In the US Senate: S. 331
In the US House of Representatives: H.R. 1180

The Work Incentives Improvement Act (WIIA--S. 331/H.R. 1180) is a bill to
remove some of the most significant barriers to employment for persons with
disabilities and to improve the way that Social Security (SSA) handles the
work attempts of disability beneficiaries. WIIA makes reforms in three
areas: health care, employment services, and Social Security work incentives.

S. 331 and H.R. 1180 started out as identical bills. However, some changes
were made in S. 331 as a result of negotiations in the Senate. Areas where
the two bills differ are noted.


Access to Health Care Coverage

Creates State Options to Extend Medicaid to Workers with Disabilities.
States can choose to extend Medicaid to the following groups:

1) Persons with disabilities who earn over 250%
of the federal poverty level (after SSI exclusions,
roughly $40,000/year) and who meet the SSI
definition of disability.
2) Persons with disabilities who lose SSDI/SSI
eligibility due to medical improvement but who
still have a severe, medically-determinable
impairment and who are working.

For both of these groups, States may impose limits
on assets and income and may charge sliding scale
premiums based on income.

States who extend Medicaid to one or both of these groups can receive
grants to support the design, establishment, and operation of
infrastructures to support working persons with disabilities. Funding for
the grants is $150 million over five years. To receive grants, states must
demonstrate that they make personal assistance services (PAS) available.

S. 331 establishes the following guidelines for sliding scale premiums:
For individuals with incomes at or below 450% of the federal poverty level,
the premium cannot exceed 7.5% of income. States are required to charge
100% of the Medicaid premium to individuals with adjusted gross incomes of
more than $75,000/year.

Creates a time-limited demonstration project permitting States to extend
Medicaid coverage to workers who have a disability that, without health
care access, would become severe enough to qualify them for SSDI or SSI.

Provides continuing access to Medicare coverage. Creates a trial program
allowing SSDI beneficiaries who return to work to continue receiving
Medicare coverage. Participants would pay no Part A premium and would pay
the normal Part B premium. At the end of the trial period, Congress would
decide whether or not the program should be continued. If it were
discontinued, those already participating would be "grandfathered" in and
would continue to receive Medicare coverage as long as they remained

H.R. 1180: Trial program is 10 years long.
S. 331: Trial program is 6 years long.

Employment Services

Establishes the "Ticket to Work Program" to increase choice in employment
services. This program would allow SSDI and SSI beneficiaries to deposit a
"ticket" with the public or private provider of their choice. Providers
would be reimbursed based on successful outcomes; i.e., when beneficiaries
are working and no longer receiving cash benefits.

Improvements to the Social Security Work Incentives

Establishes a community-based Work Incentives Planning and Assistance
Program. The program would be funded by up to $23 million per year in
competitive grants to states or private organizations and would provide
accurate information on work incentives to individuals with disabilities.

Provides for trained SSA work incentive specialists available to
consumers, community work incentive planners and others.

Provides protection and advocacy services for beneficiaries attempting to

Encourages SSDI/SSI beneficiaries to return to work by making it easier
to reaccess cash benefits if work attempts fail. Individuals who lose
entitlement to SSDI benefits due to work and then have to stop working can
receive immediate provisional benefits if they reapply within 5 years and
if their disability has not improved since their initial disability

Prohibits continuing disability reviews (CDRs) from being triggered by
work. CDRs could only take place on a regularly scheduled basis that is
not triggered by work. Work activity could not be used as evidence that an
individual was no longer disabled in a CDR.

Creates a Work Incentives Advisory Panel to advise the Social Security
Administration and other federal agencies on work incentive programs, the
"Ticket program" and related issues.

H.R. 1180: 7 out of 12 Advisory Panel members must be consumers
S. 331: 6 out of 12 Advisory Panel members must be consumers

Requires SSA to conduct a demonstration project in which SSDI benefits
are reduced by $1 for every $2 of earnings above certain limits.


The complete bill texts, Committee reports, and lists of cosponsors can be
found on the Web at

Thanks to Alaine Perry, Policy Analyst, for her ongoing work updating us on
the status of these bills.

In Solidarity,

* Bryon R. MacDonald
- Co-chair, Social Security Subcommittee
National Council on Independent Living
- Community Advocate
The Center for Independent Living - Berkeley/Oakland
436 Fourteenth Street, Suite 218
Oakland, CA 94612
Voice: 510-763-9999, press ext. 19
TDD: 510-444-1837
FAX: 510-763-4910

*Alana R. Theriault, Disability Advocate/Consultant
Work Incentives Update Listserv Manager
Berkeley, CA

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This post is from the Work Incentives Update listserv. If you would like
to add, delete or change your address on this list; have questions about
The Work Incentives Improvement Act of 1999; would like a copy of our
latest legislative summaries; or have other comments, contact Alana R.
Theriault <> or Bryon R. MacDonald <>.