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

More documents

Recommendations

Info

4 to find the right mix of services to help beneficiaries find jobs that allow them to earn their way off the rolls and toward economic self-sufficiency. Thus, TTW marks a substantial departure from earlier years when SVRAs were for many disability beneficiaries essentially the only option for obtaining employment support services. From 1981 until 1996, SSI and DI beneficiaries who were deemed good candidates for rehabilitation—potentially capable of supporting themselves through work earnings— were referred exclusively to SVRAs. The Alternate Participant Program, created in 1996, was intended to give more options to beneficiaries, but for various reasons this initiative enrolled extremely few individuals. Alternate providers filed just over two dozen payment claims from 1999 to 2001. The remainder of this section lays out the key aspects of the TTW program that stimulate beneficiary demand for services, increase the supply of employment-support service providers, and ensure the overall operation of the market. 1. Efforts to Stimulate Beneficiary Demand for Employment Support Services The Ticket Act was intended to increase demand for employment and employment support services by changing several SSI and DI program features that may discourage work efforts. 1. Continuing Disability Review Protections. While beneficiaries are using their Ticket, they are not subject to any medical continuing disability reviews (CDRs), which are checks to determine whether they remain medically unable to work. As a result, beneficiaries will not have to worry about SSA reviewing their medical disability status while they are participating in TTW. Furthermore, for long-term DI beneficiaries, starting to work will no longer trigger a medical disability review (even for those not participating in TTW). 2. Expedited Reinstatement. The Ticket Act provided for an expedited reinstatement policy that allows beneficiaries who leave the disability rolls for employment to have their benefits (and any associated health insurance) reinstated without a new application should they return to cash assistance within five years. 3. Benefit Counseling. The Ticket Act required SSA to establish a network of Benefit Planning, Assistance, and Outreach (BPAO) providers that would help beneficiaries get a better understanding of DI and SSI work incentives. 3 The act also established a network of protection and advocacy providers who could help beneficiaries negotiate the system successfully. 3 As of September 30, 2006, these organizations are known as the Work Incentives Planning and Assistance Programs. I: Introduction
4. Extended Medicare Coverage. Medicare coverage for DI beneficiaries who return to work and leave the DI rolls was extended substantially, from 39 months under earlier rules to 93 months at present, and when that period ends, beneficiaries will be able to purchase Medicare coverage. 5. Medicaid Buy-In Option. The Ticket Act made it easier for states to establish programs that allow persons with disabilities to purchase Medicaid coverage on a sliding-fee basis. In 1999, 8 states had a Buy-In program; there are now 30 states with such programs (White et al. 2005; Black and Ireys 2006). In addition to removing some work disincentives, TTW also greatly expanded the types of organizations that SSA will pay to support beneficiaries’ job search efforts. TTW allows virtually any kind of entity to sign up as an EN. ENs can come from any of the three sectors of the economy: private for-profit, public nonprofit, and private nonprofit. Any private business—from a large corporation to a sole proprietorship—can be an EN. Likewise, any public agency—a municipal office, a school district, a regional council, a state bureau, a federal department, etc.—can be an EN, whether or not its mission concerns vocational services or persons with disabilities. Virtually all private nonprofit organizations can become ENs, from faith-based groups to charitable foundations to private colleges to social service agencies. Furthermore, there are virtually no barriers to entry for interested entities. There are essentially no application costs and the general eligibility requirements are apparently easy to meet. 4 Entities signing up as ENs are not required to have any prior experience serving persons with disabilities. An organization that might someday hire even just one Ticket holder at a level that would take him/her off cash benefits can sign up as an EN. Also, TTW gives beneficiaries and the providers who serve them considerable flexibility to choose the services that will be provided. Providers and beneficiaries must agree on an individualized work plan (IWP) before a Ticket can be put into use, but SSA imposes almost no requirements for the services and arrangements to be covered by such plans. This plan could, at least in theory, include a wide array of services such as job training or placement, information to help beneficiaries better understand relevant program rules, assistance in overcoming employer misperceptions, and technology or other services to support beneficiaries after placement. TTW could also be used to provide beneficiaries with a wage subsidy by rebating some of the outcome payments to the former beneficiaries who generated those payments. Finally, the TTW program is more consumer-driven than the old system. All eligible beneficiaries get a Ticket and may decide what to do with it, and participation is completely voluntary. Also, TTW eliminated the prior process under which the Disability Determination Services—the entity determining whether an SSI or DI applicant is disabled—would refer beneficiaries exclusively to SVRAs. It thereby tried to open up the market and allow all providers that wished to become an EN to serve beneficiaries. It also 4 See Livermore et al. 2003, pp. 10-11. 5 I: Introduction
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 and 22: A CRONYMS The following acronyms ar
Page 23 and 24: E XECUTIVE S UMMARY The Ticket to W
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: operating capital and introducing a
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
Page 79 and 80: • Was already using one of the wo
Page 81 and 82: those with less than a high school
Page 83 and 84: fact that such individuals have ent
Page 85 and 86: experienced disability onset at age
Page 87 and 88:
C HAPTER IV E XPERIENCES OF TTW PAR
Page 89 and 90:
• Most had positive experiences w
Page 91 and 92:
some information on ENs before assi
Page 93 and 94:
Exhibit IV.5. Participant Awareness
Page 95 and 96:
designated in their individualized
Page 97 and 98:
cited problems with both types of p
Page 99 and 100:
Exhibit IV.12. Participants’ Pers
Page 101 and 102:
C HAPTER V E XPERIENCES OF TTW PART
Page 103 and 104:
participants were aware that they h
Page 105 and 106:
Exhibit V.2. Selected Reasons for U
Page 107 and 108:
procedures), but TTW service users
Page 109 and 110:
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
Page 119 and 120:
have the same level of alternative
Page 121 and 122:
Exhibit VI.1. Employment Rates for
Page 123 and 124:
Exhibit VI.3. Benefits Associated w
Page 125 and 126:
pipeline cases in terms of characte
Page 127 and 128:
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
Page 137 and 138:
somewhat higher Section 1619(b) use
Page 139 and 140:
Exhibit VII.4. Rates of Unsuccessfu
Page 141 and 142:
children living with them. They are
Page 143 and 144:
Exhibit VII.6. Simulated Probabilit
Page 145 and 146:
The above discussion is not intende
Page 147 and 148:
C HAPTER VIII E MPLOYMENT N ETWORK
Page 149 and 150:
e an “unpopular” program. In ou
Page 151 and 152:
Exhibit VIII.3. Ticket Assignments
Page 153 and 154:
Exhibit VIII.6. Effective Provider
Page 155 and 156:
Exhibit VIII.8. Distribution of EN
Page 157 and 158:
This analysis is limited to earning
Page 159 and 160:
In 2003, SSA introduced the Certifi
Page 161 and 162:
C HAPTER IX E MPLOYMENT N ETWORK R
Page 163 and 164:
eneficiary assigning a Ticket. Howe
Page 165 and 166:
payments, we estimate that follow-u
Page 167 and 168:
for each additional outcome payment
Page 169 and 170:
Exhibit IX.3. Comparison of Current
Page 171 and 172:
percent of the average benefit, kee
Page 173 and 174:
• An EN could break even by reduc
Page 175 and 176:
Exhibit IX.4. Hypothetical EN Reven
Page 177 and 178:
72 percent, increasing revenue by 1
Page 179 and 180:
would have to place into employment
Page 181 and 182:
C HAPTER X E XPERIENCE OF S ELECTED
Page 183 and 184:
2. Financing TTW For nearly all of
Page 185 and 186:
employment services) did not expand
Page 187 and 188:
that would reduce their costs and/o
Page 189 and 190:
Of the remaining 11 ENs, 4 have acc
Page 191 and 192:
3. Funding and Services In general,
Page 193 and 194:
Exhibit X.1. EN Revenues per Ticket
Page 195 and 196:
the rest away is the most essential
Page 197 and 198:
consistently has trouble obtaining
Page 199 and 200:
practices may be worth considering,
Page 201 and 202:
C HAPTER XI E XPERIENCE OF S TATE V
Page 203 and 204:
• Priority category one includes
Page 205 and 206:
Ticket until they know whether the
Page 207 and 208:
may only check in with the client q
Page 209 and 210:
Claims Allowed The number of benefi
Page 211 and 212:
counselors, emphasizing its own eli
Page 213 and 214:
traditional system—a feature in o
Page 215 and 216:
C HAPTER XII TTW PROGRAM I MPLEMENT
Page 217 and 218:
office had more experience processi
Page 219 and 220:
eneficiaries, down from 65,000 to 7
Page 221 and 222:
C. INFORMING PROVIDERS To increase
Page 223 and 224:
The Program Manager has produced tw
Page 225 and 226:
1. Training and Technical Assistanc
Page 227 and 228:
verification, store EN data, and ge
Page 229 and 230:
ehabilitation services. The TTW leg
Page 231 and 232:
C HAPTER XIII TTW OUTCOMES AND I MP
Page 233 and 234:
Additionally, the relatively small
Page 235 and 236:
included an upper age restriction t
Page 237 and 238:
Exhibit XIII.2. Summary of Outcome
Page 239 and 240:
were living in states where TTW had
Page 241 and 242:
D. IMPACTS ON SERVICE ENROLLMENT Th
Page 243 and 244:
The aggregate upper-bound estimates
Page 245 and 246:
eneficiaries (approximately 10 perc
Page 247 and 248:
earlier cohorts indicate the presen
Page 249 and 250:
The opportunities for generating ad
Page 251 and 252:
C HAPTER XIV P AYMENTS M ADE U NDER
Page 253 and 254:
We do not have any data on the exte
Page 255 and 256:
those with no payments) was $258. S
Page 257 and 258:
cohorts. Also considered are the di
Page 259 and 260:
earnings at a level that would redu
Page 261 and 262:
in that group. Each graph shows the
Page 263 and 264:
Exhibit XIV.7. Tickets with Payment
Page 265 and 266:
Even if the percentage of participa
Page 267 and 268:
C HAPTER XV TTW PARTICIPATION BY B
Page 269 and 270:
provider and payment types to which
Page 271 and 272:
cost accommodations. Appendix E sho
Page 273 and 274:
Exhibit XV.2. Selected Beneficiary
Page 275 and 276:
1 and 2 differ in some important re
Page 277 and 278:
etardation as a condition causing l
Page 279 and 280:
Exhibit XV.5 clearly shows the rela
Page 281 and 282:
C HAPTER XVI C ONCLUSIONS AND I MPL
Page 283 and 284:
difference might reflect unrealisti
Page 285 and 286:
TTW has not yet substantially expan
Page 287 and 288:
SSA’s proposed new regulations of
Page 289 and 290:
the administrative and other effort
Page 291 and 292:
oll out gradually over the period,
Page 293 and 294:
R EFERENCES Adequacy of Incentives
Page 295 and 296:
Mashaw, Jerry L., and Virginia P. R
Page 297 and 298:
White, Justin S., William E. Black,
Page 299 and 300:
A PPENDIX A T ICKET TO W ORK T IMEL
Page 301:
Table A.2. States and Territories I
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?