Ticket to Work and

Work Incentives Advisory Panel

**2005 Annual Report to the President and Congress**

Year Six

Social Security Administration

Ticket to Work Incentives Advisory Panel

Submitted March 2006

Ticket to Work and

Work Incentives Advisory Panel

2005 Annual Report to the President and Congress

(Year Six of the Panel)

*Submitted*

*March 2006*

![](media/image1.jpeg){width="6.125in" height="4.3597222222222225in"}

**Table of Contents**

[A Message from the Chair iii](#a-message-from-the-chairperson)

[Executive Summary 1](#executive-summary)

[Background 4](#background)

[Summary of The Ticket To Work and Work Incentives Improvement Act of
1999
4](#summary-of-the-ticket-to-work-and-work-incentives-improvement-act-of-1999)

[Strategic Partners---Public and Private
5](#strategic-partnerspublic-and-private)

[Other Partners for Titles I, II and III
6](#other-partners-for-titles-i-ii-and-iii)

[Annual Interim Report to the President and Congress -- Year Six
7](#annual-interim-report-to-the-president-and-congress-year-six)

[Introduction 7](#introduction)

[Strategic Plan 8](#strategic-plan)

[Marketing and Public Education for the Ticket to Work Program
12](#marketing-and-public-education-for-the-ticket-to-work-program)

[Proposed Amendments to the Ticket to Work and Self-Sufficiency Program
12](#proposed-amendments-to-the-ticket-to-work-and-self-sufficiency-program)

[Benefits Planning, Assistance and Outreach Program
15](#benefits-planning-assistance-and-outreach-program)

PLAN FOR ACHIEVING SELF-SUPPORT 17

[SSA Demonstration Authority 19](#ssa-demonstration-authority)

[References 20](#references)

[Appendices A-1](#appendices)

[A. The Panel A-1](#the-panel)

[B. Panel Correspondences and Policy Letters
B-1](#b.-panel-correspondence-and-policy-letters)

#   {#section .Annual-Report-Heading-1 .unnumbered}

# A Message from the Chairperson {#a-message-from-the-chairperson .Annual-Report-Heading-1 .unnumbered}

On behalf of the Ticket to Work and Work Incentives Advisory Panel (the
Panel), it is my privilege to issue the Sixth Annual Interim Report to
the President and Congress. During my first year as Chair of the Panel,
we continued to monitor the implementation of the Ticket to Work Program
by the Social Security Administration (SSA) and the activities of other
federal agencies whose programs have an effect on the employment of
individuals with disabilities.

The Panel was pleased that SSA published a Notice of Proposed Rulemaking
(NPRM) to revise its regulations for the Ticket to Work Program. The
proposed changes are consistent with many of the priority
recommendations the Panel and others have made over the past few years.
The NPRM is an excellent step in the right direction. These changes and
others recommended by the Panel need to be moved forward rapidly and
published in final rules to ensure that the Ticket to Work Program
survives and captures the apparent renewed interest of Employment
Networks and beneficiaries. Such interest will not be revived without a
coordinated marketing and substantial nationwide public education
program targeted to beneficiaries as well as providers.

In July 2005, as a nation, we celebrated the 15^th^ Anniversary of the
signing of the Americans with Disabilities Act. Unfortunately, the
barriers to employment for working age adults with disabilities remain
formidable. The promise of the Ticket to Work and Work Incentives
Improvement Act has not been realized for most Americans with
disabilities. As a parent of a young adult with disabilities, I know
first hand that the transition from school to work remains difficult
and, for many, unachievable without changes in policies, attitudes, and
support systems.

The Panel adopted a strategic plan for its remaining two years to focus
on these challenges. After a period of transition, culminating in the
appointment of a full Panel, there was agreement that in addition to
continuing to monitor the implementation of the Ticket to Work Program,
it was important to elevate and incorporate the beneficiary perspective
throughout Panel recommendations, and to work on developing
recommendations for a National Employment Investment Policy.

This interim report highlights the Panel's 2005 findings, activities,
and recommendations on the implementation of the programs of the Ticket
to Work and Work Incentives Improvement Act of 1999. The report offers
the President, Congress, and the Commissioner of Social Security
specific recommendations to help our nation realize the benefits to the
economy and society of improved employment and self-sufficiency for
Americans with disabilities. It sets the stage for significant changes
to the Ticket to Work Program through adoption of amended rules in 2006.
The Panel will continue to recommend policy and systems changes to
improve collaboration of federal and state agencies, raise expectations
about work, promote adequate supports and services, and lead to
increasing the economic self sufficiency, economic status and community
participation for Americans with disabilities. I am privileged to share
with you this Year Six Annual Interim Report.

Respectfully Submitted,

Berthy De La Rosa-Aponte, Chairperson

Ticket to Work and Work Incentives Advisory Panel

# Executive Summary {#executive-summary .unnumbered}

Calendar year 2005 marked the sixth year of implementation of Public Law
106-170, the Ticket to Work and Work Incentives Improvement Act of 1999
(the Act). The Ticket to Work Program is now operational in all 50
states, the District of Columbia, and the U.S. territories. As of
December 2, 2005, the Social Security Administration (SSA) had issued
over 11.2 million tickets to Social Security Disability Insurance (SSDI)
and Supplemental Security Income (SSI) beneficiaries. At the Ticket to
Work and Work Incentives Advisory Panel's (the Panel's) last quarterly
meeting in 2005, SSA reported that there was a 10.2 percent increase in
ticket assignments and a 1.5 percent increase in recruitment of
Employment Networks (ENs). There was also a significant increase (14.7
percent) in the number of ENs that had received payments.

Despite these positive trends, the overwhelming majority of
beneficiaries and ENs are not participating in the program. During the
past 12 months, SSA intensified its marketing and public education
events to increase awareness and involvement of ticket holders and
employment service providers. An important step to encourage new
interest in the Ticket to Work Program occurred with the publication by
SSA of the Notice of Proposed Rulemaking (NPRM) in September.

The changes proposed for the EN payment system and other modifications
incorporate important priority recommendations made by the Panel and
others over the past three years. Overall, the Panel believes that the
NPRM offers significant improvements and urges SSA to move as quickly as
possible to review comments submitted and to adopt further changes
recommended by the Panel as part of final regulations. The Panel
recognizes that the publication of new rules will require additional
training of ENs, state vocational rehabilitation agencies, and
beneficiaries and recommends that SSA incorporate intensified plans for
marketing and outreach that will coincide with publication of the new
rules.

The proposed amendments to the Ticket to Work Program were among many
proposed and adopted rule changes published by SSA last year that are
designed to offer beneficiaries additional incentives to work and to
improve their economic status. Changes proposed or finalized included
more flexibility in the timelines for completion of a Plan for Achieving
Self-Support (PASS), a quick decision disability determination process,
expedited reinstatement of benefits to former SSDI and SSI beneficiaries
who become unable to perform substantial gainful work, and extended
benefits payments to students with disabilities ages 18 through 21 who
are still participating in Individualized Education Plans (IEPs) with
appropriate providers of services.

Although no single set of actions will ensure improved employment and
economic status for Americans with disabilities, the Panel views these
proposed and final rule changes favorably. The Panel submitted written
comments on each of these changes. The Year Six Annual Report outlines
the detailed recommendations that the Panel made in these comments to
SSA.

Through quarterly meetings, the Panel heard from SSA and other federal
agencies on program implementation and opportunities to improve
coordination of supports and services to advance employment status for
people with disabilities. The Panel also heard testimony from employers,
ENs, benefits counselors, ticket holders, state government leaders, and
representatives of the insurance industry. Relationships were explored
among Benefits Planning, Assistance and Outreach (BPAO) projects,
Protection and Advocacy for Beneficiaries of Social Security (PABSS)
projects and ENs. Updates and analysis were offered from policy
researchers on enrollment trends and participant characteristics of the
states that have implemented Medicaid Buy-In programs. Related
information was offered on progress being made through the Medicaid
Infrastructure Grant program. Other presenters emphasized the importance
of asset development goals and strategies to compliment existing work
incentives as a way to advance self-sufficiency for beneficiaries.

Presentations and public testimony brought to focus for the Panel two
important themes. First, a revitalized Ticket to Work Program is
essential to attract and secure the participation of current or
potential ENs and to expand the quality and choices available to
beneficiaries who require assistance to overcome multiple barriers to
employment. Final rules that adopt Panel recommendations regarding the
payment system as well as expansion of eligible populations are
important next steps that will only be successful with targeted,
comprehensive public education and marketing. Second, the challenges to
employment for the diverse groups of beneficiaries who have received the
option of using a ticket extend beyond Ticket to Work Program
implementation. Public policy, federal and state funding and service
delivery systems, and the changing nature of work and employer demands
must be analyzed and revised to promote a consistent outcome of
employment and economic self-sufficiency for Americans with
disabilities.

The Panel developed and adopted a strategic plan for 2006 and 2007 that
highlights the importance of continuing to recommend improvements to
implementation of the Ticket to Work Program, the need to incorporate
beneficiary feedback, and the need to develop a new employment
investment model that recognizes the inherent value of employment, is
respectful of each person's values and experiences, and moves people
with disabilities toward economic self-sufficiency. Across program
authorities and federal agencies, the Panel will make recommendations
that integrate and transform approaches to assets, income, health care
and supports for people with disabilities.

The Panel adopted three guiding principles:

1.  All people should be afforded a meaningful opportunity to
    participate in the economic mainstream with or without ongoing
    supports and services.

2.  As expressed by the disability rights slogan, "Nothing about us
    without us", the perspective of the beneficiaries must be heard,
    communicated and integrated into the recommendations of the Panel.
    The diversity of beneficiaries must be recognized to include people
    from various age groups, with different impairments, levels of
    education, work experience and capacities for working, culture,
    ethnicity, and socioeconomic status.

3.  Programs should not harm those they are designed to help. As the
    Panel works to promote employment and economic self-sufficiency, the
    Panel will thoughtfully consider the full spectrum of potential
    consequences.

The Panel's most significant recommendations for 2005 are summarized
below:

**Ticket to Work Program**

Four recommendations that the Panel had made previously were adopted by
SSA in the NPRM. The Panel submitted written comments to SSA that
reaffirmed support for the following proposed changes in the NPRM
related to the EN payment system and ticket eligibility:

-   The Panel recommended that SSA modify the payment system to make
    payments more frequently and earlier to reduce the financial risk
    and renew the interest of ENs.

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-   The Panel recommended that SSA equalize the payment amount for SSI
    and SSDI beneficiaries to ENs.

-   The Panel recommended that SSA allow beneficiaries with a Medical
    Improvement Expected designation to be eligible for a ticket without
    first requiring the completion of a continuing disability review.

-   The Panel recommended to SSA that payment to an EN under the Ticket
    to Work Program payment system and to a state vocational
    rehabilitation agency (SVRA) under the cost reimbursement system
    with respect to the same beneficiary should be allowed, to expand
    beneficiary choice and to take advantage of a more effective
    combination of services.

Five previous Panel recommendations not included in the NPRM were
resubmitted to SSA for adoption in the final rules as part of a more
responsive Ticket to Work Program:

-   The Panel continued to recommend eligibility for the ticket for
    beneficiaries who are ages 16 or 17.

-   The Panel recommended that SSA establish a cross-federal agency task
    force on transition to develop a unified school-to-work system that
    removes conflicting incentives.

-   The Panel recommended that SSA consider the feasibility of
    permitting the beneficiary to be his or her own EN.

-   The Panel recommended that, under certain circumstances, SSA should
    allow a beneficiary more than one ticket during the period of
    entitlement and to expand options for effective combination of
    services from an EN and a SVRA.

-   The Panel recommended that SSA pay ENs based on a qualified
    presumption and do a reconciliation when the earnings information is
    available to SSA. In addition, once a beneficiary is certified and
    employed above the substantial gainful activity (SGA) level or
    leaves cash benefit status, the EN should continue to be paid
    monthly as long as the beneficiary remains in that status, or the EN
    has not yet received all entitled outcome payments, or until the
    beneficiary requests a new EN.

**Other Issues**

The Panel also recommended, in other letters to SSA, ways to improve the
quality and strength of the BPAO program and increase the value and use
of the PASS Work Incentive. The Panel recommended in a letter to
Congress that demonstration authority for SSA be reauthorized to enable
SSA to continue to design and test new strategies to promote employment
and reduce dependence on cash benefits.

# Background {#background .unnumbered}

## Summary of The Ticket To Work and Work Incentives Improvement Act of 1999 {#summary-of-the-ticket-to-work-and-work-incentives-improvement-act-of-1999 .Annual-Report-Heading-2 .unnumbered}

The Ticket to Work and Work Incentives Improvement Act (the Act), which
was enacted on December 17, 1999, is administered by the Social Security
Administration (SSA) and the Department of Health and Human Services
(HHS). It increases beneficiaries' choices for rehabilitation and
vocational services, removes barriers that require people with
disabilities to choose between health care coverage and work, and
ensures that more Americans with disabilities have opportunities to work
and lessen their dependence on public benefits. Different provisions of
the law became effective at various times, generally beginning one year
after enactment.

### Summary of Title I---Ticket to Work and Self-Sufficiency and Related Programs {#summary-of-title-iticket-to-work-and-self-sufficiency-and-related-programs .Annual-Report-Heading-3}

> Subtitle A---Ticket to Work and Self-Sufficiency and Related Programs

Subtitle A establishes the Ticket to Work Program, under which most
beneficiaries will receive a \"ticket\" that they can use to obtain
vocational rehabilitation, employment, or other support services from an
approved provider of their choice. This voluntary program was phased in
nationally over 3 years. It establishes a program manager, Employment
Networks (ENs), and payment systems; calls for a report on the adequacy
of incentives and the establishment of a dispute resolution mechanism;
provides for suspension of continuing disability reviews for persons
using the ticket; and establishes the Ticket to Work and Work Incentives
Advisory Panel (the Panel) to advise the Commissioner of SSA, the
President, and Congress on the Ticket to Work Program and other work
incentives and employment supports.

> Subtitle B---Elimination of Disincentives to Work

Subtitle B eliminates the work activity standard as a basis for
reviewing an individual\'s disability status and provides for expedited
reinstatement of benefits if the person does not continue working.

> Subtitle C---Work Incentives Planning and Outreach

Subtitle C sets up the Work Incentives Outreach Program, including
external Benefits Planning, Assistance, and Outreach (BPAO) programs and
the internal corps of Social Security experts on work incentives and
employment. It establishes a grant program for a protection and advocacy
(P&A) agency in each State to assist beneficiaries.

### Summary of Title II---Expanded Availability of Health Care Services  {#summary-of-title-iiexpanded-availability-of-health-care-services .Annual-Report-Heading-3}

Title II expands State options under Medicaid for workers with
disabilities. It calls for a General Accounting Office[^1] study on
extending Medicare coverage for Social Security beneficiaries, and
establishes State infrastructure grant authority and demonstration
projects. It calls for a demonstration of coverage under Medicaid of
workers with potentially severe disabilities and allows disabled
beneficiaries to suspend Medigap coverage.

### Summary of Title III---Demonstration Projects and Studies  {#summary-of-title-iiidemonstration-projects-and-studies .Annual-Report-Heading-3}

Title III extends the disability insurance program demonstration
authority and calls for specific studies and reports, including a
demonstration study of a \$1 reduction in benefits for every \$2 earned.

## Strategic Partners---Public and Private {#strategic-partnerspublic-and-private .Annual-Report-Heading-2 .unnumbered}

The Act contains numerous references to other agencies at the Federal,
State, and local levels and to private sector service providers, all of
whom are key partners in its implementation. Other Federal and State
programs and systems may not be mentioned, but they represent obvious
partners for SSA in employment services and supports. Effective
collaboration among a wide array of partners is critical to the success
of the Ticket to Work Program.

### Under Title I---Ticket to Work and Self-Sufficiency and Related Programs {#under-title-iticket-to-work-and-self-sufficiency-and-related-programs .Annual-Report-Heading-3}

Critical in the implementation and operation of employment support
initiatives, claims processing, and disability benefit programs is the
Office of Employment Support Programs (OESP), which is under the Deputy
Commissioner for Disability and Income Security Programs, and the Deputy
Commissioner for Operations (who also manages the SSA\'s 10 Regional
Offices, over 50 Area Offices, and 1,300 Field Offices). The OESP
administers employment supports, including the Ticket to Work Program,
and contracts for program management support to recruit rehabilitation
providers as ENs. Area Work Incentive Coordinators in the Area Offices
and Work Incentive Liaisons in the Field Offices implement the Ticket to
Work Program, work incentives, earnings reporting, and other employment
support programs and provisions. The Panel advises SSA, the President,
and Congress on the implementation of the Act and on an array of work
incentive programs across a number of Federal agencies.

P&A systems in the States are funded by SSA to help beneficiaries obtain
information and advocacy support related to employment services and
dispute resolution. BPAO programs are funded by SSA and provide benefits
counseling to beneficiaries. State vocational rehabilitation agencies
(SVRAs), funded by the Rehabilitation Services Administration in the
Department of Education (ED), provide rehabilitation and a broad range
of return-to-work services for SSA beneficiaries. Special education at
the State level is funded through the Office of Special Education
Programs in ED and serves beneficiaries between the ages of 14 and 22 in
school-to-work transition programs. One-Stop Career Centers at the local
level, funded through the Employment and Training Administration of the
Department of Labor (DOL), are specifically mentioned in the law as
potential ENs and may include SVRAs as One-Stop partners. Other parts of
DOL, such as the Office of Disability Employment Policy, are involved in
public policy decisions at the national level that potentially affect
beneficiaries returning to work.

### Under Title II---Expanded Availability of Health Care Services {#under-title-iiexpanded-availability-of-health-care-services .Annual-Report-Heading-3}

The Centers for Medicare and Medicaid Services of HHS at the national
level and State Medicaid agencies are partners in providing increased
medical coverage for beneficiaries. Other Federal agencies -- the
Administration on Developmental Disabilities, the Maternal and Child
Health Bureau, and the Center for Mental Health Services, also in HHS --
fund programs to provide advocacy, residential, and employment support
services to low-income SSA beneficiaries from specific beneficiary
populations.

### Under Title III---Demonstration Projects and Studies {#under-title-iiidemonstration-projects-and-studies .Annual-Report-Heading-3}

Title III amends Title II to provide for a permanent extension of
disability insurance program demonstration project authority. SSA\'s
Office of Program Development and Research, within the Office of
Disability and Income Security Programs, develops and carries out
experiments and demonstration projects, subject to specified guidelines.
The National Institute on Disability and Rehabilitation Research and the
Interagency Committee on Disability Research in ED, as well as the
Assistant Secretary for Planning and Evaluation in HHS, also undertake
or coordinate research on Ticket participants and other persons with
disabilities.

## Other Partners for Titles I, II and III {#other-partners-for-titles-i-ii-and-iii .Annual-Report-Heading-2 .unnumbered}

Other partners include the Section 8 Housing program in the Department
of Housing and Urban Development and the Transit Subsidy Program in the
Department of Transportation, which provide housing and transportation
benefits for SSA beneficiaries.

# Annual Interim Report to the President and Congress -- Year Six {#annual-interim-report-to-the-president-and-congress-year-six .Annual-Report-Heading-1 .unnumbered}

"*The Panel recommends that SSA move as quickly as possible toward final
regulations that will start the journey to reinvent the Ticket to Work
Program. It would seem reasonable to assume that the marketing plan and
non-regulatory initiatives would coincide with implementation of the new
rules."*

> Letter to Jo Anne Barnhart, Commissioner, Social Security
> Administration, from Berthy De La Rosa-Aponte, Chair on behalf of the
> Ticket to Work and Work Incentives Advisory Panel
>
> December 22, 2005

####  {#section-1 .unnumbered}

## Introduction {#introduction .Annual-Report-Heading-2 .unnumbered}

The Sixth Annual Interim Report of the Ticket to Work and Work
Incentives Advisory Panel (the Panel) represents an important milestone
in the implementation of legislation that holds enormous promise for
millions of Americans with disabilities. On September 30, 2005, the
Social Security Administration (SSA) published a Notice of Proposed
Rulemaking (NPRM) outlining changes designed to improve the overall
effectiveness of the Ticket to Work Program in assisting beneficiaries
to advance their economic self-sufficiency through work opportunities.
The changes proposed for the Employment Network (EN) payment system and
other modifications incorporate important priority recommendations made
by the Panel and others over the past three years.

On September 30, 2005, SSA published final rules that adopt Panel
recommendations regarding expedited reinstatement of benefits to former
Social Security Disability Insurance (SSDI) and Supplemental Security
Income (SSI) disability or blindness beneficiaries who become unable to
perform substantial gainful activity (SGA). These rules offer
beneficiaries additional incentives to return to work. SSA also
published a final rule on June 24, 2005, that extends eligibility for
continued benefit payments to students ages 18 through 21 who recover
medically, or whose disability is determined to have ended as a result
of an age-18 redetermination, while participating in an Individualized
Education Program (IEP) developed under the Individuals with
Disabilities Education Act with an appropriate provider of services. SSA
offered other NPRMs regarding changes to the Plan for Achieving
Self-Support (PASS) and the disability determination process. Although
no single set of actions will ensure the success of the Ticket to Work
Program and improved employment and economic status for Americans with
disabilities, these proposed and final rule changes are positive steps
that the Panel views favorably.

Moving toward self-sufficiency is a dynamic process. Barriers to
employment and economic advancement for beneficiaries challenge the
public and private sectors to form new relationships that provide the
necessary supports and opportunity for increasing the number of
individuals with disabilities who work and contribute to a community's
social and economic well being.

During the past year, the Panel continued to receive regular updates on
the Ticket to Work Program implementation activities from SSA. The Panel
also reached out to other federal agencies, state policymakers and
administrators and the business community to share insights and
perspectives on reducing and eliminating barriers to employment. In
meeting after meeting across the country, the Panel heard clearly and
consistently from current and past beneficiaries about their struggles
to understand complex rules of eligibility, the benefits of work
incentive options, and the problems of income and asset limits that
discourage improvement to economic status. SSI beneficiaries expressed
fear of loss of health care as their earnings increased and SSDI
beneficiaries complained about rules that do not permit gradual
reduction of benefits.

With two years remaining for deliberations, the Panel recognizes the
urgency to promote the Ticket to Work Program with a larger framework of
transforming approaches to assets, income, health care, and long-term
supports for beneficiaries. With the diversity of perspectives of Panel
members, with the active encouragement of beneficiary participation in
the design of system improvements, and with the continued engagement of
public and private stakeholders, the Panel is optimistic that 2006 can
bring a stronger, more viable Ticket to Work Program with improved
federal agency collaboration to build a better economic future for
Americans with disabilities.

## Strategic Plan {#strategic-plan .Annual-Report-Heading-2 .unnumbered}

With a new Chairperson and appointments for all Panel positions, 2005
presented an important opportunity to reaffirm important values and
principles to guide future Panel action and decision-making. The Panel
undertook a formal strategic planning process to refocus and provide a
strategic roadmap for the Panel over its remaining years. The Panel
developed and adopted a statement to clearly articulate the reason for
the Panel's existence and its stated goals, objectives and actions:

> *"The purpose of the Ticket to Work and Work Incentives Panel is to
> provide insight, advice, and recommendations to the President,
> Congress, and the Commissioner of the Social Security Administration
> that will lead to increased employment and greater economic
> self-sufficiency for people with disabilities."*

The Panel affirmed three guiding principles:

> 1\. All people should be afforded a meaningful opportunity to
> participate in the economic mainstream with or without ongoing
> supports and services.
>
> 2\. As expressed by the disability rights slogan, "Nothing about us
> without us" [^2], the perspective of the beneficiaries must be heard,
> communicated and integrated into the recommendations of the Panel. The
> diversity of beneficiaries must be recognized to include people from
> various age groups, with different impairments, levels of education,
> work experience and capacities for working, culture, ethnicity, and
> socioeconomic status.
>
> 3\. Programs should not harm those they are designed to help. As the
> Panel works to promote employment and economic self-sufficiency, the
> Panel will thoughtfully consider the full spectrum of potential
> consequences.

The Panel recognized its important role not only to promote change
specific to available work incentive options and to the Ticket to Work
Program but also to embrace a larger context of programs and policies
essential to increase employment and economic self-sufficiency for
people with disabilities. The Panel identified three goals to frame
future action. The three goals are:

1.  Elevate and incorporate the beneficiary perspective.

2.  Improve implementation and marketing of the Ticket to Work and Work
    Incentives Improvement Act (the Act).

3.  Develop a national employment investment policy to transform
    approaches to assets, income, health care and supports for people
    with disabilities that is person-centered, culturally competent, and
    respectful of each person's values and experiences.

Within each of the three goals, the Panel identified more specific
objectives to focus activities during the next two years. The strategy
map in Figure 1 illustrates the key relationships between the goals and
objectives. To implement Goal One, the Panel will work with
beneficiaries to plan and execute a Beneficiary Summit in the fall of
2006. Possible theme areas to be considered for discussion include the
adverse psychological impact of the disability determination process,
alternative definitions of disability that consider favorably capacity
to work, support of asset development objectives, a more gradual
approach to loss of income and supports, access to health care, improved
program integration, making the existing program more user friendly, and
youth specific challenges.

Within the focus of Goal Two on continuous improvement in the
implementation of the Act, the Panel developed eleven specific
objectives, including analysis of data and reports on ENs and
beneficiary participation in the Ticket to Work Program, and directing
attention to integration and coordination of the Ticket to Work program
with other federal and state employment programs and initiatives. Based
on input from state Medicaid agency directors, Medicaid Infrastructure
Grant (MIG) project staff, beneficiaries, researchers, and other
important stakeholders, the Panel will develop a recommendation for the
Centers for Medicare and Medicaid Services (CMS) in concert with SSA to
define a work standard, remove an upper age limit for participation in
the Medicaid Buy-In program, and to explain the parameters of medical
improvement expected (MIE) for purposes of eligibility for Medicaid
Buy-In. The Panel will also continue to review and analyze proposed
regulatory changes from SSA, the final rule amendments to the Ticket to
Work Program, and provide oversight regarding the adequacy of incentives
for the provision of EN services to individuals with significant
barriers to employment.

The adoption of Goal Three represents an important shift in the
attention of the Panel to policy alternatives beyond the Act. The Panel
has listened to and heard clearly the voices of beneficiaries seeking a
coordinated federal response that recognizes the relationship among work
and income, health care and long-term supports, and savings and asset
development.

Figure 1. The Panel Strategy Map

![](media/image2.wmf){width="5.663888888888889in"
height="7.425694444444445in"}

Recommendations to the President and Congress will be developed to
transform the approach of the federal government to determining
eligibility for cash supports, health insurance and other long-term
supports. Panel members will explore incentives to encourage integrated
public sector employment to supplement private sector opportunities, and
new options will be defined to support links among work, saving, and
asset development through home and business ownership and long-term
financial planning.

The Panel structured its committees to reflect these new priorities.
Each Panel member now participates in at least one of three committees:
the Beneficiary Voice Committee, the Continuous Improvement Committee,
and the Transformation Committee. The new structure has enabled Panel
members to concentrate more time on targeted specific objectives.

## Marketing and Public Education for the Ticket to Work Program {#marketing-and-public-education-for-the-ticket-to-work-program .Annual-Report-Heading-2 .unnumbered}

As of December 2, 2005, SSA had issued over 11.2 million tickets to SSDI
and SSI beneficiaries. The Ticket to Work Program is now operational in
all 50 states, the District of Columbia, and U.S. territories. Despite
intensified efforts by SSA and contractors to market the Ticket to Work
Program during the past 12 months, less than 1 percent of ticket holders
had assigned their ticket to a provider. Recruiting and retaining a
large number of ENs is a critical factor in providing beneficiaries
expanded choices in the provision of rehabilitation and employment
services, which is a primary goal of the Ticket to Work Program. At the
Panel's last quarterly meeting in 2005, SSA reported that there was a
10.2 percent increase in ticket assignments and a 1.5 percent increase
in EN recruitment activity. There was also a significant increase (14.7
percent) in the number of ENs that had received payments. Despite these
positive trends, the overwhelming majority of beneficiaries and ENs are
not participating in the program.

####  {#section-2 .unnumbered}

Consistent with the Panel's 2004 recommendation for coordinating a
marketing and public education campaign nationwide to increase awareness
of and interest in the Ticket to Work Program, SSA hosted a series of
Ticket to Work Conferences and Expos in ten cities. Using the theme, "It
Pays to Check It Out!," these one-day Expos provided participants and
beneficiaries, as well as employers and service providers, with a better
understanding of how and why the ticket can be useful. The Expos also
introduced beneficiaries to the employment search process and the
interview skills and strategies that they may need to achieve their goal
of successful employment. Panel members supported SSA by attending a
number of the public education events. Panel members also attended
several of the Town Hall meetings organized by SSA around the country to
seek input from beneficiaries and other stakeholders on the NPRM for the
Ticket to Work Program.

## Proposed Amendments to the Ticket to Work and Self-Sufficiency Program  {#proposed-amendments-to-the-ticket-to-work-and-self-sufficiency-program .Annual-Report-Heading-2 .unnumbered}

During the past three years, the Panel dedicated considerable time to
the development of specific recommendations to expand beneficiaries'
choice of service providers and to increase beneficiaries' incentives to
work and become self-sufficient. On September 30, 2005, SSA published an
NPRM with proposed amendments to the Ticket to Work Program, many of
which are consistent with past Panel recommendations. The Panel is
pleased that many of the proposed changes when adopted as final
regulations will start the journey to reinvent the Ticket to Work
Program, renew interest of providers, and stimulate new opportunities
for beneficiaries.

Overall, the Panel believes that the NPRM is an excellent step in the
right direction, and encourages SSA to move as quickly as possible to
review comments submitted and to adopt further improvements recommended
by the Panel over the past few years as part of final regulations. In a
December 22, 2005 letter to the Commissioner of SSA, the Panel thanked
SSA "for proposing significant improvements in the program and for
accepting several of the priority recommendations the Panel \[and
others\] had made over the past few years." In particular, the Panel
shared that the proposed amendments "recognized the multi-step nature of
returning to work."

It is important that intensified plans for marketing and outreach
coincide with publication of the new rules. The Panel recognizes that
the publication of new rules will require additional training of ENs,
state vocational rehabilitation agencies (SVRA), and beneficiaries. The
Panel recommended that SSA put in place a comprehensive and coordinated
marketing and public education program to educate all appropriate
parties of the changes and how they will work.

The Panel also recommended that SSA clarify that these proposed rule
changes apply for both "new" and "old" tickets (prior tickets assigned
to ENs). SSA should implement appropriate measures to transition the
"old" tickets to the new rules, to avoid unnecessary complexity and
potential difficulties.

SSA's proposed changes can be divided into four major areas: EN payments
for completion of milestones and successful employment outcomes for
beneficiaries; ticket eligibility; SVRA participation and beneficiary
choice; and clarifications regarding when a beneficiary is using a
ticket so as not to trigger a continuing disability review, and whether
a beneficiary should be eligible for more than one ticket during the
period of entitlement.

### EN Payments {#en-payments .Annual-Report-Heading-3}

The proposed regulations significantly revise the payment system for
ENs. Multiple changes have been proposed that adopt recommendations of
the Panel and others to make payments more frequently and earlier to
reduce the financial risk of ENs. SSA also adopted the Panel's
recommendation to equalize the payment amount for SSI and SSDI
beneficiaries to ENs.

In its review of EN payment issues, the Panel noted that the proposed
milestone reimbursement system could result in shifting too much of the
Ticket to Work Program's value to the first couple of months of
employment. This could diminish a beneficiary's ability to negotiate for
needed services later in their return to work efforts. This could create
a financial disincentive for an EN to continue serving a beneficiary.
The Panel recommended that SSA review the lump sum milestone payment
provision to ensure that beneficiaries do not lose this protection.

SSA asked for public comment on whether the evidence requirements for EN
payment are unnecessarily burdensome. The Panel concurred with an option
proposed by SSA that would allow ENs to be paid based on a qualified
presumption and to do reconciliation when the earnings information is
available to SSA, which might result in the EN repaying monies not due.
The Panel also suggested, consistent with the requirement of
beneficiaries having to report earnings to SSA, that SSA explore the
feasibility of sharing these earnings reports with ENs.

The Panel also recommended that SSA adopt a recommendation made in 2004
that would change the EN payment claims process so that once a
beneficiary has been certified as employed above the SGA level or leaves
cash benefit status, the EN should continue to be paid monthly as long
as the beneficiary remains in zero benefit status and the EN has not yet
received all entitled outcome payments, or until the beneficiary
requests a new EN. The combination of these proposed changes would
significantly reduce current major disincentives for ENs to participate
in the Ticket to Work Program.

SSA also asked for further input on whether there are circumstances
under which both Phase 1 and 2 milestones to an EN would be paid after
SSA has made a payment to the SVRA under the cost reimbursement system.
The Panel recommended to SSA that there are legitimate circumstances
that would merit payment of both milestones to an EN after SSA has paid
the SVRA. Circumstances to consider include a changing labor market
and/or disability conditions leading to unsteady or interrupted
employment. The Panel also suggested that adoption of the recommendation
to allow a beneficiary more than one ticket during the period of
entitlement would mitigate many of the inherent problems in coordinating
payments under these two programs.

### Ticket Eligibility {#ticket-eligibility .Annual-Report-Heading-3}

The Panel has consistently stated that all SSI and SSDI adult disability
beneficiaries, including those with MIE designation, should be eligible
to participate in the Ticket to Work Program. The proposed rules adopt
the Panel's recommendation and would allow beneficiaries with an MIE
designation to be eligible for a ticket without first requiring a
continuing disability review (CDR) to be conducted.

The proposed amendments do not revise eligibility for beneficiaries who
are ages 16 or 17. SSA explains that after carefully reviewing this
issue, it would be premature to offer a ticket to members of this group
because it could interfere with completion of their education, which
should be the primary focus and goal for school-age youth. As in three
previous Annual Interim Reports, the Panel continued to recommend
coverage for this age group of beneficiaries as an important alternative
to the creation of a long-term dependency on SSA disability programs.

The Panel recommended that SSA establish a cross-federal agency task
force on transition to develop a unified school-to-work system that
would remove conflicting incentives. The Panel urged SSA to use their
demonstration authority to establish more youth demonstration projects
to evaluate the potential long-term savings that can be realized by
transitioning youth into gainful employment opportunities early in life.

### SVRA Participation and Beneficiary Choice {#svra-participation-and-beneficiary-choice .Annual-Report-Heading-3}

Proposed changes in the approach, timing, and amount of payments should
expand provider interest in becoming an EN. Proposed changes would also
allow for payment to an EN under a Ticket to Work Program payment system
and to a SVRA under the cost reimbursement payment system with respect
to the same beneficiary. These changes should expand beneficiary choice
and enable beneficiaries to take advantage of a more effective
combination of services from both an SVRA and an EN.

SSA accepted the Panel's recommendation that a beneficiary with a ticket
who applies for state vocational rehabilitation (VR) services has a
choice in deciding to assign his or her ticket to the SVRA, to assign it
to another EN, or not to assign it at all. Eligibility for VR services
and VR client status should not dictate when or where a beneficiary can
use their ticket.

The Panel recommended that SSA consider the feasibility of permitting
the beneficiary to be his or her own EN as an extension of current
policy that permits family members, micro-boards and other
nontraditional providers to qualify as ENs.

**[Using a Ticket]{.underline}**

Ticket in use status ensures that SSA will not initiate a medical CDR.
This provision is designed to address the concern of some beneficiaries
that working may trigger a CDR and termination of benefits. The
beneficiary must be making "timely progress" toward self-supporting
employment to maintain this protection. Timely progress means showing an
increasing ability to work at levels that will reduce or eliminate
dependence on SSI and/or SSDI benefits.

The Panel recommended individualizing the "timely progress" requirements
based on the terms and conditions of the Individualized Work Plan and
placing the responsibility of proof and reporting on the EN with
oversight by the Program Manager. The Panel also recommended that a
ticket user who is enrolled in a certified educational/training program,
internship, or apprenticeship should not be required to interrupt this
program to meet the requirements of "timely progress."

### Eligibility for More Than One Ticket {#eligibility-for-more-than-one-ticket .Annual-Report-Heading-3}

> The Panel recommended that a beneficiary should have access to more
> than one ticket. A beneficiary whose ticket is partially used because
> of the cyclical nature of their disability and needs other continuing
> support may have difficulty finding an EN to work with them. There are
> also beneficiaries who may require ongoing support services beyond the
> period of time over which outcomes or outcome milestone payments are
> made. It would be a distinct advantage to the beneficiary to be
> eligible for more than one ticket during a longer period of
> eligibility.

## Benefits Planning, Assistance and Outreach Program {#benefits-planning-assistance-and-outreach-program .Annual-Report-Heading-2 .unnumbered}

There are 117 Benefits Planning, Assistance and Outreach (BPAO) programs
in the United States comprising 550 benefits specialties across 192
sites. The network of BPAO programs has assisted over 150,000
beneficiaries nationwide in the past four years. The Panel has heard
considerable public comment on the effectiveness and positive impact of
the BPAO program. There have also been constructive comments on ways to
improve and enhance the effectiveness of the national network. The
reports on the BPAO program from SSA indicate continued growth in the
number of beneficiaries accessing BPAO services. There is an expectation
with improvements to the Ticket to Work Program and expanded marketing
efforts that there will be an increasing demand for these critical
services.

The Panel recommended enhancements in five critical areas that could
reinforce the role of benefits planning in fostering positive employment
outcomes and improved economic self-sufficiency for beneficiaries.

### Resource Issues {#resource-issues .Annual-Report-Heading-3}

In a February 11, 2005 letter to the Commissioner of SSA, the Panel
recommended increasing the resources allocated to the national network
of BPAO programs and removing the individual awards cap for projects to
ensure that programs based in rural settings have the resources they
need to provide equitable service to their urban and metropolitan
counterparts.

To improve the assessment in the future of network capacity to increase
demand for services, the Panel recommended that all BPAO programs be
required to include data in their management information reports on
beneficiary waiting times for a response to a request for services and
the actual receipt of services. All BPAO programs should be required to
have a designated point of contact so that individuals having difficulty
receiving services from a BPAO program can contact and inform SSA about
extended wait periods for an appointment or no response.

### Underserved and Unserved Populations {#underserved-and-unserved-populations .Annual-Report-Heading-3}

The national database of BPAO activities documents that services and
supports are equitably distributed between men and women and SSI and
SSDI beneficiaries. However, the data also reveals that less than 10
percent of services are being provided to transition-age youth and that
there is limited utilization of service by specific disability groups
such as persons with intellectual disabilities and Native Americans with
disabilities.

The Panel recommended that SSA require all BPAO programs to report how
they will target and serve transition-age youth and describe how they
will ensure equitable access to and services for all disability groups.
The Panel also recommended that BPAO programs that cover tribal lands
and sovereign nations provide clear and convincing documentation of how
they will ensure equitable access and service for Native American and
Alaskan Native populations.

### Training and Quality Assurance {#training-and-quality-assurance .Annual-Report-Heading-3}

BPAO programs have a responsibility to present a myriad of options that
exist for a beneficiary making decisions about work. A benefits
specialist should be adequately trained to assist a beneficiary make
informed decisions about the total value of disability benefits and
public entitlements that they receive and the earnings they would need
to offset the loss or reduction of benefits. The Panel recognizes the
importance of a clearly articulated common program philosophy for all
BPAOs that is consistent with the purposes of the Act to increase
employment and greater economic self-sufficiency for people with
disabilities. Benefits specialists must be well versed and equipped to
provide services and supports on not only SSA's work incentives
provisions and return to work programs but also the full array of other
state and federal benefits that support the needs of beneficiaries.

The Panel recommended that quality assurance measures be put in place
that establish minimum standards for effective service delivery and
minimum qualifications for new benefits specialists. All BPAO programs
should be required to have a quality assurance plan that is in alignment
with standards set by SSA. Evidence of compliance with the plan should
be submitted regularly. The Panel also recommended that SSA continue to
use a national core competency based curriculum and that the initial
five day training session for benefits specialists be lengthened to
realistically reflect the breadth and complexity of SSA's and other
relevant federal programs and benefits. All BPAO programs should
continue to have access to ongoing technical support.

The Panel recommended that a grievance procedure be established with
each BPAO program and that all beneficiaries be provided notice of the
established grievance procedure and the availability of Protection and
Advocacy for Beneficiaries of Social Security (PABSS) programs.

### Partnerships {#partnerships .Annual-Report-Heading-3}

Partnerships can position BPAO programs to better serve unserved and
underserved populations. Some BPAO programs have developed model
partnerships with ENs to maximize the employment success of the
beneficiaries they both serve. Other BPAO programs have built strong
relationships with Disability Program Navigators (DPN) and One-Stop
Career Centers to improve access to needed service by beneficiaries.[^3]

The Panel recommended that all BPAO programs be required to have
agreements with ENs and DPNs in the geographic catchment area they cover
to promote positive working relationships and to improve access to
service.

The Panel recommended that SSA provide an incentive to BPAO programs and
ENs to collaborate and promote employment success. The Panel also urged
SSA to promote increased collaboration between SSA field offices and the
BPAO programs with greater efforts at joint problem solving in
individual situations.

## Plan for Achieving Self-Support  {#plan-for-achieving-self-support .Annual-Report-Heading-2 .unnumbered}

On July 11, 2005, SSA published an NPRM regarding changes to the PASS
work incentive. A PASS allows some people who receive or are eligible
for SSI disability benefits to set aside part of their income and/or
resources to meet an employment goal. The income and/or resource set
aside by the beneficiary under a PASS is not counted in determining the
amount of the beneficiary's SSI payment or his or her eligibility. A
PASS can be established to cover the costs of obtaining an education,
receiving vocational training, starting a business, or purchasing
support services that enable the individual to work and result in
reducing SSI/SSDI benefits. The proposed rule seeks to clarify current
policies to increase the utilization of the PASS program to advance
greater economic self-sufficiency for beneficiaries.

The Panel, in a September 9, 2005 letter to Commissioner Barnhart,
expressed support for the suggested improvements to the PASS program and
offered multiple recommendations to further increase the value and use
of this underutilized work incentive.

The Panel recommended that SSA explore strategies to maximize
utilization of a PASS and consider how the Ticket to Work and PASS
programs can better compliment each other. The number of PASS
participants varies greatly from state to state with 31 states having 20
or fewer participants. It is unlikely that participation in the PASS
program will increase substantially until beneficiaries more fully
understand the fundamentals of work incentives and the employment
supports and services available to them.

The Panel recommended that SSA refine its policies to refer
beneficiaries for additional assistance in developing a PASS not just to
SVRAs but also to BPAOs, PABSS, ENs and SSA offices. The final rules
should clarify when it will refer, what type of
organizations/individuals to which it will refer, and what level of
support applicants can expect to be provided.

The Panel supports the proposed rules that will take into account the
individual needs and employment goals of beneficiaries in determining a
"reasonable length of time" to achieve proposed goals. This approach
recognizes the heterogeneity of the beneficiary population and benefits
individuals with more severe disabilities who may need a longer time to
complete a PASS. However, the Panel is concerned that the concept of
reasonable time frames is subjective and open for interpretation. The
Panel recommended that SSA provide specific examples to assist
beneficiaries as they consider proposing their own "reasonable ending
date" and further explain that a reasonable period for completion of a
PASS will depend in large part on the impact of the individual's
impairment on their stated goals.

The Panel recommended that SSA provide more clarity regarding how much
of a reduction is "substantial" and then ensure this criterion is
consistently implemented.

The Panel also recommended that SSA provide further explanation and
details regarding the mandatory annual review of individual PASS plans
to determine whether progress is being made and ensuring beneficiaries
have access to needed supports to move toward successful completion of
the plan. The Panel recommended that PASS specialists customize
timelines for progress reviews based on the specific support needs of
the beneficiary.

The Panel recommended that SSA move as quickly as possible toward a
final PASS regulation. Adoption of the proposed clarifications of policy
and the additional recommendations of the Panel could help thousands of
beneficiaries achieve an improved economic status.

## Disability Determination Process {#disability-determination-process .Annual-Report-Heading-2 .unnumbered}

The Panel was encouraged by the NPRM released on July 27, 2005 to
improve the disability determination process. The proposal by SSA to
implement a Quick Decision Disability Determination Process to set
national standards for medical and vocational consultants, and to add a
network of qualified medical, psychological, and vocational experts
equipped to adjudicate complex cases was well received by the Panel with
a few issues of concern.

The Panel feels that the changes that are finally adopted to the
disability determination process must be communicated to applicants,
especially in the early stages of a return to work strategy. SSA should
alert all applicants, no matter whether they are approved early or
denied at the latest stage, that SSA embraces a return to work
philosophy that gives all beneficiaries the opportunity to work up to
their ability with appropriate supports. This philosophy must be
communicated often and at every step to debunk the myth that disability
benefits and work are mutually exclusive.

The proposed changes call for establishing a Disability Program Policy
Council (the Council) to provide ongoing advice to SSA. The Panel
supported the establishment of the Council with diverse representation
of individuals involved in the disability determination process. The
Panel recommended that SSA develop a procedure for adding a member to
represent beneficiaries.

Other recommendations of the Panel included an assurance from SSA that
the creation of a dedicated quick disability determination process unit
not divert resources necessary for adjudicating more difficult cases in
a timely manner. SSA should reconsider whether all federal reviewing
officials must be attorneys or whether other professionals could be
considered for certification, and that standardized decision writing
formats adopt a "plain language" standard that makes it easy for
beneficiaries to understand.

## SSA Demonstration Authority {#ssa-demonstration-authority .Annual-Report-Heading-2 .unnumbered}

SSA's demonstration authority is an important part of an overall
strategy to move beneficiaries toward self-sufficiency through
employment. SSA currently has several major demonstration projects
underway in multiple states including the Mental Health Treatment study,
the Benefit Offset Demonstration, and the Youth Transition
Demonstration.

SSA has authority to continue projects initiated by December 17, 2005,
but its authority to initiate new demonstration projects ended on
December 18, 2005. The Panel recommended in a December 20^th^ letter to
the Chairmen of the House Ways and Means Committee's Social Security
Subcommittee and the Senate Finance Committee that Congress renew SSA's
authority to begin new demonstration projects. According to Berthy De La
Rosa-Aponte, the Chairperson of the Panel: "It is important to SSA's
beneficiaries and the American people that Congress renew SSA's
authority expeditiously, so the Agency can begin new demonstration
projects. Findings from these projects are vital in forwarding the
President's New Freedom Initiative."

##  {#section-3 .Annual-Report-Heading-2 .unnumbered}

## Conclusion {#conclusion .Annual-Report-Heading-2 .unnumbered}

This interim report highlights the Panel's 2005 findings, activities,
and recommendations on the implementation of the programs of the Ticket
to Work and Work Incentives Improvement Act of 1999. The report offers
the President, Congress, and the Commissioner of Social Security
specific recommendations to help our nation realize the benefits to the
economy and society of improved employment and self-sufficiency for
Americans with disabilities. It sets the stage for significant changes
to the Ticket to Work Program through adoption of amended rules in 2006.
The Panel will continue to recommend policy and systems changes to
improve collaboration of federal and state agencies, raise expectations
about work, promote adequate supports and services, and lead to
increasing the economic self sufficiency, economic status and community
participation for Americans with disabilities.

# References {#references .Annual-Report-Heading-1 .unnumbered}

"Administrative Review Process for Adjudicating Initial Disability
Claims: Notice of proposed rulemaking," 70 Federal Register 143 (July
27, 2005), pp. 43589-43624.

"Amendments to the Ticket to Work and Self-Sufficiency Program: Notice
of proposed rulemaking," 70 Federal Register 189 (September 30, 2005),
pp. 57222-57237.

"Continuation of Benefit Payments to Certain Individuals Who Are
Participating in a Program of Vocational Rehabilitation Services,
Employment Services, or Other Support Services: Final rule," 70 Federal
Register 121 (June 24, 2005), pp. 36494-36509.

"Reinstatement of Entitlement to Disability Benefits: Final rules," 70
Federal Register 189 (September 30, 2005), pp. 57132-57146.

"Rules for Helping Blind and Disabled Individuals Achieve Self-Support:
Notice of proposed rule-making," 70 Federal Register 131 (July 11,
2005), pp. 39689-39692.

Ticket to Work and Work Incentives Advisory Panel. Strategic Plan for
2006-2007, Version 1.2. Facilitated and Documented by Catoctin
Consulting, LLC (through International Leadership Consulting, LLC),
November 17, 2005.

# Appendices {#appendices .Annual-Report-Heading-1 .unnumbered}

## The Panel {#the-panel .Annual-Report-Heading-2}

**Members of the Panel**

Twelve individuals serve on the Panel: four appointed by the President,
four by the Senate and four by the House of Representatives. The
appointees represent a cross-section of experience and expert knowledge
as recipients, providers, veterans, employers and employees in the
fields of employment services, vocational rehabilitation and other
disability-related support services. Most are individuals with
disabilities or their representatives. Several have personal experience
as beneficiaries of Social Security.

**Cheryl Bates-Harris** is a Senior Disability Advocacy Specialist for
the Training and Advocacy Support Center (TASC) of NAPAS where she has
over 20 years experience and expertise working with people with
disabilities. She currently co-chairs the CCD Work Incentives
Implementation task force and CCD Employment and Training task force and
is an active member of the CCD Social Security Task Force. She was an
invited participant in the Ticket to Work & Work Incentive advisory
Panel 2003 EN Summit. The President appointed her to serve a 4-year term
ending in 2008.

**Katie Beckett** is a college student in Iowa and has been an advocate
all her life. She has often traveled to Washington, DC, to speak before
policymakers about children with special health care needs. She is the
co-founder of Kids as Self-Advocates (KASA) and former co-chair of the
KASA Board. The Senate appointed her to serve a 4-year term ending in
2006.

**Libby Child** was the Manager of Integrated Disability Management
Services for Steelcase, Inc., for 25 years before resigning in December
2002 to pursue consulting, teaching, and writing. She was responsible
for Steelcase, Inc.\'s integrated claims system under which workers\'
compensation, short- and long-term disability, permanent and total
disability, and compliance with the Family Medical Leave Act are fully
coordinated and managed. Since 1990, she has lectured extensively
throughout the United States on workers\' compensation and integrated
disability management and continues to serve on many disability-related
boards, commissions, and councils nationally and in Michigan. Ms. Child
is also a member of the National Academy of Social Insurance. The
President appointed her to serve a 4-year term ending in 2006.

**Berthy De La Rosa-Aponte**, M.A., Chair, has been a disability
advocate for over 25 years. She resides in Florida with her husband
Milton Aponte and Luz Elena (Lucy), the youngest of her three children
who has significant developmental disabilities. Mrs. De La Rosa-Aponte
holds a Masters of Arts Degree and is a naturalized US citizen, born in
Colombia, South America. She was appointed to serve on the Ticket to
Work and Work Incentives Advisory Panel by the House to serve a 4-year
term ending in 2007 and designated by the President to chair the Panel
for a 4-year term ending in 2008.

**J. Russell Doumas** is the Chief Executive Officer for TESH, which is
a community-based non-profit rehabilitation organization. Prior to July
2005 he was the President of Job Point (formerly Advent Enterprises).
His responsibilities included operating a comprehensive employment and
training center serving persons with disabilities and the economically
disadvantaged. He has more than 30 years of experience serving
individuals with disabilities. Mr. Doumas holds a MA in Rehabilitation
Administration from the University of San Francisco and a BA in
Political Science from the University of Kentucky. The House appointed
him to serve a 4-year term ending in 2008.

**Loretta Goff** is a Registered Nurse with a BS in Health Care
Administration, a MS in Community Mental Health Counseling and extensive
experience with the New York State Office of Mental Hygiene and Office
of Mental Retardation and Developmental Disabilities as a Nurse and
Treatment Team Leader. Ms. Goff has over 25 years of experience as a
Protection and Advocacy Specialist and currently serves on the New York
State Protection and Advocacy for Individuals with Mental Illness
Advisory Council. The House appointed her to serve a 4-year term ending
in 2008.

**Thomas P. Golden** is the Associate Director of the Employment and
Disability Institute in the Industrial and Labor Relations School at
Cornell University. Since joining the faculty in 1991, he has directed
several national initiatives focusing on training, technical assistance,
and organizational development related to work incentives, transition
systems change, and employment for people with disabilities. He recently
became a member of the National Academy on Social Insurance. The
President originally appointed him for a 2-year term and the Senate for
completion of a four-year term. The Senate has reappointed him to serve
an additional 4-year term ending in 2008.

**Frances Gracechild** is the Executive Director of the Resources for
Independent Living, Inc., in Sacramento, CA. She also serves as an
instructor at California State University at Sacramento and as the
president of Health Access of California. The House reappointed her to
serve a 4-year term ending in 2006.

**Andrew J. Imparato**, J.D., is a member of the Massachusetts bar and
is President and CEO of the American Association of People with
Disabilities (AAPD). He has extensive experience in public policy work
on behalf of people with disabilities and has served as General Counsel
and Director of Policy for the National Council on Disability, as
attorney--advisor to Commissioner Paul Steven Miller at the Equal
Employment Opportunity Commission, and as Counsel to the Senate
Subcommittee on Disability Policy. He is well known for his public
speaking to dispel myths about people with mental illness. The Senate
reappointed him to serve a 4-year term ending in 2008.

**David Miller** is responsible for the overall strategic planning and
policy development for human service programs at Communication Services
for the Deaf in Sioux Falls, SD. He was formerly the South Dakota State
Director of Rehabilitation Services and was responsible for the
administration of vocational rehabilitation, independent living,
personal attendant, and disability determination services throughout the
State. He has a master\'s degree in rehabilitation counseling and more
than 29 years of leadership experience in the development and management
of large public and private disability programs. The Senate appointed
him to serve a 4-year term ending in 2006.

**Dorothy Watson** an independent consultant, is known for her in-depth
knowledge and understanding of Social Security disability programs. She
has worked on numerous disability reform proposals in both the Executive
and Legislative branches of the US Government. She retired in 2001 from
the Senior Executive Services in the Social Security Administration
(SSA) after a long career that included more than a decade in
legislative affairs as well as a stint on Capitol Hill as a Professional
Staff Member of the Senate Special Committee on Aging. Recently, she was
on staff of Concentra Medical Centers, a company that serves injured
workers and their employers and was also a member of the Adequacy of
Incentives Advisory Group that provided recommendations for improvements
in the Ticket to Work Program. The President appointed her to serve a
4-year term ending in 2008.

**Torrey Westrom**, J.D., lost his eyesight at age 14 in a farm-related
car accident in 1987. He graduated from Bemidji State University in 1995
and was elected to the Minnesota House of Representatives in 1996,
becoming Minnesota\'s first blind elected State representative. He was
re-elected to his fourth term in November 2002 and continues to work on
policy issues ranging from training/employment opportunities for people
with disabilities to transportation and agriculture. He graduated from
law school in 2003 and became a member of the Minnesota bar. The
President appointed him to serve a 4-year term ending in 2006.

**Responsibilities of the Panel**

The Ticket to Work and Work Incentives Improvement Act of 1999, Public
Law 106-170 (the Act) established the Ticket to Work and Work Incentives
Advisory Panel (the Panel) within the Social Security Administration
(SSA) on December 17, 1999. The Panel is governed by the provisions of
the Act; Public Law 92-463, as amended, which sets forth standards for
the formation and use of advisory committees; and the General Services
Administration (GSA) regulations on the Federal Advisory Committee Act.
The original charter establishing the Panel was submitted to the GSA and
filed with the Committee on Ways and Means of the House of
Representatives and the Committee on Finance of the Senate on March 21,
2000; the charter was renewed in March 2004. The Commissioner of SSA
swore in the original members of the Panel on July 24, 2000.

Panel duties include advising the President, the Congress and the
Commissioner of Social Security on issues related to work incentives
programs, planning and assistance for individuals with disabilities and
the Ticket to Work and Self-Sufficiency Program. Operating procedures
governing the activities of the Panel have been developed and approved.
The Panel meets quarterly, alternating locations between Washington, DC
and the Ticket to Work Program roll - out states to hear regional
testimony. The Panel transmits an annual interim report on the
implementation of the Act to the President and Congress. This is the
sixth such report. A final report is due no later than December 17,
2007. The Panel terminates on January 16, 2008, 30 days after the
submission of its final report.

## B. Panel Correspondence and Policy Letters {#b.-panel-correspondence-and-policy-letters .Annual-Report-Heading-2 .unnumbered}

Panel correspondence and policy letters for calendar year 2005 are
listed below and provided on the following pages.

Advisory letter to Associate Commissioner Sue Suter with the Panel\'s
recommendations for possible consideration on the Benefits Planning,
Assistance and Outreach (BPA&O) Request for Applications (RFA).

February 11, 2005 B-2

Advisory Letter to Commissioner Barnhart Concerning the Release of the
Amendments to the Ticket to Work and Self-Sufficiency Program
Regulations.

August 26, 2005 B-8

Advisory Letter to Commissioner Barnhart in response to the Notice of
Proposed Rule Making on Rules for Helping Blind and Disabled Individuals
Achieve Self Support.

September 9, 2005 B-8

Advisory Letter to Commissioner Barnhart in response to the Notice of
Proposed Rule Making on the Administrative Review Process for
Adjudicating Initial Disability Claims.

October 25, 2005 B-14

Letter to The Honorable Jim McCrery and the Honorable Charles E.
Grassley recommending the Renewal of the Social Security
Administration\'s Authority to Begin New Demonstration Projects.

December 20, 2005 B-17

Advisory Letter to Commissioner Barnhart in response to Notice of
Proposed Rule Making: Amendments to the Ticket to Work and
Self-Sufficiency Program (Volume 70, Number 189).

December 22, 2005 B-19

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[ticket to work]{.smallcaps} & [work incentives advisory
panel]{.smallcaps}

February 11, 2005

Ms. Sue Suter\
Associate Commissioner, Office of Employment Support Programs\
Social Security Administration\
6401 Security Blvd.\
Baltimore, MD 21235

Dear Sue,

Thank you for providing the Ticket to Work and Work Incentives Advisory
Panel the opportunity to provide you with our recommendations for
possible consideration as you finalize the Benefits Planning, Assistance
and Outreach (BPA&O) Request for Applications (RFA) that the Agency will
be releasing in early 2005.

The Panel continues to strongly support the work incentives outreach
provision of the Ticket to Work and Work Incentives Improvement Act
which authorizes BPA&O services. We have heard considerable public
comment on the effectiveness and positive impact of the BPA&O program as
well as some constructive feedback that could potentially enhance the
effectiveness of this national network. As the Ticket to Work Act cites,
benefits planning is a critical employment support and piece of an
effective return-to-work agenda.

Based on past experiences with the Ticket rollout, we can reasonably
expect a substantial increase in workloads as the Agency proceeds with
several major changes including: the continued sponsorship of this
national BPA&O network and several other initiatives such as modifying
existing regulations to encourage more beneficiaries and EN\'s to
participate in the program and implementing a comprehensive marketing
program to beneficiaries most of whom remain confused about what a
ticket is and why they might want to use it. In view of the expected
demands on BPA&O services, we recommend enhancements in five critical
areas that we feel could further reinforce the role of benefits planning
in fostering the positive employment outcomes and improved economic
self-sufficiency of beneficiaries.

1\. RESOURCE ISSUES

There are 117 BPA&O programs in the United States comprising 550
benefits specialist across 192 sites. To date, the network of BPA&O
programs has impacted over 150,000 beneficiaries nationwide in the past
four years. In the past two years BPA&O Programs have experienced
unprecedented growth in the number of beneficiaries accessing their
services. As they have built collaborative relationships in the
communities they serve and as word has spread so has the demand for
these critical services. This has forced some programs to establish
waiting lists, often resulting in one to three month delays in
service-time ill-afforded for someone who is ready, willing and able to
work and opportunity lost for the Agency.

Many BPA&O programs report staff turnover which inadvertently impacts
service delivery. We note that a human resource study conducted in
federal regions I, II and V by Cornell University (2002) documented that
the pay scales for benefits specialists varied drastically across
programs with the highest salaries going to specialists employed within
state agency-based BPA&O programs. The limited financial resources
available to these programs and caps on awards appear to limit their
ability to provide substantial enough compensation packages and career
advancement opportunities to incent the ongoing employment of benefits
specialist once hired and trained. Often these well-trained specialists
are enticed to job opportunities outside the BPA&O infrastructure
although still within the employment supports realm. This human resource
obstacle inevitably winds up costing both the BPA&O program and the
Agency considerable dollars.

Finally, geographic access to BPA&O services and supports is not
equitable. BPA&O programs based in rural settings face resource barriers
on several fronts. First, because their beneficiary population is small
so is their award. Many of these locations cover thousands of square
miles with no more than a \$50,000 award. This amount of money barely
covers one full time equivalent much less the travel dollars that are
needed to ensure access for all beneficiaries. Given lack of public
transportation this requires that the benefits specialist travel up to
four to five hours in some cases to provide services to beneficiaries on
the outskirts of their geographic catchment area. A benefit specialist
could spend an entire day just traveling and that is without the time
needed to conduct an interview with the beneficiary and complete a
benefits analysis. The resource picture is bleak and as the demand for
this service grows so should the resources. In our most recent Annual
Report (July 2004) the Panel noted concern about the beneficiary demand
for services and the funding levels. We recommend the following:

-   Increase the amount of resources allocated to the national network.

-   Remove the individual awards cap for projects to ensure that
    programs based in rural settings have the resources they need to
    provide equitable services to their urban and metropolitan
    counterparts.

-   Require response/acknowledgment to the beneficiary within a
    specified period of time say 24 hours.

-   Require Management Information reports to include data on
    beneficiary waiting times for a response, an appointment and for
    services.

-   Provide a point of contact so that individuals having difficulty
    receiving services from BPAO can let SSA know about the specific
    reason for example, no response at all or long wait for an
    appointment.

-   Provide special consideration to proposals that develop workable
    ways to effectively deal with limited resources **.**

2\. UN/UNDER-SERVED POPULATIONS

The National BPA&O Database maintained by Virginia Commonwealth
University documents that services and supports are equitably
distributed between men and woman and disability beneficiaries and SSI
recipients / concurrent beneficiaries. Over 80% of services are provided
to individual\'s aged 22-59 with fewer than 8% of services going to
transition-aged youth. While the majority of emphasis has been on
"working-aged" individuals, in sync with the Agency\'s increased
priority on transition-aged youth, efforts are needed to increase
outreach to transition-aged youth---preparing them for employment and
future Ticket use.

Another area in need of further study is the extent to which specific
disability groups receive equitable access to services. While over 33%
of individuals served by BPA&O programs have had a psychiatric or
emotional disability fewer than 9% have been individuals with mental
retardation. Many BPA&O programs are based in community agencies that
provide specialized rehabilitation services to specific disability
groups and measures should be taken to ensure that they are able to
provide equitable access to all disability populations. Finally, at the
2004 Annual Conference of the Consortia of Administrators for Native
American Rehabilitation (CANAR) a member of the Ticket to Work Panel
conducted a focus group with approximately 45 Native American vocational
rehabilitation (VR) specialists. One of the barriers identified by this
group was that some BPA&O programs have limited access to tribal lands
and further that they do not have formal agreements with Section 121 VR
Programs or Tribal Councils to ensure access. The Panel recommends the
following:

-   Require BPA&O programs to state how they will target and serve
    transition-aged youth.

-   Require BPA&O programs to state how they will ensure equitable
    access to and services for all disability groups regardless of their
    primary agency\'s affiliation.

-   Require BPA&O programs that cover tribal lands and sovereign nations
    to provide clear and convincing documentation of how they will
    ensure equitable access and services for Native American and Alaskan
    Native populations. Examples of this might be formal agreements with
    Tribal government, Section 121 VR Programs, etc.

3 **.** TRAINING AND QUALITY ASSURANCE

The goal of the work incentives outreach provision of the Ticket to Work
and Work Incentives Improvement Act is to ensure that beneficiaries have
access to the information they need, when they need it to support
informed decision making in regard to employment. However, one must look
more broadly at the Ticket to Work Act to understand that the employment
supports outlined in the law were not meant to be isolated from one
another. Each provision of the law carefully details an essential
employment support, that when coupled together, leading to a goal of
employment and greater economic self-sufficiency. Our understanding is
the work incentive improvements built into the law were put there to
remove fears associated with going to work---fear of losing health care
and not being able to get back on benefits if one needed as a result of
their disability. The work incentive outreach provision was to ensure
that beneficiaries had access to the information they needed to make an
informed choice about work. Protection and advocacy services were built
in to ensure legal representation and advocacy in the case that a
beneficiary experienced an obstacle on the way to work. Finally, the
Ticket to Work and Self-Sufficiency Program was the top of the
employment supports pyramid which provided the vehicle by which to
obtain work.

The Agency conducted a customer satisfaction survey in year two of the
BPA&O project as part of their program evaluation. The customer survey
elicited opinions of the information and services provided by benefits
specialists in BPA&O organizations, and addressed participant work
activity before and after counseling. Respondents\' recollection of work
activity indicated that benefits counseling had a positive impact in
this area. It was unclear from the survey the type of work in which
beneficiaries were participating. It would be useful to obtain more
information about the work activity, such as was it paid integrated
employment.

BPA&O programs have a responsibility to present a myriad of options that
exist for a beneficiary when it comes to making decisions about work
that include total economic self-sufficiency. BPA&O programs are well
positioned to help a beneficiary understand the total dollar value of
disability benefits and public entitlements that they receive and the
earnings they would need to completely offset that. This information is
also critical to Employment Networks (EN) as they consider the earnings
levels that they need to place beneficiaries at to maximize potential
for employment success. To ensure that all BPA&O programs adhere to a
common philosophy and set of service delivery standards quality
assurance measures must be put into place.

Further, we believe that Benefits Specialists must be well-versed and
equipped to provide services and supports not only on the Agency\'s
return to work programs and work incentive provisions but other state
and federal entitlements as well. While the Agency has established a
seven-day core training curriculum that encompasses all of it\'s
disability, return to work and work incentive programs as well as other
federal entitlements and programs, the panel has received extensive
public comments that the time allotted to cover all the information in
the national curriculum is not sufficient and that the number of days
for the program should be extended to allow for in-depth and through
coverage of content. Finally, while we commend the Agency for the
extensive efforts to ensure a minimum level of competency for benefits
specialists in regard to SSA and other federal programs, we are
concerned there seem to be minimal guidance to BPA&O Programs regarding
state training requirements and many other programs. In fact, we
understand that many BPA&O programs may not have formal training that
their benefits specialists receive in regard to SSA and other federal
programs. To accomplish this end we make the following recommendations:

-   Continue to use a national core competency-based curriculum that
    establishes minimum standards for effective service delivery and
    ethical considerations when preparing benefits specialists for the
    field and that they have access to ongoing technical support.

-   Increase the duration of the initial five-day training session to
    realistically reflect the breadth and complexity of the SSA\'s
    disability programs including the Ticket to Work program and other
    relevant federal programs.

-   Establish minimum qualifications for new Benefit Specialists and
    timeframes for conducting training about State and local programs.

-   Require that BPA&O programs have a quality assurance plan that is in
    alignment with standards set by the Agency and that a grievance
    procedure be established within each BPA&O program. Require that
    evidence of compliance with this plan be submitted regularly.

-   Require that BPA&O programs notify beneficiaries of the established
    grievance procedure and the availability of PABSS services.

-   Require data collection strategies to provide a full picture of the
    benefits counseling process (rather than snapshots of the
    individual\'s journey) and address the identification or resolution
    of barriers and the outcomes achieved by the individual.

4\. PARTNERSHIP

As described above, partnership and collaboration of the critical
employment supports detailed in the Ticket to Work Act are essential.
Some BPA&O programs have developed model partnerships with ENs to
maximize the employment success of the beneficiaries they both serve.
This promising practice must be reinforced and incentivized by the
Agency. A Customer Satisfaction Survey conducted by the Agency showed
that in some cases beneficiaries reported not knowing what to do with
the information they had been given by BPA&O programs---what was the
next step down the road to work. To eliminate or minimize this
occurrence we recommend the following:

-   Require BPA&O programs to have agreements with ENs, and also
    Disability Program Navigators, in their geographic catchment area to
    promote positive working relationships.

-   Provide an incentive to BPA&O programs and ENs for working together
    to promote employment success.

In addition, to the above specific recommendations we urge a stronger
linkage with SSA. Individuals in the SSA field offices need a
familiarity with the BPAO programs, and need to work together with the
benefits counselor when appropriate to resolve issues. Field offices
staff need to have confidence that the benefits counselors are providing
accurate information. SSA staff should be trained to a level where they
feel comfortable making assertions about the SSA disability programs,
but should work together with the benefits counselors to explore detail
and to understand the impact work may have on a variety of federal,
state and local benefits. While we have no specific recommendation, this
may mean making greater efforts at joint problem solving.

In line with our recommendations in other critical areas, we feel that
partnerships can position BPA&Os to enhance limited resources and to
better serve un/underserved populations. For example, inter state
cooperation to serve boarder areas or special populations, and use of
video or distance learning technology, allow BPA&Os to generate and keep
program income. Colocating BPA&O services in agencies already serving
disability groups, such as Independent Living Centers and One-Stop Work
Centers could add value to existing resources and assist in reaching the
un/underserved. This is also true of colocating services such as BPA&O
with Disability Navigators.

We appreciate your consideration of our recommendations. If you or your
staff have any questions, please contact Jill Houghton, Executive
Director, at (202)358-6430.

Sincerely,

Berthy De La Rosa-Aponte

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[^1]: The General Accounting Office (GAO) changed its name to the
    Government Accountability Office in 2004.

[^2]: The slogan, "Nothing About Us Without Us", is usually attributed
    to Ed Roberts, considered by many to be the father of the
    independent living movement. It is used by the disability rights
    movement worldwide. Ed Roberts said, "If we have learned one thing
    from the civil rights movement in the U.S., it's that when others
    speak for you, you lose." (Driedger, D, The Last Civil Rights
    Movement: disabled people's international, New York, St Martin's
    Press 1989:28).

[^3]: In 2003, SSA and the U.S. Department of Labor's Employment and
    Training Administration jointly created the DPN initiative to serve
    selected workforce investment areas and One-Stop Career Centers in
    seventeen states. The DPN is responsible for improving access and
    support in One-Stop Career Centers and improving collaboration with
    other service delivery and funding systems that impact people with
    disabilities including BPAO programs, Social Security field offices,
    Medicaid, Vocational Rehabilitation, Transportation, and Mental
    Health and Developmental Disability service agencies.