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Last Updated -- July 24, 1997, (nwr)
Speeches and Testimony
on Barriers Preventing Social Security Disability Recipients
From Returning To Work
United States House of Representatives
Committee on Ways and Means Subcommittee on Social Security
July 23, 1997
Chairman Bunning and members of the Subcommittee, thank you very much for inviting me to speak with you on the issue of barriers that prevent disabled Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries from engaging in or returning to work.
As the Department of Education's Assistant Secretary for the Office of Special Education and Rehabilitative Services (OSERS), I am responsible for providing leadership to the Rehabilitation Services Administration (RSA), the Federal agency that provides support to State vocational rehabilitation (VR) agencies and other service providers to assist individuals with disabilities to achieve employment and to live independently. My leadership also extends to the National Institute on Disability and Rehabilitation Research which -- through research, demonstration, and dissemination and utilization programs -- identifies those best practices in technology, rehabilitation, and independent living that result in greater independence and productivity of individuals with disabilities.
My appointment as Assistant Secretary and my ability to live independently would not have been possible without the broad array of rehabilitation and independent living services from which I have benefited along with my personal determination and family's support.
When I was one and a half years old, I developed polio. When I was five, the public school officials would not allow me to enroll. They told my mother that because of my wheelchair, I was a fire hazard. Instead, the school system sent a tutor to my house. When I was nine, I finally got to go to school, but I was placed with other disabled kids in a room hidden in the school basement.
I was the first student in my class to go on to high school -- but not until my mom and dad fought for this right.
After graduating from high school, I went to college. I wanted to become a teacher, but the agency financing my education believed that people who use wheel-chairs could not teach, so they refused to let me major in education. But I did manage to minor in it.
When I graduated, I applied for a teaching license in the New York City school system. I passed the written test and the spoken test. But I failed the medical test because I used a wheelchair. The school officials would not give me a license to teach. But I knew I could be a good teacher. With the support of my parents, I challenged the school system, obtained my license, and finally got a job teaching.
During this time, I became aware that other disabled people from all over the nation -- in fact, from around the world -- were also advocating for equal rights. These people, and many other disabled people and their families, became part of the growing movement for the rights of the disabled.
This broader movement enabled me to go on to graduate school, and to be a leader in the then new independent living movement. I helped found the first Center for Independent Living in Berkeley, California.
Since my childhood, we, as a country, have made significant strides in improving educational opportunities for individuals with disabilities, particularly with the enactment of the Individuals with Disabilities Education Act (IDEA) in 1975. In addition to Congress' recent bipartisan reauthorization that further strengthened IDEA, we have also made significant progress in furthering opportunities for employment and independent living for individuals with disabilities through a broad range of programs that support both rehabilitation and independent living services and research and demonstrations and programs that protect the rights of individuals of disabilities from discrimination in employment, housing, and transportation. It is estimated that approximately 800,000 individuals with disabilities are now working because of the anti-discrimination protections provided by the Americans with Disabilities Act. But significant barriers remain to achieving the goals of independence, inclusion, and empowerment for all individuals with disabilities. Despite the opportunities afforded by the Individuals with Disabilities Education Act, the Rehabilitation Act, and the Americans with Disabilities Act, nearly half of working-age persons with disabilities are unemployed.
These barriers include environmental barriers such as the lack of transportation and lack of affordable and accessible housing. Individuals like myself need access to personal assistance services in order to work. Many individuals need accommodations on the job such as assistive technology to perform effectively in the workplace. Despite the promise of the ADA, negative employer and individual attitudes regarding the employability of individuals with disabilities persist.
Notably, federal policy aimed at assisting individuals with disabilities is also creating disincentives to work for many individuals with disabilities. For example, the potential loss of health care coverage represents a significant barrier to employment for SSDI and SSI recipients. Medicare for disabled SSDI beneficiaries and Medicaid for SSI recipients provide the majority of health care coverage for these groups. While there are provisions that extend these benefits once an individual returns to work, Medicare coverage is time limited and SSI recipients who go to work lose Medicaid if their earnings exceed caps that vary by State. As a result, it's possible that people who are eligible for SSI "manage" their income to ensure that they keep Medicaid--by stopping work when they hit the caps, or even turning down promotions. In addition to primary health care services, the Medicaid program also offers a variety of optional services essential to the needs of severely disabled individuals that are both costly and difficult to obtain even if traditional employer-based health care coverage can be secured.
In order to address this dis-incentive, the President's budget proposes to help people with disabilities work without losing their health care coverage. The President's proposal would create a new State option that would allow SSI beneficiaries with disabilities who earn more than those State caps to keep Medicaid by contributing to the cost of their coverage as their income rises. The President's budget also includes a proposal for a 4 year demonstration project to extend Medicare coverage for SSDI recipient who return to work.
Federal income policy regarding disability payments may also create disincentives to employment. SSDI benefits can continue for up to nine months after an individual attempts to return to work. At that point, SSA must determine if the SSDI beneficiary has achieved substantial gainful activity (SGA), which is a trigger for termination of cash benefits. SSI recipients can continue to receive their SSI checks while they work. As long as they remain disabled, they will continue to receive their SSI check until they reach a certain level of earnings. Our data suggest that many beneficiaries are well aware of the SGA threshold and earnings, and, as they approach them, tend to limit their hours of work or earnings.
Ultimately, these barriers must be addressed if we are to achieve successful employment outcomes for many more individuals with disabilities.
The programs I administer at the Department of Education have played a significant role in our overall efforts to help individuals to be prepared for and engage in gainful employment and must continue to be part of a comprehensive strategy. One of the biggest programs is the Vocational Rehabilitation State Grants programs, which provides $2.2 billion in formula grant assistance to 82 State-operated VR service programs. These programs provide consumers with a wide range of specialized services that include, but are not limited to, job development, job training and placement, counseling and guidance, assistive technology, personal assistance services, physical and mental restoration services, reader services, interpreter services, supported employment services, and school-to-work transition services. The essence of the VR program is to provide services that meet the aspirations, needs, abilities and priorities of each individual, consistent with the individual's informed choice. A VR counselor works as a partner with an individual with a disability to design a rehabilitation program that matches the individual's strengths and interests to a vocational outcome, and they jointly develop an employment plan.
Since its creation seventy-seven years ago by the Smith-Fess Act, the VR State Grants program has assisted some nine million individuals with disabilities to achieve gainful employment. Presently, there are over 1.25 million eligible individuals receiving VR services, 77.5 percent of whom have significant disabilities. In FY 1996, 213,500 individuals who exited the VR system after receiving services achieved an employment outcome and showed notable gains in their economic status.
The State VR agencies and the Social Security Administration have a long history, dating back to 1954, of working together to assist SSDI and SSI beneficiaries to return to work. The Social Security Amendments of 1965 authorized the use of Social Security trust funds to pay for VR services for beneficiaries. The goal of the Beneficiary Rehabilitation Program is to return the maximum number of disabled beneficiaries to work so that savings in reduced benefit payments and the Social Security contributions of the rehabilitated beneficiaries would equal or exceed the amount paid for rehabilitation services.
Since 1983, VR agencies have been reimbursed by SSA only for beneficiaries who are terminated from benefits following a determination that the beneficiary has achieved substantial gainful activity. Payment is made to the VR agency only when savings to the trust fund are anticipated.
In order to examine the success of the VR program in assisting individuals with disabilities to achieve sustainable improvement in employment, earnings, and independence, the Department is currently conducting a major longitudinal study. The study, which is being conducted by Research Triangle Institute, includes a sample of approximately 8,000 current and former VR consumers at 37 VR offices over a three-year period. The time frame permits tracking of services and post-VR earnings, employment, and community integration of VR consumers.
Specifically, the study investigates:
Information obtained from this study will also enable the Department to conduct specific analysis relative to SSDI and SSI beneficiaries. Some of the preliminary data regarding the rehabilitation of SSI and SSDI beneficiaries may be of interest to you. These data show that 28 percent of all active VR clients are SSDI and SSI beneficiaries who have been receiving benefits for an average of 55 months and include recipients who have initiated contact with the VR program or who have self-referred. SSI/DI beneficiaries referred to the VR program directly by SSA or SSA's Disability Determination Service represent only 3.6 percent of all beneficiaries who apply for services because these referrals are made much earlier in the process, e.g., when they first start to receive benefits and are not yet ready to return to work. Beneficiaries entered the VR system far more often through self-referral, community health and rehabilitation programs, and schools. One implication of these data is that a majority of beneficiaries who elect to enter the vocational rehabilitation system do so after a period of receiving SSA benefits, rather than concurrent with the initiation of the receipt of benefits.
The data also show some significant differences between the SSA beneficiary population and the general population served by the VR program. Beneficiaries tend to have higher percentages of some severe disabilities. These include higher percentages of visual disabilities, severe mental illness, mental retardation, and prelingual deafness. One result of the more severe disability mix is higher cost of services. For example, in 1995, the average cost of purchased services for beneficiaries was 49 percent higher than for non-beneficiaries ($4,724 compared to $3,168).
The Department is committed to closely monitoring program outcomes to improve performance and is also in the process of developing evaluation standards and performance indicators for the VR program in order to improve program performance.
The 1992 amendments to the Rehabilitation Act made a number of important changes to the VR State Grants program that will enhance employment opportunities for individuals with disabilities. For example, the amendments modified the criteria for determining eligibility for services to streamline the process and set forth the policy that individuals with disabilities are to be active participants in their own rehabilitation programs.
In preparing for the pending reauthorization of the Rehabilitation Act, we have invited input from a broad range of groups and individuals to get their ideas for further improving the Act, and we are prepared to make a number of specific recommendations for changes that are aimed at improving results for individuals with disabilities in the areas of employment and independent living. These include further streamlining the eligibility determination process to establish presumptive eligibility for VR services for recipients of disability benefits under Titles II and XVI of the Social Security Act, and streamlining the Individualized Written Rehabilitation Plan (renamed the Individualized Employment Plan) to eliminate unnecessary process requirements and give consumers who want to take responsibility for developing their plan the option of doing so. We also support an amendment that clarifies that consumers have the right to choice in regard to the selection of their employment goal, the services needed to reach their goal, the providers of such services, and the methods to be used to procure the services.
At the same time, we recognize that vocational rehabilitation is only part of the solution to the unemployment of individuals with disabilities, and we support other options to maximize return-to-work opportunities. For example, the Social Security Administration has recently transmitted its Ticket to Independence proposal, which would authorize a new public-private partnership to assist individuals who receive SSDI or SSI benefits on the basis of disability to return to work. We look forward to working with the Social Security Administration on this effort.
We must continue to explore ways to address the broad range of factors contributing to the high unemployment of individuals with disabilities. I am convinced that by working together, the Administration, Congress, individuals with disabilities and their advocates, service providers, and employers can turn the wasted talents of disabled people into an important resource for securing our nation's future.
I want to assure the Subcommittee of my sincere desire to work with you and our partners at SSA to achieve our common goal of assisting individuals with disabilities to achieve gainful employment and to become contributing members of our society.
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