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

observe changes in their employment and benefits was confined to just 15 months or less.This problem will not be as severe in future analyses because they will be based on data for alonger follow-up period.H. THE NEW FINDINGS REINFORCE THE PRESSING NEED FOR CHANGE IF THEPROGRAM IS TO REALIZE ITS POTENTIALDespite the reasons to be optimistic about TTW’s future, albeit cautiously so, our recentfindings reinforce an important conclusion from our initial evaluation report: substantialchanges to TTW will be required in order to sustain its momentum.One place to start would be to give providers a stronger financial incentive toparticipate. Our analysis suggests that ENs are likely to lose money if they rely only on TTWpayments to support their programs. In order to ensure that ENs continue to participateactively in the TTW program, it will be necessary to make substantial changes to severalaspects of the program. In particular, it is likely to require that Ticket payment amounts beincreased, payment-processing costs be reduced, and employment outcomes for participatingbeneficiaries be improved from their current levels. Without changes to all these factors, itseems likely that TTW will be consigned to a small, supplementary role in financing servicesthat are for the most part paid for and shaped by other programs.SSA might substantially boost provider interest in TTW by changing the way the newpayment systems work when a beneficiary is also participating in one of SSA’s other workincentive programs. For example, the trial work period allows beneficiaries to receivebenefit payments for nine months even after they are earning above the amount that wouldotherwise result in zero benefits, so providers cannot receive outcome payments in thosemonths. Similarly, the Section 1619a program allows SSI recipients to earn well above thesubstantial gainful activity level indefinitely without losing all of their benefits—again makingtheir providers ineligible for outcome payments, even while SSA is achieving savings throughpartially reduced benefits. Thus, these DI/SSI program features intended to givebeneficiaries an incentive to work also make it harder for ENs to get paid. Changes thatwould provide partial payments to ENs when their clients are participating in these workincentive programs would benefit the ENs, but would require Congressional action tomodify the TTW law. Whether they would ultimately lead to more use of TTW and increasesavings to SSA will depend on the behavior impact on beneficiaries. 3Overall, it appears that TTW has yet to create a robust market that will provideemployment support services to disability beneficiaries. There seems to be substantial latentdemand for these services, as evidenced by the 15 percent of all beneficiaries who expressintent to obtain sufficient employment to leave the rolls. But that demand has yet to betranslated into actual Ticket assignments; overall beneficiary awareness of and participationin TTW remains low. With regard to the supply of services, all SVRAs participate in TTW,but other providers have not embraced the program. Recruiting ENs has become more1623 While the proposed new rules SSA published after this report was drafted would substantially increasepayments to ENs, they do not currently try to streamline the payment process further. Assessing providers’reactions to this new mix of incentives will be a major issue in future evaluation reports.X: Conclusions and Implications