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been made to TTW providers. Thus, TTW has yet to have a dramatic effect on
beneficiaries’ service use patterns, although Ticket’s effects may be felt if the economy
rebounds and as SSA continues to improve TTW operations. In addition, greater effects
may materialize over time as we begin to see the full effect of efforts to educate beneficiaries
about their work options and opportunities.
D. MORE FUNDAMENTAL CHANGES TO TTW MIGHT BE NEEDED
Although TTW, as currently designed, has not yet existed long enough for us to reach
judgments about its success, more fundamental changes to the program’s design, or to the
work incentive features of the DI and SSI programs, could be required if substantial
increases in beneficiary earnings and reduced reliance on income support are ever to be
realized. A major issue to consider would be how to increase potential providers’ interest in
participating in the program.
The obvious ways to increase ENs’ interest would be to increase the size of the
networks’ payments and to restructure payments for earlier receipt. Depending on how ENs
and beneficiaries respond, such changes might either increase or reduce total disability
program costs (i.e., benefit payments plus Ticket payments). Payment increases beyond some
point will increase total program costs for the simple reason that benefit reductions have a
finite limit. Although the intent of the Ticket Act is to reduce or at least not increase total
program costs, an increase in TTW costs might--from a broad societal point of view--be
optimal given potential impacts on costs for other programs (such as Medicaid and
Medicare) and the value of increased income to the beneficiary, among other things. 2 We do
not, however, have any empirical evidence on the extent to which any given change would
result in greater provider participation, greater beneficiary interest, or more desirable
employment and program outcomes.
Another approach to increasing EN interest would be to take steps to reduce or
eliminate SVRA use of the traditional payment system. Currently, the system is available only
to SVRAs, most of which appear to have a strong preference for continuing use of this
system rather than use of the new payment system. Limiting or eliminating use of the
traditional system would encourage the SVRAs to rely on the new payment system. Such a
change would make it a little easier for ENs to compete with the SVRAs, although the
agencies’ Title 1 funding will continue to give them a strong competitive advantage. SSA
could also consider changing the rules for the traditional payment system in ways that would
link payments more closely to SSA’s goal of increasing beneficiaries’ self-sufficiency, not just
their work activity.
2 On the grounds that marginal participants will increase their earnings from zero to the
SGA level and that increased earnings represent a benefit to society in their entirety, Orr
(2003) argues that payments should be roughly equal to SGA for DI beneficiaries. A similar
line of reasoning leads to an even higher payment for SSI beneficiaries, after allowing for the
effect of the Section 1619 benefit offset provisions.
VII: Conclusions and Implications