Evaluation of the Ticket to Work Program Initial Evaluation Report

Payment System. Many ENs do not believe that TTW payments, as currently
structured, would cover their costs, but were willing to enroll as an EN and would
participate in the future if the payment system were to become more lucrative. The lack of
funding to cover up-front costs, the belief that beneficiaries will not achieve long-term
outcome goals, limited service capacity, and uncertainty regarding whether TTW payments
would jeopardize other funding sources all contribute to many ENs currently accepting few
or no Tickets. EN Summit participants recommended that SSA:
! Shorten the length of the payment period and provide larger payments early in
the period
! Base payment on the average of SSI and DI benefits combined rather than
have separate systems for the two programs
! Reduce the difference in total payments between the milestone-outcome and
outcome payment systems
! Provide payments for partial success, at earnings less than necessary to reduce
benefits to zero
! Allow all ENs to choose between outcome-only and milestone-outcome
payments on a case-by-case basis
These changes would likely increase SSA’s Ticket costs for individual beneficiaries and
some would make the program more complex and costly to administer. Further, it is likely
that some of these recommendations would require new legislation. It is difficult to predict
the net effect of these recommendations on program savings because implementation would
likely expand Ticket participation and increase competition between ENs.
Combining Funding Sources. The nature of the TTW payment system makes it
necessary for many providers to seek and use other sources of funding in order to provide
any services upfront and to provide more intensive and ongoing services in general. Some
ENs, however, are concerned about the implications of receiving TTW revenue after
funding has been received from other sources. Some ENs receive substantial support from
state agencies, including state Medicaid, mental health, and developmental disabilities
agencies. They would like to use TTW revenue to provide additional services that would
improve their clients’ earnings, but are concerned that the other agencies will consider TTW
funds as duplicative of their funds or services and therefore not provide reimbursement.
For example, because Medicaid is payer of last resort, many providers believe that they are
not allowed to accept Ticket payments, or if they do, these payments must offset the service
costs billed to Medicaid. These providers have chosen not to serve clients under TTW in
order to keep their Medicaid funding our of jeopardy (Livermore et al. 2003)
Administrative Burden. EN’s concerns about complexity and administrative burden
center on screening beneficiaries who seek services and on filing earnings reports to ensure
payment. To some extent, concerns about screening reflect the high volume of phone calls
that ENs in Phase 1 states received when Tickets were initially mailed. In general, ENs
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III: TTW Early Implementation