Social Security Administration:
Better Planning Could Make the Ticket Program More Effective
GAO-05-248: Published: Mar 2, 2005. Publicly Released: Mar 2, 2005.
The Social Security Administration (SSA) manages the two largest federal disability benefit programs and made approximately $75 billion in payments to about 8 million beneficiaries (ages 18 through 64) in 2003. Given the size of its programs, even small improvements in SSA's ability to return beneficiaries to work offer the potential for significant savings. Until recently, Social Security beneficiaries who needed help returning to work generally had to seek services from state vocational rehabilitation (VR) agencies. Few beneficiaries used these services or successfully returned to work. Therefore, Congress passed the Ticket to Work and Work Incentives Improvement Act of 1999 (Ticket Act, P.L. 106-170) to create a Ticket to Work and Self-Sufficiency Program (the Ticket program). The program's goals are to expand the availability of service providers and to help enable beneficiaries to return to work, become selfsufficient, and stop receiving disability benefit payments. Eligible beneficiaries can use their tickets as vouchers to request vocational rehabilitation, employment, or other support services from the traditional state VR agencies or from new SSA-approved public or private providers, which are referred to as employment networks (EN). The act required SSA to implement the Ticket program and make tickets available to all eligible beneficiaries. SSA decided to use three phases to make tickets available: (1) beginning with 13 states in February 2002, (2) expanding to 20 more states and the District of Columbia in November 2002, and (3) expanding to the final 17 states and 5 territories in November 2003. The act also required SSA to perform several periodic and independent evaluations of the program. For example, SSA was mandated to periodically review the systems used to make payments to the providers and was also given authority to make needed changes. The act also required SSA to provide Congress with three independent evaluations of the effectiveness of program activities. Finally, the act created the Ticket to Work and Work Incentives Advisory Panel (the Advisory Panel) to include experts on employment and related services and representatives of individuals with disabilities to provide advice and reports on the program to SSA, the Congress, and the President. The Congress also mandated in the Social Security Protection Act of 2004 that GAO evaluate the Ticket program and provide a report to Congress by March 2, 2005. The statute requires that GAO (1) examine the annual and interim reports issued by the Commissioner of Social Security and the Advisory Panel, (2) assess the effectiveness of the activities carried out under the program, and (3) recommend legislative or administrative changes, if appropriate. To meet these requirements, our report examines: (1) the progress SSA has made in implementing and evaluating the Ticket program and achieving its goals, (2) the problems that have limited the program's ability to achieve its goals, (3) the recommendations to better achieve the goals of the program made by the Advisory Panel, researchers, and service providers, and (4) the challenges SSA faces in implementing changes to achieve the program's goals.
SSA has made progress implementing and evaluating the Ticket program, but the agency has had limited success in achieving the program's goals of expanding beneficiaries' choice of service providers and increasing beneficiaries' efforts to work and become self-sufficient. The Ticket program's ability to achieve its goals has been hindered by several factors, according to the Advisory Panel, researchers, and service providers. First, service providers believe that the program's payment system does not provide adequate compensation for the administrative costs of participating. Second, participation of eligible beneficiaries has been limited by the lack of ENs, the lack of outreach to provide information about the program, and the lack of incentives to encourage beneficiaries to participate. The Advisory Panel and others have suggested numerous changes to improve the Ticket program. The Advisory Panel and others believe that reforming the payment system is critical to expanding participation. In addition, they suggested numerous changes to reduce the administrative burden for service providers, such as having SSA provide additional services, guidance, and information to providers. SSA faces several challenges as it tries to improve the Ticket program's ability to achieve its goals. Although SSA has made some administrative changes to the program, the agency recognizes that additional changes are needed. However, SSA has deferred other reforms until it has performed additional assessments on changes that it believes could be costly. we believe rigorous planning is needed to provide sufficient and reliable information to adequately assess the numerous proposed reforms put forth by the Advisory Panel and others. Thorough and reliable analysis is particularly important because of the complexity and potential costs of this nationwide program, as well the opportunities that it could provide to beneficiaries who want to become self-sufficient. Without a well-defined plan to assess proposed changes, SSA may not be able to provide stakeholders with cost-effective and timely solutions to increase program participation and the number of beneficiaries who become selfsufficient and move off the disability rolls.
Recommendation for Executive Action
Status: Closed - Implemented
Comments: SSA has two main efforts underway to increase program participation in the Ticket to Work and Self-Sufficiency Program and the number of beneficiaries who become economically self-sufficient and no longer depend on disability benefits. On May 20, 2008 the agency issued new rules, which became effective on July 21, 2008, amending the Ticket Program to improve its effectiveness in assisting beneficiaries to maximize their economic self-sufficiency through work opportunities. The rules make changes in four areas. First, the changes will increase the value of the ticket for service providers and allow ticket user to use a combination of State Vocational Rehabilitation services and Employment Network (EN) services with the aim of providing greater beneficiary choice and access to services needed. Second, it will increase payment levels to EN service providers to expand beneficiaries' access to services and choice of quality providers. Third, it has expanded program eligibility to include SSA beneficiaries whose conditions may medically improve. Fourth, it should promote better alignment of this program with the Work Incentives Planning and Assistance Program, the Protection and Advocacy for Beneficiaries of Social Security Program, and other Social Security work incentive initiatives. Additionally, the agency has hired an outside program manager, CESSI, Inc., to assist with the development and implementation of its national recruitment, outreach, and marketing campaign to encourage Ticket Program participation. SSA's extensive and long-term evaluation plan for the program may allow the agency to determine whether proposed and current aspects of the program are cost-effectively increasing participation in the Ticket program and moving beneficiaries toward self-sufficiency. In FY09, SSA reported that, as a result of the published new rules, the agency extended the period for evaluation and analysis of the program through 2010. Prior to publication of the revised regulation, the agency identified key indicators that would respond if the new provisions were addressing the core problems of the program. The key indicators are whether new Employment Network (EN) contracts are increasing and more beneficiaries are able to access EN services and find appropriate work. SSA sees promising trends in these key areas since the new regulations were published. In addition, SSA testified on May 19, 2009 before the House Committee on Ways and Means, Subcommittee on Social Security, sharing information with the Committee on status and challenges of the Ticket to Work program. SSA continues to work with Mathematica Policy Research (MPR) to conduct ongoing evaluations and analyses of the program.
Recommendation: The Commissioner of SSA should provide to Congress a plan that defines how and when the agency will assess proposed changes so that it may provide timely and cost-effective solutions to increase program participation and the number of beneficiaries who become self-sufficient and move off the disability rolls.
Agency Affected: Social Security Administration