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

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xxiigroups of beneficiaries that Congress identified as most likely to have trouble getting servicesin the performance-based TTW environment—those who (1) require ongoing support andservices, (2) need high-cost accommodations, (3) earn a subminimum wage, and (4) workand receive partial cash benefits. The findings concerning these individuals, however, mayreflect imperfections in the process used to identify them through administrative data. Inour next report, we will identify them by using beneficiary survey data, which is likely to giveus a more accurate picture of participation.SVRA participation remains strong but appears to have fallen off somewhatin recent monthsAlthough SVRAs have about 90 percent of all the Tickets that have been assigned, theynow seem to be seeking out Tickets less aggressively than they did when the program wasfirst rolled out. Phase 1 SVRAs are obtaining fewer assignments than they obtained a yearor so earlier, and the assignment rates for Phase 2 SVRAs are well below those of thePhase 1 SVRAs at the comparable point in the TTW rollout. SVRAs were initiallyconcerned about recouping their costs because they believed that many beneficiaries wouldassign their Ticket to an EN after receiving extensive services from the SVRA. As thisconcern has diminished, SVRAs may have relaxed their efforts to obtain large numbers ofTicket assignments.In addition, there has been a drop in the percentage of SVRAs’ disability beneficiarieswhose cases are being closed because beneficiaries have secured competitive employment.The reasons for this decline, however, are unclear. The slow economy during theobservation period might explain the trend, but there was no comparable decline for SVRAclients who were not SSA beneficiaries. Given that payments to SVRAs under thetraditional payment system also fell during the same period, we can tentatively conclude thatefforts by SSA and SVRAs to promote better employment outcomes among disabilitybeneficiaries have not achieved their intended effect. We will address this issue more fully inthe next evaluation report through the use of more detailed data on beneficiaries’ use ofSVRA services.Provider interest in TTW is waningWhile many ENs continue to take Tickets, their enthusiasm for TTW appears to bewaning. The number of ENs has grown very slowly. Some have officially withdrawn fromthe program, others have stopped accepting Ticket assignments, and approximately 60percent have no assignments at all. The Program Manager reports that recruiting ENs,which was always “a hard sell,” is now “almost impossible.”ENs contacted recently cited the same issues as those cited by ENs contacted two andthree years ago. In their eyes, TTW is financially risky, few beneficiaries are interested ingoing off cash benefits, the payment process is cumbersome, and a poor economy is makingit difficult to find good jobs for beneficiaries.Executive Summary
xxiiiTheir view of the financial incentives provided by TTW is supported by our analysis ofthe ENs’ costs and revenues, which suggests that ENs that relied solely on TTW paymentswould have lost money after two years of operation. While this does not mean that theywould lose money in the long run, it does indicate that ENs must begin to see somepossibility for dramatic improvement if they are to continue to participate actively in TTW.Without their participation and willingness to take the risks inherent in a performance-basedpayment system like the one used in TTW, it will not be possible to test the programcompletely. If ENs can use other sources of funding to cover most of their costs, thefinancial picture improves, but treating TTW merely as a supplemental funding source islikely to limit its ability to achieve one of its main goals—to greatly expand the number andvariety of providers who will assist beneficiaries.SSA has addressed some issues connected with the payment process, but these changeshave yet to have a substantial impact. As of August 2004, only 11 payments had beenprocessed under the Certification Outcomes Payment Process, which is intended to simplifyand expedite the payment process. Meanwhile, SSA continues to face the high costs—inboth time and effort—associated with manually processing payments. This is true largelybecause of the sheer complexity of both program rules and many factors that are external toTTW.There is little evidence that TTW has prompted a substantial change in the deliveryof services to beneficiariesFor the large majority of Ticket holders, the service environment has essentiallyremained unchanged by the introduction of TTW. SVRAs, which have the vast majority ofTicket assignments and have chosen the traditional payment system for nearly all of them,typically report that they have not changed the mix or intensity of their services.Nevertheless, a few noteworthy changes have occurred. Some SVRAs report that their staffnow have a better appreciation for the complexity of SSA’s program rules and workincentives, and for the issues facing beneficiaries when they attempt to work. In addition,some SVRAs are trying to ensure that beneficiaries receive accurate information on howemployment will affect their financial and health care benefits, either by referring them tolocal Benefits Planning Assistance and Outreach programs (BPAOs) or by increasing theirown capacity to provide such services.National Beneficiary Survey results suggest that TTW may have unrealized potentialSurvey data indicate that TTW may have not yet reached many of the individuals whomight benefit from the program. About 9 percent of disability beneficiaries were workingwhen we interviewed them, and 15 percent report that they expect to leave the rolls for workin the next five years, while only one percent have assigned their Tickets. Although thepotential presence of untapped demand may be encouraging, caution is warranted. Historysuggests that the survey respondents’ expectations are much too optimistic, since less thanone percent of beneficiaries have left the rolls for work in the past. Furthermore, it will bedifficult for substantially more beneficiaries to assign their Ticket if providers remainreluctant to actively participate in the program. The challenge facing SSA as it tries toExecutive Summary
Page 3 and 4: A CKNOWLEDGMENTSThe Ticket To Work
Page 8 and 9: viiiChapterVI(CONTINUED)PageF. SUMM
Page 10 and 11: xChapterPageAPPENDIX A: TICKET TO W
Page 12 and 13: xiiTableVIII.3IX.1IX.2IX.3IX.4IX.5I
Page 14 and 15: xivFigureIII.5III.6III.7III.8III.9P
Page 16 and 17: xviIX.3EARNINGS OF BENEFICIARIES WI
Page 18 and 19: xviiiMIENBSNPRMOAGPABSSPSUSGASSASSI
Page 20 and 21: xxIn Phase 3, which began in Novemb
Page 24 and 25: xxivimprove TTW, therefore, is to f
Page 26 and 27: 2of disability beneficiaries, and i
Page 28 and 29: 4country. Phase 2 began in November
Page 30 and 31: Page Is Intentionally Left Blank to
Page 32 and 33: 8Only a few beneficiary characteris
Page 34 and 35: 10Figure II.2.Participation Rate, b
Page 36 and 37: 12Figure II.4.First Assignments at
Page 38 and 39: 14before Ticket, it is perhaps surp
Page 40 and 41: 16was selected for Phase 3. This ma
Page 42 and 43: 18All of the statistics in this sec
Page 44 and 45: Table II.2. Beneficiary Groups with
Page 46 and 47: 22In all Phase 1 and Phase 2 states
Page 48 and 49: 24Figure II.8. Ticket Participation
Page 50 and 51: 26Adjustments for all other charact
Page 52 and 53: 28In general, provider and payment
Page 54 and 55: 30next report, we will conduct more
Page 56 and 57: 32Figure III.2.Living Arrangements
Page 58 and 59: 34• Less likely to have reported
Page 60 and 61: 36Figure III.7.Prevalence of Diffic
Page 62 and 63: 38are more likely than all benefici
Page 64 and 65: 40Table III.1.Income and Program Pa
Page 66 and 67: 42coverage through their own employ
Page 68 and 69: 44sizable percentage of TTW partici
Page 70 and 71: 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,
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110to the SVRA under the traditiona
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112Tickets each month from November
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114about submitting virtually ident
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116To make EN recruiting efforts mo
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118E. EN ENROLLMENTThe Program Mana
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120beneficiaries who have achieved
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122quarterly basis if they have rec
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124SSA’s approval of systems spec
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128have accepted. But even at that
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130For beneficiaries who express an
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132rehabilitation counselors (Burea
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134generated a payment to an EN gen
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136the milestone-outcome payment ge
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138system is used so infrequently t
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140One option is for ENs to try to
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142approximations. Our planned anal
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144Figure IX.1. Ticket-Eligible Ben
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146Table IX.2.TTW Participation Rat
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148Figure IX.3. Earnings of Benefic
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150Compared with other beneficiarie
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152Like all other beneficiaries who
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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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