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

2of disability beneficiaries, and interviews with SSA staff, the Program Manager, andrepresentatives of ENs and SVRAs. It uses this new information to examine the programfrom the perspective of TTW-eligible beneficiaries (Chapters II through IV), serviceproviders (Chapters V and VI), and SSA (Chapter VII). Also examined are two broad policyissues that are central to the design and success of TTW: the extent to which TTW givesproviders a strong financial incentive to serve disability beneficiaries (Chapter VIII) and theextent to which TTW seems to be including the full range of beneficiaries, particularly thosewho may need more intensive supports or assistance to succeed in the labor market (ChapterIX). Overall conclusions and recommendations are presented in the final chapter.A. BACKGROUND ON TICKET TO WORK AND ITS IMPLEMENTATIONThe TTW program, together with a few other initiatives created by the same legislation,represents a new approach to an old problem. 1 The problem is that while many personswith disabilities work, relatively few who receive disability benefits from SSA ever leave therolls as a result of working, and even some who want to work may not do so—or may notsucceed in the workplace—for a variety of reasons.Disability beneficiaries who want substantial employment may face four barriers. First,the Supplemental Security Income (SSI) and Disability Insurance (DI) programs havepolicies that reduce or offset the financial gain from employment by reducing benefits asearnings increase. This lowers, in net terms, the incentive to pursue gainful employment.Second, beneficiaries may have a limited understanding of not only the provisions designedto encourage and reward work, but also the services available to help them find a job andkeep it. Third, beneficiaries may have neither the skills nor the attitudes that would increasetheir chances of succeeding in the workplace; or they may require certain accommodationsto help them overcome impairments and remain productively employed. Fourth, employersmay misunderstand beneficiaries’ abilities or even discriminate against such individuals.The Ticket Act provided a new means to help beneficiaries address these barriers andbecome employed and financially self-sufficient. In particular, it introduced a new financingsystem for service providers that added two payment options to the traditional system thatSSA has used to pay state vocational rehabilitation agencies (SVRAs) for rehabilitationservices provided to beneficiaries. The traditional system reimburses an agency’s costs, up toa limit, if a beneficiary’s earnings reach at least the substantial gainful activity level (currentlyset at $830 per month for most beneficiaries) for 9 months in a 12-month period. Both ofthe new payment options try to give providers a stronger performance incentive insofar asthey require a beneficiary earn enough so that they no longer receive cash benefits for 60months before the provider receives full payment. Of the two new systems, the first option,the “outcome-only” system, provides higher payments but only when the desired outcome isachieved, i.e., when a beneficiary leaves the rolls because of work. The other new option,1 Readers interested in more extensive background information on the TTW program or the evaluationshould see the initial evaluation report (Thornton et al. 2004) or the preliminary process analysis (Livermoreet al. 2003).I: Introduction