Statement of Sarah Wiggins Mitchell, Chair, Ticket to Work and Work Incentives Advisory Panel,
Social Security Administration

Before the Subcommittee on Social Security,
House Committee on Ways and Means

Hearing on Social Security Disability Programs' Challenges and Opportunities

July 11, 2002

Good morning.  My name is Sarah Wiggins Mitchell and I am the Chair of the Ticket to Work and Work Incentives Advisory Panel. On behalf of the Panel, I want to thank the Subcommittee for this opportunity to testify on the definition of disability underlying the disability programs administered by the Social Security Administration. I am here to represent the Panel’s interest and opinions on the topic in question. The definition is a key factor in determining how our country establishes not only eligibility for cash benefits but also for health care, employment support and many other services and supports for millions of people with disabilities.

Given that the definition is used as a gatekeeper to many public programs, the Panel has a keen interest in this topic.  Further, the Social Security Administration’s application of the definition of disability and its internal disability determination process are central to the implementation of the new Ticket to Work and Work Incentives Improvement Act programs and, as such, central to advisory duties of the Panel. 

Because I represent the Ticket to Work and Work Incentives Advisory Panel, I would like to say a few words about the Panel and its responsibilities.  The Ticket to Work legislation established the Advisory Panel within the Social Security Administration to advise the President, the Congress and the Commissioner of Social Security on issues related to work incentive programs, planning and assistance for individuals with disabilities, and the Ticket to Work and Self-Sufficiency Program established under this Act.  The Panel has an important role to play in the implementation of this new law, which provides new choices and opportunities for persons with disabilities to enter or re-enter the workforce.

The Panel is a bipartisan group of twelve citizens, four of whom were appointed by the President, four by the Senate and four by the House of Representatives. We represent a cross-section of individuals with diverse racial and ethnic backgrounds and with experience and expert knowledge as recipients, providers, disabled veterans, employers and employees in the fields of employment services, vocational rehabilitation and other disability related support services. The majority of us are individuals with disabilities, their representatives, or family members. Several Panel members have had personal experience as beneficiaries of Social Security.

The Panel offers the following general suggestions on the disability determination process used by SSA.  I will mention these topics briefly now but our written testimony provides more detail.

• Early Intervention.—Employment support services under the Ticket Program or other programs should begin as soon as possible, even before the beneficiary quits work and spends several months demonstrating to SSA that he or she cannot work at earnings levels above the SGA threshold.
• Higher Reimbursement Rates Under the Ticket Program.—Under the Ticket Program, providers of employment support services will be reimbursed at a higher rate for persons in hard-to-serve categories.  One possibility is that the disability determination process should incorporate a decision on whether the beneficiary qualifies for this higher reimbursement .
• Medical Improvement Expected.—Because the MIE designation will be used to limit eligibility for the Ticket Program, the criteria for the designation should be reviewed as part of the broader review of the disability determination process.
• Partial Disability Benefits.—Under the Disability Insurance Program, a beneficiary can face a “cash cliff”—the total loss of all cash benefits if earnings in a given month exceed a specific threshold. The “all or nothing” DI benefit structure—which is being reevaluated under the Ticket to Work Act—should be considered in your review.
• Persons with Mental Disabilities.—The disability determination process through which SSA implements the disability definition was originally designed to deal primarily with physical disabilities. A thorough review of the criteria for disability determinations to ensure equitable treatment for persons with mental or other disabilities may be appropriate.

In closing, I would like to offer, on behalf of the Panel, to solicit formal public comment on the disability definition and the disability determination process.  Comment would be taken as part of a public meeting conducted by the Panel, by letter or telephone and by e-mail.  We could also solicit input from national and international researchers and experts.  All of the comments and input would  be considered in the Panel’s public discussion and deliberations.  We would then report the Panel’s major findings and conclusions to the Subcommittee in writing.

Let me once again thank the Subcommittee for this opportunity to testify on a topic that has major implications for our Panel’s efforts to increase employment among persons with    disabilities.    And finally, on behalf of the entire Panel, I want to assure you of our commitment to work in partnership with you, the Administration and the disability community on these important and far-reaching policy concerns.                                                                                                                    

Detailed Comments: The Panel offers five comments on the definition of disability used by SSA:

• The Need for Early Intervention.—The Panel is concerned about the delay in the delivery of employment support services as the Ticket Program is now structured.  Research has shown that many apply for Disability Insurance benefits not as the first option, but as the last resort.  In many instances the person with a disability might have been able to continue working at his or her original job if provided with a key support, such as health insurance, transportation, or a workplace accommodation.  Under the current system, such a person must end employment and then attempt to qualify for cash benefits, in order to be eligible for employment support services.  This means that months pass during the medical determination before the beneficiary becomes eligible for employment support services under the Ticket Program.  Delays in processing times exacerbate this problem.  By the time of the determination the beneficiary will probably have severed the relationship with the previous employer.  “Employment support services” at this point may mean both finding a new employer and arranging for a much broader range of supports.  By contrast, early intervention—providing employment support services while the person is still working with the original employer—will probably minimize the services needed and maximize continued employment.
• Higher Reimbursement Rates Under the Ticket Program.—Under the Ticket Program, providers of job support services will be reimbursed at a higher rate for persons in hard-to-serve categories.  For example, some with significant disabilities would be considered hard-to-serve.  This implies that a determination must be made for each beneficiary as to whether he or she qualifies for the higher reimbursement rate.  One possibility is that this determination would be incorporated into the existing disability determination process.
• Medical Improvement Expected.—Under the current disability determination process, some beneficiaries are assigned the designation medical improvement expected (MIE) which implies they will undergo a continuing disability review (CDR).  According to the Ticket Program regulations recently issued, the MIE designation will also limit eligibility for the Ticket Program. That is, the MIE designation now will be used to determine eligibility for a program without a due process mechanism in place.  Because the program eligibility effects of the MIE designation have expanded considerably under the Ticket Program, the criteria for the designation should be reviewed as part of the broader review of the disability determination process. SSA is planning such a review.
• Partial Disability Benefits.—Under the Disability Insurance Program, a beneficiary can face a “cash cliff”—the total loss of all cash benefits if earnings in a given month exceed a specific threshold.  This cash cliff is thought to pose a powerful work disincentive.  It should also be noted that the SSI program uses a gradual reduction in benefits, so that SSI beneficiaries do not face a cash cliff. The “all or nothing” DI benefit structure—which is being reevaluated under the Ticket to Work Act—should be considered in your review.
• Persons with Mental Disabilities.—The disability determination process through which SSA implements the disability definition was originally designed to deal primarily with physical disabilities.  Yet recent program statistics document the growing proportions of beneficiaries with mental disabilities.  In 1999 32 percent of disabled workers under the DI program had a diagnosis of mental retardation or other mental disorder.  In the same year, 59 percent of blind/disabled SSI beneficiaries had a mental disability, similarly defined.  A thorough review of the criteria for disability determinations to ensure equitable treatment for persons with mental or other disabilities may be appropriate.  We note that later this year SSA plans to invite public comment on the Listings of Impairments for mental illnesses.