POLICY BRIEF January 2006 The Ticket to Work Program: Perspectives of Employment Networks Introduction To address the chronic problem of unemployment experienced by the disability community, Congress passed the Ticket to Work and Work Incentives Improvement Act (TWWIIA; 1999). Under this act, the Ticket to Work and Self-Sufficiency Program was established to provide eligible Social Security disability beneficiaries with increased opportunities to work by: * Increasing beneficiary choice in places to obtain employment and vocational rehabilitation services * Protecting Medicare and Medicaid benefits * Expediting reinstatement of benefits for individuals who are unable to continue working due to their disability * Providing immunity from continuing disability reviews while people are using their Ticket * Providing Benefits Planning Assistance and Outreach (BPAO) programs to assist in planning how to maximize benefits when working * Providing Protection and Advocacy for Beneficiaries of Social Security (PABSS) programs to provide training, education, and advocacy services. …it's all about CHOICE and OPPORTUNITIES! “The goal of the Ticket Program is to increase opportunities and choices for Social Security disability beneficiaries to obtain employment, vocational rehabilitation (VR), and other support services from public and private providers, employers and other organizations.” * *www.yourtickettowork.com To increase beneficiary choice, the Ticket to Work (TTW) program created Employment Networks (ENs), which provide Ticket holders with vocational training, job placement, and employment support/retention services. ENs include State Vocational Rehabilitation Agencies (SVRA), non-profit employment service agencies, and private sector entities that had not previously served people with disabilities. Initially, consumers receive a “Ticket” by mail with instructions to call Maximus (the company that administers the Ticket program). Then, Maximus provides information about local ENs. ENs work with consumers to develop an Individualized Work Plan. When Ticket holders are successfully placed in a job, ENs receive payment from the Social Security Administration (SSA) in either one of two ways: 1) outcome payments, where SSA reimburses for services after Ticket holders have started or returned to work and no longer qualify for SSA benefits or 2) milestone payments, where SSA reimburses ENs for participating individuals who have reached certain earnings levels. An evaluation conducted by Mathematica Policy Research Incorporated (2004) indicated that non-SVRA EN enrollment in the Ticket program was less than 1%, and most ENs were concentrated within SVRAs. Interviews with eight experienced ENs indicated that they were all losing money on their TTW operations. Many expressed doubts about their continued participation, and some had cut back their TTW operations due to the financial burden created by the program. Our study examined the perspectives of personnel from seven ENs located within a large Midwestern area. Of the seven ENs, one represented a SVRA. Findings from our study are consistent with Mathematica’s findings and provide additional insights into TTW program. Key Findings A total of 18 individuals participated in either a focus group or individual interview. Participants represented six non-state operated ENs and one State Vocational Rehabilitation Agency (SVRA). All ENs had previous experience serving the disability community, and had valuable experiences to share regarding the strengths and weaknesses of the TTW program. Further, for the six non-SVRA ENs, there were a number of unique challenges. Strengths of the TTW program: * EN participants recognized that expedited return to benefits (SSI/SSDI/Medical Benefits) was a strength of the legislation and would likely increase consumer interest in participating in the TTW program (50%). * EN providers were also encouraged by the great interest among the disability community in obtaining additional information on TTW and more generally employment (50%). “We were getting probably 100 calls a day when [the ticket] first went out.” * The deferment of continuing disability reviews was also viewed as a strength of the legislation (11%). Weaknesses of the TTW program: * The language of the Ticket and its accompanying materials were too complex and led to Ticket holders being misinformed (83%). “SSA should have done a better job promoting TTW, so that people can understand TTW.” * Ticket holders were difficult to place because of a lack of formal education, work history, and/or essential job skills (61%). * Consumers remained concerned about loss or reduction of their medical/monetary benefits (44%). Additional challenges for non-SVRA ENs: * Among non-SVRA ENs, there was unanimous consensus that they lacked financial resources to successfully implement TTW (100%). This lack of financial resources was due in large part to the existing payment structure of TTW. * A large number of non-SVRA ENs (77%) often referred consumers to a SVRA because they lacked the personnel and appropriate services to address consumers’ specific needs (for example, job training, transportation, education). Further, some lacked expertise in providing employment services to a specific disability group (for example, intellectual disabilities). “We became more of a source of referral. A lot of calls and probably the majority of people that called, and I’m talking 95%, we referred to the [SVRA] in the area.” * A number of non-SVRA ENs were reluctant to use TTW because they preferred to place consumers in jobs through existing contracts with SVRAs because these contracts proved to be more cost effective (66%). * A majority of non-SVRA ENs struggled with serving Latino consumers because of language barriers (56%). Recommendations Based on the strengths and weaknesses identified, we make the following recommendations: 1. Improve Consumers’ Knowledge of the TTW Program: * We are aware that a number of informational sessions have taken place nationwide to educate the general public about TTW. We recommend that these efforts be expanded to a local level, whereby disability organizations (such as Independent Living Centers) are better informed about TTW and provided with resources to help educate consumers about the program. * Educational campaigns need to be culturally competent to ensure that accurate knowledge of the program is conveyed. Spanish-speaking personnel and materials are essential to these efforts. * Materials describing the TTW program need to be simplified in order to be easily read and understood by consumers. * Consumers need additional information about their local ENs, with a particular focus on the services that they do and do not offer. 2. Improve Consumers’ Knowledge of Benefits Protection: * Outreach and information to the disability community regarding benefit planners need to be increased. “I know one of my clients was very reluctant to return to work. He had HIV and his medications were extremely expensive.” * BPAO and PABSS programs need continued funding to expand their efforts. 3. Improve the EN Payment System: * To be successful, ENs would benefit from a payment structure that provides upfront funding. * The value of part-time employment should be recognized by the TTW program, and ENs should be compensated for such efforts. * Opportunities to compensate both SVRA and non-SVRA ENs should exist, if both played in a role in helping a beneficiary obtain employment. 4. Improve Consumers’ Job Readiness: * People with disabilities continue to need quality educational opportunities to increase career development and employment skills. These educational opportunities should include competitive job skills training, vocational training, college, and English as a second language education. “The workforce, everything has changed, everything is computerized! Many [consumers] are just lost. They don’t have any computer skills. Then, they realize they have to go back to work and …go back to school.” 5. Create a National Technical Assistance (TA) Center for the TTW program: * The creation of a national technical assistance center that is devoted to the TTW program would provide ENs (especially non-SVRA ENs) with supports to improve outreach and service delivery. * In addition, a TA center could provide information, training, and workshops to ENs that are unfamiliar with the diverse needs of the disability and ethnic minority communities. This project was funded by the National Institute on Disability and Rehabilitation Research (NIDRR). The opinions expressed here are those of the researchers and not necessarily those of the funding source. For more information, please contact Brigida Hernandez, PhD, at bhernan4@depaul.edu or (773) 325-4840.