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

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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
difficult over time, and most of those that have registered are not accepting Tickets.Furthermore, it appears that those ENs that have accepted Tickets must subsidize theirTTW efforts, because the flow of Ticket payments to ENs falls far short of the estimatedcost of delivering services. Thus, the market envisioned by TTW remains frail and will needa substantial infusion of energy, along with changes to its basic structure, in order tomaintain beneficiary and provider interest. Such an infusion has significant risks—wecannot tell in advance if benefit savings will pay for the added TTW costs—but we see noother way to interest entrepreneurs, large and small, in building this market.If the market can be sustained long enough, it might be possible that exits for work willincrease in the future for several reasons. First, if the economy improves, beneficiaries mayhave more to gain from working than from receiving benefits, and providers may find iteasier to find them good jobs. Also, it appears that it may take a substantial period of timebefore major effects will be seen. Emerging research on the SVRA system suggests that itoften takes two or more years for beneficiaries who are receiving services to leave the rolls.We are just starting to reach that point for the TTW participants, so there is some hope thatmore participants will start to leave the rolls and generate payments for providers. Inaddition, SSA plans to test benefit offsets that will reduce work disincentives for DIbeneficiaries. That might provide a significant boost to demand for EN services underTTW, especially if the payment system is revised to reward partial benefit reductions. Last,TTW may benefit as non-SSA efforts to improve employment outcomes for people withdisabilities (e.g., the Medicaid Buy-In and Disability Navigator programs) are expanded andrefined.In the long term, the greatest effect of the TTW program may be to have helped changeexpectations about the potential for many people with disabilities to work if they haveappropriate supports. A change in the expectations of all stakeholders—from beneficiaries,families, and friends, to SSA staff and staff in other federal and state agencies that servebeneficiaries, to the many professionals who work with beneficiaries—may ultimatelypromote more work and greater economic self-sufficiency among people with disabilities,even if the specific features embodied in the current TTW program do not reach their fullpotential.163X: 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
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104case, the counselor selects the
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106• Most of the agreements requi
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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
Page 180 and 181: C. SVRA PARTICIPATION REMAINS STRON
Page 182 and 183: serving beneficiaries who are simil
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
Page 208 and 209: Table B.6 (continued)B-16Group Defi
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
Page 224 and 225: C.14Table C.3 (continued)AllIntervi
Page 226 and 227: C.16Table C.5. Final Weighted and U
Page 228 and 229: C.18Table C.7. Sociodemographic Cha
Page 230 and 231: C.20Table C.9. Health Status (Figur
Page 232 and 233: 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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