically a federal welfare program that doesn't require a work history but still requires somebody to meet the Social Security definition of disability and has very low income and resources.

Both groups of people are eligible to receive a ticket to work. The only difference, the only caveat that I'll point out, is that if somebody is under the age of 18, they're not going to get a ticket. They will go through an Age 18 SSI review and if they are found disabled as an adult will receive that ticket. So watch for that when you're doing your work with transition-age youth. 

Let's continue to talk about that Ticket to Work. Again, major fan here...I think it's still underused but is a major tool for getting our clients services. This is a national employment program. It's going to support career development for people with disabilities (inaudible) work. It is fully voluntary. People can choose to use these tickets, and it does bring some advantages. Again, people need to be between the ages of 18 and 64...18, provided they've gone through that review and have been determined to be a disable adult and free and voluntary. We're going to get a lot of free support services, educational services...all kinds of great stuff to help prepare our clients or re-prepare them to enter the workforce.

We just did that one...how does it work?

The Ticket to Work has ticket holders; those are our clients. We're choosing an employment service, and we're assigning that ticket. That sounds like a simple thing, but it's really a formal step. It's not handing a VR counselor their paper ticket and having that ticket slipped into a file or giving it to an EN and having them put it into a file. We have to collaborate with our clients, talk to them, set up a plan that's going to put together a roadmap to work. That plan has certain requirements. Once the plan has been agreed to by the VR/EN and the client, it's signed off by both, sent off to MAXIMUS. I'm sure you're all aware of MAXIMUS. They will approve it, and that approval happens real quick. Then your client will receive a letter from MAXIMUS on Social Security stationery that says your ticket has been assigned; that letter is real important.

The goal for the ticketholder and the person that's using it...this is a serious step. If you're familiar with a PASS plan, it's as serious as that. The goal is to reduce and, when possible, eliminate the reliance on Social Security Disability and replace that with earnings from work. Now, we know about benefits planning; and benefits planners out there are here to make sure that when we're replacing benefits with work we are making sure that people are better off. The idea of getting into the financial world and becoming financially stable generally means having more money and maintaining some health benefits rather than the opposite, as was happening when they were living on benefits. 

Most people are still squeaking by, and the SSI population is not doing well on benefits at all. Fortunately, a little bit of work goes a long, long, way here. 

The work incentives that are out there are actually pretty amazing. Now, we have two different programs; and we have to pay attention. We have to know what kinds of benefits our clients is receiving before we begin to talk to them about work incentives because some apply to Title II, the SSDI program; some apply to Title XVI, the SSI program. Some sound like the same, but they apply differently to each program...so very, very important.

More than 20...there are lots of them out there, and work incentives are something like voting in Chicago; you should be using them early and using them often, and there's nothing against the rules about using all of them if you're eligible to use them all and just to make sure that work pays. This is a way that our clients can basically go back to work, be better off, be financially stable at their own level of comfort because we all know there are still fears out there. 

And notice on this bullet here...the slide here...it says they're going to retain medical benefits. In today's day and age, it's really hard in most states for somebody to lose their health benefits. They may have to pay a little bit, but that's part of getting into the work market. Expedited reinstatement is truly an amazing thing. As you heard, I am a lawyer by trade...a work incentive specialist by choice. But when I heard about Expedited Reinstatement, I could not for the life of me figure it out.

Expedited Reinstatement is a work incentive that is available to people who have been terminated from benefits. They are success stories. They have worked to the point where benefits are terminated. They're cash benefits. If those cash benefits are terminated because of earnings, you would think Social Security would graciously walk them out the door; but that's not the case. Social Security sets up one final safety net that protects that former cash beneficiary for five years. It begins the month benefits are terminated because of work and earnings.

If at any time during the next five-year period that person's income stops or drops below substantial gainful activity, that person is maybe eligible for expedited reinstatement. And if they are, it's basically called "easy on." You don't have to start at the beginning and reapply. You can simply walk in, apply for expedited reinstatement. You will receive provisional benefits for a temporary period with some erasing over the year of up to six months while Social Security is looking at your file and determining if you are eligible for reinstatement.

You will also be eligible for Medicare or Medicaid, whichever program you were on at the beginning. Those six months' worth of benefits will never be an overpayment. That's critically important too because we need to assure our clients that this is the safe way back in. Now, it is pretty late in the month; so I'm going to say if I went in and applied for EXR today, I could potentially have a check by June 1st. I'll get my check for June; I'll get my check for July. If I'm told I can be reinstated in August, my temporary benefits stop, and I'm back in regular pay status.

The other side of the coin is if I get to month six and I don't have a decision yet, it's time to start making a little bit of noise because benefits will stop until Social Security is finished. That's something that doesn't happen often; but in some very difficult cases, it can. 

To qualify for EXR, you have to have had eligibility for SSI or SSDI. You have become unable to work at the substantial, gainful activity level; and that is countable income of $1,220 this year...countable income not gross. Now, you can't work because of the same medical condition that gave rise to your earlier period of disability or something that is substantially related to it. So this is the old song...they head bone's connected to the neck bone.

If I have a bad back and I am out on benefits and return to work the same job that I had and develop a gait problem and I can't work because of that, that's probably connected to the bad back. So try to make those connections if it's not absolutely the same condition. 

Subsidies and special conditions...very, very happy to talk about these things because they are out there; believe me, they're out there and they are very underutilized. A subsidy is a support provided to the ticketholder, provided to the new worker, by the employer. So it's a cost to the employer for having that ticketholder on the workforce, and it may result in the beneficiary receiving more pay than the salary or wage for that job when you look at what somebody without a disability is doing.

Now, I'm going to tell you that I'm going to be sitting here until 4:30 p.m. working away; and at 4:30 p.m., I may just turn off this webinar and go downstairs and watch TV with my puppies. If I'm supposed to work till 5:00 p.m. and don't provide any services to my employer and still get paid, that's a subsidy. If we look at somebody with a disability, look at the job description...what does it say? 

We all know basically four hours' worth of work gives you a 15-minute break. If you're client, because of a bad back or because of an anxiety issue, needs a little bit of extra time so that they're taking a half an hour break, you've got a subsidy; and that can be valued. That half-hour break twice a day is a half an hour's worth of salary every day that will be deducted from their gross income, and these can be quite significant. We have seen them...60% and 70%. They can be based on pure production. If I have to make 100 pieces a day but because of my manual dexterity can only make 75, and Jayme is putting out 100 and we're getting the same paycheck, 25% of my salary doesn't count because it wasn't earned through my own labor.

We have to ask our clients these questions and ask them very gently because most of our clients are very proud of their work efforts, and we are now trying to tear it apart. We need to let them know carefully that they're doing a very good job, but we need to know how this job is getting done given the description and given the disability. And that can all be valued; in fact, when Social Security gets a letter from an employer that says, "Ray has a subsidy that is valued at $500 a month or 50% of his production," Social Security will accept that and cut my income in half or reduce it by $500.

Special conditions are pretty much the same thing, but it's who's paying the freight here. A special condition is paid for by a third party. Now, all of you VR workers and all of you ENs are third parties. A job coach is the easiest example because most VR agencies for goodwill will provide a job coach for three months, and they will wean the person off of that job coach over that three-month period. Well, there's a value to that as well. 

We value it differently because what we do because it's not a cost to the worker, it's not a cost to the employer...we have to give it a value somehow, so we take the number of hours of services and multiply it by the worker's salary in order to reduce gross income to countable income to determine if this person is performing SGA. 

Now, note the very bottom slide here. Subsidies and special conditions do not affect SSI payments. SSI is a needs-based program; and remember, that person got all of the money. They got the paycheck, so Social Security will treat that payment of a salary to an SSI recipient as earned income. 

The subsidy or special condition may exist if the beneficiary receives more supervision than others. You know, Ray's a troublemaker; so at YTI, everybody gets one hour of supervision every month. Well, Ray has to get one hour every week; and my boss provides that. Well, my boss makes $100 an hour. So what's the cost of that subsidy? I'm getting three hours of supervision more than everybody else, so it's worth $300. That's a sizable amount when we're talking about an SGA determination.

You have simpler or fewer tasks to complete than other workers doing the same job for the same pay. You are given longer breaks for the same pay, or there's a job coach or a mentor who is helping you actually do the job. All of these are valuable work supports, and I do mean valuable in that they're helping our clients work; but they have cash value, and we can get to that. If the employer won't help us, we can talk to the person providing those services; or we can just talk with the Social Security claims to show what's going on, and we can come to some value. There's always a way to find a value to something, so just look for them.

And that slide is back again. Okay, so we're going to learn more about work incentives, and we're going to look at...where is my slide here...I'm not flipping my slides, and that is the trouble. 
We're going to look at learn more on Choose Work's website, and I'm looking at the Web Link portal that you have; so there's more information there.

Review Social Security's Red Book for information. That link is also in that Web portal.
Read the Choose Work Blog, which is really a great thing...some success stories, some questions and answers; and the Work Incentives Wednesdays blog series also linked through that website in the Web Site link portal.

Now, the service providers for the Ticket to Work...we need to try to help connect people who can build a return to work team, and I mean a return to work team. I've gotten beyond the point where I'm thinking about the Ticket to Work as putting people to work. I am thinking that the Ticket to Work is helping us to build a team to create a worker, and that is a hard thing to do. We are changing somebody's culture, and it's going to take some time; so we need a support team to help people do that, and everybody on the line is here to help:
State VR agencies most certainly are providing some very, very hard-core services to help get our person ready for work.
Employment networks can be doing the same type of job or could very well be providing on-the-job continuing support after VR is finished, and Greg is going to tell you all about that program. That's a fabulous program.
Workforce ENs can provide assistance.

Work Incentives Planning and Assistance programs, the benefits planners...we can't all be benefits planners because it takes a long time and is intensive. But what I would love all of you to do who aren't doing benefits planners is take a look, take a few webinars that deal with these subjects, deal with these programs, and how work incentives happen so you will know when it's time to pull in a work incentive planner to make it part of the team.

The final part of the team is the Protection and Advocacy agency in your state. It's usually Disability Rights-New York, Disability Rights-Ohio, something like that. They are funded by Social Security under the Protection and Advocacy for Social Security Benefits programs to provide some legal practices. What happens if somebody's supervisor changes and that special condition that allowed your client to have a half-an-hour break rather than a 15-minute break is taken away and that disrupts the work effort? Is there a reasonable accommodation claim? What happens if a client is sent by somebody to an interview and the wrong or inappropriate question is asked of that person? This is the legal weight; and it is all, much like the rest of the services in the Ticket to Work, provided free to those people who are looking to return to work and (inaudible) and use their ticket.

Now, State VR...you know what to do. You provide probably the widest variety of services to our clients with disabilities that are allowing them to return to work, allowing them to return to the same job only learning how to do it different, being retrained for another job, or enter the workforce for the first time. Yes, some states have two separate agencies...one to serve people with individuals, one to serve people who are blind. But you guys are a key player, a very key player; and if you add to that some early benefits counseling, just a wee bit to ease some of the nerves of the person who's returning to work, then by all means do that...just so we can make the client more comfortable with what you're doing to help them get back to work.

Now, the employment networks...we need more of you. We need a lot more of you, but those who are out there are doing a fabulous job. They're really well-organized now. They're either private or public organizations that have an agreement with Social Security to provide employment services free to the ticketholder in order to keep that person working or potentially to help them find a job. It may be what I would call an easier case from somebody who needs full-on state services; and we need a little bit of training, a little bit of interview practice, and point to some employers. Not saying that that's not important work; it's very important work, but also there are a lot of benefits planners housed within EN and the workforce ENs...both great systems.

The American Job Centers, the Workforce ENs, are places where our clients can go to find jobs, use their computer, develop a résumé with assistance. I haven't done a résumé in a long time.

Yeah, it's my dog barking, unfortunately. I'm about to string her up. It's a Beagle, and she's seeing squirrels.

The supports and services that may be provided:
Career planning and counseling
Job search and job placement...I don't know right now what I would do if I had to find a new job. I would have to go to one of these new centers because I don't know what a résumé looks like anymore. The last résumé I built was 25 years ago; they don't look like that. You don't send a résumé in the mail anymore; it's all online. Well, I don't know where those sites are; so people need some basic help using this. Job search and placement is critical. I can look for a job; but if I have someone who knows where those jobs are, all the better. 

State VR programs can provide complete training programs. There are special programs, and there are priority programs for both disabled veterans and youth in transition...two groups that have been priorities a long time and are finally coming into their own and two very, very important groups. You think about the disabled veterans coming back; they deserve everything we can give them. And a youth in transition...do we want that 18 year old to become a disabled adult, or do we want to take the time do make that 18 year old a worker with a disability...what's better? I'm finding that work brings a lot to my life. I think it does to everybody and betters everybody and makes them happier. 

Ongoing employment support...VR closes that case in 90 days. Have we made a worker in 90 days? I'm not sure. This is a new culture. We have somebody who has worked 90 days at SGA levels; but if we can then sign that ticket over to an EN and they can carry on for another six months to provide some on-the-job support, all the better to make a worker, to teach that person the culture of work.

Assistance with job accommodations...when do you admit or disclose a disability? How do you ask for a job accommodation? People are going to be uncomfortable doing that.

Benefits and work incentive counseling...that needs to be something that's happening all along. It should be a little burst at the beginning just so that people are aware, that people are made to feel safe. Then when the job starts, some hard-core reality planning with the actual numbers that are involved. What happens when Mr. Walmart says, "Jayme, I need you for ten hours a week more during the holiday season"? Jayme needs to know what that means and what's going to happen, so that's another time to point to a benefits planner to try to get some assistance.

The WIPA Projects and the CWICs...the community work incentive coordinators, the individual planners...provide free in-depth counseling. They are supported by VCU, and I spend a good amount of my day providing technical assistance to folks in the New England Region who are working with folks. They are talking to people about what's going to happen. If somebody doesn't have a job, they're making scenarios up. If you're working at $12 an hour and you're working 20 hours a week, what does the number look like? If you're working 25 hours a week, what does it look like? And then when the person gets a job and has real numbers and real times, put a real plan together. 

They're working with beneficiaries who are working, have a job offer pending, are actively interviewing, have had an interview within 30 days, or have an interview scheduled within the next two weeks, are veterans or are transition-aged youth. So there is a priority system here. Just know that these people are trained very well, and they are very well-supported and can help make sense of this.

PABSS...this was my last job when I was working in the field. I was the PABSS attorney for Massachusetts...the Protection and advocacy beneficiaries of Social Security. It provides legal support, legal advocacy, or information to beneficiaries. These are great people. If you can't find anyone to tell your client or talk to your client about how to disclose a disability, about what their rights are, about keeping that disability secret, about how to request a reasonable accommodation, about what a reasonable accommodation is, they're there to help.

One of my last cases in Massachusetts was with Home Depot. A supervisor change happened; my client was using a wheelchair, and the weekly schedule was posted too high on the board in the breakroom. He told his boss, "I can't see that." And his boss put it up there again. And he said, "Would you please just lower that so I can see it?'' First shift he missed, he was fired. Now, how much did that reasonable accommodation cost? It cost nothing; it was lowering a piece of paper so that my client could see it in the wheelchair. Unfortunately, this guy had to get an attorney involved to fix that; and that's what the PABSS agency is for.

The Find Help Tools...you're going to look for service providers at choosework.ssa.gov/findhelp. The Social Security website, at SocialSecurity.gov/work is really, really good. The Social Security website is pretty good all over. It's a very friendly site and provides a lot of great information. But this site, Find Help site, provides a directory of all of the ticket program providers including State VR, the employment networks, the WIPA projects, the benefits planners, and PABSS, the legal wing. 

You can do a general search or a specific search. The specific searches I find most useful; so I'm always ending my conversation with a client by saying, "Can I have your ZIP code so that I can find services that I know provide services to that area?" We don't want to send them on a goose chase. But it's a very, very helpful too; and you can do a broad search to look for all four or do a single search simply to find the benefits planners.

Choosing a service provider...very important. If you're not going to choose a good service provider or someone that you're going to get along with, this might not be a successful experience. So we need to connect with a service provider that we get along with, that we believe will be helping us, and that we trust. This is a big trust issue here. 

Finding an EN...you can look to see how to find an EN by accessing the URL link in the Web Link portal; and choose the right EN is another great way to figure out what types of services you may need and does that EN that you're talking to right now provide those services. You're basically interviewing people for a job, just like you're hoping to get interviewed for a job; and you need to have a meeting of the minds. Is this plan going to work? Are you able to help me? Do you help people who have spinal cord injuries? Because if you don't, maybe I need to go to someplace else. So this is all very, very important information.

All right, and I'm seeing Ben with a question. Anything out there in the box?

STACEY>> Thank you, Ray, for sharing the information on the Ticket to Work program...including work incentives and service providers. You did provide a lot of great information about the Ticket program that can be utilized to help the clients we serve. And, yes, we do have a number of questions that have come in. 

Before we jump into those, I just want to reiterate that today's webinar is directed towards the Ticket to Work service providers. If you are someone who receives Social Security Disability benefits, you may find the webinar archives or next month's webinar more useful; but we do welcome you to stay on with us as well.

We are going to pause here and take a few moments to address the questions that have been coming in on the topics that you have discussed, Ray.

Ray, we have heard from a lot of beneficiaries that they can only handle part-time work. Is that a possibility for someone participating in the Ticket program?

RAY>> Well, you know, part-time work is a great start; and I understand that people may be doing that. The Ticket program...if you are a assigning a ticket to VR or to an EN...is designed to allow that provider to get paid as income increases and as you gradually work your way off of benefits. So while part-time work and Social Security benefits still bring with them all of the work incentives and can be okay, it's not really the goal of this particular program; but it's still a good start.

STACEY>> Thank you, Ray.

Ray, we have heard from many clients that they are nervous about losing their Medicare or Medicaid. Are there supports for this?

RAY>> Oh, god, yes...health care is something, like I said, is really hard to lose...at least in most states. We v extended Medicare coverage that goes on for at least 93 months after you use your trial work period. That's seven-and-a-half years! Now, yes, if you're doing SGA and you don't receive a check, you have to pay for that month's premium; but I think it's very important that t hose of us who are providing service explain to our clients right off that they were always paying for Medicare. Those premiums came out of their benefits check. Their check wasn't $1,100; it was $1,235. So if we explain to them that they're paying health care premiums now, it's not going to come as a shock later on.

On the Medicaid side, in 45 states where there is a Medicaid buy-in, it is almost impossible to lose your Medicaid. Yes, you may pay a premium for it; but you're talking about income levels that are in the high $30,000s, $40,000s, $50,000s. I think Connecticut this year is $64,000 or $65,000. If somebody is making that kind of money, they may have an employer provider plan and maybe need Medicaid buy-in as a backup. The premiums are very, very reasonable. 
So it's really, really hard provided the person remains disabled. Remember that through the Ticket to Work, we're terminating somebody based on earnings and work. We never said they were no longer disabled. So the person needs to remain disabled and have lost their cash benefits because of earnings. But's real hard...real, real hard to lose Medicaid. There are some states now you're still seeing things where some of the states that didn't do expansions are trying to do expansions now.

STACEY>> Great information, Ray, about benefits. You also talked about the work incentive called Expedited Reinstate. Could you explain this work incentive again?

RAY>> Sure, it is a post-termination work incentive. Somebody has to be terminated from SSI or SSDI because of work. So let's take who is...the easy way is SSDI. They worked through their trial work period. They worked through that 36-month extended period of eligibility and perform SGA. If they perform SGA after their extended period of eligibility, they are terminated; and they're terminated not because they're not disabled but because of work, and that's critical.

Beginning with the month of termination, Social Security then throws out a 60-month, or 5-year, safety net. If at any time during that five-year period income falls below sustainable gainful activity or work stops completely, that person can walk back into Social Security and say, "Please turn my benefits back on. What happens is, as I said, it's later in the month; it happens real quick. So Social Security could get me a check by June 1st if I file an application today. I will be paid for six months provisionally while Social Security is determining if I can perform sustainable gainful activity due to the impairment that gave rise to the earlier period of disability. So if I had a broken back, is this work stoppage a slowdown due to my broken back or something significantly related to it.

Now, to make it even more confusing, the event...the disability...doesn't have to stop this. What causes this could be anything. We mentioned somebody not being able to take their break because of a supervisor change; and that supervisor says, "No, if you can't do with a 15-minute break, you're out of here." Removal of a special condition can cause the end of a work effort. That gives rise to EXR as well. And when Social Security is reviewing the case to see if somebody can be reinstated, they're using something that's called the "Medical Improvement Standard." It's a really hard standard.

Social Security has to prove that there has been medical improvement, which is not necessarily hard; but the hard part is they have to prove that that medical improvement relates to the person's ability to work, and that's a big jump. It's a little confusing; it's hard to wrap your head around. Sometimes you've just got to take some of this as a leap of faith and know that most of the people who are applying for EXR are successful.

STACEY>> Ray, when does the three-month grace period begin? Is it immediately after nine months or any time during EPE?

RAY>> It happens when it's supposed to; that's the best advice. There is no way to tell anybody when it's going to happen. After the nine-month trial work period when we switch into the EPE, the extended period of eligibility, we are now dealing with substantial gainful activity. If somebody is in their EPE and they perform substantial gainful activity, they receive a benefits cessation and two months grace period. So they're always paid to the cessation month and the next two months. If during the EPE that person never performs SGA, that person is never going to see a cessation. 

So this could happen ten years after the EPE when that person does SGA for the very first time and they're terminated and the termination month and the cessation month are the same. So the person will never lose that three-month package of benefits, but it truly happens when it's supposed to.

STACEY>> Thank you, Ray, for those thorough answers to the questions that our participants have sent in. We do have more questions that we will address later; however, we are going to stop here. Before we move on, I would like to remind everyone that accessible materials from todays' webinar are available either in the Web Links pod or in your confirmation e-mail for today's webinar or by emailing Ticket to Work at webinars@ChooseWork.ssa.gov. 

Oh, and we do have one more question here that I want to address before we continue on. That question is: "Does there need to be an agreement between the EN and the beneficiary for the EN to provide services? And similarly, does a beneficiary have to go through an eligibility process if they want to work with VR?"

RAY>> Well, there has to be an agreement with an EN. It's the same type of agreement that they have with VR. You're negotiating an agreement. You're finding in the end who can provide the services that are necessary for you to go to work. Like I said, I don't want somebody who works with people who are blind to help me if I have a bad back and they have no experience doing that. So you have to shop for the right EN. You need to put the plan together and get that to MAXIMUS and get it signed so there is a plan...much like the State VR puts a plan together to do that. And that State VR plan would be what would be sent to MAXIMUS.

Do they have to go through a disability review for Social Security purposes if they're working with VR?

No, they don't. If you're not disabled according to Social Security definition, you can still seek services through your State VR agency. The State VR agency can determine you're disabled; you just would not be eligible for a Ticket to Work unless you went through the Social Security process.

STACEY>> Okay, thank you, Ray. That was my last question for you at this time, so now we will turn things over to Jayme, who will help us to spread the word about Ticket to Work.

Over to you, Jayme.

JAYME>> Thanks, Stacey.

Good afternoon, everyone. This is Jayme Pendergraft, and I am the Outreach Manager for Social Security's Ticket to Work program. As Stacey mentioned, I am here today to help you learn how you can spread the word about the Ticket to Work program and learn more about some of the resources we have available.

Step 1, of course, is it's very easy for beneficiaries to connect with the Ticket to Work program in two ways. One is by calling the Ticket to Work Help Line. We have Help Line staff available Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time. Their phone number is 1-866-968-7842 or 1-866-833-2967 for TTY. That staff is there, as I mentioned, Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time; and they are there to help answer any questions beneficiaries may have about the Ticket to Work program.

Another resource that I will be talking in more detail about is the Choose Work website, which is online at choosework.ssa.gov. I will be going through a lot of links today, and they are all available in your Web Links pod on the bottom right-hand side of your screen. If you don't catch a link, you can certainly get one through your Web Links pod; or you can send an e-mail to us at webinars@choosework@ssa.gov for a list of the links from today's webinar. In addition, you also should have access to those accessible materials Stacey mentioned both in the Web Links pod and in your e-mail about today's webinar.

As I mentioned, we're going to take a quick walk through the Choose Work website. There are a couple of different main topic areas on there. Ray talked a little bit about the blog posts. We also have success stories, the WISE webinars, and additional resources and information; and now we're going to look more closely at each of these.

First, I did want to mention that if you have an "Employment" section on your website and you'd like to link to us, we would greatly appreciate it. We hope that we're a useful resource for beneficiaries, and we have some language provided here that you can include on your website if you do want to link to the Choose Work page.

So today you are attending a WISE webinar or a Work Incentive Seminar Event webinar. WISE webinars are free and open to the public. We typically hold them on the fourth Wednesday of every month unless there's a holiday conflict or a different type of conflict, but they're almost always from 3:00 p.m. to 4:30 p.m. on the fourth Wednesday of every month. We open them up to beneficiaries, service providers, and other community partners like yourself. We would greatly appreciate you sharing any information about the WISE webinars with your social media or newsletter audiences; and, of course, we invite you to come back in the future. You can learn about WISE webinars by subscribing to get updates, and the link to do that is located in your Web Links pod.

On our website, we also have another page that we call WISE On Demand. These are all of our archived past webinars. So if you miss a webinar, you can go back and take a look at the one we had last month or a few months ago...or really any particular topic you're interested in. I was actually speaking to a few people about this particular webinar, and some of their colleagues were unable to attend. So I let them know that it will be archived within two weeks. So do feel free to come back and then share this webinar if some of your colleagues were not able to attend.

Ray talked a little bit about our Choose Work Blog. We do publish information about once a week on a variety of different topics that could include Social Security work incentives. Last week I believe we published one on Autism Awareness Month. So as long as it's related to disability employment, we're getting some information out there for our audience on learning more about the reasons to go back to work.

We do have a link on here about subscribing to get new blogs posted directly to your inbox...again, available in your Web Links pod. And we do encourage you to share blog posts with your e-mail and social media audiences. You can do that by directly linking to them, or we'll talk a little bit more in a minute about sharing via social media.

If anybody out there is interested in being a guest blogger or has ideas for a blog post, feel free to contact us at socialmedia@choosework.ssa.gov. 

One of the highlights of our website are our success stores. We do have a variety of stories published that are real stories about actual Social Security disability beneficiaries who have used the Ticket to Work program and other work incentives to return to work or start working for the first time. We have published those stories on the website at choosework.ssa.gov/successstories, and we would truly appreciate your help getting the word out there about these stories to show the positive outcomes from the Ticket to Work program. 

In addition, if you've worked with a ticketholder who has achieved financial independence through work and you think they would be a good candidate for a success story, please send us an e-mail at stories@choosework.ssa.gov. As a reminder, all stories are reviewed and approved by Social Security; and if the story is selected, we will work with you to develop the content. We write the materials after interviewing both the beneficiary and their service provider or provider. So we do take care of writing the stories if they do get approved by Social Security.

This afternoon we're going to look at two specific stories. The first is about Laura. Laura had cancer as a teenager that resulted in a limb loss, and she decided she wanted to help other people who had limb loss and went into the certified orthotist and prosthetist field. One of the work incentives that helped her achieve that goal was called the Plan to Achieve Self Support. Ray mentioned that a little bit earlier. It's a great work incentive, and Laura's story talks a lot about how she was able to accomplish her goal of becoming a certified orthotist and prosthetist using both Ticket to Work and the PABSS plan.

Walter, like Ray, actually also works at Cornell. Walter had a dream since he was a child of working on the Cornell University campus. He decided to work with an EN, who helped him develop soft skills for the workplace, find that dream job at Cornell; and he absolutely succeeded on the path to financial security and stability. Walter is the very first person in his family to own his own home.

So I do encourage you to check out these two success stories. We have many, many others on the website; and there are links in that Web Links pod.

We do also have what we call the "Library Page" on our website. We have a variety of fact sheets and frequently asked questions available to the beneficiary audience. They're also, hopefully, useful for you all to potentially print out and have in your offices or to talk to your clients about. For example, one of the fact sheets we have is called the "Work Incentives for People Who Are Blind." So if you have a client who is blind who is interested in learning more about the work incentives available for that specific audience, that fact sheet will hopefully be very helpful for him.

A couple other examples are "Planning Your Employment Goals with the Ticket to Work Program." That gets into those plans that Ray mentioned...the individual plans for employment and the individual work plans that you would set up with your employment network or your VR agency once you assign that ticket. 

We also have "Ticket to Work for America's Veterans." Again, that lists a bunch of different resources for veterans who may be eligible for the Ticket program. These are just three of many resources available on that Library Page, and you can access that at choosework.ssa.gov/library. 

Now I'm going to talk a little bit about social media. We are on all of the main social media accounts:
At Facebook, we're at choosework.
On Twitter, we're on chooseworkssa.
Our YouTube channel is www.youtube.com/choosework.
And our LinkedIn page is www.linkedin.com/company/ticket-to-work.
Again, all of these links are available in that links pod.

Our Facebook and Twitter accounts feature different Ticket to Work program updates. We also share a lot of information from other disability employment-related organizations, and we do encourage you to interact with our social media accounts. This is a great way to share those WISE webinar announcements I mentioned. We do tend to actually have our webinar announcements right up at the top of our social media accounts, so they're always the first thing you'll see; and you can just go ahead and share those directly from there. We'll get into that a little more on the next couple of slides.

We also encourage you to share posts from the Choose Work website directly. If you see a blog you really like, we'd love for you to go ahead and share it. If you see a resource out there you think that our audience would be interested in, I do encourage you to send us an e-mail at socialmedia@choosework.ssa.gov. Again, that's that same e-mail address that we talked about when we talked about submitting some guest blog ideas.

With that, I'm going to go ahead and hand it over to Greg, who is going to talk to you a bit about becoming an employment network.

GREG>> Thank you, Jayme.

Again, this is Gregory Bell, Development Specialist with TPM. As Jayme had stated, I am going to talk to you about how to join the team and become an employment network.

What is an employment network or an EN?

An EN is an organization that enters into an agreement with Social Security to either provide or coordinate the delivery of services to Social Security disability beneficiaries. An EN can be a single entity or an organization or a group of organizations, similar to a consortium that works to assist Social Security disability beneficiaries to find, maintain, or advance in employment.

ENs generally provide or facilitate access to various employment-related support services including career counseling, job search, job training, job accommodation, and benefits counseling services. Again, an EN can be an individual; they can be a partnership or an alliance; they can be public or private; they can be for-profit or non-profit organizations or agencies, including service providers such as a VR vendor. I know we have some VR counselors on there; some of your vendors may be ENs or may be interested in becoming an EN...or even a local State agency. My example of that would be Department of Social Services examples. Again, they can work together as a consortium of organizations collaborating and combining resources to serve ticketholders.

Benefits of becoming an EN...the Ticket to Work program can be a good fit for organizations because the mission of Ticket, it usually does align fairly well with other organizations or their existing mission of what they're trying to do. Again, if they are a VR vendor and if they maybe have AbilityOne contracts, the mission of Ticket and what it's trying to do usually aligns fairly well with their other mission. Organizations who have yet to become an EN are also serving Ticket clients through other programs or services that they provide. Again, some of your VR vendors may actually be working with ticketholders and actually serving them but not post-VR or post VR case closure; but they may be serving those individuals now or through another program.

Ticket is an outcome-based program; in other words, employment networks only receive payments when the ticketholders you serve or an agency serves attains certain outcomes that are associated with work and earnings. These milestones mean that ticketholders have to earn $880 at trial work-level earnings or $1,220 for non-blind or $2,040 for blind ticketholders. We call it SGA, or substantial gainful activity levels of earnings, before an employment network can receive payment. We can provide more in-depth information about this for organizations who maybe want to learn a little bit more about that payment structure going forward.

Keep in mind the goal of the Ticket program is really to help Social Security disability beneficiaries reduce the reliance on their cash benefits and help them to become financially independent. An additional benefit of an EN engaging in the Ticket to Work program is the EN can use the ticket revenue at their discretion...that the state does not put limitations on how an EN can utilize any of its ticket revenue that it generates. So an organization can be...there really is no what we often sometimes refer to as "double dipping," that the State doesn't put limitations on that. 

Now, if you're serving or an organization is serving a ticketholder to another grant, that grant or that other funding source may have limitations on that; but the State doesn't put any limitations on how an EN uses that money or serves a Ticket client or where they put that money back into. If they want to put that money back into additional programs or other programs, it doesn't have to necessarily go back into the Ticket program.

Some of the steps to becoming an EN...
An organization must submit the EN request for application to Social Security in order to become an EN. We have a team of consultants who will work with agencies to ensure that they meet all the general and specific qualification requirements before they submit their RFA to Social Security. Social Security will review an agency's submission and make a determination. Once that agency receives an award, then the next steps are to involve staff completing suitability of background check profit, followed by creating a mySSA Account with Extra Security.

Suitability requires that you will be able to access personally-identifiable information. This is needed in order for you to gain access to Ticket portals, which allows an EN to conduct their day-to-day operational business...which means assigning tickets, ticket assignability. (inaudible) will provide step-by-step guidance to ensure any agency's onboarding has a smooth transition and that they're ready to serve ticketholders. TPA has put together an entire curriculum called "The Service Provider Foundations Training," which has 15 key topics covering all aspects of the Ticket program as outlined by Social Security.

Frequently Asked Questions can be accessed in the Web Links pod under FAQs. The link for qualifications for becoming an EN are listed in the Web Links pod as "EN Qualifications." The RFA can be downloaded by accessing EN Request for Application in the Web Links pod, and questions about becoming an EN can be emailed to ENOperations@yourtickettowork.ssa.gov. 

From there, are there any questions?

STACEY>> Thank you, Greg, for talking with us about becoming an employment network and sharing the resources that are available. Just a reminder that there are many tools available to support us as we assist our clients with their journey to employment and financial independence. Again, the links to these resources can be found in the Web Links pod if you would like more information on any of the topics that were discussed. They can also be found in your confirmation e-mail, or you can email the Ticket to Work at webinars@choosework.ssa.gov. 

Yes, Greg, we do have questions; and for the remainder of our webinar today, we will address as many questions as we can.

I want to start off with a question to Jayme; this goes back to her presentation: Jayme, you talked about blog posts. How often does the Ticket program publish blogs, and how can I find out when there's a new post available?

JAYME>> Thanks, Stacey.

We publish blog posts about once a week, sometimes twice a week; and there are a couple of different ways you can find out whether blog posts are available. You can look in that Web Links pod to sign up for our e-mail subscription to get blog updates. In addition, you can also follow us on those social media accounts I talked about. We share all of our blog posts on there once they're published, so feel free to check us out on Facebook and Twitter. Again, that's @choosework on Facebook and @choosework.ssa on Twitter. Again, you can get information about all of our publications on social media or by signing up for those e-mail updates.

STACEY>> Thank you, Jayme. 

You had talked about success stories, and they are a great way to share real stories about beneficiaries. So if we know someone who might be eligible for a Ticket to Work success story, how do we submit their information for consideration?

JAYME>> Another great question...thanks, Stacey.

You can send an e-mail to stories@choosework.ssa.gov. Again, as a reminder, we'll work with you to develop the content for the story; so no need to actually write a story yourself or for your ticketholder to write their own story. We'll work with you on that. Another reminder is that all story candidates do need to be vetted and approved by Social Security. So it's certainly best just to reach out to us and send us some of the details. You can do that by emailing stories@choosework.ssa.gov.

STACEY>> All right, thank you, Jayme.

I do have another question, but this question is for Greg: Greg, we've heard about Partnership Plus. Can you briefly explain what that is and how we can get more information about it?

GREG>> Yes, Partnership Plus is really a seamless transition of services from VR to an EN. So when a VR is closing a case out...and I know Ray talked about this earlier when he was talking about the 90 days of employment. So when VR is successfully closing a case out, that ticketholder often could benefit from ongoing support services...whether they be benefit counseling or someone helping them understand how to apply for a different job or deal with a promotion.

But any of those ongoing supports that we hope will ultimately reduce recidivism and ticketholders six/seven months, maybe a year down the road, end up losing their job and in a year or two coming back going through the VR. So the transition of services and allowing the EN to provide those ongoing reports just allows the ticketholder to maintain employment and increase the levels and opportunities for retention. 

This can also address some of the (inaudible) issues around second and fourth quarter reporting from a VR standpoint because if that ticketholder is engaged with an employment network, then that VR is able to reach out to that EN and gather the employment outcome data that they need. So it really becomes a win/win for all individuals involved.

STACEY>> Thank you, Greg. That sounds like a great program...definitely a win/win for everyone.

GREG>> Yeah.

STACEY>> Greg, what are the requirements for becoming an employment network?

GREG>> To become an employment network, an organization needs to have a minimum of two years' experience immediately preceding the date of application for the RFA or three years' experience within the five-year period immediately preceding the application for the RFA. That includes relevant support services and experience working with clients or individuals with disabilities.

STACEY>> All right, thank you, Greg. You have another question: Greg, if somebody is interested in becoming an EN, does Social Security offer training for new ENs on Ticket to Work and Work Incentives?

GREG>> Yes, once an employment network is approved and awarded, TPA and the Program Manager here will put that EN through a mandatory training that will address all the areas and topics related to being an EN and work with ticketholders, including how to submit and fill out an IWP. So, yes, that training is included as part of the award package for any new EN.

STACEY>> Okay, thank you, Greg. 

I do have a question that I'm going to direct toward Ray: Ray, can Ticket to Work be used to start a business or for self-employment? Ray, don't forget to unmute yourself.

[Pause]

Okay, well, I think that we may have Ray maybe having some difficulty; so I am just going to move on to our next question. If Ray can join us—

JAYME>> Hey, Stacey, I can answer that. This is Jayme. Yes, there are several specialty service providers who work with people who want to start their own business; and that is certainly a viable option under the Ticket to Work program. Again, that Library page I mentioned has some self-employment resources on there. There are a couple of specific work incentives just for people who are interested in self-employment, and I encourage you to take a look at the website to learn more about how Ticket to Work works with people interested in becoming self-employed.

We also should still have a webinar on our WISE On Demand page all about self-employment and working from home. So I would encourage you to check out that page as well.

STACEY>> All right, well, I would at this point like to thank Ray and Jayme and Greg for the answers to all of the questions that we had time to ask today...so thank you very much. 

Before we move on, I just want to remind everyone once again that accessible materials from today's webinar are available either in the Web Links pod or in your confirmation e-mail for today's webinar or by e-mailing Ticket to Work at webinars@choosework.ssa.gov.

We are out of time for questions. Thank you all for the great questions that you have sent in, and we hope we've provided answers to your questions on these programs. We will talk a little bit later about where you can go should you have additional questions.

To stay on top of what is going on with WISE and the Ticket program, you can subscribe to learn about the latest WISE webinar or get e-mail updates about new blog posts as they become available. To subscribe for WISE e-mails, go to http://bit.ly/WISEsubscribe.

To subscribe for Ticket program updates, you can go to http://bit.ly/SubscribeCW.

If we were not able to answer your questions today or you have additional questions, you can reach out to the Ticket to Work Help Line at 1-866-968-7842 or, for TTY, 1-866-833-2967.

You can also visit the Ticket to Work website at choosework.ssa.gov.

You can also stay in touch or connected to us by liking us on Facebook, following us on Twitter, subscribing to our YouTube channel, and following us on LinkedIn.

All of these social media sites can be found in the Web Links pod under "Choose Work Social Media Pages.

Please join us for our next WISE webinar; and that will be held on Wednesday, May 22, 2019, from 3:00 p.m. to 4:00 p.m. Eastern Time. You can register online at choosework.ssa.gov/wise; or you can call 1-866-968-7842 or, for TTY, 1-866-833-2967.

Your feedback is very important to us, and it helps us to plan our future webinars; so please take a few moments to provide your feedback and tell us what you think about today's webinar. To take the survey, you can follow the link that will pop up after the webinar, or you can visit the Ticket to Work website to complete the survey.

Thank you again for attending today and learning how you can make the most of the Ticket to Work program to help your clients and the people that you serve. Please take the opportunity to reach out to any of the resources we discussed today and help your clients take the next step in their career paths.

This concludes today's webinar. Have a wonderful evening.