Evaluation of the Ticket to Work Program Initial Evaluation Report

Another change requiring consideration would be to modify Ticket payments so that
providers were rewarded for increasing beneficiary productivity and reducing SSI payment
for beneficiaries who work and receive partial benefits. Currently, outcome payments are
not triggered unless beneficiaries stop receiving payments from both programs, but there are
SSI recipients, including some who also receive DI, whose benefits are reduced but not
eliminated when their earnings increase. The milestones payments give ENs some reward
for helping beneficiaries reduce their benefits. Similarly, the traditional payment system
rewards SVRAs that help beneficiaries earn above the substantial gainful activity level for at
least nine months even if those beneficiaries remain on the rolls. A partial payment system
for use by providers might be appropriate for SVRAs, perhaps even as a replacement for the
traditional payment system. Partial payments that exceed benefit savings should perhaps also
be considered on the grounds that increased beneficiary earnings have some value to society
even if they are not fully offset by benefit savings.
It is clear that the work incentive provisions of both the SSI and DI programs directly
conflict with providers’ desires to generate Ticket payments. Many of the incentives allow
beneficiaries to stay on the rolls while testing the employment waters (indefinitely for SSI),
but TTW providers generally receive payment only when a beneficiary no longer receives
benefit payments. ENs that help beneficiaries use the work incentives run the risk of not
receiving payment for their efforts. Many providers we have talked to are acutely aware of
this problem. It is also clear from evidence we have collected that the differences between
the work incentive provisions of the two programs have added substantial complexity to
TTW implementation. These differences make it difficult for SSA to integrate processes and
data systems across the two programs and are a significant source of confusion to
beneficiaries and providers alike. Depending how TTW plays out, SSA may eventually need
to give serious consideration to redesigning the work incentive programs or the TTW
program to resolve this conflict. This issue could be addressed in SSA’s forthcoming Benefit
Offset Demonstration for DI that would introduce a $1 for $2 benefit offset similar to that
in the SSI program and could include special provisions for making TTW payments to
providers that work with demonstration participants that use this new offset.
In considering any changes to the TTW program, it is important to be realistic about
what TTW can achieve, even if payments were increased and work incentive provisions
restructured. TTW is a program intended to improve employment outcomes for people who
have passed a rigorous test to show that they cannot engage in substantial gainful activity.
The severity of their impairments, combined with other personal characteristics, might make
work an unrealistic option for some beneficiaries under any circumstances. Other individuals
face environmental barriers and disincentives to work that would not be addressed by the
work incentive programs, even under the best imaginable program configuration. Barriers
and disincentives include possible reduction or loss of both income and in-kind benefits, the
existence of a highly fragmented support system, lack of marketable skills, and employers’
concerns about hiring or retaining those deemed unfit for gainful activity, regardless of
whether such concerns are legitimate. The NASI panel that proposed the Ticket concept saw
it as a way to help a small share of beneficiaries attain self-sufficiency through employment,
with net savings to the disability programs—a small step forward. It seems likely that many
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VII: Conclusions and Implications