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12-17-97
THE WHITE HOUSE
'97 DEC 16 PM7:04
WASHINGTON
capied
December 16, 1997
Mathews
MEMORANDUM TO THE PRESIDENT
Reed
Fortuna
THROUGH: Sylvia Matthews
COS
FROM:
Bruce Reed
Diana Fortuna
SUBJECT:
SSA Report on Implementation of Children's SSI Cutoffs
The Social Security Administration intends to release a report this Thursday on its
implementation of the new definition of childhood disability for SSI. This report follows
Commissioner Ken Apfel's promise, at his confirmation hearing in September, of a "top to
bottom" review of SSA's process for redetermining the eligibility of children.
As you know, the welfare law tightened the definition of childhood disability for SSI, and
required the Social Security Administration to redetermine the eligibility of approximately
288,000 children, out of about one million children now on the rolls. These reevaluations have
led to almost 140,000 terminations to date. (At the time the welfare law was enacted, CBO
estimated that 180,000 children would lose SSI; when SSA announced its interpretation of the
law, it projected that 135,000 children would become ineligible.) Advocates charge that SSA has
done a poor job on these reevaluations, causing eligible children to be dropped from the rolls.
The report concludes that SSA did a generally good job of redetermining eligibility for
these children. The report, however, identifies three areas of concern and announces actions to
address them.
First, SSA will review the cases of all children "coded" as mentally retarded who were
cut from the rolls and have not appealed, This action addresses SSA's finding that some of these
children may have been terminated incorrectly. Second, SSA will review a portion of every
state's unappealed terminations, choosing the kinds of cases most needing review in each state
and focusing heavily on states that SSA has found to have a relatively high error rate. This
review will allow SSA to give special attention to states with the highest error rates, without
singling them out as "bad actors." Third, SSA will offer all 70,000 families who did not appeal
its termination decisions a new opportunity to do SO. These actions, and the problems they
address, are further described in an appendix attached to this memo.
In all, SSA will review the cases of 48,000 children dropped from the program. (Another
70,000 have appealed.) As a result of these actions, SSA now projects that approximately
100,000 children ultimately will lose SSI benefits.
With the report, SSA also plans to release case studies of a random sample of 151
children who have lost benefits. This document is intended to explain to the public what kinds of
children are no longer eligible. Most of the children have mental disabilities other than mental
retardation, including learning disabilities and attention deficit disorder. Over a third have
improved since they were first found eligible. The majority are teenagers; only a handful are age
six or younger.
Advocates will probably have a mixed reaction to the report -- generally pleased about
the actions, but still arguing that SSA's regulation interpreting the statute is needlessly strict.
The report does not address the latter issue. The Republican leadership in Congress has been
extremely supportive of SSA's implementation of the law to date, but probably will criticize this
report on the ground that it bends over backwards to restore benefits.
SSA Report on Childhood Disability Process
SSA's report examined three areas of concern raised by advocacy groups:
I. Mental Retardation
Advocates' Charge: Too many children with mental retardation were cut from the rolls.
SSA Finding: Of the 136,000 children terminated to date, 42,000 were "coded" as mentally
retarded (MR). However, most of these children do not actually have MR, because until recently
SSA's systems did not have all the necessary codes. Instead, most of these children have other
mental disorders, such as learning disabilities or "borderline intellectual functioning" (which falls
short of full-fledged MR). Some unknown subset of the 42,000 do have MR, but either their
impairments are not severe enough to qualify them for SSI, or they were denied incorrectly.
Even with these terminations, approximately 350,000 children coded as MR will remain on the
rolls, out of the total of one million children on SSI.
SSA Action: SSA will review all cases terminated that were coded as MR, to ensure that all
those decisions were made properly.
II. State Variations in Cutoffs
Advocates' Charge: Errors in cutoffs appear likely, since termination rates varied widely by
state, from 32% in Nevada to 82% in Mississippi. Also, SSA may not have acquired all
documentation, such as school records, needed to judge a child's disability. Finally, some states
were disqualifying too many families for failure to cooperate without making adequate efforts to
reach them.
SSA Findings: SSA data show that on average 93% of termination decisions were both
accurate and complete (i.e., they included all required documentation). This exceeds SSA's
required level of overall state performance for SSI, which is 90.6%. However, 10 states had
accuracy/completion rates below 90%. Another 9 states had accuracy/completion rates below the
national average. (SSA's experience is that about one-third of the errors identified in these
measures will ultimately prove to be accurate decisions that simply lacked documentation.) SSA
found that many inaccurate decisions stem from an overly strict interpretation of the new rules
for children who exhibit maladaptive behavior.
Claims that SSA did not acquire all needed documentation were determined to be largely
unfounded. However, SSA found wide state variations in the percentage of children cut off
because their families did not cooperate with the redetermination. In a study of such cessations,
SSA found that 68% of the cases did not include documentation that all required efforts to
contact the family had been made.
-2-
SSA also performed a regression analysis to determine whether wide state-to-state variations in
overall termination rates should be expected because of legitimate factors, such as the child's age
and impairment and whether the child was initially added to the rolls based on the less strict
criteria eliminated by the welfare law. SSA found that these factors would lead you to expect the
cutoff rate to vary from 40% in Idaho to 78% in Mississippi. While this regression analysis does
not fully explain the actual state-by-state variance, it does convince SSA that most of the
variance among states is due not to errors, but to characteristics of the children.
SSA Action: SSA will review a portion of the decisions in all states, focusing more on states
with lower accuracy rates. All cases terminated as a result of failure to cooperate will be
reviewed. SSA will also provide more training on maladaptive behavior.
III. Appeal Rights
Advocates' Charge: Too few families are appealing because SSA's notice to families was
confusing, and workers discouraged appeals. Also, SSA discouraged families from requesting
that benefits be continued during the appeal, and didn't do enough to publicize free legal
services.
SSA Finding: SSA found that its workers did not discourage appeals, although this may have
occurred in isolated instances. At the same time, a survey conducted by SSA confirms that many
families did not understand their appeal rights.
SSA Action: All 70,000 families of children who were terminated and did not appeal will be
given a new opportunity to do so. In addition, all families of children who appealed but did not
request continuation of benefits during the appeal will also be given a new opportunity to make
that request. SSA will also publicize the availability of free legal services for families.
FEB-05-97 11:39 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 1
Wednesday, February 5. 1997
SOCIAL SECURITY
Phil Gambino / Tom Margenau
For Immediate Release
410-965-8904 Fax 410-966-9973
ADMINISTRATION
News Release
Statement of
Shirley S. Chater, Commissioner of Social Security
on the
Release of New Childhood Disability Guidelines to Comply With
Welfare Reform Provisions
"Today we are announcing the publication of regulations containing
the guidelines we will use to determine if children with disabilities
meet the new definition of disability outlined in the SSI provisions of
the new welfare reform law.
Because disability is a very complex issue, formulating regulations to
implement the law was an enormous task for SSA. The major
challenge was to ensure that the intent of Congress was met while
working within the framework established by Congress to add
additional criteria to the rules to ensure continued benefit eligibility
for severely disabled children and their families.
We have crafted policy guidelines that, I believe, meet the letter and
spirit of the law while protecting the rights of children and families. I
want to thank the many dedicated Social Security managers and
employees who worked long and tirelessly to make this happen. o]
With the implementation of these new rules, we estimate that about
135,000 children will no longer be eligible for SSI benefits. This is
consistent with the lower-range estimates made by the Congressional
Budget Office.
- - -
SSA has notified about 263,000 children and their families that this
change may affect them. We expect that approximately one-half of
these children will continue to receive benefits when evaluated under
the new rules. Although you may have seen news articles alleging
OPTIONAL FORM 99 (7-90)
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FAX TRANSMITTAL
# of pages
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Phone B
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202-358-6044
Fax #
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GENERAL SERVICES ADMINISTRATION
FEB-05-97 11:39 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 2
-- Page 2 ..
that children with impairments such as Downs Syndrome, severe
mental retardation, autism, or many rare diseases will lose benefits.
the new rules provide guidelines for evaluating severe impairments
such as these to ensure that such children remain eligible for SSI
benefits. In addition, these new rules include more guidance to ensure
careful evaluations of children with physical impairments as well as
children with severe impairments that re-occur despite periods of
remission.
President Clinton has made it very clear that he wants to minimize any
adverse consequences that this legislation might have on disabled
]
children and their families. The President has proposed in the budget
that Medicaid coverage continue for children who lose their SSI
benefits as a result of this change in the definition of disability, so that
the medical needs of these needy children and families continue to be
met.
As this agency has always done, SSA will work with families to
obtain evidence to substantiate the child's medical condition and if
additional evidence is needed, SSA will pay for any consultative
examinations that may be required. Also, the parents or guardians for
all children have the right to appeal any decision we make. And in
most cases, benefits can continue throughout the appeals process, until
the child's representative has had the right to present his or her case in
person before an administrative law judge.
Finally, I have asked my staff to develop plans to track the effects of
the implementation of this law. If we discover that changes are
necessary or desirable in the law, we will recommend revisions and
improvements to the President.
We must now begin the challenging process of implementing these
new guidelines in a fair and consistent manner across the country."
###
SSA Press Office
2/5/97 9:00 a.m.
FEB-05-97 11:40 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 3
Talking Points
Welfare Reform and New Regulations Published Today Regarding
Supplemental Security Income Payments for Disabled Children
Background
One provision of the Welfare Reform law passed last year changed the SSI definition
of disability for children. The new law established a new definition of disability and
ordered SSA to discontinue the use of an individualized functional assessment (IFA)
process established after the landmark 1990 Zebley Supreme Court decision. This
provision was included in welfare reform because Congress was concerned about the
rapid growth in the program as the number of children on the benefit rolls grew from
350,000 to 965,000 between 1990 and 1996.
Following the law's passage, SSA had the enormous challenge of formulating
regulations to implement the law, making sure the intent of Congress to tighten
eligibility standards was met while ensuring that severely disabled children and their
families would be protected under the new law. Today, SSA published in the Federal
Register the new rules for determining disability for children.
Key Points
--Because disability is a complex issue, SSA faced a very challenging process to
carefully develop policy guidelines that meet the letter of the law (a congressionally-
mandated tightened definition of disability for children) and the spirit of the law
(ensuring that severely disabled children are found eligible for benefits).
--Out of approximately 965,000 disabled children currently receiving benefits, SSA
estimates that about 135,000 children will potentially lose monthly benefits that
average about $425 per month. This number is consistent with the lower-range
estimates made by the Congressional Budget Office. I understand that most of those
affected can be broadly categorized as children with certain mental impairments, such
as less severe learning disabilities or behavioral disorders.
--Although you may have seen news articles alleging that children with impairments
such as Downs Syndrome, severe mental retardation, autism, or many rare diseases
will lose benefits, the new rules provide guidelines for evaluating severe impairments
such as these to ensure that such children remain eligible for SSI benefits. In
addition, these new rules include more guidance to ensure careful evaluations of
children with physical impairments as well as children with severe impairments that
re-occur despite periods of remission.
FEB-05-97 11:40 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 4
--President Clinton has made it very clear that he wishes to minimize any adverse
effects this legislation may have on children and families. Towards this end, the
President has proposed that Medicaid coverage continue 10 children who lose their
SSI benefits as a result of welfare reform, SO that the medical needs of these needy
children and families continue to be met. In addition, SSA is going to track the
effects of the implementation of this law. If they discover that revisions or
improvements in the new law are needed, they will recommend such changes to the
President.
--SSA is committed to implementing the new rules in a fair and consistent manner
across the U.S. SSA will obtain any evidence needed to substantiate a child's
medical condition. In addition, parents or guardians of affected children will have the
right to appeal any decision SSA makes and, in most cases, benefits can continue
throughout the appeals process.
Possible Questions and Answers
By statute, the new eligibility standard for disabled children was to be
published in the Federal Register by 11/22/96. Why did it take so long to issue
these regulations?
A:
Because these new rules will have a direct impact on thousands of low-income
disabled children, it was essential that SSA take enough time to ensure that the new
guidelines meet both the letter and spirit of the law in protecting the SSI eligibility
for severely disabled children. Working within the general framework established by
the Congress, SSA had to carefully examined all its eligibility criteria and, where
desirable, add additional functional criteria to the standards to ensure that SSI
eligibility for children with severe disabilities will be protected.
Q: How many disabled children will lose monthly payments? Who are the
children that will loose benefits?
A:
It is estimated that out of approximately 965,000 children currently on the
rolls, about 135,000 children will no longer be eligible for SSI payments. (This
number was in the low-range of the CBO estimates.) Those affected are children who
were allowed benefits based on the individualized functional assessment (IFA) that
was eliminated by the welfare reform law. Many can be broadly categorized as
children with certain mental impairments, such as less severe learning disabilities and
behavioral disorders.
Q:
Was the President involved in the decision of the new disability
standard?
FEB-05-97 11:40 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 5
A:
Since the passage of welfare reform, the White House has been working with
agency officials to ensure that all affected agencies implement the new law
consistently and properly. As a result, SSA consulted with the White House in
establishing the new standard, particularly to discuss policy and legal issues that
arose. I lowever, as the agency head, the Commissioner of Social Security has made
the final decision on behalf of the President. The President fully supports that
decision.
Q:
I low much money will be saved by the new rules? Was the budget a
major consideration in establishing the new rules?
A:
I understand that program savings of about $4.8 billion is estimated in the 6-
year period starting with FY 1997. SSA has stated that budget implications were not
a major consideration in establishing the new rules. SSA relied on the Statute itself
as well as its legislative history.
≈:
The advocates are arguing that the new standard is too strict and that
Congress gave the agency much leeway in the Statute to establish a more
lenient standard? Why such a strict interpretation?
A:
It is my understanding that it was very clear from the welfare reform law and
the legislative history that Congress meant to establish this severity standard in the
new law. These new rules meet that legislative intent while including important
additional elements to ensure that severely disabled children continue to be eligible
for benefits.
Q.
Is the President concerned about the affect of the new law on low-
income disabled children? If so, what is he going to do about it?
A: Yes, the Administration is concerned and has taken several steps to limit any
adverse consequences of the law. First, while meeting congressional intent, SSA
worked within the framework established by Congress to add additional criteria to
the new rules that ensure continued eligibility for severely disabled children. (The
135,000 number of expected benefit terminations was in the low range of CBO
estimates for the law.) Second, the President has proposed that Medicaid coverage
continue for children who lose SSI benefits as a result of welfare reform, SO that the
medical needs of families continue to be met Third, SSA will be tracking the effects
of the implementation of the new law. If they discover that changes are needed in
the law, they will recommend such changes to the President.
SSA Press Office
2/5/97 9:00 a.m.
FEB-05-97 11:41 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 6
A Fact Sheet on
Welfare Reform and SSI Childhood Disability
Background
One provision of the Welfare Reform law passed last year changed the SSI definition
of disability for children, completely separating it from the definition of disability for
an adult. The basic definition of disability for the Supplemental Security Income
program for an adult states that a person must have a condition that is severe enough
to prevent him or her from doing substantial work and is expected to last for at least
12 months -- or result in death.
SSA uses a multi-step process to decide if an adult meets this definition of disability.
One of the most common steps involves the use of a set of evaluation guidelines that
contain a list of impairments for each major body system (including mental
impairments) that are so severe they automatically mean a person is disabled. If a
condition does not meet the criteria on the list, or cannot be considered equal in
severity to a condition on the list, then the agency considers vocational factors (age,
education, and work experience) to decide if a person has a condition that prevents
him or her from working, thus qualifying that person for disability benefits.
Because children, especially younger children, generally do not work, the vocational
steps in the disability evaluation process do not apply to them. So, until 1990, the
final decision about a child's disability was based on the criteria in the Listing of
Impairments. A 1990 Supreme Court decision ordered SSA to develop another step
in the evaluation process, analogous to the vocational rules used for adults, that
would consider a child's ability or inability to function in a manner similar to children
of the same age. In response to the Court's decision, SSA developed a process known
as the Individualized Functional Assessment (IFA).
Between 1990 and 1996, the number of children eligible for SSI benefits increased
from approximately 350,000 to more than 965,000. About one-third of the children
entitled during this period were entitled based on the IFA. In addition, there were
anecdotal reports of parents coaching children to qualify for benefits, although studies
by SSA, the Office of the Inspector General, and the General Accounting Office did
not find any evidence of fraud and abuse.
The Welfare Reform Act
On August 22, 1996, the Welfare Reform Act was enacted. One of its provisions
changed the SSI definition of disability for children. The new law states that a child's
impairment--or combination of impairments--will be considered disabling if it causes
"marked and severe functional limitations." The new law established a new definition
of disability for children and ordered SSA to discontinue the use of the IFA.
FEB-05-97 11:41 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 7
Because disability is a complex issue, formulating regulations to implement the law
was an enormous task. The major challenge was to ensure that the intent of Congress
was met while working within the framework established by Congress to add
additional criteria to the rules that ensure continued benefit eligibility for severely
disabled children. In addition to it's own disability policy specialists, SSA consulted
with administration and congressional colleagues. The result is a set of policy
guidelines that meet the letter and spirit of the law while protecting the rights of
children and families.
The New Disability Standard
Under the welfare reform law, a child's impairment, or combination of impairments,
is disabling if it causes "marked and severe functional limitations." Congress
|________________________
eliminated the IFA process and the language in the conference report clearly indicated
that SSA should use listing-level severity as the test for entitlement to benefits. The
new law and the conference report language also emphasized the importance of
functional assessments.
The new rules, therefore, define listing-level severity for functional limitations. The
severity of an impairment in the listings is generally shown by a) "marked" limitations
in either two broad areas of functioning, such as social functioning and personal
walk. functioning; or b) extreme limitations in one area of functioning, such as inability to
The new rules reflect both the letter and spirit of the law. They provide an accurate
mechanism to ensure that needy children with severe disabilities continue to qualify
for SSI payments while fairly implementing the intent of Congress.
While eliminating the IFA, and incorporating other specified changes in the listings,
the new rules incorporate several features that will help to better evaluate children
under the new law. The new rules add an area of "motor" functioning to ensure that
limitations from physical conditions are not overlooked. The new rules also
emphasize the importance of "functional equivalence" by providing guidelines that
direct disability evaluators to consider conditions that are not necessarily defined in
the listings, but are as severe as a condition in the listings. For example, guidance is
included on the evaluation of chronic, episodic impairments in children, which can be
severe but difficult to evaluate. Finally, a new form has been created to guide
decision-makers through the new rules to ensure consistency in applying the criteria.
Who is affected?
SSA estimates that about 135,000 children, out of approximately 965,000 children
who currently receive SSI, will no longer be eligible for monthly benefits. This is
consistent with the lower-range estimates made by the Congressional Budget Office.
FEB-05-97 11:41 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 8
3
Most of the children affected by the new definition of disability can be broadly
categorized as those with certain mental impairments, such as less severe learning
disabilities and behavioral disorders.
Although some news articles have alleged that children with impairments such as
Downs Syndrome, severe mental retardation, autism, or many rare diseases will lose
benefits, the new rules provide guidelines for evaluating severe impairments such as
these to ensure that such children remain eligible for SSI benefits. In addition, these
new rules include more guidance to ensure careful evaluations of children with
physical impairments as well children with severe impairments that re-occur despite
periods of remission.
Implementing the new guidelines
One of SSA's highest priorities over the next several months will be to make sure that
the new disability guidelines are implemented fairly and consistently across the
country.
SSA was required to notify the parents or guardians of children already getting
SSI benefits who are potentially affected by the welfare reform bill by January 1,
1997. Last December, SSA sent letters to about 263,000 children who may have
their cases reviewed using the new guidelines.
During February 1997, SSA personnel will be trained on the new procedures. By
mid-month, SSA will begin interviewing the parents or guardians of the children
affected to get current information about their medical conditions.
If additional medical or other evidence is necessary to determine if the child is still
disabled under the new law, SSA will obtain the necessary evidence. The first
decisions will go out in March and continue going out throughout this fiscal year.
Under the law, no benefits will be stopped before July 1, 1997. Letters sent to the
parents or guardians of children no longer considered disabled under the new law will
explain their appeal rights, including the fact that benefits can continue during the
appeals process until a face-to-face hearing is held before an administrative law judge.
Administration Safeguards to Ease the Transition for Families
President Clinton has made it very clear that he wishes to minimize any adverse
effects this legislation may have on disabled children and their families. The
President has proposed that Medicaid coverage continue to children who lose their
FEB-05-97 11:42 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 9
4
SSI benefits as a result of welfare reform, SO that the medical needs of needy children
and families continue to be met.
In addition, SSA is working on procedures to track the effects of the implementation
of this law. If the agency discovers that changes are needed in the new law, they will
recommend revisions and improvements to the President.
Source: SSA Press Office
Last updated: 2/5/97
9:00 a.m.
Richard
180,000
160,000 - Kids currently
2002
new
snapshot
70,000 current
90,000 now
180
- 135
45
110
190 135
135
110 90
45
330 225
180
FEB-04-97 12:42 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 1
FACSIMILE SHEET
SOCIAL SECURITY ADMINISTRATION
Office of the Commissioner
Suite 823, 500 E Street, SW,
Washington, DC 20254-0001
Brueel
Date: 2/4/97
Elena
Number of Pages: 9
Perrin
To: Diana Fortuna
From: Brian D. Coyne
Chief of Staff
Location/Organization:
Telephone Number: (202) 358-6013
Telephone Number:
Fax Number:
(202) 358-6076
Fax Number: 456-7431
Message:
I
Revised steets
)
Timetime
Kids
Kidreach
FEB-04-97 12:42 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 2
Tuesday, February 4. 1997
Phil Gambino / Tom Margenau
For Immediate Release
410-965-8904 Fax 410-966-9973
News Release
DRAFT
SOCIAL SECURITY
DRAFT
Statement of
Shirley S. Chater, Commissioner of Social Security
on the
Release of New Childhood Disability Guidelines to Comply With
Welfare Reform Provisions
"Today we are announcing the publication of regulations containing
the guidelines we will use to determine if children with disabilities
meet the new definition of disability outlined in the SSI provisions
of the new welfare reform law.
Because disability is a very complex issue, formulating regulations
to implement the law was an enormous task for SSA. The major
challenge was to ensure that the intent of Congress was met while
working within the framework established by Congress to add
additional criteria to the rules to ensure continued benefit eligibility
for severely disabled children and their families.
We have crafted policy guidelines that, I believe, meet the letter and
spirit of the law while protecting the rights of children and families.
I want to thank the many dedicated Social Security managers and
employees who worked long and tirelessly to make this happen.
With the implementation of these new rules, we estimate that about
135,000 children will no longer be eligible for SSI benefits. This is
consistent with the lower-range estimates made by the
Ken
Congressional Budget Office.
change may affect them. We expect that approx? one-half of these children
SSA has notified about 263,000 children and their families that this
will continue to receive benefits when evaluated under the new
meekedson
rules 4 Although you may have seen news articles alleging that
high about
-- More
FEB-04-97 12:42 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 3
-- Page 2 --
children with severe maime impairments such as Downs Syndrome, mental
fair?
severe
retardation, autism, or rare diseases will lose benefits, the new rules
provide guidelines for evaluating severe impairments such as these
MR
to ensure that such children remain eligible for SSI benefits. In
addition, these new rules include more guidance to ensure careful
evaluations of children with physical impairments as well as children w/sen.
impairments that re-occur despite periods of remission.
President Clinton has made it very clear that he wants to minimize
?Ken
any adverse consequences that this legislation might have on
that Medicaid coverage continue for children who lose
disabled children and their families. The President has their proposed SSI the budyet
benefits as a result of welfare reform, so that the medical needs of
these needy children and families continue to be met.
this
SSA will obtain evidence to substantiate the child's medical
condition. Also, the parents or guardians for all children have the
right to appeal any decision we make. And in most cases, benefits
payfor exams
can continue throughout the appeals process, until the child's
representative has had the right to present his or her case in person
before an administrative law judge.
Finally, I have asked my staff to develop plans to track the effects
of the implementation of this law. If we discover that changes are
necessary or desirable in the law, we will recommend revisions and
improvements to the President.
We must now begin the challenging process of implementing these
new guidelines in a fair and consistent manner across the country."
###
outreach?
SSA Press Office
2/4/97 11:00 a.m.
FEB-04-97 12:42 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 4
Internal
Shriver,eter
Talking Points
Welfare Reform and New Regulations Published Today Regarding
Supplemental Security Income Payments for Disabled Children
Background
estable new Def.
One provision of the Welfare Reform law passed last year changed the SSI
definition of disability for children. The new law ordered SSA to discontinue the
use of an individualized functional assessment (IFA) process established after the
landmark 1990 Zebley Supreme Court decision and, instead, established a new
definition of disability. This provision was included in welfare reform because
-St
Congress was concerned about the rapid growth in the program as the number of
et
children on the benefit rolls grew from 350,000 to 950,000 between 1990 and
1996.
Following the law's passage, SSA had the enormous challenge of formulating
regulations to implement the law, making sure the intent of Congress to lighten
eligibility standards was met while ensuring that severely disabled children and their
families would be protected under the new law. Today, SSA published in the
Federal Register the new rules for determining disability for children.
Key Points
--Because disability is a complex issue, SSA faced a very challenging process to
carefully develop policy guidelines that meet the letter of the law (a congressionally-
mandated tightened definition of disability for children) and the spirit of the law
No
(protecting the rights of disabled children and their families).
ensure that severaly dis ch as JA eli of
at rue 4 Imactant
--Out of approximately 950,000 disabled children currently receiving benefits, SSA
estimates that about 135,000 children will potentially lose monthly benefits that
average about $425 per month. This number is consistent with the lower-range
estimates made by the Congressional Budget Office. I understand that most of
those affected can be broadly categorized as children with certain mental
impairments, such as less severe learning disabilities or behavioral disorders.
--Although you may have seen news articles alleging that children with severe
impairments such as Downs Syndrome, mental retardation, autism, or rare diseases
will lose benefits, the new rules provide guidclines for evaluating severe impairments
such as these to ensure that such children remain eligible for SSI benefits. In
addition, these new rules include more guidance to ensure careful evaluations of
children with physical impairments as well assimpairments that re-occur despite
periods of remission.
chw/sev.
--President Clinton has made it very clear that he wishes to minimize any adverse
effects this legislation may have on children and families. Towards this end, the
President has proposed that Medicaid coverage continue to children who lose their
FEB-04-97 12:43 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 5
SSI benefits as a result of welfare reform, so that the medical needs of needy
children and families continue to be met. In addition, the Administration is going
to track the effects of the implementation of this law. If they discover that revisions
or improvements in the new law are needed, they will recommend such changes to
the President.
--SSA has informed the President that they is are committed to implementing the new
rules in a fair and consistent manner across the U.S. SSA will obtain any evidence
needed to substantiate a child's medical condition. In addition, parents or guardians
of affected children will have the right to appeal any decision SSA makes and, in
most cases, benefits can continue throughout the appeals process.
Possible Questions and Answers
By statute, the new eligibility standard for disabled children was to be published in
the Federal Register by 11/22/96. Why did it take so long to issue
these regulations?
in protecting
A:
Because these new rules will have a direct impact on thousands of low-income
disabled children, it was essential that SSA take enough time to ensure that the new
guidelines meet both the letter and spirit of the law and at the same time protect the
??
SSI eligibility for severely disabled children. Working within the general framework
established by the Congress, SSA had to carefully examined all its medical criteria
and, where desirable, add additional functional criteria to the standards to ensure
that SSI eligibility for children with severe disabilities will be protected.
elig
≈
How many disabled children will lose monthly payments? Who are the
children that will loose benefits?
A:
It is estimated that out of approximately 950,000 children currently on the
rolls, about 135,000 children will no longer be eligible for SSI payments. (This
number was in the low-range of the CBO estimates.) The majority of those affected ?All?
are children who were allowed benefits based on the individualized functional
assessment (IFA) that was eliminated by the welfare reform law. Many can be
broadly categorized as children with certain mental impairments, such as less severe
learning disabilities and behavioral disorders.
2:
Was the President involved in the decision of the new disability standard?
A:
Since the passage of welfare reform, the White House has been working with
agency officials to ensure that all affected agencies implement the new law
consistently and properly. As a result, SSA consulted with the White House in
establishing the new standard, particularly to discuss policy and legal issues that
arose. However, as the agency head, the Commissioner of Social Security has made
the final decision on behalf of the President. The President fully supports that
Ken
FEB-04-97 12:43 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 6
decision.
Q:
How much money will be saved by the new rules? Was the budget a major
consideration in establishing the new rules?
4.6
A:
I understand that program savings of about $8 billion is estimated in the 6.
A
year period starting with FY 1997. SSA has stated that budget implications were
not a major consideration in establishing the new rules. However, SSA did rely on 7
the Statute itself as well as its legislative history.
&
The advocates are arguing that the new standard is too strict and that
Congress gave the agency much leeway in the Statute to establish a more lenient
standard? Why such a strict interpretation?
A:
It is my understanding that it was very clear from the welfare reform law and
the legislative history that Congress meant to establish this severity standard in the
new law. These new rules meet that legislative intent while including important
additional elements to ensure that severely disabled children continue to be eligible
for benefits.
Q.
Is the President concerned about the affect of the new law on low-income
disabled children? If so, what is he going to do about it?
A:
Yes, the President is concerned and has taken numerous sereral steps to limit any
Adm
No
minimize
adverse consequences of the law. First, while meeting congressional intent, SSA
worked within the framework established by Congress to add additional criteria to
the new rules that ensure continued eligibility for severely disabled children. (The
135,000 number of expected benefit terminations was in the low range of CBO
estimates for the law.) Second, the President has proposed that Medicaid coverage
continue for children who lose SSI benefits as a result of welfare reform, so that the
medical needs of families continue to be met. Third, SSA will be tracking the
effects
progress and development of those children that lose benefits based on the new law.
If they discover that changes are needed in the law, they will recommend such
changes to the President.
SSA Press Office
2/4/97 11:00 a.m.
FEB-04-97 12:43 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 7
A Fact Sheet on
Welfare Reform and SSI Childhood Disability
Richard
for and
anabilit
One Background provision of the Welfare Reform law passed last year changed the SSI
definition of disability for children The basic definition of disability for the
Supplemental Security Income program states that a person must have a condition
that is severe enough to prevent him or her from doing substantial work and is
expected to last for at least 12 months or result in death.
SSA uses a multi-step process to decide if an adult meets this definition of disability.
One of the most common steps involves the use of a set of evaluation guidelines that
contain a list of impairments for each major body system (including mental
still
impairments) that are so severe they automatically mean a person is disabled. If a
condition does not meet the criteria on the list, or cannot be considered equal in
severity to a condition on the list, then the agency considers vocational factors (age,
education, and work experience) to decide if a person has a condition that prevents
long
him or her from working, thus qualifying that person for disability benefits.
Because children, especially younger children, generally do not work, the vocational
steps in the disability evaluation process do not apply to them. So, until 1990, the
final decision about a child's disability was based on the criteria in the Listing of
Impairments. A 1990 Supreme Court decision ordered SSA to develop another
step in the evaluation process, analogous to the vocational rules used for adults, that
would consider a child's ability or inability to function in a manner similar to
children of the same age. In response to the Court's decision, SSA developed a
process known as the Individualized Functional Assessment (IFA).
Between 1990 and 1996, the number of children eligible for SSI benefits increased
from approximately 350,000 to more than 950,000. Only about one-third of the
children entitled during this period were entitled based on the IFA. In addition,
there were anecdotal reports of parents coaching children to qualify for benefits,
although studies by SSA, the Office of the Inspector General, and the General
Zirly
Accounting Office did not find any evidence of traud and abuse.
The Welfare Reform Act
On August 22, 1996, the Welfare Reform Act was enacted. One of its provisions
changed the SSI definition of disability for children. The new law states that a
child's impairment--or combination of impairments--will be considered disabling if it
causes "marked and severe functional limitations." The new law ordered SSA to
discontinue the use of the IFA process and, to establish a new definition of disability
for children.
Two
Because disability is a complex issue, formulating regulations to implement the law
was an enormous task. The major challenge was to ensure that the intent of
Congress was met while working within the framework established by Congress to
FEB-04-97 12:44 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 8
add additional criteria to the rules that ensure continued benefit eligibility for
severely disabled children. In addition to it's own disability policy specialists, SSA
consulted with administration and congressional colleagues. The result is a set of
policy guidelines that meet the letter and spirit of the law while protecting the rights
of children and families.
The new regulations will be submitted to Congress for their review as required under
the law.
Add new G imagel immed,
The New Disability Standard
clearly
Under the welfare reform law, a child's impairment, or combination of impairments,
is disabling if it causes "marked and severe functional limitations." Congress
eliminated the IFA process and the language in the conference report indicated that
SSA should use listing-level severity as the test for entitlement to benefits The new
night
law and the conference report language also emphasized the importance of
functional assessments.
Bren
The new rules, therefore, define listing-level severity for functional limitations. The
severity of an impairment in the listings is generally shown by marked" limitations
in either a) two broad areas of functioning, such as social functioning and personal
]*
functioning; or b) extreme limitations in one area of functioning, such as inability to
walk.
The new rules reflect both the letter and spirit of the law. They provide an accurate
mechanism to ensure that needy children with severe disabilities continue to qualify
for SSI payments while fairly implementing the intent of Congress.
improve/sette
While eliminating the IFA, and incorporating other specified changes in the listings,
the new rules incorporate several features that will help to evaluate children under
the new law. The new rules add an area of "motor" functioning to ensure that
limitations from physical conditions are not overlooked. The new rules also
emphasize the importance of "functional equivalence" by providing guidelines that
direct disability evaluators to consider conditions that are not necessarily defined in
the listings, but are as severe as a condition in the listings. For example, guidance is
included on the evaluation of chronic, episodic impairments in children. which can
beldifficult to evaluate. Finally, a new form has been created to guide decision-
makers through the new rules to ensure consistency in applying the criteria.
severe but
Who is affected?
SSA estimates that about 135,000 children, out of approximately 950,000 children
who currently receive SSI, will no longer be eligible for monthly benefits. This is
consistent with the lower-range estimates made by the Congressional Budget Office.
Most. of the children affected by the new definition of disability can be broadly
categorized as those with certain mental impairments, such as less severe learning
disabilities and behavioral disorders.
FEB-04-97 12:44 FROM: OC/WASHINGTON
ID: 2024827139
PAGE 9
3
Although some news articles have alleged that children with severe impairments such
as Downs Syndrome, mental retardation, autism, or rare diseases will lose benefits,
the new rules provide guidelines for evaluating severe impairments such as these to
ensure that such children remain eligible for SSI benefits. In addition, these new
rules include more guidance to ensure careful evaluations of children with physical
impairments as well impairments that re-occur despite periods of remission.
Implementing the new guidelines
One of SSA's highest priorities over the next several months will be to make sure
that the new disability guidelines are implemented fairly and consistently across the
country.
SSA was required to notify the parents or guardians of children already getting
SSI benefits who are potentially affected by the welfare reform bill by January 1,
1997. Last December, SSA sent letters to about 263,000 children who may have
their cases reviewed using the new guidelines.
During early February 1997, now SSA personnel will be trained on the new procedures.
By mid-month, SSA will begin interviewing the parents or guardians of the children
affected to get current information about their medical conditions.
If additional medical or other evidence is necessary to determine if the child is still
disabled under the new law, SSA will obtain the necessary evidence. The first
decisions will go out in March and continue going out throughout this fiscal year.
Under the law, no benefits will be stopped before July 1, 1997. Letters sent to the
parents or guardians of children no longer considered disabled under the new law
will explain their appeal rights, including the fact that benefits can continue during
the appeals process until a face-to-face hearing is held before an administrative law
judge.
Administration Safeguards to Ease the Transition for Families
President Clinton has made it very clear that he wishes to minimize any adverse
effects this legislation may have on disabled children and their families. The
President has proposed that Medicaid coverage continue to children who lose their
SSI benefits as a result of welfare reform, so that the medical needs of needy
children and families continue to be met.
SSA
In addition, the Administration is working on procedures to track the effects of the
implementation of this law. If the agency discovers that changes are needed in the
new law, they will recommend revisions and improvements to the President.
Source: SSA Press Office
Last updated: 2/4/97
11:00 a.m.
FEB-04-97 19:46 FROM: ODCLCA DC 202 3586074
ID: 6074
PAGE 1
TO: Diane F.
(RTW) (RTW) list other list
January 29, 1997
for briefings
NOTE TO KEN McGILL
Subject: OComm List for Use in Inviting National Organizations
to Attend Briefings on the SSA Alternative
Rehabilitation Provider Initiatives- INFORMATION
The liaison staff in the Office of National Affairs has compiled
the attached list of organizations for your use. They believe
that these organizations would be interested in being included in
briefings on the new alternative provider rehabilitation program
initiatives. They have also suggested that Susan Daniels,
Associate Commissioner for Disability, would be the most logical
SSA spokesperson at these briefings, and we believe she could do
an outstanding job of explaining the regulations as well.
Should you have questions, please contact me or Martha Seabrooks
in OComm (who compiled the list for the OComm Disability Programs
and Welfare Reform Team)
7 Fred Crawford
CC:
Charles Fosler
Martha Seabrooks.
FEB-04-97 19:46 FROM: ODCLCA DC 202 3586074
ID: 6074
PAGE 2
Scott Marshall, Director of Public Relations
American Foundation for the Blind
(202) 457-1487
1615 M Street, NW
Suite 250
Washington, DC 20036
Judith Moore, President and CEO
National Industries for the Blind
(703) 9980770
1901 North Beauregard Street
Suite 200
Alexandria, Virginia 22311-1727
Marc Maurer, President
National Federation of the Blind
(410) 659-9314
1800 Johnson Street
Baltimore, Maryland 21230
Leroy F. Saunders, President
American Council of the Blind
(202) 467-5081
1155 15th Street, NW
Suite 720
Washington, DC 20005
National Association of the Deaf;
(410) 587-1788
814 Thayer Avenue
Silver Spring, Maryland 20910
Self Help for Hard of Hearing People, Inc.;
(301) 657-2249
7910 Woodmont Avenue
Bethesda, Maryland 20814
American Society for Deaf Children
(800) 942-2732
2848 Arden Way
Suite 210
Sacremento, California 93825-1373
(though its headquarters is in Sacramento, CA, this office has a
representative in the D.C. area and this group is and has been
very vocal about the welfare reform and the childHood benefits)
Northern Virginia Resource Center for Deaf and Hard of Hearing
Persons
(703) 352-9055
Association of Late-Deafened Adults
(815) 899-3040
10310 Main Street
Box 274
FEB-04-97 19:47 FROM: ODCLCA DC 202 3586074
ID: 6074
PAGE 3
Fairfax, Virginia 22030
Center for the Study of Social Policy
1250 Eye Street NW Suite 503
Washington DC 20009
Tom Joe Director
P 202 371-1565
f 212 371-1472
Center on Social Welfare Policy and Law
275 Seventh Avenue
Suite 1205
New York, NY 10001-6708
P 212 633-6967
f 212 633-6371
Council on Social Work Education
1600 Duke Street Suite 300
Alexandria, VA 22314
Donald W Beless Ph.D., Executive Director
P 703 683-8080
f 703 683-8099
Families, USA Families
1334 G Street, NW
Washington DC 2005
Phyllis Torda
Director, Health and Social Policy
Ronald F. Pollack, President
P 202 628-3030
f 202 347-2417
Family Service America
11700 W Lake Park Drive
Milwaukee, WI 53224
Peter Goldberg CEO & President
p (414) 359 1040
Nat'l Assoc of Public Child Welfare Admin
C/O Amer Public Welfare
810 First Street, NE
Suite 500
Washington, DC 20002-4267
Elizabeth Thielman, Project Manager
P (202) 682-0100
f (202) 289-6555
Nat'l Assoc of Social Workers
750 First Street
Washington, DC 20002-4241
Sheldon Goldstein, Exec Dir
P (202) 408-8600
f (202) 336-8312
FEB-04-97 19:47 FROM: ODCLCA DC 202 3586074
ID: 6074
PAGE 4
Amer Assoc on Mental Retardation*
M. Doreen Croser, Exec. Dir.
444 N. Capitol St., NW, Ste. 846
Washington, DC 20001-1512
Amer Diabetes Association
Myrl Weinberg
Dir. Gov't. t. Affairs
1660 Duke St., P.O. Box 25757
Alexandria, VA 22314
Arc*
Marty Ford
Asst Dir, Gov Affair
1730 K Street, NW, Suite 1212
Washington, DC 20006
Autism Society of America*
Veronica Zysk
Administrative Dir
7910 Woodmont Ave., Ste. 650
Bethesda, MD 20814
Bazelon Center for Mental Health Law
Rhoda Schulzinger
1101 15th Street, NW, Suite 1212
Washington DC 20005
Brain Injury Association
Alice Demichelis
Legislative Liaison
1776 Massachusetts Ave., NW, Suite 100
Washington, DC 20036
Consortium for Citizens with Disabilities*
Marty Ford
Co-Chair, SSA Task F
c/o The Arc, 1522 K Street, NW, Suite 516
Washington, DC 20005
Disabled American Veterans*
Arthur Wilson
Natl. Adjutant
807 Maine Avenue, SW
Washington, DC 20024
Epilepsy Foundation of America
Paulette Maehara
CEO
4351 Garden City Drive, Suite 406
Landover, MD 20785
Learning Disabilities Assoc of Amer
Justine Maloney
FEB-04-97 19:47 FROM: ODCLCA DC 202 3586074
ID: 6074
PAGE 5
4156 Library Road
Pittsburgh, PA 15234
Muscular Dystrophy Association
Robert Fitzgerald
Human Resources Dir
3300 E. Sunrise Drive
Tucson, AZ 85718
Nat'l Alliance for Mentally Ill
Laurie M. Flynn
Executive Director
2101 Wilson Blvd., Ste. 302
Arlington, VA 22201
Nat'l Assoc of Developmental Dis Coucil
Chris Metzler
Asst Exec Dir
1234 Massachusetts Ave., NW, Suite 103
Washington, DC 20005
Nat'l Assoc of Protection & Advocacy System
Vicki Smith
Deputy Dir
900 2nd Street, NE, Suite 211
Washington, DC 20002
Nat'l Assoc of St Dir of Dev Disabled Servs
Robert M. Gettings
Executive Director
113 Oronoco Street
Alexandria, VA 22314
Nat'l Assoc of St Mental Hlth Prog Dir
Robert Glover
Executive Director
66 Canal Center Plz, Suite 302
Alexandria, VA 22314-1591
Nat'l Down Syndrome Congress*
Michael Leonard
1605 Chantilly Dr., Ste. 250
Atlanta, GA 30324-1146
Nat'l Easter Seal Society*
Randy Rutta
VP Govt Affairs
700 13th St., NW
Washington, DC 20005
Nat'l Mental Health Association
Al Guida
VP Gov Affairs
1021 Prince Street
FEB-04-97 19:47 FROM: ODCLCA DC 202 3586074
ID: 6074
PAGE 6
Alexandria, VA 22314-2971
Nat'l Multiple Sclerosis Society*
Robert Enteen
Public Policy Assoc.
733 3rd Ave.
New York, NY 10017
Nat'l Org of Soc Sec Claimants' Reps
Cathy Thompson
Staff
6 Prospect Street
Midland Park, NJ 07432
Nat'l Senior Citizens Law Center
Ethel Zelenske
Staff Attorney
1815 H Street, NW, Suite 700
Washington, DC 20006
Paralyzed Veterans of America*
Gordon Mansfield
Executive Director
801 18th Street, NW
Washington, DC 20006
FEB-05-1997 14:42
HCFA-OLIGA
2026908168 P.01
HUMAN SERVICES ,USA
HEALTH
HCFA
8
FAX COVER SHEET
MEDICARE MEDICAID
- Care Family Minicistration
DEPARTMENT
OFFICE OF LEGISLATIVE &
INTER-GOVERNMENTAL AFFAIRS
Number of Pages: cover +
\
Date: 2/5/97
From:
To: Diana Fortuna
Jennie Bonney
Fax:
Fax: 202-690-8168
Phone:
Phone:
REMARKS: FYI - here is SSAs write up
of the health provisions I don't
have anything on the "ticket"
HEALTH CARE FINANCING ADMINISTRATION
200 Independence Ave., SW
Room 341-H, Humphrey Building
Washington, DC 20201
FEB-05-1997 14:43
HCFA-OLIGA
2026908168 P.02
DRAFT
The Right Incentive: Health Care Security
Additionally, the Health Care Financing Administration will
propose to create more health care access for beneficiaries who
return to work. For Medicare, the proposal would extend Part-A
coverage premium free for those who work beyond the current
coverage period during a 4-year demonstration. For Medicaid,
States would have an option to extend Medicaid coverage for
people who work beyond current coverage levels. States would be
allowed to create a sliding-scale premium for those individuals
who choose this coverage.
These proposals represent a new opportunity for people with
disabilities to make the move from dependence to independence.
with greater access to and confidence in the stability of health
care and more choice and flexibility in employment services,
Americans with disabilities will have greater opportunities for
productive and secure lives.
FAx to
Jennie Benney
FAX 202-690-8168
Jennie look OK to you?
OPTIONAL FORM " (7-30)
FAX TRANSMITTAL
of
Dept./Agency To Jennie Bonney
From Ken , pages
Phone
410-965-3988
Fax 202-690-8168 ,
Fax 9
440-966-8591
NBN 7540-01-317-7368
5099-101
GENERAL SERVICES ADMINISTRATION
TOTAL P.02
FEB-05-97 12:58 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 1
Fact Sheet
Social Security Proposes "Ticket to Independence"
for Disabled Beneficiaries:
Background: The Social Security Administration (SSA) now pays more than $36 billion
a year in disability insurance benefits to 4.5 million disabled workers, and pays $25
billion a year in Supplemental Security Income to more than S million low-income people
with disabilities. Today Social Security refers disabled beneficiaries to State vocational
rehabilitation agencies. SSA reimburses these State agencies for their costs in providing
rehabilitation services when the beneficiary works for nine months. Last year SSA paid
state VR agencies about $71 million for approximately 6,000 disabled beneficiaries who
returned to work.
Proposal: The President's fiscal year 1998 budget proposes a new initiative, in
partnership with the private sector, to help more beneficiaries achieve their goals of
leaving the benefit rolls and returning to work. SSA will begin in five to ten states to
pilot the new approach:
Consumer Choice: Disabled beneficiaries will receive a "ticket to independence" to use
with any participating public or private employment or rehabilitation provider of
their choice.
Paying for Results: The provider will be paid when the beneficiary works and no longer
receives cash benefits.
Health Care Incentives: Disabled beneficiaries will have more secure health care
coverage. A demonstration project will extend Medicare beyond the current-law
maximum for some beneficiaries returning to work. For SSI beneficiaries who
work. States would have the option to extend Medicaid coverage beyond current-
law limits as well.
Advantages over current law:
Creates a public-private partnership between Social Security and private
employment/VR agencies with the goal of returning beneficiaries to work.
Offers potentially significant savings to the Social Security trust funds by helping
Americans with disabilities to work.
Gives beneficiaries the control and flexibility they need in securing VR services.
Minimizes bureaucratic involvement in the choice of providers and services.
Feb. 4, 1997
OPTIONAL FORM 99 90)
FAX TRANSMITTAL
# 01 pages
3
To
Drain Fortune
From
Suran Devid
Dept /Agency
Phone If
Fax #
Fax #
6011
NSN 7540 111
PAGE 2
FEB-05-97 12:58 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
Thursday. February 6. 1997
Phil Gambino / Tom Margenau
For Immediate Release
410-965-8904 Fax 410-966-9973
Newson Relerase
SSA Proposes A "Ticket To Independence" For Disabled
Today. when you sign up for disability benefits with Social Security. you may
get a referral to a state agency for possible vocational rehabilitation services.
In the near future. instead you'll get a "ticket to independence" you can take
to a private or public vocational agency in exchange for help in finding work.
The President's fiscal year 1998 budget proposes a bold new initiative to
leverage innovation in the private sector to help more beneficiaries achieve
their goals. to leave the benefit rolls, and return to work. SSA will begin to
pilot this new approach in five to ten states. Here are the highlights:
Consumer Choice: Disabled beneficiaries will receive a
"ticket to independence" to use with any participating
public or private employment or rehabilitation provider of
their choice.
Paying for Results: The provider will be paid when the
beneficiary works and no longer receives cash benefits.
The Right Incentives: Disabled beneficiaries will have more
secure health care coverage. A demonstration project will
extend Medicare beyond the current law maximum for
some beneficiaries who return to work. For SSI
beneficiaries who work. states would have the option to
extend Medicaid beyond current law limits as well.
Shirley S. Chater, Commissioner of Social Security, called the proposal an
important step in fulfilling the President's vision of leveraging private sector
initiative to better serve its customers. Also. it will help the President achieve
his goal of moving people from exclusion and paternalism to inclusion and
empowerment. "President Clinton has said he wants people to be less
dependent on government." Chater said. "Our plan is to give disabled
Americans who want to work a ticket to independence."
-- More ---
- - Page 2 -
Recognizing that SSA's current work incentive programs simply were not doing
FEB-05-97 12:58 FROM: DEPUTY/EXECUTIVE-STAFF
ID:
PAGE 3
the job - - less than one percent of the approximately 8 million disability
recipients successfully return to work each year -- Chater asked her disability
managers and staff in 1994 to develop a plan to help disability recipients
return to the workplace. After listening to people with disabilities and their
advocates. vocational and rehabilitation counselors. as well as employers and
other government agencies. SSA developed this unique approach to helping
people get off the disability rolls and on the job.
Here's how it will work: Once an individual's disability claim is approved. he or
she may be given a return to work ticket which can be presented to any
approved provider in exchange for employment
or rehabilitation services. SSA will pay for results. If the beneficiary returns
to work and stops receiving disability benefits. the provider will receive it
payment.
SSA's return to work policies include other incentives that encourage
employment. For example. beneficiaries who try working can keep receiving
full monthly disability payments for up to a year after they start a job. And
generally. disability recipients who return to work can keep their medicare or
medicaid coverage for a number of years after returning to work.
"Many of our customers with disabilities tell us they can work if the incentives
are right and if the services they need are available." Chater said. "With this
plan. we are creating new ways of helping people find work and achieve their
goals."
The return to work ticket and other incentives apply to both disability
programs administered by SSA. The Social Security disability insurance
program pays more than $36 billion annually to almost four and one half
million people. The Supplemental Security Income disability program pays $25
billion each year to more than five million low-income individuals with
disabilities.
###
ODCLCA QUICK FAX
(202)358-6030- Voice / (202 358-6074/6075- Fax)
2/4/97
TO: Diana Fortuna
FROM: Judy Chesser
COVER + 11 pages
COMMENTS:
This form is produced on reused paper
PAGE 1
6074 :01
FEB-04-97 18:38 FROM: ODCLCA DC 202 3586074
FAX TU. Diane Fortuna.
contacts.
Author: William Daly at -SADC
Date:
1/30/97 5:00 PM
Priority: Normal
for children's
TO: Frank Jasmine
Subject disability list
regs.
Message Contents
attached
PAGE 2
6074 : aI
FEB-04-97 18:39 FROM: ODCLCA DC 202 3586074
Page 1
Accreditation Council People w/Dev. Disabil
Pres.. James Gardner Ph.D. CEO8100 Professional Place, Suite 204
Landover. MD 20785-2225
Alliance of Genetic Support Groups
Joseph Smith
38th and R Streets. NW
Washington, DC 20007
Pres., Joan O. Weiss
Amer. Acad. of Otolary nology-Head & Neck
Joseph Goldstein
One Prince Street
Alexandria. VA 22316
Amer. Assoc. for Counseling & Development
John Jaco
Govt. Relations Office.
5999 Stevenson Ave.
Alexandria. VA 22304
Pres., Doris Cox
Amer Assoc on Mental Retardation
M Doreen Croser
Exec Dir
444 N. Capital Street, NW, Ste. 846
Amer. Assoc of Univ. Affiliated Programs
Elaina Eklund, Assoc. Exec. Director
8630 Fenton Street, Suite 410
Silver Spring. MD 20910
Pres., William Jones
Ame.r. Athletic Association of the Deaf
1052 Durling Street
Ogden, Utah 84403
Amer Council of the Blind
Glen Plunkett
1155 15th Street, NW, Suite 720
Washington, DC 20005
Pres., Leory F. Saunders
Amer. Diabetes Association
Myrl Weinberg, Dir of Gov't Affairs
1660 Duke St., P.O. Box 25757
Alexandria, VA 22314
Amer. Fndn. for the Blind*
Scott Marshall
Dir., Govt. Relations
1615 M Street, NW, Suite 250
Washington, DC 20036
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Amer. Horticultural Therapy Association
Mary DeRiso
9200 Wightman Rd., Suite 400
Gaithersburg, MD 20901
Pres., Steven Davis
Amer Network of Community Options and Resources
Aause Righter
4200 Evergreen Lane, Suite 315
Annadale, VA 22003
Pres, Joni Fritz
Amer Occupational Therapy Association
Frederick Somers
1383 Piccard Dr., P O. Box 31220
Rockville, MD 20824-1220
Pres., Jeanette Rair
Amer. Red Cross
17th and D Streets, NVV
Washington, DC 20006
Amer. Soc. For Deaf Children
Pres., Jeffery Cohen
814 Thayer Avenue
Silver Spring, MD 20910
Amer Speech-Language-Hearing Associati
Dr. Frederick T. Spahr
10801 Rockville Pike
Rockville, MD 20852
Ame: Tinnitus Association
Pres., Gloria t Reich
P.O. Box 5
Portland, OR 97207
Assoc. for Education & Rehab of the Blind& Vis Imp
Pres., Kathy Megivern
Executive Director
206 N Washington Street, Suite 320
Alexandria, VA 22314
Assoc. for Persons in Supported Employm
Pres., Wendy Wood
Tammara Geary Freeman, Executive Director
1627 Monument Street, Suite 301
Richmond, VA 23220
The Arc
Marty Ford
Asstn Dir, Gov Affairs
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1730 K Street, NW Suite 1212
Washington, DC 20006
Arthritis Foundation
1314 Spriong Street. NW
Atlanta, GA 30309
Assoc. for Persons with Severe Disabilities
Celane McWhorter
206 W. Glendale Ave
Alexandria, VA 22301-2405
Pres., Liz Lindley
Assoc. of Late Deafened Adults
Pres.. Bill Graham
P.O. Box 64173
Chicago, II. 60664
Autism Society of Ametica
Veronica Zysk, Administrative Dir
7910 Woodmont Ave, Ste. 650
Bethesda, MD 20814
Better Hearing Institute
Pres., Joseph Rizzo
5021-B Backlick Road
Annandale, VA 22003
Caption Center
Pres., Larry Goldberg
125 Western Avenue
Boston, MA 02134
Captioned Films/Videos f/t Deaf
Pres., Don Zink
5000 Park Street North
St. Petersburg, FL 33709
Conv of Amer Intructors of the Deaf
Pres., Claire Bugen
P.O. Box 2025
Austin, TX 78768
Catholic Charities USA
Deputy to the Pres., Sharon Daly
1731 King St.. Suite 200
Alexandria, VA 22314
Coun. of State Admin of Vocational Rehab.
Joseph Owen, Executive Director
P.O. Box 3776
Washington, DC 20007
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Ctr. for BiCultural Studies, Inc.
Betty Colonomos, Director
SSQC. Yenilwarth Ave., Suite 105
Riverdale, MD 20737
Deaf Artist of America, Inc.
Pres. Tom Willard
87 North Clinton Avenue Suite 408
Rochester. NY 14604
Deafness & Communicative Disorders Bra
Pres.. Wallace Babington
330 C Street SW Room 3303
Washington. DC 20202
Deafness Research Foundation
Monte H. Jocoby
9 East 38th Street
New York, NY 10016
Deafpride, Inc
Ann Champ-Wilson
1350 Potomac Avenue SE
Washington, DC 20003
Development Team, Inc.
Shirley Roholley
1615 Thames Street, Suite 300
Baltimore, MD 21231
Disability Rights Education & Defense
Pat Wright
1633 Q Street, NW, Suite 220
Washington, DC 20009
Pres., Mary I on Breslin
Disabled American Veterans
Authur Wilson\Nat'l Adjutant
807 Maine Avenue, SW.
Washington, DC 20024
Epilepsy Foundation of America
Paulette Maehara, CED
4351 Garden City Drive, Suite 406
Landover, MD 20785
Gallaudet University
Pres. Dr. I. King Jordah
800 Florida Avenue, NE
Washington, D.C 20002-3695
Gazette International Networking Institute
Joan Headly, Director
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4207 Lindell Blvd., #110
St. Louis MO 63108-2915
Goodwill Industries
Kenneth Shaw Dir. of Rehab. Service
9200 Wisconsin Avenue
Bethesda, MD 20814
Pres.. David Cooney
HEATH Resource Center
(Higher Educ & Adult Train. for People W/Disa
One Dupont Circle
Washington, DC 20036
Pres., Rhona C. Hartman
Hear Now
Barbara Rocketts
4001 S. Magnolia Way
Suite 100
Denver, CO 80237
Int'l Assoc. of Bus., Industry & Rehab
Charles Harles
P.O Box 15242
Washington, DC 20003
Int'l Assoc of Psycho Social Rehab Svc
Ruth Huqhes, Ph.D., Executive Director
10025 Governor Warfield Pkwy #301
Columbia, MD 21044-3330
Learning Disabilities Assoc. of Amer.
Justine Maloney
4156 L ibrary Road
Pittsburgh, PA 15234
Muscular Dystrophy Assoc
Robert Fitzgerald
Human Reources Dir.
3300 E. Sunrise Drive
Tucson. AZ 85718
Nat'l Alliance for Mentally III
Laurie M. Flynn, Executive Director
2101 Wilson Blvd., Ste 302
Arlington, VA 22201
Nat'l Assoc of Developmental Dis Council
Chris Metzler, Asst Exec Dir
1234 Massachusetts Ave., NW, Suite 103
Washington, DC 20005
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Nat'l Assoc of Disability Examiners
Pres., Marty Marshall
2704 Frank Street
Lansing, MI 48911
Nat'l. Assoc of Rehab. Prof. in Private
Bonnie Sheldon
313 Washington Street
Newton, MA 02158
Nat'l. Assoc of Rehabilitation Facilities
Robert E. Brabham, Ph.D., Executive Director
P.O. Box 17675
Washington, DC 20041
Nat'l Assoc of Residential Care Facilities
Barbara B. Jameson. Executive Director
2306 F. Broad. Suite 200
Richmond, VA 23220
Nat'l. Assoc. of Special Education Direc.
Dr. Martha J Fields
1800 Diagonal Road, Suite 320
Alexandria, VA 22314
National Assoc of St. Dir of Dev Disabled Servs
Robert M. Gettings Exec. Director
113 Oronoco Street
Alexandria, VA 22314
Nat'l. Assoc. of State Mental Health Program
Clarke Ross
444 N. Capitol St., NW, Hall of States
Washington, DC 20001
Nat'l. Assoc. of the Deaf
Nancy J. Bloch, Exec. Dir.
814 Thayer Ave
Silver Spring. MD 20910
Nat'l Black Deaf Advocates, Inc.
Pres., Carl M. Moore
One Lomb Memorial Drive
Rochester, NY 14623
Nat'l. Captioning Institute
Pres., John F. D. Ball
5203 Leesburg Pike
Falls Church, VA 22041
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Nat'l. Catholic Office of The Deaf
Pres. Nora Letourneau
814 Thayer Avenue
Silver Spring, MD 20910
Nat'l, Congress of Jewish Deaf
Pres. Barbara Boyd.
13580 Osborne Street
Arleta. CA 91331
Nat'l. Coun on Disability
Speed Davis, Acting Exec. Dir.
1331 F Street, NW, Suite 1050
Washington, DC 20004
Nat'l Coun on Independent Living
Ann Marie Hughey, Exec. Dir.
2111 Wilson Blvd., Suite 400
Arlington, VA 22201
Nat'l. Ctr. For Law and Deaf
Pres., Su DuBow
800 Florida Avenue NE
Washington, DC 20002-3695
Nat'l. Cued Speech Assoc.
Pres. Pamela Beck
1615-B Oberlin Road
Raleigh, NC 27622
Nat'l Down Syndrome Congress
Michael Leonard
1605 Chantilly Dr., Suite 250
Atlanta, GA 30324-1146
Natil Easter Seal Society
Randy Rutta, Vice Pres Gov. Affairs
700 13th St., NW
Washington, DC 20005
Nat'l. Fedn. of the Blind
James Gashel, Dir., Public Policy
1800 Johnson Street
Baltimore, MD 21230
Pres., Marc Maurer
Nat'l. Fraternal Society Of The Deaf
Pres., Robert Anderson
1300 W. Northwest Highway
Mt. Prospect. IL 60056
Nat'l. Hearing Aid Society
Pres., Michael K. Stone
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20361 Middlebelt Road
Livonia, MI 48152
Nat'l. Industries for the Blind
Robert K. Hanye
524 Hamburg Turnpike, CN 969
Wayne, NJ 07474
Pres.. George J. Mertz
Nat'l. Industries for the Severely Hand.
Ken Laureys
2235 Cedar Lane
Vienna, VA 22182
Pres., Elivind H. Johnson
Nat'l. Info. Ctr On Deafness
Pres., Laura DiPietro
800 Florida Avenue NB
Washington, DC 20002-3695
Nat'l Info Ctr for Child & Youths w/Disabls
Suzanne Ripley
Information Service Manager
1875 Connecticut Ave. NW
Washington, DC 20008
Nat'l. Inst. on Deafness & Other Comm Di
Pres., James Snow
9000 Rockville Pike, Building 31, RM 1
Bethesda. MD 20892
Nat'l Mental Health Assoc.
AI Guida, Vice President for Gov. Affairs
1021 Prince Street
Alexandria, VA 22314-2971
Nat'l Multiple Sclerosis Society
Robert enteen, Public Policy Assoc
733 Third Avenue
New York, NY 10017
Nat'l Org for Rare Disorders
Michael Langan
Director of Public Policy
PO Box 8923
New Fairfield, Connecticut 06812-8923
Nat'l. Org. on Disability
Pres., Alan A. Reich
910 16th Street, NW, Suite 600
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Washington, DC 20006
Nat'l Rehabilitation Association
Robert H. Brabham, Executive Director
633 South Washington Street
Alexandria, VA 22314
Nat'l. Rehabilitation Info. Center
Phil Bongiorno
8455 Colesville Road Suite 935
Silver Spring. Md. 20910
Pres., Mark Odum
Nat'l. Resource Ctr. on Homelessness & Ment. III
Deborah L. Dennis, Director
262 Delaware Avenue
Delmar, NY 12054
Pres., Gail Hutchings
Nat'l. Technical Institute for the Deaf
Pres., Dr William E. Castle
P.O. Box 9887
Rochester, NY 14623
Nat'l. Theatre of the Deaf
Pres., David Hays
The Hazel E. Stark Center
Chester, CT 06412
Paralyzed Veterans of America
Gordon Mansfield, Exec Dir
801 18th Street NW
Washington, DC 20006
President's Comm. on Employment of
People with Disabilities
Richard C. Douglas, Executive Director
1331 F Street, NW, 3rd Floor
Washington, DC 20004
President's Comm. on Mental Retardation
Ashot Mmatazakanian, Exec. Dir
WJ Cohen Building, Room 5325
Washington, DC 20201
Registry of Interpreters f/t Deaf, Inc
8719 Colesville Road Suite 310
Silver Spring, Md. 20910
See Ctr f/t Advancement of Deaf Childr
Main Office P O. Box 1/181
Los Almitos, CA 90720
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Self Help for Hard of Hearing People
Pres., Howard Stone
7800 Wisconsin Avenue
Bethesda, Md 20814
Spina Bifida Assoc of America
Lawrence Pencak. Exec. Dir.
4590 MacArthur Blvd., NW Suite 250
Washington, DC 2007
Telecommunications f/t Deaf
Pres., Alfred Sonnenstrahl
814 Thayer Avenue
Silver Spring, Md. 2091 10
The Assoc for Persons w/ Severe Handicaps
Celane McWhorter, Dir Govt. Relations
1600 Prince Street, Suite 115
Alexandria, VA 22314
United Cerebral Palsy Association
John Kemp. Dir. Govt. Affairs
1660 L Street, NW #700
Washington, DC 20036
Vestibular Disorders Branch
Pres., Jerry Underwood
1015 NW 22nd Avenue D-230
Portland. OR 97210
Volunteers of America
Raymond C. Tremont, National Director
3813 North Causeway Blvd.
Metairie, LA 70002
Pres., Clint Chezalher
World Federation of the Deaf
Pres. Liisa Kauppinen
Ilkantie 4. P. 0. Box 65
SF-00401 Helsinki, Finland
World Institute on Disability
Judy Heumann
700 Constitution Ave., NW
Washington, DC 20002
Pres., Edward V. Roberts
World Rec Assoc of the Deaf, Inc/USA
Pres., Bruce Gross
P.O. Box 3211
Quartz Hill, CA 93586
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