Evaluation of the Ticket to Work Program Initial Evaluation Report

The TTW program and other elements of the Ticket Act try to provide the means to
help beneficiaries overcome these barriers. In particular, the TTW program introduces a
new financing system for providers and gives beneficiaries a choice over which provider to
use. The new financing system adds two payment options to the traditional payment system
that SSA has used in the past to pay state vocational rehabilitation agencies (SVRAs) for
rehabilitation services provided to beneficiaries. The traditional system reimburses an
agency’s costs, up to a limit, if a beneficiary obtains earnings of at least the substantial gainful
activity level (currently set at $810 per month for most individuals) for nine months. The
new options have substantially stronger performance incentives because they require a
beneficiary to exit cash benefit status by reason of increased earnings for 60 months before
the provider receives full payment. The first new option, the outcome-only payment system,
provides higher payments but makes no payments until a beneficiary leaves the rolls. The
other new option, the milestone-outcome system, provides smaller outcome payments, but
can provide up to four larger milestone payments while a beneficiary is still receiving
benefits, if a beneficiary achieves intermediate earnings targets.
TTW increases choice by greatly expanding the types of organizations that it will pay to
assist beneficiaries’ work efforts. Beneficiaries can choose between a range of public and
private providers other than SVRAs, called Employment Networks (ENs), that have signed
a contract with SSA. ENs cannot use the traditional payment system, they must elect to be
paid under either the outcome-only or milestone-outcomes payment systems. SVRAs can
act as ENs by using the new payment systems, but they can also decide to serve beneficiaries
under the traditional system.
In addition, TTW gives service providers and beneficiaries considerable flexibility to
choose the services that will be provided. In fact, providers and beneficiaries must agree on
an individualized employment plan before a ticket can be put into use. This plan could, in
theory, include a wide array of services designed to help beneficiaries overcome barriers
related to their knowledge of the system and labor market, their employment-related skills,
and even employer misperceptions of their abilities.
Service delivery is constrained, however, by providers’ desire to limit service
expenditures to a level that fits within the payments they expect to receive and by providers’
assessments of whether the services they can provide are likely to result in a beneficiary
leaving the rolls. Participation in TTW is completely voluntary for beneficiaries and
providers, so providers can refuse to serve beneficiaries whom they think have a low
probability of leaving the rolls due to work (thereby triggering outcome payments).
The TTW legislation also introduces other changes that try to reduce the policy barriers
that can make work unattractive to some beneficiaries. In particular, the Ticket Act
contained the following provisions: 1
3
1 Other than the suspension of medical disability reviews, these provisions are available
to beneficiaries regardless of whether they are using a Ticket.
I: Overview of the Ticket to Work Program and Its Evaluation