Evaluation of the Ticket to Work Program Initial Evaluation Report

Act. At the same time, some ENs have argued that the guidance gives SVRAs an unfair
advantage and limits ENs’ ability to recruit and serve beneficiaries. Requiring SVRAs to
obtain a signed Form 1365 might increase beneficiary assignments to ENs, although we have
no evidence that a substantial increase would occur.
The issue of the relationships between SVRAs and ENs is part of an even larger issue
concerning the ability of ENs to co-mingle funds from TTW with funds they receive from
other public and private sources. As noted in Chapter III, some providers are refraining
from serving Ticket holders because they believe that their funding from other sources (for
example, Medicaid) will be jeopardized by Ticket to Work revenue. The essential question is
whether it was Congressional intent for the Ticket to Work program to make beneficiaries
ineligible for the full range of Title I VR services, Medicaid, or other supports provided by
the many programs for which beneficiaries might be eligible, by making them eligible for EN
services under Ticket to Work? Or is it the legislative intent for the TTW program to
provide additional and longer-term funding for beneficiaries who often require ongoing and
intensive supports to maintain employment? The issue of whether TTW should be viewed as
substitute or complementary funding has not been adequately addressed by SSA, and is
inhibiting the ability of providers to serve Ticket holders. While it appears that SSA has not
yet been able to provide clear policy guidance on the issue, it is certainly not an issue that
SSA can address alone. This will require working in collaboration with other federal entities
providing funding for services to people with disabilities, and may also require clarification
by Congress on the fundamental intent of the legislation.
Beyond the pressure point issues discussed above, the TTW performance is likely to be
affected by the downturn in the economy. As the evaluation proceeds, we will pay careful
attention to the extent to which local economic conditions affect the extent to which TTW
influences beneficiaries’ employment, earnings, and benefit receipt. It is essential that SSA
understand how well TTW works in different economic environments so that it can make
accurate projections of program costs and effects on the beneficiary rolls.
The economic downturn might have affected the program in several ways. The most
obvious is that the downturn has reduced the number of job vacancies and increased
competition for those positions that remain. Other possible effects are subtler. A poor
economy tends to reduce state budgets, with the result that state funds that might otherwise
have helped support beneficiary return-to-work efforts are less likely to be available. State
Medicaid programs, which have seen states tighten eligibility requirements and reduce
coverage (Smith et al. 2003), provide a clear example. Beneficiaries also are likely facing
greater competition from others for state employment and other support services. Some
SVRAs we interviewed for the study reported cuts in state funding. Some ENs might be
facing financial difficulties for reasons related to the economy but unrelated to TTW, making
it harder for them to finance their entry into TTW.
We can reasonably conclude that TTW, as initially implemented, has had, at most,
extremely small effects on beneficiary exits due to work. We base our conclusion on the fact
that overall participation rates in TTW are still noticeably low, that most beneficiaries who
use Tickets are served by the traditional payment system, and that only a few payments have
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VII: Conclusions and Implications