Evaluation of the Ticket To Work Program - Mathematica Policy ...

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xxii FPL Federal poverty level IADL Instrumental activities of daily living IDMS Integrated Disability Management System IPE Individualized plan for employment IWP Individual work plan JWOD Javits Wagner O’Day Program MIE Medical improvement expected (as determined by SSA) NBS National Beneficiary Survey NPRM Notice of proposed rule making OAG Office of Acquisitions and Grants OESP Office of Employment Support Programs PABSS Protection and Advocacy for Beneficiaries of Social Security Program PMRO Program Manager for Recruitment and Outreach PSU Primary sampling unit SGA Substantial gainful activity SSA Social Security Administration SSI Supplemental Security Income (Title XVI of the Social Security Act) SVRA State vocational rehabilitation agency RSA Rehabilitation Services Administration TTH Ticket to Hire TTW Ticket to Work VR Vocational rehabilitation WIL Work incentive liaison WIPA Work Incentives Planning Assistance Acronyms
E XECUTIVE S UMMARY The Ticket to Work and Self-Sufficiency program (TTW) was designed to enhance the market for services that help disability beneficiaries become economically selfsufficient. To do so, the program tries to give beneficiaries a wide range of choices for obtaining services and to give employment-support service providers new financial incentives to serve beneficiaries effectively. It also modifies the rules for the Disability Insurance (DI) and Supplemental Security Income (SSI) programs in order to give beneficiaries more incentives to participate. To date, the Social Security Administration (SSA) has successfully begun the market enhancement process by putting the core elements of the TTW program in place across the country. At the end of program rollout in September 2004, SSA had mailed Tickets to more than 11 million disability beneficiaries, inviting them to use their Tickets as a way to obtain meaningful employment. It also implemented new SSI and DI program rules that allow beneficiaries to attempt to work without fear that such efforts will trigger a review of their disability status. Finally, SSA and its TTW Program Manager had enrolled a group of providers, including all state vocational rehabilitation agencies (SVRAs) and more than 1,300 service providers, or employment networks (ENs), that offer beneficiaries new choices for providers and service mixes. While getting these core elements in place represents a major accomplishment, the market has experienced several serious problems. Beneficiary participation rates have risen continuously since the early months of rollout but remain low relative to the number of beneficiaries who express interest in work. For example, between March 2004 and December 2004, the participation rate rose from 1.1 percent of eligible beneficiaries to 1.4 percent in the early implementing states (those included in the Phase 1 rollout) while 26 percent of disability beneficiaries see themselves working for pay in the next five years and 15 percent see themselves earning enough to stop receiving benefits. Further, only a third of ENs had taken any Tickets, and signs suggested that all types of providers (ENs and SVRAs) were losing interest in the program. Loss of interest appears to reflect concern over several operational features of TTW, including (1) substantial financial risks for ENs, (2) administrative procedures viewed by ENs and SVRAs as excessively burdensome, and (3) a lack of incentives for beneficiaries who become gainfully employed to supply their service
Page 1 and 2: Contract No.: 0600-03-60130 MPR Ref
Page 3 and 4: A CKNOWLEDGMENTS This report reflec
Page 5 and 6: C ONTENTS Chapter Page ACRONYMS ...
Page 7 and 8: Chapter Page V (CONTINUED) B. SERVI
Page 9 and 10: Chapter Page X (CONTINUED) B. RECEN
Page 11 and 12: Chapter Page XIII (CONTINUED) 4. Lo
Page 13 and 14: E XHIBITS Exhibit Page I.1 POPULATI
Page 15 and 16: Exhibit Page IV.4 AGENCIES AND INDI
Page 17 and 18: Exhibit Page VI.7 OCCUPATION AND IN
Page 19 and 20: Exhibit Page X.2 REVENUES AND TICKE
Page 21: A CRONYMS The following acronyms ar
Page 25 and 26: Beneficiary Demand for Employment S
Page 27 and 28: xxvii obtain Tickets from many of t
Page 29 and 30: IMPACTS OF TTW ON BENEFICIARY BEHAV
Page 31 and 32: xxxi Furthermore, the changes sough
Page 33 and 34: C HAPTER I I NTRODUCTION The Ticket
Page 35 and 36: operating capital and introducing a
Page 37 and 38: 4. Extended Medicare Coverage. Medi
Page 39 and 40: serve beneficiaries whom they think
Page 41 and 42: procedures that accommodate the nee
Page 43 and 44: C HAPTER II C HARACTERISTICS OF W O
Page 45 and 46: eport receiving any other non-SSA c
Page 47 and 48: Many beneficiaries have characteris
Page 49 and 50: Exhibit II.3. Age at Disability Ons
Page 51 and 52: Exhibit II.5. Percent of Beneficiar
Page 53 and 54: Exhibit II.7. Current General Healt
Page 55 and 56: for not working, although many more
Page 57 and 58: Phase 1 states where TTW had been f
Page 59 and 60: 3. School Enrollment and Degree-See
Page 61 and 62: program like TTW could address. Whe
Page 63 and 64: C HAPTER III B ENEFICIARY P ARTICIP
Page 65 and 66: stands out as a particularly import
Page 67 and 68: the beginning of each rollout, rate
Page 69 and 70: a substantial difference between th
Page 71 and 72: Exhibit III.4. Percentage of Benefi
Page 73 and 74:
in-use Tickets were under the tradi
Page 75 and 76:
period 8 to 15 months after the sta
Page 77 and 78:
South Dakota’s participation rate
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• Was already using one of the wo
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those with less than a high school
Page 83 and 84:
fact that such individuals have ent
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experienced disability onset at age
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C HAPTER IV E XPERIENCES OF TTW PAR
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• Most had positive experiences w
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some information on ENs before assi
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Exhibit IV.5. Participant Awareness
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designated in their individualized
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cited problems with both types of p
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Exhibit IV.12. Participants’ Pers
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C HAPTER V E XPERIENCES OF TTW PART
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participants were aware that they h
Page 105 and 106:
Exhibit V.2. Selected Reasons for U
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procedures), but TTW service users
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C. SCHOOL ENROLLMENT AND DEGREE-SEE
Page 111 and 112:
Exhibit V.8. Phase 1 Beneficiaries
Page 113 and 114:
Exhibit V.9. Service Use Among Bene
Page 115 and 116:
Exhibit V.11. Types of Services Use
Page 117 and 118:
C HAPTER VI E XPERIENCES OF TTW PAR
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have the same level of alternative
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Exhibit VI.1. Employment Rates for
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Exhibit VI.3. Benefits Associated w
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pipeline cases in terms of characte
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Exhibit VI.7. Occupation and Indust
Page 129 and 130:
Exhibit VI.9. Employer-Provided Acc
Page 131 and 132:
Exhibit VI.11. Job Satisfaction Amo
Page 133 and 134:
C HAPTER VII N ONPARTICIPATION IN T
Page 135 and 136:
percentage of beneficiaries worked
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somewhat higher Section 1619(b) use
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Exhibit VII.4. Rates of Unsuccessfu
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children living with them. They are
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Exhibit VII.6. Simulated Probabilit
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The above discussion is not intende
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C HAPTER VIII E MPLOYMENT N ETWORK
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e an “unpopular” program. In ou
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Exhibit VIII.3. Ticket Assignments
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Exhibit VIII.6. Effective Provider
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Exhibit VIII.8. Distribution of EN
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This analysis is limited to earning
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In 2003, SSA introduced the Certifi
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C HAPTER IX E MPLOYMENT N ETWORK R
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eneficiary assigning a Ticket. Howe
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payments, we estimate that follow-u
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for each additional outcome payment
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Exhibit IX.3. Comparison of Current
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percent of the average benefit, kee
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• An EN could break even by reduc
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Exhibit IX.4. Hypothetical EN Reven
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72 percent, increasing revenue by 1
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would have to place into employment
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C HAPTER X E XPERIENCE OF S ELECTED
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2. Financing TTW For nearly all of
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employment services) did not expand
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that would reduce their costs and/o
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Of the remaining 11 ENs, 4 have acc
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3. Funding and Services In general,
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Exhibit X.1. EN Revenues per Ticket
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the rest away is the most essential
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consistently has trouble obtaining
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practices may be worth considering,
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C HAPTER XI E XPERIENCE OF S TATE V
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• Priority category one includes
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Ticket until they know whether the
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may only check in with the client q
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Claims Allowed The number of benefi
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counselors, emphasizing its own eli
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traditional system—a feature in o
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C HAPTER XII TTW PROGRAM I MPLEMENT
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office had more experience processi
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eneficiaries, down from 65,000 to 7
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C. INFORMING PROVIDERS To increase
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The Program Manager has produced tw
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1. Training and Technical Assistanc
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verification, store EN data, and ge
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ehabilitation services. The TTW leg
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C HAPTER XIII TTW OUTCOMES AND I MP
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Additionally, the relatively small
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included an upper age restriction t
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Exhibit XIII.2. Summary of Outcome
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were living in states where TTW had
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D. IMPACTS ON SERVICE ENROLLMENT Th
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The aggregate upper-bound estimates
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eneficiaries (approximately 10 perc
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earlier cohorts indicate the presen
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The opportunities for generating ad
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C HAPTER XIV P AYMENTS M ADE U NDER
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We do not have any data on the exte
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those with no payments) was $258. S
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cohorts. Also considered are the di
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earnings at a level that would redu
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in that group. Each graph shows the
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Exhibit XIV.7. Tickets with Payment
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Even if the percentage of participa
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C HAPTER XV TTW PARTICIPATION BY B
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provider and payment types to which
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cost accommodations. Appendix E sho
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Exhibit XV.2. Selected Beneficiary
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1 and 2 differ in some important re
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etardation as a condition causing l
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Exhibit XV.5 clearly shows the rela
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C HAPTER XVI C ONCLUSIONS AND I MPL
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difference might reflect unrealisti
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TTW has not yet substantially expan
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SSA’s proposed new regulations of
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the administrative and other effort
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oll out gradually over the period,
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R EFERENCES Adequacy of Incentives
Page 295 and 296:
Mashaw, Jerry L., and Virginia P. R
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White, Justin S., William E. Black,
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A PPENDIX A T ICKET TO W ORK T IMEL
Page 301:
Table A.2. States and Territories I
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