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

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This kind of mixed success in the early stages of the program was envisioned byCongress when it passed the Ticket Act. Specifically, the legislation provided for thecommissioner to assess the program as it rolled out, making changes that would help toachieve program goals more effectively (or recommending changes when legislation wouldbe required). As we prepared this report, SSA used its Ticket Act authority to propose newregulations that seek to strengthen the financial incentives for providers to participateactively in TTW (SSA 2005). SSA has also launched an analysis of ways to increasebeneficiary awareness of and participation in TTW. Future evaluation reports will examinehow these efforts may be helping TTW to reach its full potential.Beyond these general observations about the status of the TTW program in its secondtwo years of operation (2003-2004), eight key findings emerged from the implementationanalysis documented in this report that will need to be considered in the TTW review andrefinement process.A. THE INITIAL TTW ROLLOUT HAS BEEN COMPLETED; EFFORTS NOW FOCUS ONONGOING OPERATIONSIn September 2004, SSA completed the TTW rollout with the final mailing of Tickets toeligible DI and SSI beneficiaries who were on the rolls when TTW began in their state.Nationwide, SSA mailed more than 10 million Tickets, and approximately 9 millionbeneficiaries were eligible to use their Ticket in September 2004. Now that the initial rolloutis complete, the program has reached the point of ongoing operations: SSA, with theassistance of the Program Manager, is mailing Tickets to new beneficiaries, facilitating Ticketassignments to ENs and SVRAs, and paying providers for those beneficiaries who aremeeting milestones or working enough to reduce their cash benefits to zero. In addition,SSA continues to refine TTW operations, pursue potential revisions to Ticket regulations,and enhance its broader effort to encourage and support beneficiary return to work. 1The Program Manager has implemented all systems needed to operate TTW and, as ofearly 2005, had recruited more than 1,300 ENs. At this stage, one of the greatest challengesto sustaining the program is to recruit and retain more ENs. Innovative marketingapproaches have become necessary as recruitment and retention of ENs has become moredifficult. The Program Manager also must implement the “timely progress” requirements ofTTW and must continue efforts to help ENs complete payment paperwork accurately andtake other measures to make the payment process more efficient.B. BENEFICIARY PARTICIPATION CONTINUES TO GROW BUT REMAINS VERY LOWSince mid-2002, the beneficiary participation rate in Phase 1 states has increased eachmonth, although the increases are quite small, bringing the overall participation rate to 1.1percent in March 2004. The participation rate in Phase 2 states has also risen continuously1561 After this report was drafted, SSA published proposed revisions to TTW payment rules that wouldsubstantially increase payments to ENs. We will discuss these new rules more completely in our next report.X: Conclusions and Implications
ut had reached only 0.6 percent by March 2004. 2 Participation rates are substantially higherfor some beneficiary groups than others. For example, rates are higher for youngbeneficiaries, those with sensory impairments or some college education, and those who livein certain states or participate in DI or SSI work incentive programs, but no group has anextraordinarily high rate. Even for those with hearing impairments, the group with thehighest identified participation rate, the rate is under 6 percent in the Phase 1 states.It is important to note that the observed participation rates reflect not only abeneficiary’s decision to enter the program but also the beneficiary’s ability to find a providerwilling to accept their Ticket. In other words, the rates reflect beneficiary demand foremployment services as well as the supply of providers willing to accept Tickets under thecurrent payment system. Raising the participation rate is therefore likely to involve targetingboth beneficiaries and providers.Interestingly, there is some preliminary evidence that participation is higher than averageamong the four groups of beneficiaries identified by the Ticket Act as those likely to havedifficulty obtaining services in the performance-based TTW environment: (1) individualswith a need for ongoing support and services, (2) individuals with a need for high-costaccommodations, (3) individuals who earn a subminimum wage, and (4) individuals whowork and receive partial cash benefits. To some extent, this finding reflects the fact that weimperfectly identified these groups on the basis of the available administrative data. As aresult, we have probably included some individuals who do not face substantial barriers togetting services along with those who do. In our next report, we will examine participationrates based on the survey data, which will allow us to substantially refine the definitions ofthese groups.In assessing participation rates, it is important to remember that there has always beensome uncertainty about how many beneficiaries will participate in the TTW program. Theprogram designers saw TTW as a way to change expectations and opportunities, therebyimproving a system under which only one-half of one percent of beneficiaries left the rollsbecause of employment (Mashaw and Reno 1996; Berkowitz 2003). In essence, thereseemed to be a sense that the old system was not effective in helping beneficiaries reach theirfull potential and that the new system could only make things better.In the Ticket Act, Congress did not set out expectations for participation rates, althoughit did refer to the historically low rate of exits due to employment and expressed hopes for adoubling of that rate to at least one percent of beneficiaries. Thus, one way to viewparticipation rates is whether they are high enough to generate an increase in program exitsdue to work. The participation rates are higher than 0.5 percent, so the program has thepotential to increase access to services and thereby increase work-related program exits.Also, as noted in Chapter IV of this report, there is some suggestive evidence that TTW mayhave such an effect. However, any clear conclusions about this issue cannot be drawn untilthe impact findings, presented in the next evaluation report, are available.1572 We do not analyze Phase 3 participation rates in this report, because at the time we conducted theanalysis we only had data from the first 5 months of the Phase 3 rollout.X: Conclusions and Implications
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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.
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56Figure IV.2. Phase 1 Ticket Recip
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58situation described in the preced
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60the end of the follow-up period w
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62Figure IV.6. Average Monthly Bene
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Page Is Intentionally Left Blank to
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66ENs were reluctant to expand serv
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68As of July 2004, there were about
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70But most EN representatives saw T
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72Figure V.2. Number of EN Terminat
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74received a total of just about $2
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76Relatively few ENs have received
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78According to their representative
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80Five EN officials recognized that
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82This was particularly true for so
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84• Another EN representative fou
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86• A third EN received 50 calls
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88resolve administrative issues suc
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90• Raise payments for SSI benefi
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92Finally, the real and perceived w
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94efforts to obtain Ticket assignme
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96SSA payments to SVRAs under the T
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98Figure VI.3. Total SSA Payments t
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100assigning their Tickets to ENs (
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102Table VI.1. SVRA Ticket Assignme
Page 128 and 129: 104case, the counselor selects the
Page 130 and 131: 106• Most of the agreements requi
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 180 and 181: C. SVRA PARTICIPATION REMAINS STRON
Page 182 and 183: serving beneficiaries who are simil
Page 184 and 185: observe changes in their employment
Page 188 and 189: Mashaw, Jerry L., and Virginia P. R
Page 190 and 191: A-2Table A.1 (continued)Time Period
Page 194 and 195: Table B.1. DefinitionsB-2Variable D
Page 196 and 197: Table B.1 (continued)B-4Variable De
Page 198 and 199: Table B.1 (continued)Variable Defin
Page 200 and 201: B-8Table B.3. Participation Rate by
Page 202 and 203: B-10C. PARTICIPATION RATES BY BENEF
Page 204 and 205: Table B.6. Participation Rates by C
Page 206 and 207: Table B.6 (continued)Group Definiti
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Page 212 and 213: C-2survey. Whenever possible, the i
Page 214 and 215: C-4given the large number of benefi
Page 216 and 217: C-6• Young SSI recipients who are
Page 218 and 219: C-8beneficiary may have had with EN
Page 220 and 221: C-10Table C.2. Overview of the Nati
Page 222 and 223: C-12Sample completes (n=1,178) and
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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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