Evaluation of the Ticket to Work Program, Implementation ...

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106• Most of the agreements require the EN to reimburse the SVRA only for thecosts of services provided. However, five agreements entitle the SVRA to ashare of the EN’s payments even after the SVRA has been completelyreimbursed for its expenditures.SVRA Incentive Payments. For Tickets assigned to an SVRA, a small number ofagreements define situations in which the SVRA will make “incentive payments” to a partnerEN for support services provided to help a beneficiary successfully maintain earnings aboveSGA. Five of the 27 SVRA-EN agreements identify some type of incentive payment,generally in the form of a lump-sum payment to the EN for services such as ongoingsupport to employed beneficiaries.Payment Sharing. Just three agreements call for an SVRA and an EN to share SSApayments in cases where the Ticket has been assigned to the SVRA. The intent of theseagreements is to allow ENs to receive reimbursement beyond the direct cost of purchase ofservice agreements previously negotiated with the SVRA for specific services. Theseprovisions are intended to balance out the provisions in the SVRA-EN agreements underwhich the ENs pay the SVRA in situations where the EN holds the Ticket and reimbursesthe SVRA for services provided. The result is a reciprocal arrangement in which the SVRAshares its payments with ENs (instead of the one-way agreements typical of most states,whereby only the EN shares its payments with the SVRA). From the perspective of SVRAs,this procedure is designed to increase ENs’ willingness to serve SSA beneficiaries.2. RSA Guidance on Comparable BenefitsSeveral SVRAs have criticized RSA for not providing clear guidance related tocomparable benefits. To date, RSA has not issued definitive written guidance on howSVRAs should address comparable benefits in their agreements with ENs. In early January2005, RSA began circulating a draft information memorandum for comment. However, asof this writing, RSA has not finalized and transmitted the memorandum, entitled “Principlesand Promising Practices for Effective Cooperative Agreements between State VocationalRehabilitation Agencies and Employment Networks under the Ticket to Work Program.”Presentations by RSA staff (Stafford 2004) indicate that the question of whether servicesprovided under TTW constitute a comparable benefit is something that must be consideredfor each beneficiary rather than solely on the basis of the service-related informationspecified in an EN’s application to SSA.3. Extent to Which SVRAs and ENs Jointly Serve Beneficiaries Under the Terms ofSVRA AgreementsAlthough many SVRAs have drawn up agreements with ENs, many ENs in a state maynot have signed the documents. Moreover, the fact that SVRAs may have signedagreements with several ENs does not ensure that large numbers of beneficiaries are jointlyserved under the terms of the agreements. For example, among the eight SVRAs weinterviewed:VI: State Vocational Rehabilitation Agency Participation in Ticket to Work
107• Two have yet to finalize an agreement with ENs• Three drew up agreements that have been signed by several ENs but do notjointly serve any beneficiaries under the agreement• Three have developed agreements and jointly serve beneficiaries under theterms of the agreement (although one reported jointly serving just onebeneficiary)The extent to which the above experiences mirror those of other SVRAs is unknown.However, the fact that over 85 percent of all Tickets have been assigned to SVRAs, coupledwith the reality that SVRAs assign over 90 percent of all Tickets under the traditionalpayment system, strongly suggests that relatively few beneficiaries are served under the termsof SVRA-EN agreements. This is significant because, as reported in Chapter V, some ENsare not accepting Tickets from individuals with any connection to the SVRA system; theseENs believe that the acceptance of a Ticket assignment is financially unwise under theSVRA-EN agreement.E. EFFECT OF TTW ON SVRAS AND THE TRADITIONAL VR REIMBURSEMENTPROGRAMOverall, TTW’s effects on SVRAs range from positive, to neutral, and even to negative.This section discusses some of the important ways in which TTW has affected the eightSVRAs we interviewed.1. Deeper Insight into the Employment Support Needs of SSA BeneficiariesAlthough TTW may not have changed the amount or type of services SVRAs provideto beneficiaries, five of the eight SVRAs interviewed in 2004 reported that TTW haschanged how their staff—from central office officials to local rehabilitation counselors—seethe service needs of SSA beneficiaries. Some SVRAs have concluded that local counselorsdid not fully understand the employment obstacles unique to SSA beneficiaries. Inparticular, by making payments to ENs conditional on the beneficiary’s cash benefit reachingzero, TTW has caused some SVRAs to undertake a critical examination of their programgoals related to SSA beneficiaries. One respondent said, “The TTW program raised the levelof discourse in the agency about clients’ values and goals, the agency’s values and goals, andreturn-to-work issues. People are thinking and talking more about what is the best thing todo in different situations, for different people, and that involves considering potentiallydifferent values.”2. Staff Development and OutreachSeveral SVRAs now understand that local rehabilitation counselors, service vendors,and beneficiaries do not completely comprehend the effect of employment and earnedincome on disability benefit status and access to health care among SSA beneficiaries. Thisrealization has prompted SVRAs to step up their efforts to educate staff in the employmentVI: State Vocational Rehabilitation Agency Participation in Ticket to Work
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A CKNOWLEDGMENTSThe Ticket To Work
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viiiChapterVI(CONTINUED)PageF. SUMM
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xChapterPageAPPENDIX A: TICKET TO W
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xiiTableVIII.3IX.1IX.2IX.3IX.4IX.5I
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xivFigureIII.5III.6III.7III.8III.9P
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xviIX.3EARNINGS OF BENEFICIARIES WI
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xviiiMIENBSNPRMOAGPABSSPSUSGASSASSI
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xxIn Phase 3, which began in Novemb
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xxiigroups of beneficiaries that Co
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xxivimprove TTW, therefore, is to f
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2of disability beneficiaries, and i
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4country. Phase 2 began in November
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Page Is Intentionally Left Blank to
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8Only a few beneficiary characteris
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10Figure II.2.Participation Rate, b
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12Figure II.4.First Assignments at
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14before Ticket, it is perhaps surp
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16was selected for Phase 3. This ma
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18All of the statistics in this sec
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Table II.2. Beneficiary Groups with
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22In all Phase 1 and Phase 2 states
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24Figure II.8. Ticket Participation
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26Adjustments for all other charact
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28In general, provider and payment
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30next report, we will conduct more
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32Figure III.2.Living Arrangements
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34• Less likely to have reported
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36Figure III.7.Prevalence of Diffic
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38are more likely than all benefici
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40Table III.1.Income and Program Pa
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42coverage through their own employ
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44sizable percentage of TTW partici
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46Overall, 9 percent of working-age
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48leave the rolls in the next year,
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50next year and in the next five ye
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52in their characteristics, levels
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54percentage points to 3.7 percent.
Page 80 and 81: 56Figure IV.2. Phase 1 Ticket Recip
Page 82 and 83: 58situation described in the preced
Page 84 and 85: 60the end of the follow-up period w
Page 86 and 87: 62Figure IV.6. Average Monthly Bene
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Page 90 and 91: 66ENs were reluctant to expand serv
Page 92 and 93: 68As of July 2004, there were about
Page 94 and 95: 70But most EN representatives saw T
Page 96 and 97: 72Figure V.2. Number of EN Terminat
Page 98 and 99: 74received a total of just about $2
Page 100 and 101: 76Relatively few ENs have received
Page 102 and 103: 78According to their representative
Page 104 and 105: 80Five EN officials recognized that
Page 106 and 107: 82This was particularly true for so
Page 108 and 109: 84• Another EN representative fou
Page 110 and 111: 86• A third EN received 50 calls
Page 112 and 113: 88resolve administrative issues suc
Page 114 and 115: 90• Raise payments for SSI benefi
Page 116 and 117: 92Finally, the real and perceived w
Page 118 and 119: 94efforts to obtain Ticket assignme
Page 120 and 121: 96SSA payments to SVRAs under the T
Page 122 and 123: 98Figure VI.3. Total SSA Payments t
Page 124 and 125: 100assigning their Tickets to ENs (
Page 126 and 127: 102Table VI.1. SVRA Ticket Assignme
Page 128 and 129: 104case, the counselor selects the
Page 132 and 133: 108needs of SSA beneficiaries and,
Page 134 and 135: 110to the SVRA under the traditiona
Page 136 and 137: 112Tickets each month from November
Page 138 and 139: 114about submitting virtually ident
Page 140 and 141: 116To make EN recruiting efforts mo
Page 142 and 143: 118E. EN ENROLLMENTThe Program Mana
Page 144 and 145: 120beneficiaries who have achieved
Page 146 and 147: 122quarterly basis if they have rec
Page 148 and 149: 124SSA’s approval of systems spec
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Page 152 and 153: 128have accepted. But even at that
Page 154 and 155: 130For beneficiaries who express an
Page 156 and 157: 132rehabilitation counselors (Burea
Page 158 and 159: 134generated a payment to an EN gen
Page 160 and 161: 136the milestone-outcome payment ge
Page 162 and 163: 138system is used so infrequently t
Page 164 and 165: 140One option is for ENs to try to
Page 166 and 167: 142approximations. Our planned anal
Page 168 and 169: 144Figure IX.1. Ticket-Eligible Ben
Page 170 and 171: 146Table IX.2.TTW Participation Rat
Page 172 and 173: 148Figure IX.3. Earnings of Benefic
Page 174 and 175: 150Compared with other beneficiarie
Page 176 and 177: 152Like all other beneficiaries who
Page 178 and 179: This kind of mixed success in the e
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C. SVRA PARTICIPATION REMAINS STRON
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serving beneficiaries who are simil
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observe changes in their employment
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Mashaw, Jerry L., and Virginia P. R
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A-2Table A.1 (continued)Time Period
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Table B.1. DefinitionsB-2Variable D
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Table B.1 (continued)B-4Variable De
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Table B.1 (continued)Variable Defin
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B-8Table B.3. Participation Rate by
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B-10C. PARTICIPATION RATES BY BENEF
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Table B.6. Participation Rates by C
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Table B.6 (continued)Group Definiti
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Table B.6 (continued)B-16Group Defi
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C-2survey. Whenever possible, the i
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C-4given the large number of benefi
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C-6• Young SSI recipients who are
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C-8beneficiary may have had with EN
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C-10Table C.2. Overview of the Nati
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C-12Sample completes (n=1,178) and
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C.14Table C.3 (continued)AllIntervi
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C.16Table C.5. Final Weighted and U
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C.18Table C.7. Sociodemographic Cha
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C.20Table C.9. Health Status (Figur
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C.22Table C.11. Program Participati
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C.24Table C.14. Awareness of TTW (F
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C.26Table C.16. Employment Expectat
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D-2Table D.1. Selected Characterist
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D-4information from two pretest int
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