Mental Illnesses Treatment Support & Programs NAMI Advocacy Find Your Local NAMI NAMIWalks
 | Print this page | 


Employment Update: HCFA and Social Security Move Forward on Work Incentives Implementation

For Immediate Release, June 13, 2000
Contact: Chris Marshall

Over the past few weeks, federal agencies responsible for implementing the 1999 Ticket to Work and Work Incentives Improvement Act (TWWIIA) have issued major announcement for grant programs under the new law. These announcements, from the Health Care Financing Administration (HCFA) and the Social Security Administration (SSA), mark the first step in a multi-year process to implement changes to the SSI, SSDI, Medicare and Medicaid programs that will allow people with disabilities to work without losing their medical coverage. NAMI, along with allied disability advocacy groups, pushed hard for this new law as a means of erasing federal policies that have penalize efforts to leave Social Security’s disability programs by working at even part-time jobs. In addition these recent announcements by HCFA and SSA, the U.S. Department of Labor has announced a major initiative for persons with disabilities under the so-called "One Stop Center" program.

I. The First Step in TWWIIA Implementation

The HCFA and SSA grant announcements, detailed below, are just the first step in putting TWWIIA into place. In the coming months, both agencies will be making announcements regarding larger parts of the law including the new "ticket to independence" program, state Medicaid "buy-in" options, extended Medicare coverage for SSDI beneficiaries, protection against unscheduled Continuing Disability Reviews (CDRs) and expedited re-entry to cash benefits for former beneficiaries. Each of these provisions has a separate effective date, indicated on the chart at the end of this message.

More detail on TWWIIA, including the text of the law, "plain English" explanation of its provisions, analysis of state advocacy efforts to establish Medicaid buy-in programs and federal agency announcements are available from the numerous websites listed below.

II. HCFA TWWIIA State Infrastructure Grants

This grant announcement, issued by HCFA on May 31, makes funds available to states to build the capacity to implement TWWIIA. A separate announcement sets the terms for new state demonstration programs for workers with disabilities who can no longer work because of the threat of losing Medicaid eligibility. Both can viewed at:

III. Social Security Announces Benefits Planning and Assistance Program

TWWIIA authorizes SSA to award one or more cooperative agreements to entities in every state to provide benefits planning and assistance services and conduct outreach services to all SSI and SSDI beneficiaries. This provision was included in the new law to better assist all disabled beneficiaries in trying to cope with Social Security’s complicated and often conflicting rules governing eligibility for cash benefits and health coverage. As many NAMI members know first-hand, SSA field staff too often give erroneous advice or strongly counsel beneficiaries against even trying to work. More troubling, even minor violations of eligibility rules can result in substantial penalties for overpayments. This new benefits planning assistance program is designed to help SSI and SSDI beneficiaries get accurate, unbiased information about eligibility for cash benefits and health coverage so that consumers can make better informed decisions about working.

More information on this program is available at SSA’s website at: Non-profit disability organizations are eligible to receive these funds. It is expected that established statewide advocacy groups such as protection and advocacy programs and Centers for Independent Living will be aggressively competing to receive these cooperative agreements from SSA. In some states, these non-profits have little experience either serving or working with individuals with severe mental illnesses and their families. Thus, it is critically important that NAMI advocates remain engaged in this process at the state level to ensure that these new benefit counseling and assistance programs meet the test of serving all SSI and SSDI beneficiaries, regardless of disability. In some cases, NAMI affiliates may want to apply themselves, or partner with other allied organizations.

IV. TWWIIA and NAMI’s OMIRA Initiative

As NAMI advocates know, for more than a year, NAMI state affiliates have been pursuing a comprehensive package of reforms aimed at improving the capacity and performance of state and local mental illness treatment programs. These model state legislative proposals focus on every aspect of treatment and service programs, all toward the objective of fostering recovery for individuals living with severe mental illnesses. Among the key provisions of OMIRA are insurance parity, replication of evidence-based programs such as PACT, housing, decreasing criminalization of mental illness and curbing the use of inappropriate restraint and seclusion in hospitals. Also included in OMIRA is a model state legislative proposal to establish a Medicaid "buy-in" program.

This title of OMIRA has now been revised to reflect the many provisions in TWWIIA including a new "medical improvement" eligibility category, new demonstration programs for retention of savings and resources and state participation in SSA’s upcoming SSDI "2 for 1" cash benefit demonstration program, NAMI is especially grateful to Center for the Advancement of Disability Policy at George Washington University for their assistance in drafting this legislation. The text of OMIRA can viewed by clicking on: NAMI staff are currently working to develop separate OMIRA bill designed to establish and replicate programs that use evidenced-based approaches job training and rehabilitation that serve individuals with severe mental illnesses participating in SSA’s new "ticket to independence" program authorized by TWWIIA.

It is worth noting that state Medicaid "buy-in" programs are perhaps the most important part of TWWIIA for individuals with severe mental illnesses. TWWIIA requires states to include prescription drug coverage as part of any Medicaid "buy-in" program. From NAMI’s perspective, coverage of prescriptions and programs such as PACT are central to establishment of meaningful protections for individuals attempting to leave the SSI and SSDI rolls, as well as for those who in the past were forced to quit a job to avoid losing coverage.

As with all of the model state bills in OMIRA, NAMI affiliates are strongly encouraged to share this TWWIIA Medicaid legislation with key state officials (governor, legislators, mental health commissioner, Medicaid director, etc.) and colleague disability organizations. In some states, legislation may not be needed for a state to initiate a TWWIIA Medicaid buy-in program, i.e. it can be done simply submitting a "plan amendment" to HCFA. In either case, this OMIRA legislation can be used to build a statewide disability advocacy coalition to push state officials to make the promise of TWWIIA a reality.

V. DoL Work Incentive Grants for "One Stop" Centers

On May 25, the Employment and Training Administration at the U.S. Department of Labor issued a notice of funding availability for a new competitive grant program designed to enhance employment opportunities for people with disabilities through the new "one stop" delivery system under the 1998 Workforce Investment Act (WIA). This $20 million grant program is intended to push these "one stop" centers to be more responsive to the needs of people with disabilities. Under WIA, "one stop" centers have become the central focus of the mainstream job training system – a system that has historically done poor job of serving people with disabilities, especially adults with severe mental illnesses. Both public and private non-profits can apply for these funds. The text of DoL’s announcement can be viewed at:

VI. SSA Regional Conferences on TWWIIA

Over the past few months, SSA has been holding regional forums on implementation of TWWIIA. NAMI advocates have been participating in many of these conferences, offering input on implementation of the new law. While these forums are open to all disability advocates, reservations are typically required. Upcoming forums include Boston, MA on June 26 and Chicago, IL on August 1. More information on SSA's forums can be obtained through their TWWIIA website at or by e-mailing the following contacts: or

Ticket to Work and Work Incentives Improvement Act
Implementation Timeline
Activity Date

Work Incentives Outreach Program (Authorized through 2004)

December 17, 1999

Protection and Advocacy Services (Authorized through 2004)

December 17, 1999

Medigap Suspension Protection Takes Effect

December 17, 1999

Establish Work Incentives Advisory Panel

March 17, 2000

SSA Report on All Income Disregards

March 17, 2000

SSA Report on Demonstration Authority

June 9, 2000

Premium-free Part A Medicare Extension Begins

October 01, 2000

Medicaid Buy-in Authority Begins

October 01, 2000

Medicaid State Infrastructure Grant Authority Begins

October 01, 2000

Medicaid Demonstration Authority Begins

October 01, 2000

Complete Ticket to Work Regulations/ Begin Ticket to Work Phase-In

December 17, 2000

Work Incentives Advisory Panel First Report

December 17, 2000

Ticket to Work Users CDR Protection from Work Activity

January 01, 2001

Expedited Reinstatement of Benefits Authority Begins

January 01, 2001

SSA Report on Demonstration Authority

June 9, 2001

Work Incentives Advisory Panel 2001 Report

December 17, 2001

SSA First Report on $1 for $2 Demonstration

December 17, 2001

GAO Report on SGA Levels

December 17, 2001

Full CDR Protection from Work Activity

January 01, 2002

SSA Report on Demonstration Authority

June 9, 2002

GAO Report on Medicaid Options

December 17, 2002

Work Incentives Advisory Panel 2002 Report

December 17, 2002

SSA 2002 Report on $1 for $2 Demonstration

December 17, 2002

SSA Report on High Needs Beneficiaries

December 17, 2002

GAO Report on Employer Incentives & Tax Credits

December 17, 2002

GAO Report on Coordination of SSDI and SSI Programs

December 17, 2002

SSA Report on Demonstration Authority

June 9, 2003

SSA 2003 Report on Ticket to Work Program

October 01, 2003

Work Incentives Advisory Panel 2003 Report

December 17, 2003

SSA 2003 Report on $1 for $2 Demonstration

December 17, 2003

Complete Implementation of Ticket-2004

January 1, 2004

SSA Report on Demonstration Authority

June 9, 2004

Authorization for Work Incentives Outreach and P&A expires

September 30, 2004

HHS Report on Medicaid Potentially Severe Disabilities

October 1, 2004

Work Incentives Advisory Panel 2004 Report

December 17, 2004

GAO Report on SSA General Demonstration Effectiveness

December 17, 2004

GAO Report on Medicare Effectiveness and Cost

December 17, 2004

SSA Demo authority ends

December 17, 2004

SSA 2004 Report on $1 for $2 Demonstration

December 17, 2004

SSA 2005 Report on Ticket to Work Program

October 01, 2005

Work Incentives Advisory Panel 2005 Report

December 17, 2005

SSA 2005 Report on $1 for $2 Demonstration (annually until complete)

December 17, 2005

Work Incentives Advisory Panel 2006 Report

December 17, 2006

SSA 2007 Report on Ticket to Work Program

September 30, 2007

Work Incentives Advisory Panel Final Report

December 17, 2007

Work Incentives Advisory Panel Terminates

January 17, 2008

HHS Report on Medicaid Infrastructure Grant Continuation post 2011

October 1, 2010


 | Print this page | 


Support NAMI to help millions of Americans who face mental illness every day.

Donate today

Speak Out

Inspire others with your message of hope. Show others they are not alone.

Share your story

Get Involved

Become an advocate. Register on to keep up with NAMI news and events.

Join NAMI Today
  • Follow NAMI
  • Contact Us
    • NAMI
    • 3803 N. Fairfax Dr., Suite 100
    • Arlington, Va 22203
    • Main: (703) 524-7600
    • Fax: (703) 524-9094
    • Member Services: (888) 999-6264
    • Helpline: (800) 950-6264