**Ticket to Work and Work Incentives Advisory Panel**

**Quarterly Public Meeting**

**Sheraton Crystal City Hotel**

**Arlington, Virginia**

**October 31 -- November 1, 2007**

**[Day One -- Wednesday, October 31, 2007]{.underline}**

**Attendees**

[Advisory Panel Members]{.underline}

Berthy De La Rosa-Aponte, Panel Chairperson, Katie Beckett, Libby Child,
Russell Doumas, Loretta Goff, Thomas Golden, Frances Gracechild, Cheryl
Bates-Harris, Andrew Imparato, David Miller, Dorothy Watson, Torrey
Westrom.

[Advisory Panel Staff]{.underline}

Jill Houghton, Executive Director, Mike Anzick, Debra Tidwell-Peters,
Jenn Rigger, and Pat Laird.

[Designated Federal Officer]{.underline}

Chris Silanskis

[Members of the Public]{.underline}

Becky Roberts, Peggy Hathaway, Damon Terzaghi, Andrew Sperling, Allen
Jensen, Leverdia Roach, Michael McLendon, Djuna Parmley, Wesley Young,
and Brad Turner-Little.

**Call to Order**

Chris Silanskis, Designated Federal Officer, called the meeting to order
at approximately 9:02 a.m. and turned the meeting over to the Panel
Chairperson, Berthy De La Rosa-Aponte.

**Welcome, Introductions, and Review of the Agenda**

Berthy De La Rosa-Aponte, Panel Chairperson, began by welcoming Panel
members, staff, consultants and attendees. She continued by asking
meeting attendees to make brief introductions, and she reviewed the
meeting agenda.

Berthy de la Rosa-Aponte made an opening statement recognizing that this
was the last quarterly Panel meeting and encouraging everyone to
approach the Panel's draft final report as a collection of ideas and to
identify areas of common ground as well as areas where there might be
disagreement. Ms. De la Rosa-Aponte then reiterated the Panel's charge
to advise the President, Congress, and SSA regarding the Ticket and
other work incentives.

Following the review, she read from the transcript of a February, 2001
Panel meeting to which Congressional staff had been invited to give
their perspective on the role of the Panel. She reminded the current
members that staff had told the early Panel members that it was
important that they be independent and take a broad approach to their
work. The transcript quotes included references to a fragmented service
system that needs improvement. Ms. De la Rosa-Aponte reminded the group
that this was why the Panel has taken its approach with the final
report. She discussed the various stakeholder groups that have testified
to the Panel and the strategic planning process that had focused on a
need for change in work incentive programs.

Also, she summarized the letters the Panel has received from Congress
stating that the Panel has gone beyond its charge. She also explained to
the Panel that she met with SSA Commissioner Michael Astrue regarding
the final report and was told that its contents went beyond the Panel's
charge. She said that the letters and other feedback would be discussed
during deliberation to ensure that it was all given its due importance.

Mrs. De La Rosa-Aponte stated her belief, as Panel Chair, that the
Panel's overall process had been transparent and had involved many
stakeholders. She listed the various types of briefings that Panel
members have given to the White House, Congress, and SSA, and she stated
that no subject has dominated the Panel's time more than the Ticket
program She discussed the role of SSA at each of the 30 quarterly
meetings, the EN and beneficiary summits, and the seven annual reports
with their recommendations that have already been transmitted to
policymakers. She reminded all in attendance of the multiple efforts by
the Panel to encourage SSA to publish the final rule for the Ticket
program. In closing, she recognized all those who provided comments on
the drafts of the final report and stated her hope for a good meeting
and a stronger document as a result of the deliberation.

**Stakeholders Panel I**

Rafael Rivas, President of Voices for Work's Steering Committee,
reported that the Panel asked his organization to comment on the draft
report and that he is pleased that the elimination of the SSI marriage
penalty, which was one of the top 10 priority recommendations from the
Panel's Beneficiary Summit, was included in the draft final report.

Mr. Rivas' organization's top three recommendations are: 1) Raise the
SGA amount to \$1800 and keep COLA (cost of living adjustment). Adjust
earnings and asset limits to today's dollars with COLA. Raise the SSI
resource limit to at least double (\$7,000/\$10,000 with a COLA) with
more asset exclusions (allow asset development, savings and retirement);
2) Allow people with disabilities on SSI/SSDI to work and keep some of
their cash and medical benefits. Allow beneficiaries to keep health care
when they go back to work, including self-employment; and 3) Develop and
implement a Work Support Program (what the Panel now calls the TESS) to
allow people with disabilities to go back to work and gradually cut back
benefits.

Mr. Rivas concluded by stating that beneficiaries need to be involved in
the development and implementation of the Work Support Program and that
he is pleased that these recommendations are reflected in the Panel's
draft final report.

The next speaker was Marty Ford, Chairperson for the Consortium for
Citizens with Disabilities (CCD). She began by stating that it is
essential that any proposals to promote employment for persons with
disabilities do not threaten necessary income supports for individuals
with disabilities who rely on the Social Security and SSI cash benefit
programs for their basic subsistence. She continued by saying that CCD
does not support radical changes in the existing Social Security and SSI
disability programs which serve as a critical source of income support
and related health care for millions of individuals with severe
disabilities.

Ms. Ford stated that initiatives to promote employment among Title II
and SSI disability beneficiaries must first and foremost "do no harm"
and that any discussion about ways to change and improve the existing
Title II and SSI disability programs must follow four basic
principles: 1) Retain the current Social Security and SSI statutory
definition of disability; 2) Allow participation in work or
pre-employment activities to be voluntary; 3) Eligibility and cash
benefits should not be subject to time limits; and 4) Any new programs
to promote employment should not be coupled with cutbacks to existing
Title II and SSI disability programs: eligibility criteria for cash and
health care benefits should not be narrowed.

She noted CCD's concerns about language in the draft final report
regarding the National Employment Investment Strategy, including calling
for: 1) A change in the definition of disability for the Social Security
and SSI disability programs; and 2) Replacing the SSI and SSDI programs
for people ages 14 to 30. CCD believes these proposals are not in the
best interest of people with disabilities and strongly opposes inclusion
of them in the Panel's final report.

Instead, CCD recommends that the Panel make recommendations to improve
the existing programs to better serve those who are able to work and,
through appropriate program improvements, assist those who are able to
transition off benefits while maintaining access to critical health and
long term care coverage. Ms. Ford noted that the Panel has included a
number of these or similar recommendations in the draft final report, as
well as in the Panel's report, *Voices for Change: Beneficiaries Paving
the Way to Work*.

The last speaker was Michelle Martini, a Social Security beneficiary in
Wisconsin, who focused her comments on the Panel's recommendations on
the definition of disability, health care reform, and the Transition to
Economic Self-Sufficiency program (TESS).

*Definition of Disability***---**Ms. Martini described SSA's current
definition of disability as "archaic", noting that it was created during
a time when there were few expectations that people with disabilities
would work. She reported on her personal experience with continuing
disability reviews, stating that she is "forced into a hypocritical
situation where I must deceive the federal government. I must stress how
I am unable to work or not to my full capacity. While at the same time,
I'm working with VR, a federally funded agency, and telling them of my
desire to work while using work incentives to make that happen. I'm made
to feel dishonest, while I pursue my employment goals, and I'm always
uneasy about whether this is the right thing to do." She stated that the
new definition being proposed by the Panel is in keeping with the more
modern legislation such as ADA.

*Health Care Reform***---**Ms. Martini expressed her support for the
draft recommendation giving states incentives to establish publicly
supported, short-term disability programs. In addition, she supports the
draft recommendation to provide access to affordable health care and
long-term services and supports. She noted that she and others with
disabilities worry about earning too much money and that every pay
increase or job change raises concerns about earning too much. She
reported turning down raises and promotions several times, because she
could not risk the consequences of losing health insurance. She
continued talking about needing to protect her savings and retirement
and having to deplete savings down to the asset limits of \$2,000 to
attain Medicaid coverage. She also pointed out the negative impact of
marriage on her access to Medicaid coverage.

*Transition to Economic Self-Sufficiency (TESS)***---**Ms Martini next
commented on the Panel's draft recommendations about TESS. She
recommended that it is time for major change, not incremental changes or
baby steps. She concluded by saying, "What more do we need to tell
people that the system is broken? It's an antiquated system for
individuals who were believed never to work again. Persons with
disabilities are missing out on one of life's most valued gifts, the
ability to work and feel productive by contributing to society. Our
disabilities must not also sentence us to a life of poverty. We crave
the equality and are willing and able to work."

Panel members then had an opportunity to ask questions. Thomas Golden
asked Marty Ford about the data she referenced that suggested there's a
very large percentage of beneficiaries who don\'t have the capacity to
maintain ongoing employment. She said this was the recent report on the
SSI program and those who work which showed that 5.7 or 5.9 percent of
people on SSI are working. Marty Ford agreed the program needs
improvement but not to be eliminated. She clarified that CCD is adverse
to the notion of combining the SSI and Title II programs into something
new; however, CCD isn't totally adverse to the work the Panel has done
around this issue and could support a separate program that creates
other services and supports. In response to other questions, she stated
CCD isn't against trying something new but that it should be voluntary
and open to everyone. In regard to the proposed new definition of
disability, she remarked that SSA looks at the barriers now in
determining eligibility. She cautioned that what the Panel proposes will
be taken up by some people without considering the thinking that went
behind it.

Andy Imparato asked Rafael Rivas and Michelle Martini to comment on the
statement in the Congressional letter that the Panel heard from a
self-selected group of beneficiaries who have an interest in work, who
have the capacity to participate in our discussions, and the folks
we\'re hearing from aren't really representative of the typical Social
Security beneficiary. Both disagreed with the statement, saying from
their work and personal experience there are millions out there similar
to them who are working or want to work but are deterred by the
disincentives. Rafael Rivas stated you can't say there is an average
beneficiary, because the spectrum of such beneficiaries and people with
disabilities is so broad. He felt that people lack confidence, get
disinterested, and give up easily because they've gone through the
system and they\'re getting rejected. He reflected that that is why
it\'s very important to have a restructuring, because this isn\'t
working right now.

Andy Imparato next asked Marty Ford about whether CCD or any of the
groups had discussed the recommendation on creating a national
beneficiary advisory council and advocate within SSA. She said they
hadn't, but didn't think they would oppose it.

Thomas Golden asked Michelle Martini how she sees TESS helping
transition age youth. Her reply was the vocational
rehabilitation/independent living center (VR/ILC) interaction will play
an important role since it will provide for peer mentoring. She cited
that her first job was at an ILC and that she learned about being
independent, about the disability rights movement. She described the
youth program her center is operating. Rafael Rivas shared that as a
youth coordinator at an ILC he thinks ILCs can help youth with the
transition from school to work.

**Stakeholders Panel II**

Bobby Coward, Executive Director of DIRECT Action, focused his remarks
on cultural competency. He defined cultural competency as the
integration and full inclusion of diverse individuals with disabilities
into specific standards, policies, practices, and attitudes used in
appropriate cultural settings to increase the quality of services,
thereby producing better outcomes. He recommended that all levels of
government promote cultural competence.

Mr. Coward reported that cultural competency awareness guidelines for
disability programs should be as simple to understand and as easy to
administer as possible. He noted that barrier removal to cultural
awareness to resources and service program in diverse communities and
economically disadvantaged communities is particularly weak. He
continued by stating that disability programs should be effectively
coordinated across agencies and among levels of government with
clearly-articulated benchmarks to evaluate success.

Mr. Coward stated that federal, state and local government departments
and service providers have information about disabilities; however, the
information being disseminated is not articulated by an identifying
cultural representative. As a result, the person with a disability who
is inquiring often finds it difficult to understand the information
being shared.

Mr. Coward stated that there is a lack of mentors and role models for
diverse individuals with disabilities in the workplace and that
mainstream job coaching, on the job training and internships are often
not readily available to diverse individuals with disabilities. He
concluded by saying that mainstream and minority communities and
religious organizations tend to overlook their capability to support the
employment of diverse individuals with disabilities.

The next presenter was John Lancaster, Executive Director, National
Council on Independent Living. He first acknowledged the Panel for
having the vision to take a broad interpretation of their charge and to
address the issues that need to be put on the table. He pointed out that
the employment rate for people with disabilities hasn't changed much in
the last 30 years and a vision is needed like the national employment
investment strategy (NEIS). He thinks that the final report makes a
solid attempt to integrate workers compensation and state disability
systems, prerequisites for real cultural and systematic change. He
described the draft final report as constructive and thought provoking
and one that should serve the debate well. He did point out a few has
omissions in the draft report. The first is how to pay for it. Next, we
need to get various providers from the insurance industry at the table
because they don't understand the vision. Mr. Lancaster mentioned the
NEIS is similar in approach that NCIL has taken by creating a new
employment support program. Another omission is employer incentives to
hire people with disabilities. He concluded by commending the Panel for
its transformational approach.

The last presenter was Charlene Dwyer, Administrator, Wisconsin Division
of Vocational Rehabilitation, who began her comments by saying that what
she had heard so far amounts to a mantra about the need for change and
to do more, but, at the same time, to do no harm moving forward. Ms.
Dwyer referred to the Social Security Advisory Board and to the multiple
"do no harm" references in the draft final report. It becomes an issue
of degrees, according to Ms. Dwyer.

She referred to her work as a VR director, stating beneficiary
statistics for her agency's customers. She stated that there is a need
for bold action and that she found the draft final report inspiring. Ms.
Dwyer raised specific areas for discussion:

1.  She suggested adding federal housing programs to the list including
    SSDI, SSI, Medicaid and Medicare;

2.  She was very excited by the TESS program as a demonstration project
    and recognizes through her VR work a need for a new approach to
    youth;

3.  She stated the need for stronger demonstration authority so that
    ideas from NCIL, the Panel, or her home state of Wisconsin could be
    taken "from the printed page," and implemented, and as part of that
    she hoped that the Panel would partner with the SSAB, NCIL, WID, the
    Substance Abuse and Mental Health Services Administration (for their
    offset demo) to leverage all of these important proposals;

4.  She said that, while benefit offsets are an important cost savings,
    so is return on investment. She hopes that beneficiaries who want to
    can one day become taxpayers; and

5.  She hopes that the Panel's recommendation for health care will be
    expanded to allow for buy-in programs to have 100% federal match to
    expand the programs in the states.

Panel members then had questions for the presenters. Thomas Golden asked
John Lancaster about promising practices from the Veterans
Administration (VA) and whether they were evidenced based. He didn't
know if they were evidence based but knew much had been spent on
research. Mr. Lancaster reported that, in terms of practices, the VA has
a strong employment supports program and benefits and income program for
service connected veterans. Nationally, he doesn't think we could afford
the same level of support system but certainly by reform in Medicaid and
Medicare significant supports could, indeed, be provided. He also
referenced the program at the Office of Disability and Employment
Support (ODEP).

Andy Imparato then asked all three about the statement in the
Congressional letter that the SSI/SSDI programs have been successful.
Bobby Coward felt they're looking at the programs broadly and not
focused on employment. Charlene Dwyer stated there's no dignity in these
programs. From her experience, there are many who would like to work
more hours but don't because of the fear of losing needed public
supports. John Lancaster posed the question: "What kind of financial
security, dignity, and independence do you have in this country in this
day and age as an individual with a disability with \$24,000 a year as
your sole source of income?"

Dorothy Watson asked John Lancaster to clarify funding the TESS program
through payroll taxes. He responded that more research needs to be done,
noting that the research needs to look at the positive impact of income
and tax revenues if more people are working. In addition, he said this
should be spread out broadly over the entire nation since at any moment
someone can become disabled, which could justify a payroll tax. Dorothy
Watson followed up by noting that SSI is a welfare program with asset
limitations, while the SSDI program doesn't have the same limitations.
She asked John Lancaster how he would address this gap. He responded
that if you take the millions of people on the SSI program and give them
the opportunity to have income supports, health care and a job, then, at
least you have something coming back into the economy to pay for SSI.
This is the reason for having a program like TESS or an employment
supports program.

Dave Miller asked Charlene Dwyer to clarify her comment about the
portability of the Medicaid Buy-in program and a 100% match. She was
recommending what was cited in the final report about 100% matching of
state Medicaid funds. She thinks it's doable. There are many ideas for
cost sharing around different segments of the population that need to be
tested with the understanding the one size doesn't fit all.

**Public Comment**

Peggy Hathaway from United Spinal Association first acknowledged the
improvements in this version of the final report. She noted the
improvements in health care would be great if enacted and TESS has some
good aspects to it such as the financial literacy and outreach to those
under age 16, it's now a demonstration and individuals could keep their
cash benefits. She noted, however, that the Youth TESS program isn't a
choice for those between 14- 30. She mentioned grave concerns about
applying a new definition of disability to the SSI/DI population. She
would rather use a new definition on the TESS program. She's supportive
of the beneficiary voice but believes those who have spoken aren't
representative of the full spectrum of people who need these programs,
because they are able to participate in this process. Lastly, she states
that text in the draft final report mentions that many disability groups
were contacted, which was true, but it implies there was a consensus on
this especially regarding the TESS program. Her organization regrets not
seeing the TESS vision earlier.

Bruce Bordan, a beneficiary from Wisconsin, described a program called
Making Work Pay, which provides an opportunity for full employment for
people with the most significant disabilities with high-cost long-term
needs. The program developed a new method of cost sharing, public health
care, and is consumer driven. It also combined the different service
delivery systems that people with disabilities utilize. He explained the
program removes barriers to allow the person with a disability to keep
benefits and has a Medicaid Buy-in cost share for insurance based on
earned income. This program recognizes it costs more money to live
independently in the community and be employed if you have a disability.
The program purpose is to allow individuals to work up to economic
independence by getting off the benefit system and paying their fair
share.

Andrew Sperling is the Director of Legislative Advocacy for the National
Alliance on Mental Illness (NAMI). He admitted the current systems need
improvement and are failing people who want to go to work and can go to
work. However, he stated that NAMI is very concerned about this draft
final report. First, he expressed that changing the definition of
disability could undermine the safety net nature of the programs.
Second, TESS, should be strictly on a voluntary basis. NAMI knows what
works to reward and help people with serious mental illness go to work
such as supported employment. NAMI is concerned about proposals to
significantly increase the funding for systems that aren\'t doing a very
good job right now serving people with serious mental illness. Mr.
Sperling mentioned the pay go rules and the administrative burden SSA is
operating under which will effect the implementation of these ideas.

Brian Bard, the delegate from Delaware offered his comments on the draft
final report. He felt that the new definition of disability is too
broad, and that we need special treatment for people with severe
disability due to the higher expenses related to their disability. Mr.
Bard mentioned his supports for having permanent beneficiary
representation in SSA. He feels attitudes are the greatest barrier to
employment. He agrees with many of the recommended changes to work
incentives in the report. He thinks the work support program is a good
idea and agrees with investing in VR. He believes the SSI/DI systems are
too complicated.

Ardis Bayzyn, one of the beneficiary summit planners, first provided
comments on the TESS program. She feels it's a step in the right
direction to give young people the mind set of working. She thinks the
SSA beneficiary council and the beneficiary advocate is crucial because
many of the Social Security employees aren't focused about their own
services and products. Another area stressed in report is the importance
of the intra-department and inter-department coordination, which she
thinks is key. She thinks this is one of the reasons many people with
disabilities hesitate to go back to work is because they don\'t have the
infrastructure and by linking the federal agencies the problems with
housing, transportation, discrimination, technology could be resolved.

**Panel Deliberation**

The Panel members agreed they needed to resolve the scope of the Panel
since this would impact on the relevancy of the recommendations
contained in the draft final report. A discussion then took place around
this issue.

Thomas Golden quoted from the House letter saying at first it sounds
like our scope is broad but the statement is in the context of the
programs under the Ticket legislation is narrow. Andy Imparato brought
up the strategic plan and the formation of the subcommittees. He
reminded members of the discussion a year ago about the first letter
from Congress. He raised the question of how can we deal with work
incentive improvements unless we look at the problems. Dorothy Watson
remarked that the draft final report contains recommendations for three
new entitlement programs and a specific change to the definition of
disability which were never discussed. Libby Child asked the chairperson
to repeat what the Congressional staff had said to the Panel at its
first meeting. Dorothy Watson responded saying this refers to improving
the fragmentation between federal programs beyond the Ticket but not
create new entitlement programs. Torrey Westrom reminded members that
eight years ago most of them and the current Congressional staff weren't
here. He felt the Panel took a "nest egg approach" in proposing new
programs such as TESS. He continued that the Panel needs to come to
consensus that recommendations were done in good faith and that the
strategic plan laid a foundation so the Panel should start to move
through the recommendations. Cheryl Bates-Harris disagreed. Frances
Gracechild felt the Panel had acted in good faith. The Panel made the
following motion.

***Motion: The Panel passed a motion that the recommendations are within
the scope of the Panel's charge.***

Panel members opposing were Cheryl Bate-Harris, Dorothy Watson, and
Thomas Golden. Torrey Westrom abstained.

Berthy De La Rosa-Aponte then asked Becky Roberts to explain the process
that will be used for reviewing the recommendations. The recommendations
from the BVC and CIC would be addressed first since they had been
discussed and approved at prior Panel meetings. Next, members would
identify anything that was missing. The last step would be to review
remaining recommendations. The Panel made the following motion.

***Motion: The Panel passed a motion to move beyond recommendations 1
and 15-30.***

Panel member opposing was Torrey Westrom.

A general discussion of the draft final report took place. Dorothy
Watson stated she had a problem with the content of the report to which
Russ Doumas responded that this will be addressed and clarified as the
Panel proceeds through the report. He shared that recommendation 32
isn't sufficient as a recommendation for Ticket improvement and the text
for short-term ("Moving Forward") isn't enough. Dave Miller felt the
information is out there and he questioned whether SSA is ready for
15,000 ticket assignments. Thomas Golden raised concerns about whether
those individuals addressed in the AOI report will be overlooked and
whether the new payment system will be successful, and what will the EN
evaluation reveal. He stated that these are areas that Congress will
need to examine. Thomas Golden then brought up the issue of adding a new
recommendation to support an increase in SSA's administrative authority
to address the surge in Ticket implementation. He suggested the Panel
could provide guidance to Congress on this issue in the final report.
Background material could be taken from the Panel's past position on the
Ticket regulations, reference to the Ticket evaluation and the
Mathematica's evaluation and analysis of the Ticket. Many members agreed
to add a recommendation regarding administrative funding and
infrastructure. Torrey Westrom noted that recommendation 34 to renew
SSA's demonstration authority isn't enough since the Panel had concerns
about the lack of results and the slow implementation process plus the
delay in the final regulations. Dave Miller felt recommendation 33
concerning the MIG program was inadequate and it should have a
correlation to the health care system section of the final report.
Frances Gracechild raised her concern that a segment of the disability
population is making sub-minimum wage, which isn't addressed in the
final report.

The Panel next began a discussion of individual recommendations that
were outstanding. The first was recommendation 35, marriage penalty.
Dorothy commented there was insufficient information to make a
recommendation; this was a deeming issue. Frances Gracechild reminded
members that this had been the number one priority for the delegates at
the beneficiary summit. The Panel made the following motion.

***Motion: The Panel passed a motion that Congress should eliminate the
financial and work disincentives to marriage inherent in the present
SSI, SSDI, Medicaid and Medicare programs that result from one spouse's
earned income and assets being deemed to the eligible spouse.*** \[Note:
the Panel revised this decision Day 2 of the meeting.\] Panel members
Thomas Golden and David Miller abstained.

Recommendation 36, overpayment issue, was brought up for discussion.
Dorothy Watson felt it doesn't do what the Panel wants to achieve and
appears uninformed about the need for investigation to determine an
overpayment. Thomas Golden brought attention to the need for better
information to beneficiaries on the waiver process. Cheryl Bates-Harris
reminded members of the e-Works initiative and other steps SSA has taken
to address this issue. The Panel made the following motion.

***Motion: The Panel passed a motion to delete recommendation 36 and add
it to recommendation 30 to read "Increase beneficiary awareness of
earnings reporting requirements, including waiver process for
overpayments, and promote greater self-efficacy."***

The next recommendation considered was #2, social marketing campaign.
Thomas Golden felt the Ticket context was missing. Andy Imparato
responded that its covered under the work supports section. There was a
discussion about who will pay for it and which agency would take the
lead. The following motion was made by the Panel.

***Motion: The Panel passed a motion*** ***that the President should
take the lead to establish and provide financial support for a
comprehensive, cross agency, culturally competent social marketing
campaign to raise expectations about the productive employment potential
of people with disabilities. This campaign should target people with
disabilities, their families, educators, employers, health care
professionals and those that serve people with disabilities and the
community. This marketing campaign should use the most accessible and
effective media ---including television, radio, the Internet, and
mainstream and specialty magazines and newspapers.***

Recommendation 3 was briefly discussed, with the conclusion that it
needed more drafting after today's meeting.

The next item was the short-term disability insurance program under
recommendation 4. Russ proposed that this recommendation and
recommendations 6-9 be grouped together under recommendation 34 and be
tested as large scale demonstration projects, be evaluated for their
effectiveness and cost, and unintentional consequences. Some members
disagreed with this saying each recommendation should be considered
separately. After some discussion, the Panel made the following motion.

***Motion: The Panel passed a motion that*** ***SSA should implement a
demonstration that tests the costs and benefits of establishing a
publicly supported short-term disability insurance program at the state
level that will be modeled on the best programs that have been developed
in the private sector and by state governments, which would be available
to individuals with work histories who do not have private disability
insurance.***

Panel members Dorothy Watson and Cheryl Bates- Harris abstained.

The meeting adjourned at approximately 5:10 p.m.

**[Day Two -- Thursday, November 1, 2007]{.underline}**

**Attendees**

[Advisory Panel Members]{.underline}

Berthy De La Rosa-Aponte, Katie Beckett, Libby Child, Russell Doumas,
Loretta Goff, Thomas Golden, Frances Gracechild, Andrew Imparato, David
Miller, Dorothy Watson, Torrey Westrom.

[Advisory Panel Staff]{.underline}

Jill Houghton, Executive Director, Mike Anzick, Debra Tidwell-Peters,
Pat Laird, and Jenn Rigger.

[Designated Federal Officer]{.underline}

Chris Silanskis

[Members of the Public]{.underline}

Susan Prokop, Dorothy Firsching, Ken McGill, Djuna Mitchell, Allen
Jensen, Marty Ford, and Alaine Perry.

**Call to Order**

Chris Silanskis, Designated Federal Officer, called the meeting to order
at approximately 9:02 a.m. and turned the meeting over to the Panel
Chairperson, Berthy De La Rosa-Aponte.

**Welcome Introductions and Review of the Agenda**

Berthy De La Rosa-Aponte, Panel Chairperson, began by welcoming Panel
members and meeting attendees to Day Two of the meeting. She then asked
meeting attendees to make brief introductions.

**Panel Deliberation**

The Panel began its morning session with the continuation of its review
of the recommendations. As instructed, Panel staff and contractors had
reorganized the final report recommendations based on the previous day's
discussions. The Panel used this new format and renumbering of
recommendation for the remainder of deliberations.

The definition of disability as modified (Rec. 9/32) was the first item
discussed. Thomas Golden shared his extreme concern about calling for a
demonstration of such significant scope of something we have no idea
what the unintended consequences of it are going to be. He recognized
that the House Ways and Means Committee had asked the Panel a few years
ago for input; however, he felt the Panel hadn't done enough homework to
be able to make a recommendation about what needs to be demonstrated. He
continued his concern about the nature of the definition being much more
functionally based than it is medically based, and what does this mean
for partial disability. He stated he supports a movement toward looking
at barriers that limit ability to work; but also supports the notion of
full versus partial disability and that there might be individuals who
just need the access part to health care.

Thomas Golden mentioned that he would want to see the disability
community much more engaged in how it's redefined. Andy Imparato
responded saying this is the reason for a demonstration so you know what
to change. For instance, he suggested that SSA could do seven small
demonstrations with eight different definitions and then do a larger one
based on the results that they get. He shared that the Transformation
Subcommittee was focusing on the barriers that people encounter as a
healthier way to talk about eligibility for this program than simply
saying inability to engage in substantial gainful activity. He mentioned
that Congress and SSA can either do a demonstration or they can get
community input for testing it another way. Thomas Golden reiterated
that the Panel shouldn't be so prescriptive but rather allow Congress to
decide which one is going to accomplish the impact of modernizing the
definition. Dorothy Watson commented that typically demonstration
projects are reserved for the very few issues where there is consensus
and you want to find out if it will work; for example the \$1 for \$2
benefit offset demonstration. She reminded members of the long startup
for the current SSA demos and the costs for implementing such demos. She
feels the recommendation is well-intentioned but it's too important of a
decision to make hastily.

Russ Doumas reflected on the progress since the 1970s that has been made
by people with disabilities and that nothing is really changed about
people with disabilities and what their abilities are to do work. The
only thing that\'s changed is the attitudes of their communities, their
families, their schools, and employers around them. He stated that the
current definition creates a context in which we think of people with
disabilities as unable to work. Russ Doumas articulated the goal is to
request a demonstration that changes the context of how society will
look at people with disabilities. Andy Imparato pointed out there
weren't a lot of recommendations that people have made for how the
definition should change. The best he has seen was the recent UN
convention on the rights of people with disabilities, which describes
the interaction between the person\'s impairment and the barriers around
them; that\'s what creates a disability. He then offered a change to the
recommendation which would acknowledge the interaction between a
person\'s impairment and the environment.

Libby Child shared that from her work in the business world she has
heard from people constantly that unless the definition of disability is
updated or changed, that there's going to be little progress in the
disability programs and getting people to return to work. In response to
a comment about the limited time to address this issue, Berthy De La
Rosa-Aponte clarified that the Panel is recommending changing the
definition because it has listened to people and that Panel
subcommittees have shared their work with the Panel either in meetings
or conference calls. A final comment was made by Torrey Westrom who
described this issue as one that Congress doesn't wish to deal with
until there's a crisis. At the conclusion of this lengthy discussion,
the Panel made the following motion.

***Motion: The Panel passed a motion that Congress and the
Administration should take action to evaluate the impact of modernizing
the Social Security definition of disability by defining disability in a
manner that acknowledges the interaction between the person's impairment
and the environment and does not require the individual to prove their
inability to engage in substantial gainful activity.***

Panel member opposing was Dorothy Watson, and Cheryl Bates-Harris
abstained.

The recommendation concerning the new TESS program as modified (Rec.
7/30) was next discussed by the Panel. Andy Imparato clarified that the
targeted population is the same as the SSI/DI population and the TESS
program would follow the same rules for the SSI/DI programs. The only
difference is that the 14-30 year olds wouldn't be eligible for SSI and
the rules for this group are set out in the text of the final report.
Dave Miller felt the Panel had done as much as it could to simplify the
work incentives within the structure of the law and now we've tried to
make a more unified program that will allow people to lift themselves
out of poverty by retaining more assets. Thomas Golden expressed that
this part of the report is very prescriptive, with little homework done,
and it's premature given that the SSA Youth Demonstration project hasn't
provided any data on outcomes and this was a project the Panel asked for
and given specifics on. He felt another layer of complexity would be
added. Torrey Westrom shared the Panel had discussed youth intervention
and the Ticket when he first came on the Panel. He thought the term
"newly-branded" entitlement program should be changed.

Cheryl Bates-Harris remarked that the age range of 14-30 year olds is
confusing, since most programs for youth end at age 22. She also felt
this was a new package for an old problem. Andy Imparato explained that
the National Governors Association had recommended through age 30
because some students don't finish high schools until age 22 and need
the time to establish a work record. Russ Doumas stated the program was
for those having the greatest barriers. Berthy De La Rosa-Aponte
reminded members that transitioning for those with significant
disabilities takes longer. The SSA Youth Demonstration project was
brought up and that the Panel hasn't seen the data. Cheryl Bates-Harris
asked about who is going to provide the employment services under this
new program. Andy Imparato responded VR ILCs are the two logical places
for there to be an infusion of support. The Panel made the following
motion.

***Motion: The Panel passed a motion that SSA should design and
implement a large-scale demonstration project that studies the
feasibility, cost-effectiveness, and any unintended consequences of a
voluntary Transition to Economic Self-Sufficiency (TESS) Program for
young people who are between 14 and 30 years old and qualify for SSI
and/or SSDI. This demonstration project would build on the goals of the
Ticket program and evaluate the feasibility of a program that would
transform SSI and SSDI by establishing unified rules that: provide a
graduated cash payment to address the effects of disability-related
barriers on income; build on the Ticket to Work to increase the
availability of and consumer control over employment-related services;
promote optimal educational outcomes; and enable program participants to
maximize income and assets without fear of losing critical supports.***

Panel members opposing were Thomas Golden, Cheryl Bates-Harris, and
Dorothy Watson.

The Panel then undertook a discussion of allowing dissenting views. The
following points or concerns were made by members.

-   Everyone has an opportunity to vote against a motion and state their
    reasons why for the record.

-   It sends a wrong message if there are dissenting views on the
    report.

-   There are procedural tools such as making a motion to not accept a
    certain section.

-   The public isn't going to look at the record; they're going to look
    at the report, which is why dissenting views should be allowed.

-   The Panel adopted a rule to operate under a majority vote, not a
    consensus.

-   By showing diversity you show your strength. The Panel shouldn't be
    afraid of dissenting opinions.

-   A few of the recommendations are controversial for various reasons
    and thus the reason for allowing dissenting views.

The following motion was made by the Panel.

***Motion: the Panel passed a motion to allow for Panel members to
insert dissenting views on Recommendation 30 within the text leading up
to the recommendation.***

Passed unanimously.

**Social Security Administration Update**

Mr. David Rust, Acting Deputy Commissioner for the Office on Disability
and Income Security Programs (ODISP), began by expressing his
appreciation for the work the Panel has done over the past 7 years. He
then shared some background on the Social Security programs, describing
them as large and mature in nature. He gave statistics on the various
programs. Because of the largeness of the entire program, change
produces large costs to the program and to the trust fund. He referred
to the constrained budget SSA is operating under particularly now with
the continuing resolution (CR). SSA is about to go below 60,000
employees for the first time since 1973. The return to work issues
haven't changed in last 20 years, which indicates how large and
difficult they are. Factors the Panel needs to keep in mind about the DI
program are there are high standards for benefits, it's a long and
difficult process to get on, people on the rolls are severely disabled
and on average 52 years old, and only about half of one percent leave
the rolls which hasn't changed in 20 years.

Mr. Rust thanked the Panel for their responsiveness to the concerns of
SSA and the Congress. From a philosophical point of view, he reminded
Panel members of the time and place we\'re dealing with right now.
Therefore, when the Panel goes to Congress or to the SSA, it's going to
be very, very hard to take on major controversial challenges at this
point. He then urged the Panel to keep in mind their mandate and the
practical constraints. He reminded them to remember the fact that for
many of the interest groups in the program too much change is
unsettling. Regarding the Panel's new ideas, he recommended these be
placed in a separate document or in the appendix of the report for
consideration as a national dialogue in the future. He acknowledged the
numerous Panel recommendations over the years that are directly related
to work incentive and stated these have taken into consideration by SSA
for managing the Ticket program and in developing the proposed
regulations. Again, he reminded the Panel of the slowness of the
government to move and that some things take awhile to get considered
and work their way into the political debate. Thus, the Panel might want
to think in terms of what it can impact in the near term in the programs
with the work incentives we have. He concluded by thanking the Panel for
their effort and appreciated the amount of time and sacrifice they have
given over a long period of time.

Marianna LaCanfora, Assistant Deputy Commissioner for ODISP, was the
next speaker. When the Panel kicked off, she was a claims representative
and was part of a local outreach effort to get community organizations
involved in the effort. She addressed her remarks to work incentives
since this is an area of focus for the coming year because of the
growing population, particularly of concurrent beneficiaries. She
recognized the complexity of the programs and shared that SSA will be
proactive in the coming months to look at how to simplify work
incentives for Title II and Title XVI. She's particularly interested in
looking at the potential for aligning the work incentives for both
programs, because they\'re very different. She knows the Panel has
looked at wage reporting and that she's excited about SSA's telephone
wage reporting system. She reiterated SSA's challenge of balancing cost
with service, which requires creative and proactive ways of thinking
about what influence we can have on the structure of the program. This
is why she's particularly interested in automation. She finished by
thanking the Panel for all of their work.

The last speaker was Richard Balkus, Acting Associate Commissioner for
the Office of Program Development and Research (OPDR) within ODISP. He
provided an update on some of the demonstration projects. He began with
the Benefit Offset National Demonstration (BOND), stating that it has
presented major challenges in terms of a research design. He thinks SSA
is moving closer to reducing some of the complexity and some of the
treatments that were presented in the original design. They've learned a
lot from the four state projects in terms of implementation and
operational issues that will be of value as they move forward to
operationalize the final design for the project. He expects that a
report on the four state pilots to be ready by mid-2008. Mr. Balkus
stated that, currently, there are about 900 people enrolled in the
project. There are still issues in the project that SSA is wrestling
with, one of which is induced entry. This has been a major issue in
terms of the design for the project and the recommendation from the
contractor is that it be eliminated from the research design. He hopes
to finalize the research design in the coming months, and move forward
with enrollment in early 2009.

The next project he discussed was the Youth Transition Demonstrations,
which has had a mid-course correction because particular sites didn't
have a good research design and experimental design for evaluating the
number of interventions that were being tested. SSA has moved with three
of the original sites into an experimental design having random design
treatment and control groups. There are different interventions being
tested in these different sites, yet they all have some common
objectives in terms of those interventions, that is, a very strong
employment-base intervention. SSA has gone on to select five additional
sites that are in a testing mode with limited enrollments; three of
these will be selected to become full demonstrations. He said they're
hoping to have an evaluation from the original three demonstrations in
2010.

Regarding the Mental Health Treatment study, SSA is about halfway in the
enrollment period and has been progressing well in terms of the
interventions. The early results are showing that the interventions have
been helpful in at least stabilizing the condition and helping these
disabled recipients to go back to work and sometime return to work.
Lastly, he mentioned the Homeless Outreach Program project is winding
down and the evaluation results have shown this type of case management
and support has made a difference in terms of getting a determination
earlier in the process and that after a period of 12 months fewer are
homeless or faced with emergency periods where they are homeless and
have been able to secure a more permanent residence.

The Panel had an opportunity to ask questions. Thomas Golden inquired of
Mr. Balkus if the early intervention study, which is now being
eliminated due to high costs, will be addressed in some way. His
response that pieces of it in other demonstrations may allow this but
said that SSA currently doesn't have anything on the table that mirrors
the early intervention effort that was envisioned with the original
contract design. Frances Gracechild referred to the statement made that
change is costly, yet doing nothing, being conservative, being cautious,
being frugal has a cost also assigned to it that rarely seems to be
measured. She asked the presenters to address this issue. Mr. Rust
responded that primarily their actuaries look at what the dynamics are
in the trust fund and at Medicare but not beyond that generally. In
terms of research, his test is it implementable, does it work, what is
it\'s value? Mr. Balkus added that in some of the research that SSA has
been doing in the last few years he thinks SSA is much more mindful in
terms of program interactions. He thinks the demonstration projects do
go beyond looking at the immediate cost savings and how this has
provided other benefits and what some of the additional costs are. Mrs.
LaCanfora referred to the redeterminations and the costs it would save,
yet due to budget constraints SSA isn't able to process as many as it
would like to. From their perspective, they've got to be sure that if
SSA moves forward to try to implement something that's far reaching,
that the long-term benefit from both the taxpayer perspective and the
benefit to our recipient actually outweighs the cost, and specifically
the transition cost.

Andy Imparato then asked about their thoughts on getting the
beneficiaries as part of their vetting as they think about implementing
new programs, as they're marketing programs, ways to get them involved.
Mr. Rust stated they've got advisory boards and seek public comment and
are trying to figure out ways, mechanisms that allows SSA to get that
input. Yet, it's difficult when you are spending so much of your time
and effort focusing on sort of managing as best you can. Dorothy Watson
asked if they could share any details on benefit offset project. Mr.
Balkus answered that one thing SSA will be testing the offset above SGA,
the \$1 for \$2 above SGA as well as testing a threshold below SGA
though the amount hasn't been determined. The number of particular
groups is also undetermined at this point. In regard to the accelerated
benefits demonstration, that particular project is basically providing
health insurance for individuals who don't have health insurance during
that 24-month waiting period. It does have a treatment group where
there's also being provided some additional behavioral and employment
supports. Dorothy Watson then asked about the ticket evaluation report.
Richard Balkus responsed that this has been released in the past month.
Torrey Westrom asked about the coordination of projects between SSA and
CMS to which there wasn't an immediate answer. He then asked about any
date for release of the proposed Ticket regulations and again wasn't
given any specific date except for the spring of 2008. Lastly, he raised
the point about the number of people found ineligible after a CDR and
isn't this a target group for the Ticket program which could result in
savings.

**Panel Deliberation**

The Panel continued its deliberation of recommendations. It began
discussing recommendation 29/6 as modified concerning health care. The
main points made by members were the following:

-   In light of the Congressional and economical environment how do we
    make this doable.

-   The government is spending 16 percent of gross national product on
    health care which will continue to raise with the baby boomers and
    those people at age 50 who acquire disabilities because of lack of
    access to health care,

-   This is about our vision for a health care system that would really
    work for people with significant disabilities and not have work
    disincentives built into it.

-   There needs to be a link with the Medicaid Infrastructure grants
    (MIGs).

-   If this is meant as universal health access, it shouldn't be limited
    to people with significant disabilities.

-   Convey message that this is a bipartisan issue needing a bipartisan
    solution.

-   We're not saying to Congress how to do it but the outcome needs to
    be that every person with a significant disability has these
    elements available to them and that we would like it, if possible,
    to have it in the context of a system that works well for everyone.

-   What do we mean by affordable unless the government is involved in
    some way; this should be one of the elements of health care
    coverage.

The Panel concluded its discussion of this recommendation and made the
following motion.

***Motion: The Panel passed a motion that Congress should work in a
bipartisan fashion to build on the goals of the Medicaid Buy-in and the
MIG to ensure that people with significant disabilities have access to
affordable coverage for health care and long-term services and supports
that is comprehensive; portable; supported by beneficiary contributions,
where appropriate; independent from qualifying for income support; and
coordinated with employer-sponsored benefits.***

Panel members Dorothy Watson, Cheryl Bates-Harris and Thomas Golden
abstained.

A new recommendation (#2) concerning administrative funding for SSA was
the next item the Panel discussed. This had been an action item from the
previous day the staff was asked to draft language. Members agreed that
the Panel needed to be supportive of SSA's basic functions while at the
same time elevating the post-entitlement issues of CDRs,
redeterminations and overpayments that impact beneficiaries return to
work. The Panel noted the fiscal crisis facing SSA. The Panel members
recognized there was insufficient time to devote to drafting a
thoughtful recommendation. Therefore, it decided to refer this item to
the Continuous Improvement subcommittee. The Panel made the following
motion.

***Motion: The Panel passed a motion that Congress should appropriate
the funds necessary for SSA to support effective service delivery,
particularly related to the Ticket program and return-to-work such as
work report processing and overpayments. The Continuous Improvement
Subcommittee will frame and refine it.***

Another new recommendation (#3) on the publishing of the Ticket
regulations was next taken up by the Panel. After a short discussion
about a specific time frame, the Panel made the following motion.

***Motion: The Panel passed a motion that*** ***SSA should publish
revised final regulations pertaining to the Ticket to Work and
Self-Sufficiency program (9/05 NPRM) no later than April 1, 2008.***

**Centers for Medicare and Medicaid Update**

Stephen Hrybyk was the first speaker. He's a Project Officer in CMS'
Disabled and Elderly Health Programs Group. He gave an update on the
Medicaid Infrastructure Grant (MIG) program and the Demonstration to
Maintain Independence and Employment (DMIE). There are now 41 States
with MIGs and the funding amount ranges from a minimum award of
\$500,000 to approximately \$6 million. CMS recently eliminated the MIG
conditional eligibility category in the 2008 MIG solicitation. The MIGs
end September of 2011 with progressively shorter and shorter project
periods. The DMIE has a definite cut off date of September 30, 2009.
Their current NBI enrollment is 98,264 people who are enrolled in MIG
states or the Buy-in program at some point during 2006. There's a total
of 39 Buy-in programs nationally but 61% of the Buy-in enrollment were
from only five States (Massachusetts, Wisconsin, Iowa, Pennsylvania, and
Indiana) while 23% were from Minnesota, Connecticut, California, New
Jersey, and New Mexico, and the remaining 22 States only made up 15%. In
the area of premiums, in 2006, 25 States collected premiums; nationally,
more than \$22 million in Buy-in premiums were collected in 2006. The
bottom line is that the state Buy-ins vary significantly, dependent upon
the parameters the states develop, such as income and resource limits.

In regard to the DMIE, currently there are five states participating --
DC, Minnesota, Texas, and Hawaii. Hawaii, Texas and Minnesota are still
enrolling since they recently started their programs in the last year.
Kansas has an enrollment of 400 and DC has 420. Total estimated
enrollment all five programs, is estimated in 2008, about 4,000
participants. Mississippi and Louisiana had to close down as of
September 2007 due to hurricanes Katrina and Rita. The preliminary
report is due from Mathematica Policy Research between January - March
of 2008. Successes of the program so far are pretty scanty. However, CMS
is seeing an increase utilization of services that don\'t necessarily
come with a Medicaid program, that is, the dental and vision services.
The only thing that would actually bolster this program would be to have
more time available so that we can see significant differences, a
significance of the findings.

Next was Effie Shockley, who is a Health Policy Analyst with CMS'
Disabled and Elderly Health Program Group. She emphasized some
accomplishments of the MIGs to date. One was the expansion of personal
assistance services among the states. Another accomplishment is the
increased number of states with Buy-ins and enrollments.

After the presentations the floor was opened for questions and comments
by Panel members. Torrey Westrom asked about coordination with SSA.
Effie Shockley reported that in terms of their data efforts there's an
interagency workgroup. However, she admitted they have a long way to go.
A follow-up question was whether there was any difference in enrollment
of the states that didn't charge a premium. Effie Shockley stated their
enrollment is lower and her speculation is that it costs the states more
to collect it. Thomas Golden asked Effie Shockley why only 5 states had
high enrollments. Again, she speculated that they had higher income and
resource levels. Dave Miller asked Effie Shockley about any numbers for
work employment participation. She said this is difficult, since there's
no definition of work; however, CMS does collect earnings data on an
annual basis, which will be available the end of this year for their
next annual report. Thomas Golden expressed his concern that the
majority of the people coming into the program were migrating from the
spend down and we haven't been able to impact the population the Buy-in
was originally intended to serve. Dorothy Watson asked about outreach
efforts used by the states. Effie Shockley shared that Minnesota is
using an 800 number that is marketed on the radio. Dorothy Watson
inquired about any best practices or program features that stand out
among the states. Effie answered that Vermont has evidence that benefits
counseling leads to increased earnings. CMS is also seeing several
states working on supported employment efforts especially for their
citizens with mental health conditions. They're also seeing increased
number of youth, which CMS has found are the higher earners. Thomas
Golden posed why only 5 DMIE States when there's so much funding
available. Steve Hrybyk responded that much of it had to do with how the
first solicitations were constructed and plus the fact there was a
downturn in the economy back in 2001 when the first solicitation was
issued. There have been other contributing factors. In addressing other
questions, CMS stated there will be more data on the states in their
2006 annual report coming out next year.

**Panel Deliberation**

Before continuing their deliberation of the recommendations, the Panel
reviewed the September 2007 Panel teleconference minutes and a motion to
accept the minutes with corrections into the record.

***Motion: The Panel passed a motion to accept the September
2007teleconference minutes with corrections into the record.***

The Executive Director, Jill Houghton, presented a timeline for the
completion of the final report. The Panel accepted the proposed timeline
and an additional teleconference to be set for November 26 or 27.

The Panel reconsidered recommendation 7 (marriage penalty) as a result
of Dave Miller's concern that the language passed would have very
serious unintended consequences, would have much broader implications
than just removing the marriage penalty and have very significant
financial implications. Thomas Golden agreed, expressing that it was
really a deeming issue related to Medicaid coverage because the spouse's
asset are counted. Dave Miller offered alternative language that would
give states the flexibility to devise a solution through their Medicaid
program. He explained that currently, within the Medicaid Buy-ins,
states are taking into consideration the spouse\'s earned and unearned
income in terms of determining their continued eligibility for Medicaid.
The following motion was made by the Panel.

***Motion: The Panel passed the motion to change the recommendation to
p***r***ovide states flexibility in devising Medicaid programs to reduce
the marriage penalty for persons with disabilities.***

Panel members Russ Doumas and Libby Child opposed the motion.

The Panel moved on to the new recommendation 4 (social marketing) which
was a rewrite from the previous day. After a brief discussion and
clarification about the intent of the Ticket evaluation, best practices
and the Panel's past recommendations, the Panel made the following
motion.

***Motion: The Panel passed the motion*** ***that SSA should plan for
and (upon promulgation of the revised final regulations pertaining to
the Ticket to Work and Self-Sufficiency program (9/05 NPRM)),
immediately implement a marketing plan for beneficiaries and ENs that is
informed by evidence-based best practices, the results of the Ticket
evaluation, as well as previously reported Panel recommendations.***

Next, recommendation 31/8 (TESS for adults) was discussed. Dorothy
Watson stated this is a new program that establishes a new time limit on
benefits. Russ Doumas explained that the Transformation Subcommittee
wanted to give adults the opportunity to take advantage of the TESS
program, but for a time limited period, because of the costs. He stated
that the subcommittee never discussed individuals coming on and off over
a period of time. Cheryl Bates-Harris felt this was a very dangerous
path by recommending time limited benefits because someone will use it
to limit other benefits. Dave Miller brought up that there's now two
recommended demonstrations and maybe using TESS model withthis older
group simultaneously when you're using it with this younger group
doesn\'t make as much sense; maybe we should wait to see how successful
TESS is with the younger group first. The Panel made the following
motion.

***Motion: The Panel passed the motion to delete this recommendation.***

Panel member Torrey Westrom abstained.

Recommendation 31/10 regarding state VR funding was the next item
discussed. Cheryl Bates-Harris reminded members that SSA has been clear
about its dissatisfaction with state VR services, the VR program is a
federal/state match which about 25% of the states haven't been able to
make their allocation, and the disability community has expressed their
lack of support for state VR. Dave Miller remarked that the Panel had
passed the TESS program demonstration recommendation and it would need
some additional source of funding to be implemented. Thomas Golden felt
that state VR doesn't need any additional funding since it can use the
traditional cost reimbursement and the resources are there for them to
do incredible things if it desires. Cheryl Bates-Harris referred to VR's
outcomes and how the program is based on people making choices related
to the level of self-sufficiency which can be part-time work. Also, she
believes this would require a change to the Rehabilitation Act, since
it's targeting a population group. Berthy De La Rosa-Aponte made the
point that their earlier recommendation for funding for SSA would
address this, since it's SSA who would be implementing the
demonstration. The Panel then made the following motion.

***Motion: The Panel passed the motion to not approve this
recommendation.***

Panel members Dave Miller and Russ Doumas opposed.

The Panel then discussed recommendation 34/11 concerning funding for
independent living centers (ILC). Frances Gracechild felt the ILCs could
play an important role in incubating and developing the beneficiary
voice within SSA. She also mentioned that many ILC boards have
beneficiaries as members. She was open to tightening the language so
make it closer to the IL movement and dropping any particular amount of
money. Thomas Golden brought up there are many people who believe that
ILCs have contributed to much of the underemployment of people with
disabilities with the message of benefits maximization; however, he
knows there are others that promote full employment and have become ENs
so all of them have the opportunity to become ENs. Frances Gracechild
responded that many ILCs would like to participate, but they probably
don\'t have the venture capital needed to hire additional staff with the
appropriate skills. Russ Doumas suggested adding it to the TESS
demonstration. Frances Gracechild stated that ILCs have certain
principles and one of them is full participation in society, and that
would be self-sufficiency and economic advancement. She also thinks this
is a unique opportunity to fortify the Panel's belief in a beneficiary
voice in consumer controlled activities.

Thomas Golden mentioned the EN capitalization project through Maximus
and suggested that effort could be focused on ILCs. Dave Miller stated
that members keep finding fault with different programs but if we don't
support resources for the TESS demonstration to be able to improve work
opportunities. Dorothy Watson pointed out the demonstration will take
time and this may not be the best mechanism for ILCS which are
underfunded. Russ disagreed, saying the demonstration will show who in
the community can get the job done and that we're talking about some of
the most difficult people to return to work. Thomas Golden stated that
the capitalization program has targeted certain populations so he sees
no problem in doing this for ILCs. The Panel made the following motion.

***Motion: The Panel passed the motion that SSA should identify business
models for investing in ILCs as ENs.***

Panel members opposing were Torrey Westrom, Libby Child, Russ Doumas and
Dave Miller. Dorothy Watson abstained.

Katie Beckett asked to make a final statement since she needed to leave.
She expressed her view that whether a person needs a medical or mental
health facility it should be of their choosing and all of these
professionals should work together for the goal of helping the person to
go back to work or enter the workforce for the first time.

Recommendation 35/12 was next discussed. Torrey Westrom felt
coordination between the federal agencies needed to be stressed. Members
were reminded that they had discussed making the President/White House
as the lead for administering this recommendation. Dorothy Watson
suggested that the members may want to make it clear that this isn't the
first time this type of council has been recommended; that the Panel was
aware of others. Therefore, the Panel may wish to be more specific how
this entity would be different from past ones. Frances Gracechild
responded that the Panel should reinforce the concept that we need more
federal collaboration and cooperation, not necessarily another council.
Libby thought the council was a good idea because it does create a body
that would have the responsibility under the executive office to make
sure this happens. Dave Miller suggested that the White House's Domestic
Policy Council be the lead and that way a new council doesn't need to be
created. The Panel made the following motion.

***Motion: The Panel passed the motion that the Domestic Policy Council
should ensure ongoing communication and collaboration among federal
programs that provide employment services and supports.***

It was noted that recommendation 36/13 to establish a state coordinating
council had been deleted yesterday. The Panel proceeded to
recommendation 37/14 concerning the Disability Program Navigator (DPN).
Dave mentioned that there's no data on the impact to beneficiaries, thus
why would we make this nationwide. Dorothy Watson brought up the issue
of inaccessibility of the One-Stops. Cheryl Bates-Harris responded that
programmatic funding could be an incentive for them to become accessible
and people with disabilities should be able to get employment services
from the same place as other people. Berthy De La Rosa-Aponte echoed
this saying her One-Stop has been inclusive because of the DPN. Thomas
Golden questioned if this is the case then why isn\'t the Department of
Labor (DOL) investing in this to begin with. Cheryl Bates-Harris
reminded members that DOL has been funding the DPN for the last 3 years.
Thomas Golden pointed out that DOL's national data base only includes 3
indicators on disability, which is insufficient to capture data on
outcomes. The following motion was made by the Panel.

***Motion: The Panel passed the motion to delete recommendation 36.***

Panel members Russ Doumas, Libby Child, Andy Imparato, Frances
Gracechild, and Berthy De La Rosa - Aponte opposed.

The next recommendation considered was 5/33 concerning the Medicaid
Infrastructure Grant program (MIG). Torrey Westrom emphasized the need
for Congress to require better communication between SSA and CMS, since
both have related demonstrations. Thomas Golden thought this
recommendation dealt with extending the authority of the MIG program.
Cheryl Bates-Harris commented that coordination and communication was
addressed in the prior recommendation. Thomas Golden questioned whether
the Panel wanted only to stimulate innovative problem solving or to
stimulate the states efforts to refine comprehensive systems of
employment supports for people with disabilities through the
demonstrations to Maintain Independence and Employment (DMIE). The
following motion was made by the Panel.

***Motion: The Panel passed the motion that Congress should extend the
MIG and DMIE program authority through 2014 to stimulate innovation by
states seeking to refine comprehensive systems of employment supports
for people with disabilities.***

The Panel then moved on to recommendation 6/34 about SSA's demonstration
authority. Torrey expressed concern that SSA hasn't used this authority
effectively or responsively in making these demonstrations a priority
and thus the Panel needs to stress the urgency of completing these
demonstrations. Thomas Golden brought attention to GAO reports related
to this issue. Dave Miller agreed that some mention of timelines or
Congressional oversight needs to be inserted. Dorothy Watson noted that
Congress and GAO have criticized SSA for their lack of a research
agenda. The Panel brought forth the following motion.

***Motion: The Panel passed the motion that Congress should renew, with
greater Congressional oversight, SSA's demonstration authority to design
and evaluate additional strategies that overcome multiple barriers to
employment and support economic self-sufficiency for individuals with
significant disabilities and place urgency on getting the demonstrations
done.***

The last recommendation (24/31) on Congressional hearings was next
discussed. Torrey Westrom felt that Congress needs to provide regular
oversight on the Ticket program. Thomas agreed but felt that particular
issues could be identified in Berthy De La Rosa-Aponte's cover letter of
the final report, such as the groups in the Adequacy of Incentives
report. The Panel made the following motion.

***Motion: The Panel passed the motion to delete recommendation 24 and
highlight certain issues as priorities within the Chair's cover
letter.***

The Panel then discussed the order of the final report noting SSA's
comments on separating out the transformational section. The following
motion was made by the Panel.

***Motion: The Panel passed the motion to have one report with three
sections as written now per the strategic goals, advised by the SSA
Deputy Commissioner, as distinguishable.***

The title of the final report was discussed by the Panel and the
following motion was made.

***Motion: The Panel passed the motion to change the title of the final
report to read "Building on the Ticket: A New Paradigm for Investing in
Economic Self-Sufficiency for People with Significant Disabilities."***

The Panel briefly discussed dates for another teleconference after
Thanksgiving. The following motion was made by the Panel.

***Motion: The Panel passed the motion to hold a teleconference on
November 26 from 1:00 to 5:00 p.m. EST.***

**ADJOURNMENT**

The meeting was adjourned at 6:05 p.m.