The Ticket to Work and Work Incentives Improvement Act of 1999 is a federal law intended to reduce work disincentives, and increase health insurance coverage and benefits eligibility for people who have a disability and are able to work. It does this by expanding Medicare and Medicaid coverage and expanding vocational rehabilitation service options. North Carolina has not taken advantage of the new Medicaid Options provided by the legislation. But in June of 2003 North Carolina will implement the Ticket to Work portion of the legislation that gives consumers greater choice in choosing their provider of VR services. Individuals who qualify for SSI or SSDI will no longer be referred automatically to the state Division of Vocational Rehabilitation for services but will be given a "ticket" to choose from a network of providers.

But what remains the greatest barrier to employment is the loss of benefits when an individual begins to work. The federal legislation adds two new optional eligibility categories for states: 1) states are able to offer Medicaid coverage to SSI beneficiaries who go to work and earn up to 250% of the poverty level, and 2) states can allow a Medicaid buy-in for people with disabilities who earn more than 250% of the poverty level up to 450% if the state charges a sliding-scale premium. If the state takes advantage of these options it will allow people with a disability due to mental illness to earn more money without jeopardizing their health benefits through Medicaid. This has been a major disincentive to return to work as many part-time and re-entry work positions do not provide health coverage.

NAMI North Carolina will monitor the implementation of Ticket to Work to ensure that consumers are offered an informed choice of service providers and that quality of services and employment outcomes improve. While the state’s current budget situation makes it unlikely that legislators will support the expansion of benefits and programs, NAMI North Carolina will continue to advocate that the state take advantage of the Medicaid options offered through the Ticket to Work and Work Incentives Improvement Act to allow individuals to work without losing Medicaid benefits. Taking advantage of these options supports recovery and, in the long run, will likely save the state money as individuals are able to return to productive work.