Evaluation of the Ticket to Work Program Initial Evaluation Report

noticeably low, and, among the very few ENs that had accepted several Tickets, many were
in various stages of contracting or leaving the market (Chapters III and V). No EN we have
talked to thus far appears to be making money on its TTW activities, and the SVRAs
continue to dominate the market for employment services to eligible beneficiaries.
It is important to note that some groups of eligible beneficiaries are participating at
much higher rates than others. For the Phase 1 states, the participation rate in August 2003
was 1 percent for those who received their Tickets in the first rollout mailing (February
2002), 2 percent for those under age 40, 4.4 percent for those classified as having a severe
hearing impairment, and over 1 percent in four states, including 1.9 percent in Delaware.
Similarly, some groups are more likely than others to use the new payment systems.
Variation by state is particularly wide-ranging—from a high of 45 percent of assignments
using the new payment options in Arizona to a low of just 5 percent in South Carolina. We
also find greater use of ENs funded through new payment systems by older beneficiaries and
by those whose impairments are associated with medical conditions that increase in
prevalence with age.
C. IT IS STILL TOO EARLY TO JUDGE THE TICKET TO WORK PROGRAM
FULLY
It is too early to know whether TTW, as currently designed, can achieve all its goals.
The evidence we have been able to collect to date clearly shows that implementation
problems have reduced provider interest in the program.
SSA is attempting to address the major pressure points, that is, those issues that have
been most detrimental to the program, and it is possible that changes already in place will
stimulate provider and beneficiary interest. Most important, SSA has taken steps to simplify
the documentation of earnings required to trigger Ticket payments and to improve the
timeliness of payments once evidence is submitted. It has also taken steps to reduce backlogs
in post-entitlement workloads that have made confirmation of Ticket eligibility and
adjudication of EN claims for payment problematic, and it recently launched a significant
beneficiary outreach effort as well as an effort to help providers find other sources of
funding to support their operations. Whether these steps will prove sufficient to enable
TTW to achieve its goals cannot be determined until more data become available. However,
it appears that SSA must continue to address these pressure points aggressively if the
program is to succeed.
One important issue demanding consideration is the continued dominance of SVRAs in
the employment services market for beneficiaries. Even though TTW has clearly expanded
choice for beneficiaries, most Tickets have been assigned to SVRAs under the traditional
payment system. The dominance of SVRAs appears to be inconsistent with the objective of
developing a competitive market for beneficiary services. If SSA wants to increase
competition it will have to work with the Rehabilitation Services Administration (RSA) to
develop new ways to involve both SVRAs and ENs in the TTW program.
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VII: Conclusions and Implications