Evaluation of the Ticket to Work Program Initial Evaluation Report

C HAPTER II
S TRUCTURE AND B ACKGROUND OF THE
T ICKET TO W ORK P ROGRAM
T
he ideas behind the TTW program are fairly simple, but the program itself has
become fairly complex (Berkowitz 2003). The basic approach was developed by a
panel formed by the National Academy for Social Insurance, which sought to make
the rehabilitation system more effective by paying providers only when they enabled a
beneficiary to earn his or her way off the rolls. The panel’s entire concept was summarized
in the following few sentences:
Under the Panel’s plan, disability beneficiaries would receive a return-to-work
ticket, akin to a voucher, that they could use to shop among providers of
rehabilitation or return-to-work services in either the public or private sector.
Once a beneficiary deposits the ticket with a provider, the Social Security
Administration would have an obligation to pay the provider after the beneficiary
returned to work and left the benefit rolls. Providers whose clients successfully
returned to work would, each year, receive in payment a fraction of the benefit
savings that accrued to the Social Security Trust Funds because the former
beneficiary is at work and not receiving benefits (Mashaw and Reno 1996).
However, as this idea was translated into practice, the actual program became fairly
complicated. Eligibility rules were established to avoid paying for services to beneficiaries
who were expected to medically recover and exit the rolls anyway or for SSI recipients who
had recently turned 18 but who had not yet been determined eligible for SSI as adults.
Milestone payments were introduced to help providers finance services and encourage them
to serve beneficiaries who would not be expected to leave the rolls quickly. Payment
amounts were tied to overall average benefit payments rather than to each individual’s
benefits. Because average monthly SSI benefits are lower than average monthly DI benefits,
the payments to ENs for serving SSI-only recipients are lower than those for serving DI
beneficiaries. To resolve arguments between beneficiaries and providers, SSA established a
dispute resolution process. The agency also created new computer systems to track program
participation and exits due to earnings as well as to pay providers.
This chapter describes the structure of the TTW program as it is implemented today
(late 2003), including the key groups and organizations involved; the rules that guide its
operations; and the context in which it has been established, including the service and
payment system it is replacing and related initiatives that may help the program succeed.