Statement of John Kregel, Ed.D., Principal Investigator, Benefits Assistance Resource Center,
Virginia Commonwealth University, Richmond, Virginia

Testimony Before the Subcommittee on Social Security
of the House Committee on Ways and Means

Hearing on Fourth in a Series on Social Security Disability Programs' Challenges and Opportunities

September 26, 2002

Benefits Planning, Assistance, and Outreach:
The First Stop on the Road to Employment

Introduction

Benefits planning and assistance is the first stop on the road to employment and economic self-sufficiency for SSA beneficiaries. Authorized by Section 121 of the Ticket to Work and Work Incentive Improvement Act of 1999, 116 Benefits Planning, Assistance and Outreach (BPAO) programs are providing services to SSA beneficiaries in all 50 states and five territories. Collectively, the 116 BPAO projects employ over 400 benefits specialists, many of whom are themselves individuals with disabilities, and have served over 30,000 individuals since their inception less than two years ago.

The purpose of the national BPAO initiative is to provide beneficiaries with accurate and timely information about SSA work incentives and other Federal efforts to remove regulatory and programmatic barriers to employment for persons with disabilities. Trained benefits specialists working in local BPAO programs work with individual beneficiaries to explain the myriad of regulations, provisions, work incentives and special programs that complicate an individual’s decision to enter or reenter the workforce. Benefits specialists do not tell beneficiaries what to do or make specific recommendations. Instead, they allow beneficiaries to make their own informed decisions based on complete and accurate information. In addition, they support individuals who choose to enter employment by assisting them to comply with all relevant regulations and reporting procedures.

The questions posed to benefits specialists by beneficiaries are basic and straightforward. What will happen to my benefit check if I return to work? What is the ticket program and what will it do for me? I am currently working and got a letter from SSA – can you help me? How can I notify SSA when I work so I can avoid overpayment situations? As simple and basic as these questions are, their answers are often complex and convoluted. Even more frustrating to beneficiaries is the overwhelming amount of confusing and inconsistent information they receive from SSA, Employment Networks, Vocational Rehabilitation and other agencies involved in the employment process. This sea of misinformation makes employment seem a perilous and terrifying undertaking and lessens the resolve of many beneficiaries attempting to pursue their career goals.

Benefits planning and assistance is designed to fill this information void by providing beneficiaries access to complete, individualized information from a trained professional in a confidential setting apart from SSA. Armed with an understanding of the impact of employment on their benefits, beneficiaries can make informed choices about entering employment, maintaining health care coverage, and obtaining necessary supports and services. With the help of benefits planning and assistance, beneficiaries can take charge of their own careers without the constant worry that the application of an unknown rule or a mistake by a federal caseworker will jeopardize their ability to pay for their basic needs or treat their health conditions. Viewed in this way, benefits planning and assistance is the most basic of all employment programs.

This testimony contains four sections. The first section discusses the achievements and challenges of the national BPAO initiative. The second section describes the current and future role of BPAOs in the implementation of the Ticket to Work program. The third section makes several recommendations for improving the BPAO program. Finally, the fourth section summarizes current trends in the implementation of benefits planning and assistance based on information from the National BPAO Data System maintained by Virginia Commonwealth University.

Section I:
Achievements and Challenges of the Benefits Planning,
Assistance and Outreach Initiative

Accomplishments

The national BPAO initiative is less than two years old. In that short time 116 local programs have been established, staff members have been hired and trained, and relationships have been developed between BPAOs and SSA field offices, Employment Support Representatives, Employment Networks, Vocational Rehabilitation Agencies and community advocacy and provider organizations. Several of the key accomplishments of the BPAO initiative are summarized below.

The national BPAO initiative has grown at a remarkable rate. BPAO projects are located in independent living centers, advocacy agencies, State Vocational Rehabilitation agencies, community rehabilitation providers, legal aid agencies, universities, and other diverse settings. Over 400 benefits specialists have received ongoing training and technical assistance to insure program quality. To date over 30,000 individuals have received services from BPAOs, with over 3,000 new beneficiaries receiving service each month. SSA has done an outstanding job of launching a major new national service in a very short amount of time.

Benefits planning and assistance is an employment program, providing support to SSA beneficiaries who want to work. Approximately 85% of all individuals who contact a BPAO are either employed or are actively seeking employment. Another 13% are attempting to get information about work incentives, the ticket, and other programs that will help them decide whether to pursue employment. Only 2% of persons contacting BPAOs are in the process of terminating employment or reducing their work hours. The BPAO initiative is not about helping people stay on benefits. Rather, its purpose is to empower individuals to take charge of their lives and enhance their economic self-sufficiency.

The national BPAO initiative is essential to the successful implementation of the ticket program. When the Ticket to Work program was launched in 13 states, BPAOs rose to the challenge and provided assistance to over 9,000 individuals in a very short time. The Project Manager, Employment Networks, local SSA offices, Protection and Advocacy agencies, and State Vocational Rehabilitation agencies all refer ticket holders for information and support.

Individuals with disabilities are actively involved in the delivery of benefits planning and assistance services. Approximately half of the 400 benefits specialists working in BPAO programs are individuals with disabilities. Many of these individuals have personal experience with SSA disability programs. Individuals with disabilities, serving in paid professional positions, are using their knowledge, skill, and personal experience to assist other persons with disabilities to navigate the maze of SSA work incentives and regulations to obtain employment and maximize their economic self-sufficiency.

The national BPAO initiative is a major component of a multi-faceted effort by Congress and SSA to improve services to beneficiaries. Congress and SSA have developed and launched a network of services and support structures that have enhanced the overall efficiency and responsiveness of the agency. The BPAO initiative allows beneficiaries to get their questions answered by a trained professional without the fear of losing their cash benefits, medical benefits and experiencing further financial barriers. At the same time, a cadre of Employment Support Representatives, working inside the agency, are indispensable for the success of the overall reform initiative. ESRs provide crucial access to information and guidance to BPAOs on cases, thereby making the BPAOs more effective.  BPAOs need an SSA "insider" with significant work incentives knowledge to assist with developing work CDRs. Employment Support Representatives provide support to benefits specialists, as well as provide direct service to beneficiaries. In addition, the Modernized Return to Work system, currently being implemented all across the country, has automated and vastly improved the exchange of information between SSA and the BPAOs.

Challenges

The national BPAO initiative began during a time of tremendous change in the disability benefit programs. The launch of the Ticket to Work program, the creation of Medicaid buy-in programs, the implementation of enhanced work incentives in the TWWIIA, and the establishment of the Employment Support Representative pilot all contributed to a spirit of innovation and reform. At the same time, the speed at which these changes occurred created significant challenges for the BPAO program. Several of these are summarized below.

The national BPAO initiative lacks sufficient capacity to adequately meet current and future demand. The number of beneficiaries requesting services has overwhelmed a large number of local BPAOs. The problem is particularly acute for BPAOs in ticket rollout states, and programs in rural areas where extensive travel reduces potential service time. As a result, a significant number of BPAOs are curtailing their outreach efforts, so that they do not create a demand that cannot be met. With aggressive marketing efforts, many programs indicate they could substantially increase the number of beneficiaries served. The following examples illustrate the current situation.

• In northern California, Legal Services of Northern California is attempting to serve 87,000 individuals in 19 counties in and around Sacramento with just three benefits specialists.
• Beneficiaries in Plano, Texas are served by the West Texas and Panhandle Benefits Planning Services project in Odessa, a full seven hours away. In this project, one benefits specialist is attempting to serve a catchment area of 38,000 beneficiaries who live in 59 counties.
• MCIL in Baltimore serves a catchment area of over 50,000 beneficiaries with 2.5 benefits specialists. The project has served over 500 beneficiaries since its inception and is struggling to handle its current caseload. They have limited their outreach activities for fear they could not adequately respond to the resulting referrals.
• In Arizona, six benefits specialists have served over 1,000 beneficiaries across the entire state. In northern Arizona, 1.5 staff members serve 59,000 square miles from the Navajo reservation to Lake Havasu.
• In Austin, Texas, four staff from the Austin Resource Center for Independent Living are attempting to serve a catchment area of 119,000 individuals spread across 58 counties. Beneficiaries frequently wait two weeks to meet with a benefits specialist, as each specialist is responsible for serving anywhere from 11 to 15 counties.
• In Los Angeles, beneficiaries are experiencing delays of seven to ten business days before seeing a benefits specialist. Goodwill Industries of Southern California and AIDS Project Los Angeles have served over 700 individuals, many of whom have significant cognitive or psychiatric disabilities that require an extensive amount of service, with just four benefits specialists.

Youth are currently not significantly represented in the population served by the Program. Indeed, less than eight percent of beneficiaries receiving services from local BPAOs are under the age of 22. At one level this is understandable, as current implementation efforts have focused on assisting in the rollout of the ticket program. However, the challenges faced by transition-aged beneficiaries are unique, and specific work incentives have been developed to assist them in their employment efforts. Future BPAO outreach activities should focus on contacting and serving adolescents and young adults.

For many BPAOs, staff turnover is becoming a serious issue. Stability of direct service staff is essential to the success of a local BPAO, or any human service program. Unfortunately, for an increasing number of BPAOs, staff turnover has become a significant problem. The role of a benefits specialist is a brand new professional position in many states, and some degree of turnover should be expected in any new initiative. However, in some instances staff turnover is resulting from a disparity in salary structures in the various systems that employ benefits specialists. Specifically, specialists working in independent living centers and non-profit community organizations are leaving to take similar positions in State Vocational Rehabilitation agencies, universities, or Department of Labor settings. Retaining skilled, experienced benefits specialists may remain a significant problem for small BPAO programs for the foreseeable future.

Section II:
Role of BPAOs in the Implementation of the Ticket to Work Program

The national BPAO initiative is crucial to the successful implementation of the Ticket to Work program. The vast majority of Employment Networks have little knowledge of SSA benefit programs and applicable work incentive provisions. Many ENs are “non-traditional” providers who may be working with SSA beneficiaries for the first time and encountering the complex array of rules and procedures with little knowledge or support.

Similarly, State Vocational Rehabilitation (VR) agencies in the initial rollout states and the Project Manager are ill equipped to adequately address questions being asked by ticket holders. Responding to hundreds of inquiries when tickets are mailed, State VR agencies simply lack the resources and trained staff to answer questions about benefit changes, health care coverage, and eligibility for other programs. Most local VR counselors possess little more than basic knowledge of work incentives and are unable to provide accurate and complete information. The Project Manager, faced with receiving tens of thousands of inquiries annually, is not staffed to provide lengthy, detailed information to each individual ticket holder.

Without this information, ticket holders will justifiably be reluctant to jeopardize crucial financial and health care benefits and assign their ticket to an EN. Local BPAO programs have stepped forward to meet this need in the initial rollout states. For example:

• Gulfstream Goodwill in West Palm Beach, Florida has responded to over 500 individuals who have contacted the program inquiring about the use of their ticket. Ticket holders make up over half of the 900 individuals served by the agency’s BPAO since program inception. While keeping the BPAO and EN components of the agency separate, Gulfstream Goodwill has nevertheless been able to provide timely and accurate information to ticket holders that can aid beneficiaries in decision-making.
• The Ticket to Work Coordinator in the Arizona Rehabilitation Services Administration has received over 900 telephone inquiries since the ticket rollout began in his state. After explaining the role of the State VR agency, the Coordinator refers the ticket holder to the BPAO organization for an explanation of the ticket program and a detailed analysis of the impact of program participation on an individual’s income and health care. Interested ticket holders then contact their local VR office to assign their ticket.
• An Oklahoma benefits specialist reports receiving several calls from an SSI recipient who had been told by an agency involved in ticket implementation that he could earn up to $560 without his benefit being reduced. Her message to others in her region, “If you are getting ready to be a Ticket state get ready to undo a lot of damage!”
• In Oregon, the Oregon Vocational Rehabilitation Services staff member who screens Ticket to Work calls explains program features and goals, but refers all callers to the local BPAO to address specific benefit and work incentive questions. However, available BPAO resources in the state make it difficult to consistently respond in a timely manner and a number of ticket holders have experienced significant waits for BPAO services.
• In Florida, Oklahoma, Arizona and other states, ENs and BPAOs are implementing innovative strategies to maximize the availability of BPAO services. BPAO staff are attending and participating in orientations sponsored by ENs that are conducted for interested ticket holders. In this way, the ENs and BPAOs are attempting to make sure that beneficiaries have all necessary information before beginning the ticket assignment process.
• The Houston Center for Independent Living has already begun to educate and inform the Houston community about the upcoming ticket rollout. The Center, which serves 13 counties and 12,500 square miles, estimate that the workload for each of the four current benefits specialists will double when the ticket program is launched in Texas in 2003.

Section III:
Recommendations for Improving the National BPAO Initiative

It’s about trust. If beneficiaries are to accept personal responsibility for their careers and their economic self-sufficiency, they have to be able to trust the information they receive and the service providers that assist them. If a beneficiary is told that employment will affect his or her benefit in a certain manner, they have to be able to trust and act on that information. If individuals with diabetes, epilepsy or a psychiatric disability are told that they will still have access to health care coverage even though they no longer receive a cash benefit from SSA, they must be able to depend on this information, as erroneous information may literally put them in a potentially life threatening situation. If an individual complies with all with all SSA regulations and reporting requirements and SSA fails to accurately apply that reporting information to the individual’s case, the resulting overpayment can have a catastrophic and disheartening effect on even the most courageous and patient beneficiary. The following examples illustrate these concerns.

• Staff from Project ABIL in Phoenix, Arizona report talking to many individuals who have received conflicting and sometimes inaccurate information from the Project Manager, VR, SSA, and ENs. This confusion increases fear and causes concerns among individuals bravely attempting to return to work.
• One benefit specialist in south Florida, discussing the advantages of the BPAO, stated, “Beneficiaries are able to ask questions of a BPAO benefits specialist that they are simply afraid to ask Social Security.”
• In Los Angeles, Goodwill Industries of Southern California describe a number of consumers who have stopped working while on benefits because of substantial overpayment situations, many of which are due to improper SSA record keeping or insufficient knowledge of how to report and keep track of earned income.
• In western Kentucky, staff from the Center for Accessible Living report that beneficiaries have responded positively to the simple fact that accommodations such as sign language interpreters are provided by the BPAO project upon requests. Many beneficiaries have noted they have not been provided accommodations at the SSA office even when requested.
• The Sheperd Center in Atlanta has served over 400 beneficiaries throughout the metropolitan Atlanta area, including Fayette, Henry, and Clayton counties. Shepard Center staff report dozens of instances in which beneficiaries accurately report earnings to SSA, yet these reports are not acted upon, resulting in significant overpayments to beneficiaries and loss of trust in SSA. Center staff is relying on assistance from the local SSA public affairs specialist to work up and resolve the cases.
• In Los Angeles County, most beneficiaries contacting Familia Unida have language and cultural barriers that affect their communication with SSA. Most of these individuals are afraid to call the SSA office and are not clear about the information they have received.

We need to learn from the lessons of welfare reform. Beneficiaries need to know and understand the rules, and have them consistently interpreted and applied, in order to fulfill their own responsibilities under the program and accept responsibility for their economic self-sufficiency. The national BPAO initiative, if effectively implemented, is an essential component of Congressional efforts to include individuals with disabilities in our nation’s workforce. To this end, five recommendations are offered.

Congress should expand the network of local BPAO projects to meet existing demand for the service and adequately serve beneficiaries attempting to participate in the Ticket to Work program. The BPAO program simply lacks the capacity to respond to the overwhelming demand for services. In some instances, BPAOs have been forced to make beneficiaries wait up to two weeks for initial appointments. In other communities, BPAOs have sharply curtailed outreach activities so that they don’t create a demand that they just can’t meet. BPAOs estimate that when the ticket program is rolled out across the nation, benefits specialists’ caseloads will double. Additional program capacity will enable BPOAs to address current and future demand. In addition, enhanced program capacity would allow BPAOs to increase marketing activities that would allow thousands of individuals, who now feel that they are incapable of employment, to test their abilities without jeopardizing their livelihood.

SSA should work with the Project Manager, State Vocational Rehabilitation agencies, and Employment Networks to insure that benefits planning and assistance supports are available to beneficiaries early in the Ticket to Work process. When a beneficiary contacts the Project Manager, he or she should receive information about the availability of BPAO services in the local area, as well as the type of services provided by BPAOs. Clear policies should be developed regarding the extent to which Project Manager staff members should provide work incentive information to beneficiaries. Similarly, State Vocational Rehabilitation agencies should provide information about BPAOs to the hundreds of beneficiaries who contact them during the initial stages of ticket rollout. Technical assistance should be provided to local Employment Networks so that they understand the importance of BPAO services and assist potential ticket holders to access the service.

Efforts to improve the overall capability of SSA to effectively and responsibly serve disability beneficiaries should be maintained and expanded. BPAOs operate independently of SSA, but not in isolation from the agency. The piloting of the Employment Support Representative position, the creation of the Modernized Return to Work (MRTW) software, continued training for field office staff, and efforts to collaborate with State Protection and Advocacy agencies are all strategies that support the BPAOs and improve service to beneficiaries. The Employment Support Representative program should continue and be expanded. The MRTW automation efforts should be immediately implemented nationwide.

SSA should begin now to evaluate the effectiveness of the national BPAO initiative.  SSA plans to initiate a consumer satisfaction survey of beneficiaries who have received BPAO services in the near future. In addition to consumer satisfaction, SSA should plan and implement an impact evaluation of the BPAO program. The resulting information can be used to determine the effect of BPAO services on beneficiary employment and earnings, as well as the cost-effectiveness of the program.

SSA’s national BPAO initiative should coordinate its activities with other programs and agencies providing benefits planning and assistance services. In addition to BPAOs, benefits planning and assistance services are being supported by the Center for Medicaid and Medicare Services, the Department of Labor, the Rehabilitation Services Administration and other funding agencies. SSA should coordinate training, evaluation and quality assurance activities with its Federal partners to insure that these efforts maximize combined program capacity and increase long-term program stability.

Section IV:
Benefits Planning, Assistance and Outreach Summary:

Results from the National BPAO Data System

Nationally, 116 organizations, 156 sites, 400 benefit specialists, and 27,502 beneficiary recipients participated in the BPAO Program between March 1, 2001 and July 31, 2002.  An organization, defined as the primary BPAO awardee, is an entity or agency that has directly entered into a cooperative agreement with SSA to provide benefits, planning, assistance, and outreach services to beneficiaries.  An organization may be providing all BPAO services directly, or may have established agreements with subcontractors to assist with service delivery.  Each organization can have one or multiple sites, a decision that is dependent upon physical location and data partitioning preferences.

Many different types of organizations are providing BPAO services. Centers for Independent Living (CILs) are providing services in 53 communities, accounting for nearly half of all BPAO organizations. Non-profit communities organizations, ranging from Goodwill Industries to mental health centers, provide services in 21 locations. State Vocational Rehabilitation (VR) agencies operate BPAO programs in 18 states. Other BPAO organizations include advocacy organizations (e.g. United Cerebral Palsy), universities, and legal aid agencies (including Protection and Advocacy organizations).

Many of the 116 organizations provide their services at a single site. In many instances staff based at the site may travel locally, or in some instances across large geographic areas, to meet and serve beneficiaries. In other instances, in order to adequately serve its specified catchment area, a project may establish multiple sites across a region or an entire state. At the present time, 156 sites are represented across the 116 organizations.

At the present time 400 benefits specialists are submitting data into the VCU BPAO database. Approximately half of these benefits specialists are individuals with disabilities, many of whom have personal experience with the SSA disability programs. This is a key feature of SSA BPAO program. Individuals with disabilities, serving in paid professional positions, are using their knowledge, skill, and personal experience to assist other persons with disabilities to navigate the maze of SSA work incentives and regulations to obtain employment and maximize their economic self-sufficiency.

The Benefits Assistance Resource Center at Virginia Commonwealth University maintains a uniform data management system was developed that allowed BPAO contractors to submit, revise, and aggregate information on their clientele via web-based forms. The National BPAO Data System collects information on:

Beneficiary Name
Social Security Number
Address
Age
Sex
Type of Disability
Current Benefits Received
Current Employment Status
Reasons for Contacting the BPAO
Types of Services Delivered
Work Incentives and Provisions Discussed with Beneficiary
Amount of Time Required to Assist Beneficiary

This national reporting effort is being used to gather information that documents the degree to which the BPAO Program is achieving the outcomes intended by Congress when it established the program as a key component of the Ticket to Work and Work Incentives Improvement Act.  The program continues to expand rapidly, providing an array of services to SSDI and SSI beneficiaries that will ultimately enable an increasingly diverse population of people with disabilities to fulfill their goals of returning to work and achieving self-sufficiency.

Total Number of Beneficiaries Served in the BPAO Program

The data reported below reflects the experiences of 27,502 beneficiaries who received services through the 116 organizations on or before July 31, 2002, based on information submitted to the national BPAO data system maintained by Virginia Commonwealth University. To better understand the activities of the local projects, beneficiaries are grouped based upon the level of services received.  One group consists of 14,044 beneficiaries (51%) who receive only Information and Referral and/or Problem Solving and Advocacy services. The second group (49%) includes 13,458 persons who received “Benefits Analysis and Advisement,” “Benefits Support Planning,” and/or “Benefits Management” and is referred to as individuals who receive Intensive Benefit Support. As illustrated in the table below, SSDI and concurrent beneficiaries are significantly more likely to receive Intensive Benefit Support services than SSI recipients.

The number of beneficiaries served by the BPAO Program and the intensity of services provided varies greatly by state, as the following table reveals. This information should be interpreted carefully. The state-by-state data presented in the table below does not reflect services provided but not reported to the VCU database, services provided by other funding sources, or services provided or reported since July 31, 2002.

Intensive Benefit Support Recipients

Age - The vast majority of individuals receiving Intensive Benefits Support services are between the ages of 20 and 59, with less than 10 percent falling either above or below this range.  Both sexes were represented equally.

Primary Disability - BPAOs serve individuals with a wide variety of both physical and mental disabilities. The two most common primary disabilities reported for beneficiaries receiving intensive benefit support were mental/emotional disorders and system diseases, such as neurological, endocrine, respiratory and circulatory systems. These two categories jointly account for more than half of all beneficiaries receiving Intensive Benefit Support.  The categories reported least often are traumatic brain injury, sensory impairments, and infectious diseases. Just over seven percent of all intensive benefit support recipients reported having some sort of special language consideration, such as the use of sign language or English as a second language.

Employment Status - More than 90 percent of those individuals who receive intensive benefit support through the BPAO Program are either employed or in the process of seeking employment.  Most are currently not working, but have a desire to change their employment status.  Slightly more than half indicate that they were not employed, but are actively seeking employment, and nearly 30 percent are currently employed part-time, working less than 30 hours a week.  Less than six percent of intensive benefit support beneficiaries were employed full-time, working 30 or more hours a week.

Reasons for Contacting BPAO - Nearly 75 percent of beneficiaries have requested services in direct response to the outreach efforts of the BPAO Program.  Having an interest in examining new or expanded work options is another relatively common reason for seeking services, cited by over 40 percent of individuals receiving Intensive Benefit Support.  Approximately nine percent of beneficiary recipients indicate that communication from SSA led them to request services.  Eight percent of total recipients indicate that they sought services in response to Ticket to Work communications from SSA; this finding must be interpreted with caution, however, since of the 27,502 total beneficiaries, only 9,583 were in the 13 states included in the first phase of implementation of the Ticket to Work Program.

Types of Services Provided - Services providing by local BPAO programs are classified into five distinct service categories to facilitate comparison and communication across programs. Services most often delivered to the Intense Benefit Services group are "Benefits Analysis and Advisement," during which the benefit specialist may assess the potential impacts of employment or other changes on the person’s financial well being and develop an outline of available options and projected outcomes. "Information and Referral," which involves providing basic written and verbal information in response to inquiries about benefit program, and referral to government agencies or other resources, has been provided to 80% of beneficiaries.  The service category least frequently provided to this group was "Benefits Management," although the nature of this category, which involves the provision of ongoing, comprehensive benefits monitoring and management assistance to those beneficiaries who are likely to experience dramatic life changes, makes it critical to those individuals who do receive it.

Amount of Services Provided – The amount of services provided to individuals varies significantly. About a quarter of beneficiaries receive one hour or less of services, and nearly half receive between two and four hours, with an average service time of about 3.4 hours.  Nearly a quarter of beneficiaries received more than five hours of service; however, only about five percent received more than 10 hours.  Individuals with mental and emotional disorders, and currently unemployed individuals seeking to obtain employment tend to receive the largest amount of services.

Intensive Benefit Support Recipients Grouped by SSA Benefit Status

In addition to the findings above, it is useful to compare the experiences of beneficiaries receiving Intensive Benefit Support on the basis of whether they receive SSI only (n = 4089), SSDI only, (n = 6500), or Concurrent SSI and SSDI (n = 2694).  Nearly 90 percent of those receiving SSI or concurrent SSI/SSDI and just over 30 percent of those receiving SSDI are currently utilizing Medicaid.  SSDI beneficiaries are more likely to receive private health insurance (although coverage is quite low in absolute terms), and less likely than the other two groups to currently receive subsidized housing or food stamps.

Current Employment Status - The current employment status of the recipients did not appear to vary much across the three benefit categories; type of benefit does not appear to predict employment status among the individuals served by the BPAO Program.  Across all three groups, more than half of the intensive benefit support recipients were not currently employed, but actively seeking employment.

Work Incentives Recommended for Consideration - While benefit specialists are not responsible for recommending a specific course of action to beneficiaries, they do describe work incentives and provisions that are available to particular individual, fully discussing the requirements of and possible ramifications of each. 

The incentives and provisions that described by specialists as options for beneficiaries to pursue vary across current benefit status, consistent with expectations.  A Trial Work Period, which provides an opportunity for beneficiaries to test work skills while maintaining benefits, has been discussed with nearly 80 percent of SSDI and concurrent beneficiaries, and a subsequent Extended Period of Eligibility has been described to about three quarters of these individuals.  A Plan for Achieving Self Support was presented to roughly a third of SSI and concurrent recipients and to 16 percent of SSDI beneficiaries.  Impairment Related Work Expenses were presented to about half of all intensive benefit support recipients, regardless of benefit status.

Section 1619(a) has been presented to about a third of SSI and concurrent recipients, and 1619(b) has been discussed with nearly two thirds of SSI and concurrent recipients.  The Medicaid Buy-In program was slightly less likely to be presented as an option for SSDI beneficiaries than for either of the other two groups.  Extended Medicare has been presented to approximately a third of concurrent beneficiaries and to a slightly greater proportion of SSDI beneficiaries, while the opposite trend was true for Subsidy Development.

The incentives presented as options least frequently overall were Blind Work Expense and Student Earned Income Exclusion, reflecting the demographic characteristics of the individuals currently served by the BPAO Program.  Indeed, the data must be examined within the context of the appropriate subgroups to provide a more accurate understanding of the extent to which these incentives are indicated to beneficiaries.  Student Earned Income Exclusion was indicated for 30 percent of the 989 intensive benefit services youth under the age of 22, and Blind Work Expense was indicated for over half of the 680 individuals with visual disabilities who received intensive benefit services.

Other Provisions - Continuing Disability Review Protections are discussed as an option for a slightly higher proportion of concurrent and SSDI beneficiaries than for SSI beneficiaries, Expedited Reinstatement of Benefits were less likely to be presented to SSI recipients than to the other two groups, and the provision of Property Essential to Self Support was least likely to be presented to SSDI beneficiaries, although the overall trends were very similar across all three benefits groups.

Anticipated Change in Employment Status - The overall patterns of anticipated employment status change are consistent across the three groups; however, there are a few minor differences.  Over half of the beneficiaries in each group anticipated that they would be seeking a new or supplemental job in the future.  A similar pattern was found for intention to use the Ticket to Work Program to seek a new or supplemental job.  A smaller proportion of SSDI beneficiaries indicated that they intended to pursue education/training than was true for the other two groups.  Less than two percent of all intensive benefit services recipients sought planning assistance due to an intention to cease employment or decrease work hours. It appears that individuals receiving Intensive Benefits Support clearly intend to enter employment or improve their employment situation, regardless of the type of benefit they presently receive from SSA.

Amount of Services Provided - In terms of the amount of services provided to Intensive Benefit Support recipients, SSI recipients are slightly more likely to receive less than one hour of service, while concurrent beneficiaries are least likely to receive less than one hour of service. Not surprisingly, concurrent beneficiaries are likely to receive more services than the other two groups. Mean service hours are 2.6 for the SSI group, 2.8 for the SSDI group, and 2.9 for the concurrent beneficiary group.

Information and Referral/Problem Solving Recipients

The second major category of beneficiaries served by the BPAO Program includes 14,044 individuals receiving “Information and Referral” and/or “Problem Solving” only.  In this group, virtually all beneficiaries receive information and referral services, and approximately a quarter also receive problem solving and advocacy services.  Nearly half of these individuals receive less than one hour of total service.  The average service time for this group is 1.3 hours, with less than 14 percent receiving three or more hours.

Individuals in the I & R Problem Solving group receive significantly less service than the Intensive Benefit Support group, primarily due to the nature of the various services included in each.  Nearly 70 percent of individuals in the I & R/Problem Solving group receive one hour or less of total service, whereas most of those in the intensive benefit support group receive one hour or more of service, with only 12.5 percent receiving less than one hour.

Due to the less intensive nature of the services received by beneficiaries in this category through the BPAO program, the submission of some of the data collected from this group was not strictly required by the program.  Therefore, the data that was obtained may not be completely representative of this group as a whole, and may underestimate the general trends that exist within the group.

Results suggest that the level of support received did not appear to vary based on beneficiary demographics. As in the Intensive Benefit Support group, no differences in sex emerged, and the majority of beneficiaries were between the ages of 20 and 59, with slightly more than 13 percent of I & R/Problem Solving recipients falling above or below this range. 

Mental and emotional disorders are indicated as the primary disability by nearly a third of beneficiaries in the I & R/Problem Solving group, followed by system diseases and non-spinal cord disabilities and amputations.  The least commonly reported primary disability categories were sensory impairments and infectious diseases.  Overall, the pattern of primary disabilities indicated in the I & R/Problem Solving group was very similar to that in the intensive benefit support group.  Nearly eight percent of I & R/Problem Solving group reported that they require some sort of special language consideration. 

Benefits Received - I & R/Problem Solving recipients received a broad range of benefits.  Nearly 80 percent received either SSI or SSDI only, with a smaller percentage receiving concurrent SSI/SSDI.  Nearly 90 percent received either Medicaid or Medicare.  In terms of other benefits, food stamps and subsidized housing were most common in this group, and Workers Compensation, Veterans Benefit, and unemployment insurance were least common.  It is possible that the data below for I & R/Problem Solving recipients underreport the number of individuals receiving SSA benefits; due to the structure of the databases, a small number of cases contain missing data on this element. Data from the intensive benefit support group is repeated in several tables in this section, for the purpose of facilitating comparisons between the two service groups.

Employment Status - Just over half of all I & R/Problem Solving recipients indicate that they were not currently employed, but seeking employment.  Eighteen percent of these individuals were employed part-time, yet only four percent were working full-time.  I & R Problem/Solving Recipients are less likely to be employed part-time and far more likely to not be employed and not seeking employment than individuals receiving Intense Benefit Services.

Although over half of the beneficiaries in each of the two categories indicate that they were currently not employed, but seeking employment, a greater proportion of individuals in the Intensive Benefit Support group are currently employed than was true for the I & R/Problem Solving group.  This is true for both full and part-time work.  The proportion of individuals who are not employed and not seeking employment in the I & R/Problem Solving group is more than twice that of the Intensive Benefit Support group. 

Anticipated Employment Status Change – Individuals in the I & R/Problem Solving group are less likely to be seeking employment when they contact the BPAO. They are for more likely to not have made a decision regarding their future employment status. Generally, these individuals are requesting assistance regarding communication from SSA, seeking information about the Ticket to Work program, or asking a specific question about their benefit status.

Work Incentives Recommended for Consideration - A variety of work incentives have been discussed with for the I & R/Problem Solving recipients; a Trial Work Period and subsequent Extended Period of Eligibility were presented most frequently, along with Impairment Related Work Expenses and Section 1619(b).  As would be expected, benefits specialists discuss far fewer incentives with individuals receiving I & R/Problem Solving services, since a detailed knowledge of the individuals specific situation is required before the benefits specialist can provide customized information on a range of incentives.

Ticket to Work Rollout States

Of the 27,502 total beneficiaries, 9,583 (34%) were in the 13 states included in the first phase of implementation of the Ticket to Work Program.  Within those states, the Ticket was presented as a provision to 47.2 percent of I & R/Problem Solving beneficiaries and to 42 percent of Intensive Benefit Support beneficiaries.  Nearly a third of the I & R/Problem Solving group and just over 20 percent of the Intensive Benefit Support group responded to Ticket to Work communication from SSA as a reason for seeking services from the BPAO Program.  Nearly a quarter of the I & R/Problem Solving group and almost 30 percent of the Intensive Benefit Support group indicated that they intended to use the Ticket program to seek a new or supplemental job.

It seems apparent that in the Ticket to Work impacted BPAO in at least two ways. First, the Ticket program creates a considerable demand for BPAO, accounting for over one third of all beneficiaries accessing BPAO services. Second, large numbers of beneficiaries in these states are indicating a desire to use the Ticket to obtain a new or supplemental job, requiring the BPAO to provide Intensive Benefit Support services.