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

the “milestone-outcome” system, provides smaller outcome payments but can also provideup to four larger payments while a beneficiary is still receiving benefits if the beneficiaryachieves specified earnings targets, or “milestones.” 2In addition to the new payment system, TTW also greatly expanded the types oforganizations that SSA will pay to support beneficiaries’ job search efforts. In addition toSVRA’s, these organizations include a range of public and private providers, calledemployment networks (ENs), that have signed a contract with SSA to offer work-relatedservices. In addition, TTW gives service providers and beneficiary’s considerable flexibilityto choose the services that will be provided. In fact, providers and beneficiaries must agreeon an individualized work plan before a Ticket can be put into use. This plan could, intheory, include a wide array of services designed not only to help beneficiaries overcomebarriers related to their knowledge of the service system and the labor market but also toaddress their need for new or enhanced job skills as well as employer misperceptions of theirabilities.Service delivery in TTW is constrained, however, by two main factors: the providers’desire to limit service expenditures to a level that fits within the payments they expect toreceive and their assessment of whether the services they can provide are likely to result in abeneficiary leaving the rolls. In fact, providers can refuse to serve beneficiaries whom theythink are not likely to trigger outcome payments because they are not likely to leave the rolls.Beneficiaries who want to work only at an earnings level that would enable them to retainpart or all of their benefits will generally not be attractive clients to providers operating inthe TTW system.Finally, the Ticket Act addressed some of the SSI and DI program features that maydiscourage work efforts. First, while beneficiaries are using their Ticket, they are not subjectto continuing disability reviews (CDRs), which are recurring checks to determine whetherthey remain medically unable to work. Second, for long-term DI beneficiaries, starting towork will no longer trigger a medical disability review (even for those not participating inTTW). Third, an expedited reinstatement policy gives beneficiaries a five-year period afterthey leave the disability rolls for employment, during which their benefits (and any associatedhealth insurance) will be reinstated, without a new application, should they go back on cashbenefits. Fourth, Medicare coverage for DI beneficiaries who return to work was extendedsubstantially, from 39 months under earlier rules to 93 months at present, and when thatperiod ends, beneficiaries will be able to purchase Medicare coverage. Finally, the Ticket Actmade it easier for states to establish programs that allow persons with disabilities to purchaseMedicaid coverage on a sliding-fee basis; at present, about 30 states have these MedicaidBuy-In programs (White et al. 2005).After the Ticket Act was passed, TTW was rolled out in three phases. In Phase 1,which began in February 2002, the program was made available in 13 states across the32 After this report was drafted, SSA proposed changing these payment options (SSA 2005). Thesechanges will be examined further in future evaluation reports.I: Introduction