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

**Quarterly Public Meeting**

**Sheraton Crystal City Hotel**

**Arlington, Virginia**

**April 11-13, 2007**

**[Day One -- Wednesday, April 11, 2007]{.underline}**

**Attendees**

[Advisory Panel Members]{.underline}

Katie Beckett, Libby Child, Russell Doumas, Loretta Goff, Thomas Golden,
Frances Gracechild (via phone), 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, Tinya White-Taylor, and Pat Laird.

[Designated Federal Officer]{.underline}

Chris Silanskis

[Members of the Public]{.underline}

Becky Roberts; Jonathan Young; Dorothy Firsching; Monica Newton; Raphael
Rivas; Jessica Lehman; Mikelle Learned; Michel Bagbonon; Jim Brown; Sue
Suter; Dan O'Brien; Peter Mead; Stephen Sachs; Michael Morris; Valerie
Riggs; Allen Jensen; Regina Bowden; Mane Arnold; Peggy Hathaway; Ryan
Hess; Sharon Shreet; Janice Edwards; Candice Riley; Gloria Lowe; Ethel
Bryant; Regina Briggs; Sylvia Johnson; Debra Barker.

**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 acting
Panel Chairperson, Libby Child

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

Libby Child, acting Panel Chairperson, began by expressing
congratulations to Berthy De La Rosa Aponte, Panel Chairperson, for
becoming a grandmother. She then welcomed Panel members, staff,
consultants, and attendees. She continued by asking meeting attendees to
make brief introductions, and she reviewed the meeting agenda.

**Beneficiary Summit: Voices of Delegate Participants**

**Monica Newton**, delegate from New Hampshire, shared her background
about having a chronic mental illness with the occurrence of relapses
and trying to remain in the workforce. She explained that without DI and
medical benefits as her safety net she would not have been able to
secure the services she needed for recovery. However, she reported that
returning to benefits can take a year or longer and places you in peril
of losing your economic and medical stability. She noted that the way
the system is set up now, the risks are too great and the fear of
survival is far too high. She felt we need to make it easier for people
to get the help they need in navigating their way through the system.
She did it on her own, but it was very difficult and she had to overcome
hundreds of barriers to get her needs met.

**Raphael Rivas**, delegate from New Jersey, has been on SSI since age
18 and is currently looking for employment after graduating from
college. He only has had a summer job and feels there needs to be more
employment opportunities for beneficiaries so they're not dependent on
benefits all their lives. He would also like to see more doctors and
dentists accept Medicare and Medicaid since beneficiaries can't afford
to pay higher fees yet they need medical care.

Jim Brown, delegate from Montana, had grown up on a farm and had gained
an education as an international agricultural economist before becoming
disabled. He shared his experience of having a huge medical bill from
his accident, requiring him to sell his cows and spend down to become
eligible for Medicaid and DI. After doing so, he learned quickly about
SGA and the difficulties it posed in trying to work and save money for
bills. He received an overpayment notice which took many appeals before
being resolved. During that time he got conflicting information from the
benefits specialist and SSA field staff. He now works part-time at an
after school program. He would like to see the SSA programs be changed
so people with disabilities can live productive lives like everyone
else.

**Jessica Lehman** from California had been one of the beneficiary
planners for the Summit and has been organizing the delegates. She had
been on SSI while in college but during that time was never informed of
the work incentives available to her. She realized how complicated the
system was, which led to her incurring an overpayment. She has been a
community organizer and now works at an independent living center. She
explained how a big percentage of her salary goes toward paying for her
personal assistant services. She emphasized the beneficiary voice needs
to be listened to since they know the realities of the system.

**Mikelle Learned**, delegate from Colorado, shared that, because she
uses assistive technology to communicate, many people have doubted that
she can work or would want to work. She has a PASS plan and is
progressing on her goals. She does a lot of public speaking and
mentoring of families with children with disabilities.

**Michel Bagbonon**, delegate fromVirginia, is originally from West
Africa and has worked internationally. He's very active in his community
volunteering at various organizations. He acquired his disability and
has found it difficult to use the Ticket. He stated that, in reality,
the Ticket program isn't working as intended; it needs changes. He
expressed his desire to be part of the process for change; to make the
Ticket work.

All the delegates gave updates on the aftermath of the Summit. Jim Brown
first shared his observations from the Summit. He learned that many
delegates had endured hardships due to flaws in the federal government
programs, many people with disabilities have given up or grown
complacent. In spite of this, many left the Summit with a new found
solidarity. Next, the delegates discussed their outreach activities in
their States. They have been pleasantly surprised by the support,
interest and press coverage. Raphael described the major actions that
had taken place in organizing the delegates. A listserv has been
established, monthly teleconferences are being held, and committees have
been created (funding, recommendations, communication, media and
membership) with more to come. Jessica reported on their participation
in the Congressional briefing that took place on April 10. She and the
delegates provided background about themselves, shared their experiences
with the Ticket and the other work incentives and other disability
programs, and their feelings about the Summit. The congressional
staffers were aware of the frustrations with the disability programs and
discussed a possible hearing on SSA's work incentives in May 2007.

**Social Security Administration Update**

Sue Suter, Associate Commissioner, Office of Employment Support
Programs/SSA, updated the Panel on SSA's activities. She began by saying
this is a transition time for SSA and that Manny Vaz is the Acting
Deputy Commissioner of ODISP. He has been briefed by her office
especially about the regulations. He has agreed to a 60 day comment
period for the "timely progress" regulations and then these will be
combined with the September 2005 Ticket regulations. She also mentioned
how pleased she is to be working with beneficiary delegates on various
issues and is looking forward to their ideas.

Sue reported that five new awards have been made for the WIPAs, which
means the whole country is now covered. Her office is having monthly
calls with the projects and site visits will start end of April. The
first local work incentive seminar events (WISE) will begin in mid-May.
There will be five pilots first with a total of ten to be conducted. The
purpose of these seminars is to get ready for when the final regulations
are issued. She is also having regular calls with the Area Work
Incentive Coordinators (AWIC) and the Community Work Incentives
Coordinators (CWIC).

She mentioned a beneficiary survey that was conducted by SSA last year
of 400 beneficiaries who had assigned their Ticket and 400 who had not.
The survey groups included both SSDI and SSI beneficiaries with various
impairments and of varied ages. One of the preliminary results is 18-25
year olds are three times more likely to use the Ticket. A final report
should be done soon. In addition to the survey, a targeted marketing
mailing to 500,000 Ticket eligible SSDI and SSI beneficiaries will take
place this spring. SSA will select 10 targeted mailing sites, which will
include one metropolitan area in each SSA region.

In terms of the marketing strategy, Sue reported that CESSI is
conducting a survey of ENs to determine who is available and what's
their capacity. Her office is continuing their effort to recruit new
ENs. Department of Labor arranged a meeting with 4-5 One Stops to hear
from SSA about becoming ENs. Other possibilities are United Cerebral
Palsy Associations and Walgreen's Distribution Center. CESSI is also
contacting non-active ENs to keep them interested in the program.

A question by Andy Imperato on how SSA is defining the success of the
Ticket program led to a discussion on this issue. Sue responded that
there are a number of ways of measuring success: 1) a goal of 2-5%
assigned tickets, though this may be unrealistic; 2) providing choice
which should allow for any configuration for person to work; 3) outreach
and marketing results; 4) data on who's working, at what level and for
how long; 4) quality assurance of beneficiaries receiving accurate
information. Another measurement of success suggested by other Panel
members was the reduction in the number of beneficiaries dependent on
benefits, we should not rely only on the numbers of tickets assigned and
how many payments since many beneficiaries will park at the SGA level.

**Perspective from the Centers for Medicare and Medicaid Services**

Joe Razes, Senior Technical Advisor for the Centers for Medicare and
Medicaid Services (CMS), provided updates on the Medicaid Infrastructure
grant (MIG), the Buy-In, and the Demonstration to Maintain Independence
and Employment (DMIE). He first gave a brief overview of the programs.
He reviewed the goals of the MIGs: 1) Maximize employment for
individuals with disabilities; 2) Provide access to healthcare and
employment supports; 3) Increase availability of personal assistance
services inside and outside the home; and 4) Develop and expand Medicaid
Buy-In programs. Joe proceeded to give the latest data on the MIGs and
Buy-In programs, which is a compilation of various Medicaid and Medicare
data and SSA data.

-   41 states, including D.C., are participating in MIGs.

-   33 states that have a Buy-in.

-   Buy-in enrollment according to 2007, 78,000 people.

-   The numbers of people working and receiving benefits through a
    buy-in is increasing about 20 percent per year.

-   71% Caucasian, 20% African American, 9% other.

-   23% had earnings exceeding \$810 per month

-   53% of People in Buy-in were 45-64 years old

-   Less than 1% were over 65, and 1% under 21

-   Primary Disabling Condition -- Mental Illness 30%

He mentioned that an interagency work group comprised of CMS, SSA, and
the Department of Labor is exploring how each of their data can be
shared to give a complete picture of the person who is returning to work
and what are the influences upon the person for doing so. They hope
Rehabilitative Services Administration (RSA) and HUD will become
partners.

He then described the following challenges faced by the States.

-   Expand personal assistance services (40 hours per week-inside and
    outside the home)

-   Implement/Expand Criteria under a Medicaid Buy-In

-   Promote Interagency Collaboration

-   Define and Collect Data on Measurable Outcomes

-   Encourage Best Practices

He stated that the Federal government has challenges as well. These are
to continue and expand its data collection and analysis collaboration
with SSA and others, grant coordination among Federal partners, the
ability to continue enhanced funding in the future to MIG states that
have a comprehensive grant despite a reduction in their Buy-In service
costs due to coverage under Medicare Part D, and the submission by the
HHS Secretary in consultation with the Panel of a recommendation to
Congress on the continuation of the MIG program by 2010 when the Panel
is sun setting and further data is needed.

Lastly, he reported on the Demonstration to Maintain Independence and
Employment (DMIE). The goal of this demonstration is to test the effect
on an individual\'s continued employment and independence by providing
medical assistance and other supportive services to people with
potentially disabling conditions with the assumption this will keep them
from applying for disability benefits. There are six States
participating in the demonstration each having a targeted disabling
condition. Most of these States got started about two years ago due to
fiscal issues and the demonstration ends in September 2009. This may not
provide sufficient evaluative information to make any recommendations
for the report due in 2010. An evaluation design is still being
developed.

Panel members expressed concern over the data showing 10% top wage
earners in the Buy-In program weren't on SSDI/SSI and inquired about the
composite and characteristics of people who are in the Buy-In program
and their migration from any of the other Medicaid programs. This led to
a discussion of the lack of a definition of work and could this be
impacting on who participates in the Buy-In program. Joe stated a new
report on State participation rates and profiles will be published soon
that will have this information.

**Panel Deliberation and Discussion**

The panel deliberation session was facilitated by Becky Roberts,
President of Catoctin Consulting, LLC. The Panel identified the
following items for consideration by Panel subcommittees.

Many Panel members first expressed their reactions to the delegate
presentations. The delegates seemed uncertain as to what programs should
be changed and how, they appeared focused on Medicaid. In addition, the
delegates conveyed a fear about not getting consistent and accurate
messages from the SSA field offices. The Panel expressed an interest in
getting delegate input on subcommittee work.

1\. How to define success for Ticket Program under the new regulations

\-- Provide Panel's best thinking on how to measure success.

\-- Identify indicators of success (qualitative vs. quantative)

\-- CIC Report and the National Employment Investment Strategy (NEIS)

2\. Do we want to address "should the Ticket Program continue?"

\-- Program is branded (bad brand); "New Coke" (no rapid response to
save product).

\-- Future deliberations, discuss in subcommittees.

\-- Do we have a clear understanding of the indicators we want to
benchmark and

measure in "Son of Ticket" (e.g., WIPA Nat'l data base) -- all
subcommittees

\-- What should we look for in new program/"Son of Ticket"/Ticket Act II
-- might be

easier to get agreement on, in middle of implementation and evaluation.

\-- Original Ticket plus new regulations equals foundation for Ticket
and other

recommendations equal improved program.

3\. Address in final report

\-- improved Act will not make a significant difference in return to
work.

\-- what should Congress look at a year or two down the road after the
Panel sunsets.

4\. Medicaid Buy-In and MIG grants

\-- 90% using it are at \$5,000 income level -- use as supporting data.

\-- Large variance among MIG States, but they all get \$500 K -- is this
good stewardship, low return on investment.

**Perspectives from Stakeholders**

**Andrea Harles** is the Associate Executive Director of the
International Association of Business Industry and Rehabilitation
(I-NABIR). She was representing the Employment and Training Task Force
of the Consortium for Citizens with Disabilities (CCD). CCD is a
coalition of over 100 national disability organizations and advocates
for national public policy that seeks to ensure the inclusion of
children and adults with disabilities in all aspects of society. Her
remarks centered on the delay in the publication of the proposed Ticket
regulations. She provided a historical timeline. This delay has damaged
the program and has branded it as a failed program. She encouraged the
Panel to increase their efforts to convey the urgency of release of the
regulations to the SSA and Congress. CCD had met with Commissioner
Astrue, who said he's committed to getting the Ticket regulations out
soon; however, CCD has heard this in the past. In the meantime, CCD has
met with members of Congress and staff and shared their view that it's
time to consider changes to the Ticket legislation whether or not the
regulations are forthcoming.

**Peter Mead**, President of the National Employment Network Association
(NENA), shared three solutions for eliminating the culture of dependency
on the disability programs which would lead to a healthy Ticket program
and a stronger DI trust fund. The first concerns the backlog in
processing disability claims. SSA suggests it will process 2.5 million
initial claims for disability benefits this fiscal year. If there's a
reduction in the backlog, this represents an increase in the number of
disability beneficiaries and if we coupled that with the failure to
employ or to reemploy them, this creates a situation of an even faster
exhaustion of the DI trust fund. He believes the proposed regulations
provide an effective solution, and thus SSA needs to get them published.
His second solution tries to address the fear of losing benefits and
receiving accurate information. A culture needs to be created in SSA
that SSI/SSDI can be revolving doors rather than dead ends. This should
be part of the application process, as well as advertising to
beneficiaries. Their third solution concerns the field office and their
focus on the core services. NENA proposes that the Office of Employment
Support Programs (OESP) should perform income verification since it's
more of a natural fit with the Ticket program. This could be done
through automation which has been tested with SSI beneficiaries.

**Rita Martin**, Assistant Director of the Council of State
Administrators of Vocational Rehabilitation (CSAVR) agreed with Andrea
Harles about the urgency of publishing the proposed regulations. Aside
from the regulations, she noted that healthcare is a critical component
in any work program when you are speaking of disability and Social
Security beneficiaries. CSAVR would like to see all States have a Buy-In
program or, in the absence of that, some other creative opportunity for
states to be able to provide healthcare assistance to individuals with
disabilities who went to work. CSAVR believes any recommendation by the
Panel to improve the disability programs without a mandatory provision
of health care is doomed to fail. She also encouraged the Panel to look
at some of the early intervention models beyond the demonstration
authority where you wrap healthcare and financial resources around
people who truly want to attempt job training and employment without
worrying how to pay for other daily living needs. Lastly, she suggested
some increase in funding for the work incentives planners. There are not
enough planners to be able to even access the number of beneficiaries
who want to work.

**Public Comment**

**Joy Tuscherer** is the delegate from South Dakota. Upon the onset of
her disability, she has tried to maneuver the various government
disability programs, which is a maze of government bureaucracy. During
that time she was never told about the Ticket program. She urged the
Panel to use their limited time to take action on fulfilling their
shared vision of inclusion and empowerment for beneficiaries.

**Wayland Wong**, the delegate from California, provided the following
suggestions to the Panel. The first is the need to adjust the SSI and
Medicaid rules for inflation. The limits placed on these programs are
burdening those who need to buy items that are essential for living. The
second concerns what is called the marriage penalty on someone with a
disability who wants to be married but if s/he does the income and
assets of the other person will interfere with their future benefits or
public assistance. He pointed out that someone who is in need of
personal assistance or durable medical equipment will always require
these things even when s/he gets married because of their disability and
these are extra expenses. His third is to increase the pool of employees
with disabilities by providing a salary for a certain percentage to
attract employers.

**Monica Newton**, delegate from New Hampshire, reiterated the need to
allow those with chronic illnesses that experience relapses to easily
flow in and out of the system without risk of losing everything they
have accumulated. The result is fear of returning to work.

**Jessica Lehman**, beneficiary planner from California, thanked the
Panel for including beneficiaries in their meeting and encouraged them
to involve beneficiaries in the work of the Panel. She also used the
time to reach out to beneficiaries who might be listening to inform them
of the organization that is being formed. The web site address is
[www.voicesforwork.org](http://www.voicesforwork.org/) or email:
<INFO@voicesforwork.org>. This organization will be reviewing the Summit
recommendations and deciding what the top 3-5 recommendations should be
that they want to pursue at this time. She reported that a Senate
hearing might held on SSA's work incentives in the spring.

**Susan Webb** from the Arizona Bridge to Independent Living in Phoenix,
Arizona shared some suggestions with the Panel. The first was the
importance of working with employers to maintain the employment of an
individual with a disability. She has found after 5 years as an EN that
many folks bring their disability issues to the workplace when they
should be concentrating on performing their job. She wouldn't advise
employers of becoming ENs because this places the issues of disability,
such as benefit planning, in their realm rather than focusing on the
person. The other concerned the annual SSA retirement statement that
most people get informing them of the amount of their retirement
benefits at certain ages or, if they became disabled, what amount they
would receive. Someone on SSDI doesn't get this annual statement which
means they don\'t understand that when they reach retirement age
disability benefits stop and retirement benefits begin and their
benefits will be reduced because they have not been paying into the
retirement plan. She feels they should get a similar statement
explaining all of this and information on work incentives.

The meeting adjourned at approximately 5:38 p.m.

**[Day Two -- Thursday, April 12, 2007]{.underline}**

**Attendees**

[Advisory Panel Members]{.underline}

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

[Advisory Panel Staff]{.underline}

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

[Designated Federal Officer]{.underline}

Chris Silanskis

[Members of the Public]{.underline}

Becky Roberts; Dorothy Firsching; Henry Claypool; Allen Jensen; Jonathan
Young; Michael Morris; Bonnie O'Day; Alaine Perry; Peggy Hathaway; and
Carey Fay Vandergrift.

**Call to Order**

Chris Silanskis, Designated Federal Officer, called the meeting to order
at approximately 1:30 p.m. and turned the meeting over to the acting
Panel Chairperson, Libby Child.

**Welcome Introductions and Review of the Agenda**

Libby Child, acting 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.

**Draft Transformation Subcommittee Report:** "Enabling Work: Policy
Recommendations to Promote Employment for People with Significant
Disabilities"

Andy Imparato, chair of the Transformation Subcommittee, first thanked
Panel members for the amount of time being devoted to discuss the
National Employment Investment Strategy, noting their input is very
valuable to the subcommittee. He explained the draft is very much a work
in progress and reflects the subcommittee's current thinking in terms of
the report. They hope to have a much more detailed draft to everybody by
the end of May and be able to vote on the recommendations at the July
Panel meeting. He then turned it over to Jonathan Young, a contractor
working on the report.

Jonathan began reviewing the draft summary by starting with the "Case
for Change". He explained that examples of life experiences of
beneficiaries will be added as sidebars as a way to illustrate the case
for change and the barriers. The main point under "Long-Term Investment"
is that the unemployment rate hasn't changed despite federal legislation
and the government can't sustain increased enrollments in the benefit
programs. The "Definition of Disability" section addresses where the
Panel has been on these issues without making a recommendation. The
remainder of the summary outlines a multi-prong approach to promoting
work that reflects the diversity of the disability population by
recognizing no one program or policy is the solution. With this in mind,
Jonathan explained the approach contains four programmatic
components(improving existing work incentives, creating a work support
program, promoting workforce connection, and creating a youth
dimension)and three implementing components(building an effective
infrastructure, raising expectations, and increasing job opportunities).
He then turned it over to the Chair for discussion.

As a preface to the discussion, Andy Imparato told Panel members the
subcommittee is interested in knowing of any concepts presented in the
draft summary that are particularly worthwhile to develop further and
asked if there are there things that raise red flags that need to be
addressed. A discussion began between the Panel members. The main issues
identified for further consideration and clarification by the
subcommittee were the following.

1\. Eligibility criteria for this new option and how would beneficiaries
gain information about it.

2\. Other relevant legislation and programs are missing (e.g., Rehab
Act) in the "Case for Change" section.

3\. New policies and programs need to reflect the perspective of the
disability community.

3\. Cost factor as it relates to return on investment vs. the status
quo.

4\. Financial literacy training.

5\. Link to existing programs.

6\. Defective implementation and under funding of current policies and
programs is a major problem in the poor employment rate of people with
disabilities.

7\. Justification for new changes.

8\. State contributions to these programs isn't reflected.

9\. Unlimited income and portability of comprehensive health care will
be problematic with decision makers and require further explanation.

**Public Comment**

**Raphael Rivas**, the delegate from New Jersey, first thanked the Panel
members for inviting the delegates to present at their meeting. Next, he
wanted to encourage the other delegates to stay involved because there
will be many opportunities for them to provide their input and advice.

**Sandy Burk** from Maryland provided an update on her situation, since
her last public comment to the Panel during the February 2007 Quarterly
Meeting. She now has a statement from SSA that a medical review will be
triggered when she applies for expedited reinstatement (EXR), which is
inconsistent with the Ticket regulations. The EXR regulations must be
changed to correct this contradiction that is causing beneficiaries to
lose their health benefits. Her U.S. Senator is willing to facilitate a
meeting with SSA about this issue. She believes a small change in the
regulations will correct the problem. The issue hinges around the
concept of "medically improved" which is raised when you work over SGA.
Andy Imparato responded by stating her issues have been addressed under
the draft National Employment Investment Strategy and past
recommendations of the Panel.

**Marcie Goldstein** from Virginia shared her views on the Ticket
program. Many of the ENs have been service providers for years with a
poor track record of placing individuals with disabilities in
professional positions. Most of their placements are in entry level jobs
that pay low wages. Also, many of these providers don't employ people
with disabilities in management positions despite being Federal
contractors. Secondly, she would recommend that the Ticket program use
mainstream recruiters such as Manpower to place individuals into jobs.

**Kim Allen,** the delegate from Maryland, offered ideas on how to
impact successful work attempts for many individuals returning to work.
A self-directed system that allows the individual to develop a
rehabilitation program with viable, measurable outcomes is one way.
Better collaboration with Federal, State and local governments to
maximize resources, funding and services is another idea. All services
should be integrated and include medical support services, education,
housing, and non-traditional supports. Redevelopment of the Social
Security disability services should recognize services for children and
youth as a priority population so they can become workers, business
owners, and taxpayers. Beneficiaries need representation at the Federal
level by creating a beneficiary advocacy office with direct reporting to
SSA Commissioner, the White House and Congress. This office would work
within SSA to address the needs of beneficiaries as well as coordinate
with staff and Federal agencies. Lastly, we need to address the various
supports and services people need, the variance in the cost of living
around the country, quality of life, encouragement of recovery, and
transitional expenses associated with returning to work. She expressed
her appreciation for the existence of the entitlement programs which
have provided income and medical services.

**Allen Jensen** from George Washington University provided comments on
the draft report of the Transformation subcommittee. He and Bobby
Silverstein recently facilitated a discussion with the four pilot States
(Vermont, Wisconsin, Connecticut and Utah) participating in the SSA \$1
for \$2 benefit offset demonstration. These pilots told them that
continued attachment is needed by the beneficiaries. He recommended that
the Panel have them present. He felt the draft report is going backwards
with the concept of time limited work incentives, it has old ideas with
the hope of more money. He mentioned the State variances in the numbers
of SSI recipients working and the differences in the Medicaid Buy-In
States as examples of how we can move forward. Andy Imparato welcomed
Allen's comments and assured him that the new work support program would
allow an individual to return to benefits, especially health care. He
also clarified that the subcommittee is trying to present a model that
will be more cost effective in the long-term than the existing programs.

The meeting adjourned at approximately 5:16 p.m.

**[Day Three -- Friday, April 13, 2007]{.underline}**

**Attendees**

[Advisory Panel Members]{.underline}

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

[Advisory Panel Staff]{.underline}

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

[Designated Federal Officer]{.underline}

Chris Silanskis

[Members of the Public]{.underline}

Dorothy Firsching; Jonathan Young; and Michael Morris.

**Call to Order**

Chris Silanskis, Designated Federal Officer, called the meeting to order
at approximately 9:05 a.m. and turned the meeting over to the acting
Panel Chairperson, Libby Child.

**Welcome Introductions and Review of the Agenda**

Libby Child, acting Panel Chairperson, began by welcoming Panel members
and meeting attendees to Day Three of the meeting. She then asked
members, staff and audience to make brief introductions.

**Business Meeting**

Libby Child, Chairperson, reviewed the business agenda. The business
meeting session was led by Libby Child.

[Meeting Minutes]{.underline}

The meeting began with the review of the February 2007 Panel minutes and
a motion to accept the minutes into the record.

***Motion: The Panel passed a motion to accept the February 2007 minutes
into the record.***

[Congressional Briefing]{.underline}

Berthy Del La Rosa Aponte, David Miller, and Libby Child participated in
a congressional briefing on April 10^th^. Also participating from the
beneficiary summit were the five delegates and the beneficiary planner
who presented on the first day of the Panel meeting. They met with staff
of various House and Senate subcommittees with jurisdiction over Social
Security, Medicare, Medicaid and private health insurance, along with
staff from the Congressional Research Service. The main focus of the
briefing was the Beneficiary Summit. Other topics covered were the three
subcommittee reports (the Summit Recommendations, Work Incentives
Utilization, and the National Employment Investment Strategy), SSA\'s
marketing of the Ticket program and other work incentives; and the delay
in the final Ticket regulations. Dave felt that by bringing the
delegates it captured the attention of the congressional staffers. He
thought they did an excellent job of both weaving their own personal
stories as well as recommendations for change in their testimony. Later
they had an opportunity to dialogue after the briefing with the
congressional staff. He thinks it went well and was very effective, and
was reflective of the Panel\'s effort to elevate direct feedback from
beneficiaries. Berthy commented that congressional staff asked the
delegates about their personal experiences with the Ticket use. She was
very impressed with the delegates that many were highly qualified but
due to barriers many of them haven't been able to fully utilize their
potential and skills. She was also impressed with the cross-section of
the delegates representation in terms of disability, geography and
race/ethnicity. Libby agreed with Dave about the effect of having the
delegates there in person, it put a face on the effort that the Panel is
working on and made a tremendous difference. When asked about the
reaction of staff to the delayed regulations, Dave responded that Kim
Hildred of the House Ways and Means/Subcommittee on Social Security
mentioned their disappointment. He added that he had suggested the
possibility of a hearing on the SSA regulations and the Ticket, which
was stalling the program and not getting the attention within SSA. The
decrease in the number of ENs was also mentioned. Kim also praised the
work of the Panel for raising the return to work issue as an important
function of SSA and had asked Libby about the interest of employers in
the Ticket.

[Outreach Activities]{.underline}

1\. [SSA's Teleconference Calls: WIPA Projects]{.underline}

Cheryl Bates-Harris reported on the monthly teleconference call that she
participated in on March 19. The purpose of the call is to bridge the
gap between SSA and information that the projects need. This month there
were four topics. The first was the status of the long-term training
contract and the data base. The second was on protecting personally
identifiable information since the projects are now subject to more
stringent requirements in terms of security clearances. Next,
representatives from the Department of Labor discussed the web site
"disabilityinfo.gov" and asked for feedback or suggestions for

improvement. Lastly, IRS discussed their collaborative effort to educate
low income workers about tax credits and tax incentives that are
available to them as a means of building a foundation of financial
literacy for people to find their way out of poverty.

[2. Regional EN Meeting]{.underline}

Torrey Westrom participated in another regional EN meeting held on March
7th for Minnesota and Wisconsin. He reported the consensus was they were
eager to get the new Ticket regulations out and start the new payment
system. Most weren't actively participating in the Ticket program, since
it didn't make good business sense. Someone from Easter Seals told him
they had screened 200 people but placed 15 and these were mostly
part-time jobs which meant the organization didn't get paid. Calls about
the Ticket are still being received by one EN. Another person did
mention that the payment system is smoother now. Ken Rodgers, the
delegate from Minnesota, was present and gave an update on the Summit.

[3. Rhode Island Medicaid Infrastructure Grant Summit, "Changing
Attitudes, Changing Lives"]{.underline}

Berthy De La Rosa Aponte and Jill Houghton attended this summit convened
by the director of the Medicaid Infrastructure Grant (MIG) to discuss
SSA reforms and barriers to employment. The theme was changing
attitudes, changing lives. It was facilitated by the Center for Workers
with Disabilities. Various stakeholders from around the State attended,
including two of SSA's District Managers. The two things that resonated
throughout the summit was better communication between SSA and CMS and
the definition of disability. It was expressed how the definition
doesn\'t work for a lot of folks because it sends the wrong message that
people can\'t work. From a state level, people were focused on wanting
to work to change the definition of disability; however it was mostly
discussion. One of the workshops had a chart that outlined federal
efforts to promote employment starting from the 1960\'s through today
showing progress had been made in the numbers over the years. Berthy
noted that many in attendance didn't know about the different work
incentives especially 1619(b). The Panel members then had a discussion
of the definition of disability. Andy suggested that in the final report
both sides of the argument should be represented. He mentioned that
outside of DC there's strong feelings for changing it but no one has any
recommendations on how to change it. Most feel the definition should be
based on a functional assessment that doesn't rely on the concept that
there is a direct connection between impairment and inability to engage
in substantial gainful activity. It was noted that there are some
researchers working on this but nothing has been proposed thus far for
public discussion.

[Committee Reports]{.underline}

Libby Child requested committee chairpersons to give reports on their
recent activities.

[Beneficiary Voice Subcommittee]{.underline} -- David Miller,
chairperson, began by reviewing an outline for the Summit Report. A
draft of the report will be done within a month and it will be reviewed
by the delegates. The raw recommendations will be organized into a
summary which will try to maintain their intent and tenor. The final
draft will be shared with the Panel for its June teleconference and a
rollout at the July Panel meeting. It was suggested by Andy Imparato
that the report be accessible to those with intellectual and cognitive
disabilities. Dave added that along with their usual audience the
grassroots is the primary audience and thus, the importance of trying to
remain true to the intent and language of the delegates. Pictures and
quotes will be embedded into the report. There are also very good video
testimonials that hopefully will be placed onto the web site. He next
reported on the progress of collecting beneficiary testimony given to
the Panel. Staff are preparing a summary. The subcommittee is continuing
to research a model to create a permanent structure for the beneficiary
voice within SSA. One being considered is the National Taxpayer Advocate
within the IRS system. It provides taxpayer feedback, taxpayer advocacy
within IRS. It basically is an internal customer satisfaction, Q & A
process; however it does have a component that deals with systemic
problems. Another possible model is the Department of State that has an
internal body that advises them on policy issues. Lastly, the
subcommittee hopes to be scheduling a meeting date with SSA Office of
Operations on customer service issues.

[Continuous Improvement Subcommittee]{.underline} -- Libby Child,
chairperson, reported the subcommittee has a contract in place for
drafting the work incentives utilization report. Thomas will serve as
the point person to the contractor. She feels the report will feed into
the National Employment Investment Strategy report and the final report.
It's their goal to have a draft ready for the June teleconference and a
final version for the July Panel meeting. The key issues in the report
are 1) overview of SSA\'s current work incentives and their utilization;
2) marketing and outreach of the current work incentives; 3) interaction
with federal programs on return to work efforts; and 4) real life
scenarios of work incentive usage. In response to a question about
development of recommendations and engaging beneficiaries in that
process, the subcommittee discussed it but hasn't determined a plan yet.
An outline of the report will be given to Panel members in time for them
to submit any comments before May 2, the first teleconference with the
contractor and authors. As for the marketing campaign, there wasn't
anything new other than what Sue Suter reported to the Panel. It was
suggested that Panel members should attend the upcoming WISE seminars
mentioned by Sue.

[Transformation Subcommittee]{.underline} -- Andy Imparato, chairperson,
stated his subcommittee would like a briefing on SSA's Benefit Offset
National Demonstration (BOND). He feels many of the good ideas and
thinking that have gone into crafting the demonstration are consistent
with their subcommittee's thinking regarding National Employment
Investment Strategy (NEIS) particularly, the Work Support Program
element of it. Once the new commissioner is briefed, he hopes their
briefing will occur in time for them to incorporate what they learn into
the NEIS. The subcommittee has asked for three delegates to be
identified to review the iterations of the NEIS. He realized the summary
discussed earlier this week was high level thinking and the next draft
will be more detailed. He felt that draft should be circulated to
stakeholders to gain their feedback. He hopes to have another draft for
the Panel before the end of May. Andy concluded by sharing some outreach
activities he will be participating in as a Panel member along with
Berthy and Jill and separately as the president/CEO of AAPD.

[Executive Director's Report]{.underline}

Jill Houghton pointed out the photo of the Summit delegates that was in
their notebooks. She shared that staff are working with the
subcommittees on updating their actions plans.

In relation to these plans, the Panel needs to decide when their final
meeting will take place and when they wish to release their final
report. She then turned the meeting over to Libby for a discussion of
these two items.

Libby explained that the Executive Committee had been discussing the
various reports that are being worked on by the subcommittees and their
scheduled dates for completion. It was felt that the original September
Panel meeting wasn't practical/realistic in relation to these reports.
It was agreed to propose a later date, October 31 -- November 2, 2007,
and a final one day meeting in December to rollout the final report
possibly consisting of a press conference. After a discussion of the
proposed new date for the Panel meeting, the Panel made the following
motion.

***Motion: The Panel passed a motion to have its meeting on October 31,
November 1 -2, 2007.***

The Panel then discussed having a one day final meeting in December.
Andy Imparato suggested Dec. 3 since it's the UN International Day of
Disability and possibly holding the press conference at the National
Press Club. It was agreed that the whole day should be held open. The
Panel made the following motion.

***Motion: The Panel passed a motion to have its final meeting on
December 3, 2007.***

In conclusion, Jill Houghton reminded members of the time frame for the
final report. At their June 13 teleconference they will be finalizing
the outline and themes of the final report. Between June 13 and the July
Panel meeting, subcommittees will be developing their recommendations
for deliberation at the July Panel meeting with a vote on the
recommendations at the Panel meeting on October 31^st^ - November 2^nd^.

**PANEL DELIBERATIONS**

The Panel session was led by Libby Child, acting chairperson, and
facilitated by Jill Houghton. The Panel identified the following items
for the Congressional briefing and for consideration by Panel
subcommittees.

[Action Items]{.underline}

1\. Panel representation at WISE seminars

2\. "Changing Attitudes, Changing Lives" could be the theme for the
social marketing campaign.

3\. Vet CIC Work Incentives Utilization Advice report w/Consortium for
Citizens with Disabilities, Voices for Change, National Employment
Network Association, National Council on Independent Living, Social
Security Advisory Board, and others.

4\. BVC activities

\-- Draft Summit Report to Panel for June 13 teleconference.

\-- Elevating the beneficiary voice within SSA through an on-going
structure will be

part of their recommendations for July Panel meeting.

\-- Invite delegates to roll-out event of Summit Report in July, either
on Hill or invite

Hill staff/ members of Congress and SSA Commissioner.

5\. CIC Report

\-- need to review CMS data presented since more recent than Mathematica
reports

\-- data on people using the ticket that Dan O'Brien presented.

6\. May need to establish a process for preparing the Panel chair and/or
member for

possible Senate hearing - should be ready for recommendation regarding
on-going

structure for beneficiary voice.

7\. Final report -- include opinion on whether there should be a similar
advisory panel.

\-- another purpose of Panel was to bring together other federal
agencies for

cross- cutting information.

\-- beneficiaries recommendation for continuation of Panel or something
similar.

\-- what type of Panel, lessons learned should inform any
recommendation.

[Congressional Briefing]{.underline}

1\. Share the following documents prior to: draft Summit report, draft
report outlines (CIC, TC) CMS PowerPoint presentation, and SSA Update.

\-- for briefing have fleshed out documents to engage in dialog (e.g.,
CIC data from

Work Incentives Utilization Report).

\-- guidance from Executive Committee on important points to highlight.

2\. Panel formally requesting the assistance of Congress to encourage
SSA to release Ticket regulations with results of what's happening due
to their delay.

3\. Pose question regarding the Panel meeting their objectives, and if
not, why not; and lessons for the future.

4\. How to meet CMS Medicaid Buy-In Report requirement by 2010.

**ADJOURNMENT**

The meeting was adjourned at 12:01 p.m.