So You Want to Go Back to Work?

What TWWIIA means for people with MS

Many people who leave their jobs because of disability hope to work again someday Retraining, rehabilitation, the remission of disabling symptoms any or all can make this a real possibility. But the rules of the game have been in the way.

While out of the workforce, most people turn to SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) for income benefits and health insurance coverage. For SSDI recipients, the coverage is Medicare; for people on SSI, it's Medicaid. Both terminate eventually if the person gets a job. But because finding adequate health insurance at a reasonable price is, to put it gently, difficult, some people who could be employed again have to choose between working or retaining their federal health coverage. Those caught in this squeeze often feel forced to choose the security of adequate healthcare coverage.

To fix this classic Catch-22, the Ticket to Work and the Work Incentives Improvement Act (TWWIIA) was signed into law in December 1999. It will be phased in over a 4-year period. TWWIIA (pronounced twee-ah) makes it easier to keep or to get Medicare or Medicaid.

Changing the Medicare rules

Beginning this coming October, work returners who were on SSDI will keep Medicare Part A premium-free for 8.5 years, an extension of 4.5 years. After that time, they may buy Medicare coverage for $301 a month. If they have met a 7.5-year work-history requirement by that point, they may buy into Medicare for $170 a month. Prescription drugs remain a problem, as they are not covered by this program.

Should a person need to quit again ...

The new law includes a protection of special use to people with fluctuating diseases like MS: accelerated reentry into SSDI or SSI. People who have to stop working again due to disability will not have to file a new benefit application if this occurs within 5 years of getting off these programs. They'll be eligible for health coverage and cash for 6 months while the Social Security Administration (SSA) reviews the case. Even if SSA ultimately denies eligibility, cash received during the review period does not have to be repaid.

A "ticket to work"

Beginning in January 2001, both SSDI and SSI recipients can obtain a ticket to work--vouchers for vocational rehabilitation, employment services, and other support from an employment network of their choice to help them enter or reenter the workforce. This program is completely optional.

New Medicaid opportunities, state by state

Since Medicaid coverage includes prescription drugs, the National MS Society is particularly excited about new Medicaid options now permitted by TWWIIA:

* States can allow working people with disabilities with annual incomes up to $75,000 a year to buy into Medicaid on a sliding fee scale.

* States can offer continued coverage to workers who lose their Medicaid eligibility because their condition has improved. This coverage would also be purchased on a sliding fee scale.

* States may apply for approval of a demonstration project permitting people who have a potentially disabling condition but are still able to work to buy into Medicaid. The demonstration projects will track the economic impact of providing specific medical services that may keep people on the job.

The big "but" is a call to action

Medicaid is a joint federal/state program. So while TWWIIA allows a state these new options, each state must decide whether or not to participate. In addition, state legislatures have to approve funding.

In every state, a concerted effort will be needed to persuade health-care agencies to apply for the programs and state legislators to include the necessary funds in state budgets. For information on the state of your state and how you can be an advocate for work incentives and improved access to Medicaid, call 1-800-FIGHT MS (1-800-344-4867), select option #1, and ask the chapter office about its Government Relations Committee.

For more information on TWWIIA, e-mail <[e-mail]>.

For more information on return-to-work options and support, call the SSA at 800-772-1213, or log on to <www.ssa.gov/work>.

Martha King is editor of this magazine. Sara Collins is manager of Federal Government Relations in the Washington, D.C. national office.