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

C HAPTER XC ONCLUSIONS AND I MPLICATIONSBy the end of 2004, the third year of TTW operations, SSA had successfullyimplemented the TTW program as designed, but two key limitations inherent in thatdesign have become apparent and will need to be addressed.One limitation is the low rate of participation in TTW. Even in the Phase 1 states,where the program has operated the longest, just 1.1 percent of beneficiaries have assignedtheir Ticket to a provider. This participation rate reflects, in part, the paradox inherent inTTW: Its goal is to promote work among a group of individuals judged to be incapable ofsubstantial employment, which is the very basis for receiving disability benefits from eitherthe DI or SSI program. In reality, the vast majority of beneficiaries will not attempt tosecure a job once they are on the rolls. For instance, only about 2.5 percent of anyenrollment cohort will ultimately leave the rolls due to work, and less than 0.5 percent of allbeneficiaries on the rolls at a point in time eventually leave due to work (Newcomb et al.2003; Berkowitz 2003). Nevertheless, our findings from the TTW evaluation surveyssuggest that 7 percent of beneficiaries see themselves earning enough to stop receivingbenefits in the next year, and 15 percent see themselves doing so in the next five years.Thus, far fewer beneficiaries have participated in TTW than express an interest in achievingthe earnings that would move them off the rolls. Although our knowledge about the reasonsfor this gap is limited, its presence suggests that it would be worthwhile to investigate waysto increase beneficiary participation.The second limitation is the relatively low rate at which service providers activelyparticipate in TTW. While more than 1,100 providers had registered as ENs by June 2004,60 percent of them have not yet accepted any Tickets, and the program manager reports thatit has become increasingly difficult to recruit more ENs. Our analysis suggests that this lowparticipation rate is at least partially a result of the structure of TTW payments, which doesnot appear to create a financial incentive for providers to recruit and serve beneficiariesbeyond what they can fund with their other revenue streams. Furthermore, interviews withSVRA staff indicate that their agencies are becoming less aggressive in pursuing Tickets thanthey were early in the program rollout. Without active participation by ENs and SVRAs,TTW cannot achieve its goals of increasing beneficiaries’ use of employment-assistanceservices and expanding the range of service choices available to them. Further programrefinements may be warranted if greater provider participation is to be encouraged.