Ticket to Work and Work 

Incentives Advisory Panel

Annual Report to the President and Congress 

Year Four 

May 2004 
Contents 

A Message from the Chair 

Executive Summary 

Background 

Annual Interim Report to the President and Congress—Year Four 

Emerging Issues 

Update on Evaluations and Demonstrations Conducted by SSA 

References 

Summary of Year Four Public Meetings and Panel Activities 

APPENDICES 

A. The Panel 

B. Panel Correspondence and Policy Letters 

C. Advisory Panel Recommendations 

D. Ticket to Work and Work Incentives Advisory Panel Advice Report to Congress and the 

Commissioner of the Social Security Administration, The Crisis in EN Participation: A 

Blueprint for Action, Issued February 2004 

Annual Report to the President and Congress ii 
A Message from the Chair 

On behalf of the Ticket to Work and Work Incentives Advisory Panel, it is my privilege to issue our 

Fourth Annual Interim Report to the President and Congress. Our report includes the Panel’s findings, 

issues, conclusions, and recommendations on the implementation of the programs and projects of the 

Ticket to Work and Work Incentives Improvement Act of 1999 (the Act) by the Social Security 

Administration and other Federal agencies that are responsible for implementation or whose programs 

affect it. The Panel has raised a number of timely and important issues in this report, which makes 

specific recommendations to the President and his Commissioner of Social Security, and to Congress. 

It was an active year for implementation of the Ticket Program and implementation and operation of the 

Act’s other employment support programs, such as the Benefits Planning Assistance and Outreach 

Program and the new work incentives. Millions of tickets were mailed out to beneficiaries, and 

thousands of people assigned their tickets to employment networks or State vocational rehabilitation 

agencies. Although the Panel is encouraged by the continued interest in the programs, it is important to 

point out new policy and program areas of serious concern. We have highlighted these areas in this 

report and hope that our discussions and the advice and recommendations we make will contribute to 

improvements in these programs and projects and, ultimately, to increased employment opportunities for 

Supplemental Security Income recipients with disabilities and Social Security Disability Insurance 

beneficiaries. 

It is my privilege to share with you this Year Four Annual Interim Report. 

Respectfully submitted, 

Sarah Wiggins Mitchell, Chair 

Annual Report to the President and Congress iii 
Executive Summary 

Calendar year 2003 marked the fourth year of implementation of Public Law 106–170, the Ticket to 

Work and Work Incentives Improvement Act of 1999 (the Act). Passed by a vote of 99 to 0 in the 

Senate and by an overwhelming majority in the House of Representatives, this legislation represents a 

bipartisan shift in the Nation’s attitude toward the employment of people with disabilities and the 

contributions they can make to our economy. During this fourth year, millions of Social Security 

recipients received tickets, thousands seeking employment deposited them with an employment network 

(EN) or a State vocational rehabilitation agency (SVRA), and thousands of others went to work using 

new State Medicaid Buy-In Programs and other work incentives now available under the Act. 

This is certainly encouraging, but the Panel (see appendix A for a list of members) has serious concerns 

about a number of important implementation issues that surfaced this year and/or continue to exist. 

These issues, specifically those vital to the success of the Ticket Program as well as those important to 

the efficient and effective operations of the Social Security Administration’s (SSA’s) overall 

employment support programs, are discussed in this report. The Panel believes that if the problems 

outlined herein are not addressed immediately by the Commissioner of Social Security, the President, 

and Congress, they will effectively eliminate the work incentives and employment supports created 

under the Act. Inaction will deter the future use of these programs and threaten the very existence and 

success of the Ticket Program. Neglecting to address these problems would label the Ticket Program a 

failure without its ever having had a chance to succeed. 

PANEL RECOMMENDATIONS—YEAR FOUR 

The Panel recommends that, if necessary, Congress amend the statute to permit the Commissioner to 

increase the sum of payments available for Supplemental Security Income (SSI) recipients to equal the 

sum of payments available for Social Security Disability Insurance (SSDI) beneficiaries. 

The Panel recommends that, if necessary, Congress amend the statute to expressly permit payments to 

ENs to be set at a level greater than 40 percent of average benefits for both SSDI and SSI beneficiaries. 

The Panel recommends that Congress direct the Commissioner to immediately modify the EN payment 

system to move more of the payment into the first 12 months of employment, reduce the difference 

between milestone and outcome payments, and test two or three creative cost-effective approaches that 

place more of the up-front financial risk on SSA. 

The Panel reiterates its previous recommendation to Congress to authorize payments to ENs for benefits 

reduction that results in other than zero benefits. 

The Panel recommends that Congress immediately direct the Commissioner to change the EN payment 

claims process so that once a beneficiary has been certified as 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 zero benefit status. 

The Panel recommends that Congress clearly articulate its intent that the Ticket Program’s outcome and 

milestone payments should provide additional resources to help beneficiaries attain and retain 

Annual Report to the President and Congress 1 
employment; in effect, Congress did not intend to make beneficiaries ineligible for the full range of 

services from vocational rehabilitation (VR) programs, Medicaid, or other Federal and State programs 

by making them eligible for the Ticket Program. 

The Panel recommends that the President and Congress direct the Commissioner to implement the 

Ticket Program as a complement to the traditional SSA VR Reimbursement Program, reimbursing State 

VR agencies for up-front services and early employment outcomes and paying ENs for long-term 

employment supports and outcomes. 

The Panel recommends that the President and Congress direct the Commissioner to immediately 

implement a strong national marketing program and that Congress designate adequate resources for this 

effort. 

The Panel recommends that the President and Congress direct the Commissioner to inform beneficiaries 

about the Ticket Program at least once a year. 

The Panel recommends that Congress designate funds and direct the Commissioner to increase efforts to 

provide accurate and timely information on the Act and its programs and on other work incentives 

available to SSI and SSDI beneficiaries. 

The Panel recommends that Congress fund the Benefits Planning Assistance and Outreach (BPAO) and 

Protection and Advocacy for Beneficiaries of Social Security (PABSS) Programs at the following levels: 

increase funding for the BPAO Program to $46,000,000, increase the minimum amount of each State 

grant for the PABSS Program to $200,000, and increase PABSS funding as a whole to $14,000,000 per 

fiscal year (FY). 

The Panel recommends that the President direct the Secretaries of the Departments of Education (ED), 

Labor (DOL), and Health and Human Services (HHS) and the Commissioner of Social Security to 

provide leadership to increase the level of cooperation on implementation of the Act and true integration 

of services. 

The Panel recommends that Congress direct the Commissioner to work closely with other Federal and 

State systems to develop and implement a national training plan. Congress should also designate the 

additional funds needed for training and technical assistance. 

The Panel recommends that Congress extend the Continuing Disability Review (CDR) protection 

currently available to participants in the Ticket Program to any and all beneficiaries participating in an 

approved VR program. 

The Panel recommends that funding be identified for increased training and outreach to parents and 

youth on SSI work incentives and transition planning. 

The Panel recommends that Congress change the mandatory redetermination age from 18 to 22. 

The Panel recommends that Congress increase the age limit for the Student Earned Income Exclusion to 

at least 26. 

Annual Report to the President and Congress 2 
The Panel recommends that Congress create, or encourage Federal agencies to create, an interagency 

research priority on youth who have disabilities and are receiving SSI. 

The Panel recommends that Congress provide the Centers for Medicare & Medicaid Services (CMS) 

with a mandate and funding to study the impact of the Medicaid Buy-In Program on employment 

outcomes for people with disabilities. 

The Panel recommends that Congress amend the statute to grant additional flexibility to States in 

meeting matching fund requirements for the demonstration projects in order to maintain independence. 

The Panel recommends that Congress strengthen and simplify the expedited reinstatement provision by 

allowing SSA to use the beneficiary’s diary date to decide whether someone who applies for expedited 

reinstatement is required to undergo a CDR, eliminating the legislative requirement that beneficiaries 

can apply for an expedited reinstatement only if the disability is the only reason for the job loss and 

eliminating the 24-month waiting period so that beneficiaries who use this provision can access all work 

incentives immediately. 

Annual Report to the President and Congress 3 
Background 

Summary of the Act 

This legislation, enacted on December 17, 1999, is administered by SSA and 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 the opportunity to work and thereby lessen their dependence on public benefits. 

Different provisions of the Act became effective at various times, generally beginning a year after 

enactment. 

Summary of Title I—Programs 

Subtitle A—Ticket and Related Programs 

Subtitle A established the Ticket Program, under which most Social Security and SSI disability 

beneficiaries received a ticket that they can use to obtain VR, employment, or other support services 

from an approved rehabilitation provider of their choosing. This voluntary program was phased in 

nationally over 3 years. It establishes a program manager, ENs, and EN payment systems; calls for a 

report on the adequacy of incentives and the establishment of a dispute resolution mechanism; provides 

for suspension of CDRs for those using the ticket; and establishes the Ticket to Work and Work 

Incentives Advisory Panel to advise the Commissioner of Social Security, the President, and Congress 

on this 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 BPAO Programs and the 

internal corps of Social Security experts on work incentives and employment. It also establishes a grant 

program for a protection and advocacy (P&A) agency in each State to help beneficiaries. 

Summary of Title II—Expanded Availability of Health Care Services 

Title II expanded State options under Medicaid for workers with disabilities. It calls for a General 

Accounting Office study on extending Medicare coverage for Social Security recipients and establishes 

a State Medicaid Infrastructure Grant authority and demonstration projects. It calls for a demonstration 

of Medicaid coverage of workers with potentially severe disabilities and allows beneficiaries with 

disabilities to suspend Medigap coverage. 

Annual Report to the President and Congress 4 
Summary of Title III—Demonstration Projects and Studies 

Title III extended 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 

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 will be 

critical to the success of the Ticket Program. 

Under Title I—Ticket and Related Programs 

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 (ODISP) 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 Program, 

and selected Maximus, Inc., as the contract program manager to recruit rehabilitation providers as ENs. 

Area Work Incentive Coordinators (AWICs) in the Area Offices and Work Incentive Liaisons (WILs) in 

the Field Offices work within SSA to implement the Ticket Program, work incentives, earnings 

reporting, and other employment support programs and provisions. The Ticket to Work and Work 

Incentives Advisory 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. 

The Act authorizes and SSA administers grants to State P&A systems. These grants are intended to help 

beneficiaries obtain information and advocacy services on issues related to receiving employment 

services and to work with all parties to resolve disputes. BPAO Programs are authorized by the Act and 

funded by SSA to provide benefits planning and counseling to beneficiaries and outreach and public 

education to communities on work incentives and employment supports for beneficiaries. State VR 

agencies, authorized by the Rehabilitation Act of 1973 and administered by the ED’s Rehabilitation 

Services Administration (RSA), provide VR and a broad range of return-to-work services for SSA 

beneficiaries. Special Education at the State level, administered by the ED’s Office of Special Education 

Programs, serves beneficiaries between the ages of 14 and 22 in school-to-work transition programs. 

One-Stop Employment Centers at the local level, administered by DOL’s Employment and Training 

Administration, are specifically referenced in the Act as potential ENs, and the Centers typically include 

State VR agencies as One-Stop partners. Other parts of DOL, such as the Office of Disability 

Employment Policy, are involved in national public policy decisions that potentially affect beneficiaries 

returning to work. 

Under Title II—Expanded Availability of Health Care Services 

The CMS and State Medicaid agencies are partners in providing increased medical coverage for 

beneficiaries. 

Annual Report to the President and Congress 5 
Other HHS agencies represent obvious potential partners. Agencies such as the Administration on 

Developmental Disabilities, the Maternal and Child Health Bureau, and the Center for Mental Health 

Services are authorized and funded to provide advocacy, residential, and employment support services 

to low-income individuals with disabilities, a large number of whom are from specific SSA beneficiary 

populations. 

Under Title III—Demonstration Projects and Studies 

SSA’s Office of Program Development and Research, within the ODISP, conducts or commissions 

mandated demonstration projects and studies. 

Other natural partners in this area include the ED’s National Institute on Disability and Rehabilitation 

Research (NIDRR) and the Interagency Committee on Disability Research, as well as the Assistant 

Secretary for Planning and Evaluation in HHS, and the independent National Council on Disability. All 

undertake or coordinate research on people with disabilities, including SSI recipients and SSDI 

beneficiaries. 

Finally, work and earnings impact many other programs that SSI and SSDI beneficiaries are eligible for, 

including public housing programs such as Section 8 and housing subsidies administered by the 

Department of Housing and Urban Development (HUD) and the Transit Subsidy Program administered 

by the Department of Transportation (DOT). Both of these program areas present profound opportunities 

for creating public policy partnerships and integrating service systems. 

Annual Report to the President and Congress 6 
Annual Interim Report to the President and Congress—Year Four 

Introduction 

This fourth annual report of the Ticket to Work and Work Incentives Advisory Panel identifies issues 

and recommends improvements that affect a variety of important Federal and State programs mandated 

by the Act. These programs are administered by SSA and the Departments of Health and Human 

Services, Education, and Labor. They include the SSI and SSDI work incentive provisions, Workforce 

Investment Act and Rehabilitation Act programs, and the Medicaid and Medicare programs. 

The Act, which passed by a vote of 99 to 0 in the Senate and by an overwhelming majority in the House 

of Representatives, represents a clear, bipartisan shift in the Nation’s attitude toward the employment of 

working-age persons with disabilities and the contributions they can make to our economy and society. 

By passing this legislation, Congress recognized that a significant number of people who have 

disabilities and are eligible for SSI and/or SSDI desire to work. Congress also acknowledged that many 

national policies and procedures in a number of large Federal programs act as disincentives and barriers 

to work, preventing people with disabilities from even attempting to do so. Congress concluded that 

with the proper supports, many of these individuals would attempt to work, but that the appropriate 

services and supports were not available to help them make the transition. Finally, by passing the 

Medicaid and Medicare provisions in the Act, Congress recognized the critical importance of continuing 

health care for people who have disabilities and want to return to work. 

Calendar year 2003 marked the beginning of the final stage of ticket rollout to the remaining 20 States. 

To date, almost 7 million tickets have been mailed to SSI recipients and SSDI beneficiaries in 13 Phase 

One, 20 Phase Two, and 20 Phase Three States, and all beneficiaries will have received their ticket by 

September 2004. The response from beneficiaries has been overwhelming and encouraging but 

troublesome at the same time; hundreds of thousands have called the national program manager, 

Maximus, and their locally listed ENs for information. During 2003, the Maximus Ticket to Work Web 

site www.yourtickettowork.com received 10 million hits. More than 1,200 ENs have applied for the 

Ticket Program, and 1,064 are enrolled, but only 386 ENs are actually serving beneficiaries. Although 

almost 39,500 beneficiaries have deposited their tickets, either with their current SVRA or with one of 

the EN providers (this is a threefold increase over last year), 90 percent have deposited their tickets with 

a SVRA and have not used other ENs that have enrolled in the program. Of the beneficiaries who have 

deposited their tickets, about 700 are in outcome payment status because of employment; however, the 

ENs who served 300 of these beneficiaries have not yet begun to receive payments from SSA. 

Consumers have also continued to access SSA’s two new grant programs. As of December 31, 2003, 

almost 100,000 beneficiaries had used the BPAO Program for information on benefits planning. Some 

11,629 people had received services ranging from information and referral to legal representation from 

the PABSS Programs, which are operated by State P&A agencies. The Panel is pleased to note that SSA 

provided full funding for both of these programs in FY 2003, but is nevertheless concerned that these 

vital programs have yet to be adequately funded. 

States that have opted for the Medicaid Buy-In Program are now positioned to address lack of access to 

health care as a barrier to employment. Forty-two States and the District of Columbia are receiving the 

Medicaid Infrastructure Grants authorized under the Act, and 27 States now have operational Medicaid 

Annual Report to the President and Congress 7 
Buy-Ins, enacted under the authority created both by this Act and by the Balanced Budget Act. More 

than 60,000 people with disabilities are working in the 27 States participating in the Medicaid Buy-In 

Program. At least 5 other States (Louisiana, Nevada, North Dakota, Michigan, and West Virginia) have 

approved legislation to establish such a program. 

Further, SSA continued to issue regulations to implement provisions of the Ticket Program and to 

clarify implementation practices. In July and October 2003, respectively, final rules to eliminate 

sanctions for refusal of VR services and proposed regulations on expedited reinstatement (section 112) 

were published. In August 2003, a Notice of Proposed Rule Making (NPRM) on the Continuation of 

Benefits to Certain Individuals Who Are Participating in a Program of Vocational Rehabilitation 

Services, Employment Services, or Other Support Services was issued. SSA is also drafting regulations 

on exemption of work activity as a basis for a CDR and reports considering proposed rules that would 

revisit several areas of the final rules published in December 2001 for the Ticket Program, including 

eligibility, State VR participation, and provisions related to EN payment rates and processing. 

Development of regulations will be a significant and ongoing SSA activity during the next several years 

of Ticket Program implementation and evaluation. The Panel will continue to provide input into the 

policy process and to review and provide our best advice to the Commissioner of Social Security as 

regulations are developed. 

The information provided so far is encouraging, but the Panel has serious concerns about a number of 

important implementation issues that surfaced this year and/or continue to exist. We discuss these issues 

in this report and believe that if they are not addressed immediately by the appropriate authorities (the 

President or the Commissioner and Congress), they will effectively eliminate the work incentives and 

employment supports mandated under the Act and undermine the employment efforts of SSI and SSDI 

beneficiaries across the board. Inaction will deter the future use of these programs and other 

employment support programs at SSA and elsewhere, and, indeed, the very existence of the Ticket 

Program is threatened. Neglecting to address these problems would label the Ticket Program a failure 

without its ever having had a chance to succeed. 

SSA has failed to market the Ticket Program to beneficiaries, most of whom remain confused about 

what a ticket is and why they might want to use it. The Panel also believes that SSA has failed to engage 

enough ENs for the Ticket Program and has failed to support the ones that have enrolled. Enrolled ENs 

are serving only a fraction of the beneficiaries thought to be interested in participating, and although 

approximately 1,100 providers have enrolled, only about one-third have accepted tickets and are serving 

beneficiaries. 

Finally, an overwhelming number of tickets, approximately 90 percent, have been assigned to SVRAs. It 

appears that the fundamental principle enacted by Congress in this legislation, that of allowing 

beneficiaries to choose providers, is not a priority for SSA. The Panel urges Congress and the 

Commissioner of Social Security to give immediate attention to the very real problems affecting EN 

participation and the Ticket Program. Over the past 4 years, the Panel has made a number of substantive 

recommendations to the Commissioner, the President, and Congress. (See appendix B for a sampling of 

Panel correspondence and policy letters and appendix C for a full compendium of recommendations and 

policy or legislative responses.) Although some of these recommendations have been addressed, several 

have not. The Panel is fully aware of the budget cuts, limitations, and fiscal constraints Federal 

programs face, particularly those in SSA’s field operations and program administration. For this reason, 

we believe it important to note that when Congress authorized SSA to administer the programs and 

Annual Report to the President and Congress 8 
projects under the Act, it did not designate additional administrative funds to support and develop these 

new systems and programs and to administer the new activities and procedures necessary for startup and 

operation. Funding for these activities has had to compete with every other claims processing and 

customer service priority for scarce administrative resources. This situation has not gotten any better; in 

fact, competition for administrative dollars will intensify this year and in the coming years. The 

President’s budget request for SSA administrative funding in FY 2004 was reduced by more than $160 

million. Experts predict that this situation will get worse with the coming retirement of the baby 

boomers. Critical Ticket Program functions, employment support program operations, and 

administrative supports are in jeopardy because of the obvious lack of financial and administrative 

support for them. 

Implementation Issues 

The Panel has received regular updates on implementation from SSA and CMS officials and has invited 

a variety of field professionals, constituents, and other experts to share their knowledge and opinions. 

During 2003, the Panel also provided Social Security beneficiaries, employment services providers, 

advocates, and grantees with extensive opportunities for public input. SSA updates, expert briefings, 

research, and ongoing public comment from beneficiaries, advocates, employment service providers, 

field experts, and grantees have raised a number of serious implementation and policy issues. The Panel 

has studied and prioritized these issues and will next discuss them in detail. 

EN payment issues: The most significant problem contributing to low EN participation is the payment 

system. We see this as the most urgent issue requiring attention. According to a recent evaluation of the 

Ticket Program, ENs face significant difficulties with program implementation because of problems 

with the EN payment structure (Thornton et al., 2004). The evaluation team interviewed eight of the 

most successful ENs, determined by numbers of tickets assigned and payments received. All of them 

said that they were losing money on the Ticket Program. Despite the fact that all of these ENs had 

thriving, well-thought-out programs and had experienced some success in placing beneficiaries in 

employment, the situation looked fairly bleak. The evaluators conclude that the problem is so serious 

that many of these ENs will not be able to continue as providers unless circumstances change 

dramatically. On the basis of public testimony, the Panel believes that the dire situation faced by these 

ENs reflects that of most ENs enrolled in the Ticket Program. 

In February 2004, the Panel issued a Ticket Program report to Congress and the Commissioner titled 

The Crisis in EN Participation: A Blueprint for Action, which presented specific analysis and 

recommendations on important and timely issues. (See appendix D for the Executive Summary of this 

report.) The following section, based on the report, highlights three fundamental problems that 

discourage the active participation of many providers. 

Financial risk: Three aspects of the payment system appear to impose significant risk on providers. 

First, it requires ENs themselves to provide the capital to serve beneficiaries, while simultaneously 

requiring them to wait a relatively long time before they can recoup their costs. Most service models 

offered by ENs entail more intensive services early on (e.g., during the first year) and less intensive 

services over time. Second, the current payment system requires providers to wait 60 or more months to 

recoup full payment, introducing significant risk because, over time, more and more factors outside the 

provider’s control will affect the likelihood of the beneficiary’s employment (e.g., changes in health 

status, living arrangements, and labor market dynamics). The payment system, which involves equal 

Annual Report to the President and Congress 9 
outcome payments over time, does not recognize this increased risk to providers. Third, the risk is not 

equitably shared between ENs and SSA. ENs receive only 40 percent of the average expected savings to 

SSA but bear nearly all of the costs associated with generating those savings. 

Tom Foran, CEO, Integrated Disability Resources, Inc., public testimony, February 2004 

“In order to survive any longer, we cannot work with anyone on SSI. We just flat out cannot do it. 

Last year, the monthly payment for an SSI client was $167. It cost us almost that much to get 

paid—just to get paid, not to provide the services, not to place anybody; to get the actual payment, 

it cost us almost that much.” 

Payment for all work outcomes: During the past 20 years, Congress has adopted several work 

incentives that enable SSI beneficiaries to retain Social Security and medical benefits while working. 

For example, the $1 for $2 income benefit offset enables people to receive benefits while earning a 

monthly net income of almost $1,200. Many SSI beneficiaries must retain some level of benefits to live 

independently in the community, either because they will never earn enough to be self-supporting or 

because they use Medicaid funds for personal assistance services or adaptive equipment that they cannot 

obtain through private insurance. Beneficiaries who use these work incentives may remain on cash 

benefits longer than they would have without the incentives, or they may never entirely leave the benefit 

rolls. Because ENs are paid in full only when the beneficiary receives zero cash benefits, they face a 

higher risk of not receiving payment for the services they provide and, consequently, are less likely to 

serve SSI beneficiaries at all. The Panel has heard testimony repeatedly to this effect. In addition, the 

eight ENs interviewed in the Ticket Program evaluation (Thornton et al., 2004) agreed that they 

deserved some payment for the work they had done to get SSI recipients back to work, even though those 

recipients were still receiving cash benefits. 

The Panel raised this issue in its Year Two and Year Three Annual Interim Reports to the President and 

Congress. Beneficiaries who reduce their dependence on SSI not only reduce costs for the program, but 

also return a portion of their earnings in taxes and FICA (Federal Insurance Contributions Act) 

payments. ENs should have incentives to work with all beneficiaries who have some earnings potential, 

regardless of whether they can earn enough to completely leave the benefit rolls. One solution is for 

SSA to develop a payment schedule for ENs that helps beneficiaries find employment and reduces but 

does not eliminate their SSI payment. 

Lower payments for SSI recipients: The lower payment to ENs for serving SSI-only recipients relative 

to SSDI beneficiaries is problematic for several reasons. First, it is widely accepted that SSI-only 

recipients, on average, will be more difficult to place in long-term employment than SSDI beneficiaries. 

The combination of limited work histories, low skill levels, and severe physical and/or cognitive 

impairments makes SSI-only recipients more difficult to serve. Because of this fact and because EN 

payments for SSI-only recipients are lower relative to those for SSDI beneficiaries, SSA has created a 

strong incentive for ENs not to serve SSI recipients. The EN payment system neither recognizes that 

there are immediate savings to the SSI program when a recipient goes to work even at relatively low 

levels of wages nor rewards ENs accordingly for partial success. Reforming the EN payment system to 

provide payments earlier in the process and to ensure adequate funding so ENs are willing to serve a 

Annual Report to the President and Congress 10 
wide range of beneficiaries who want to work has been recommended by the Panel in its past three 

annual reports. The Panel continues to believe that it is imperative for SSA to move quickly to enhance 

the payment system to make it more attractive to ENs. To delay further will significantly jeopardize the 

success of the Ticket Program and the credibility of the Commissioner’s commitment to support returnto-work efforts. 

The Panel recommends that, if necessary, Congress immediately amend the statute to 

permit the Ticket Program to increase the sum of payments available for serving SSI 

recipients to equal the sum of payments available for serving SSDI beneficiaries. 

The Panel recommends that Congress clarify the language in the statute that permits 

payments to ENs to be set at a level greater than 40 percent of average benefits for 

both SSDI and SSI beneficiaries and authorize the Commissioner to increase EN 

payments for beneficiaries of both programs. 

The Panel recommends that Congress direct the Commissioner to immediately modify 

the EN payment system to move more of the payment into the first 12 months of 

employment and reduce the difference between milestone and outcome payments. 

Congress should direct the Commissioner to test two or three creative approaches that 

place more of the up-front financial risk on SSA, but that, if successful, could 

significantly increase Ticket Program participation by both ENs and beneficiaries, 

thus increasing long-term savings to the SSDI Trust Fund and decreasing General 

Fund expenditures. 

The Panel reiterates its previous (2001) recommendation to Congress to authorize 

benefits reduction that results in other than zero benefits not only as a successful 

employment outcome but also as a reasonable way of accruing additional savings to 

the Trust Fund. 

EN Payment Processing 

The financial risk and working capital problems we have noted are compounded by two factors 

associated with submitting and processing EN claims: the long-term tracking of beneficiary earnings and 

the long processing delays. SSA’s requirement that ENs provide long-term proof of earnings after a 

Ticket Program beneficiary is no longer in cash payment status is highly problematic. The eight ENs 

interviewed (Thornton et al., 2004) cited difficulties obtaining acceptable documentation of workers’ 

earnings, obtaining approval for payment requests, and receiving the payments owed. 

The policy of having ENs ensure that beneficiaries submit the appropriate documentation of earnings on 

a monthly basis is labor intensive and administratively burdensome. The problem is compounded by the 

fact that beneficiaries who are successfully employed have little or no incentive to cooperate with EN 

providers. Even when proof of earnings is obtained from beneficiaries, there are often long delays in 

processing EN claims for payment. The delays stem from a variety of sources, including EN 

misunderstanding of the process, missing or inadequate earnings information on beneficiary pay stubs, 

Annual Report to the President and Congress 11 
and the need for SSA to verify and adjust past and current benefits based on the information submitted. 

ENs have reported waiting as long as 120 days to receive payment on a claim (Livermore et al., 2003). 

SSA recently modified the payment claims process to address the issue of monthly earnings tracking 

and, to some extent, payment delays. Under certain circumstances, an EN need only submit a quarterly 

statement indicating that the beneficiary’s earnings have not declined. The Panel is pleased that SSA has 

moved to quarterly submissions and will monitor the impact of this change on ENs. However, we are 

concerned that SSA will make quarterly rather than monthly payments based on these statements and 

retroactively validate them. Small ENs without significant working capital report that they will have 

difficulty waiting for a quarterly payment. 

The Panel recommends that Congress immediately direct the Commissioner to 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 60 months of outcome payments or until the beneficiary requests 

a new EN. Moreover, the payment claims processing system should be refined to 

ensure timely payments to ENs within a businesslike time frame, such as 30 days. 

Marketing of the Ticket and other Provisions 

In its Year Two and Year Three Annual Interim Reports, the Panel urged Congress to direct the 

Commissioner to increase public awareness of the Act through an immediate, coordinated national 

marketing and public information effort that would explain to the general public, providers, and 

employers the array of programs and work incentives authorized under the Act and related legislation. 

Currently, beneficiaries are informed only once about the Ticket Program and may not be informed at all 

about other provisions and work incentives. The only information or marketing material most 

beneficiaries receive is a letter describing the program when the ticket is being rolled out or when they 

first become eligible for benefits. 

Beneficiaries apply for SSA benefits because they believe that they are unable to work. Many times it 

takes months for their claim to be decided and for them to receive benefits. Given their physical and 

emotional states, many beneficiaries who have been through the typically long and arduous process to 

obtain benefits will need more outreach from the Ticket Program. To shift their thinking to employment, 

many beneficiaries will need time and good, ongoing information. The Nation is spending millions of 

dollars on the public information and marketing campaign for the new Medicare Drug Discount 

Program. Operating a truly effective Ticket Program and employment support program could require a 

similar investment. In fact, the demand for tickets is beginning to diminish in the Phase One and Phase 

Two States, and many providers and advocacy groups are asking for another letter or contact by SSA to 

encourage beneficiaries to use the programs. 

The Ticket Program evaluation conducted by Mathematica Policy Research, Inc. (Thornton et al., 2004), 

found that the number of calls ENs received from beneficiaries about the Ticket Program dwindled 

significantly a few months after the ticket rollout in their State. This drop greatly concerns the Panel. A 

number of ENs have left the program because of the lack of demand for their services. 

Annual Report to the President and Congress 12 
SSA recently issued two contracts to support marketing efforts. The Employment Network Review 

Project will review and analyze available information about EN attitudes and experiences, collect 

supplemental information about EN needs, identify barriers to participation, and recommend ways to 

remove those barriers. The second contract, Strategic Marketing Plan and Implementation, will develop 

and implement a marketing plan aimed at each of the Ticket Program’s primary stakeholders: providers, 

beneficiaries, and employers. 

The Panel is pleased that the Commissioner appears to have begun implementing the Panel’s 

recommendations on marketing. Although these are very positive steps, we remain concerned that the 

next year or two will be devoted to planning instead of actually marketing the Ticket Program. 

Extensive planning will delay implementation of a national marketing plan even further. It is reasonable 

to assume that marketing would occur, not after, but before or during, the rollout of a new program, as is 

the case with the new prescription drug benefit. 

The Panel recommends that the President and Congress direct the Commissioner to 

immediately implement a strong, national marketing program and to engage the Panel 

in its marketing efforts, consistent with its advisory role. The Panel further 

recommends that Congress designate adequate resources for this campaign. 

The Panel recommends that the President and Congress direct the Commissioner to 

inform beneficiaries about the Ticket Program at least once a year. 

Employment Support Infrastructure 

In its Year Two and Year Three Annual Interim Reports, the Panel recommended that SSA implement 

its legislative mandate to “establish a corps of trained, accessible, and responsive work incentives 

specialists within the Social Security Administration who will specialize in disability work incentives 

under titles II and XVI” (Subtitle C, section 1149(a) (2) (C). Although the Commissioner has taken 

significant and positive steps during the past year to implement this mandate, the Panel still has a 

number of concerns. 

SSA has hired 58 staff who will work full-time as AWICs, that number to be expanded up to 70 as the 

need arises. Each AWIC will manage and coordinate the dissemination of information on work 

incentives and public outreach and provide expertise on ticket-related and other work incentives to 20 to 

30 Field Offices. Additionally, each of the more than 1,300 Field Offices has designated an existing staff 

person as a WIL. During the May 2003 quarterly Panel meeting, Deputy Commissioner Linda 

McMahon outlined SSA’s plan for training the internal corps of work incentive specialists. The plan 

included a “fan down, train-the-trainer” approach to increasing knowledge about work incentives among 

SSA staff. The AWICs received 2 weeks of training during the summer of 2003 and in turn provided a 

4-day training course for the WILs to initially equip them for their positions. The AWICs are also 

responsible for providing ongoing training in the Field Offices in addition to acting as the resident 

experts for everyone in the area. According to Deputy Commissioner McMahon’s presentation, all frontline SSA staff, including teleservice and claims representatives, will receive a 4-hour training session on 

SSA work incentives, although we have received no update on the status of this training. 

The AWICs are supposed to serve as the focal point for SSA’s work incentive efforts. They will provide 

outreach to advocacy groups and undertake other community education activities and will also provide 

Annual Report to the President and Congress 13 
ongoing technical assistance to the WILs. The WILs will continue to receive work incentive 

responsibilities in addition to their existing duties and will serve as a resource to all front-line Field 

Office staff. SSA officials have taken the position that “return to work” is the job of every SSA 

employee. 

The AWICs provide dedicated, full-time work incentive specialists as recommended by the Panel, and 

we commend the Commissioner for attempting to initiate this culture change and paradigm shift by 

creating the AWIC position. SSA’s obligation to provide quality employment support services at the 

field level has been long overlooked, and the Panel is very pleased to see such positive movement 

forward. At the same time, the Panel has concerns about several aspects of SSA’s current plan. 

For example, the Panel believes that the number of AWICs is not large enough to handle all of these 

responsibilities. All return-to-work efforts, particularly the Ticket Program, will fail unless SSA 

provides timely, accurate, and meaningful information about work incentives, earnings reporting, work 

CDRs, and related issues to hundreds of thousands of beneficiaries and their families and to the 

providers that want to serve them. Under SSA’s plan, the AWICs will provide expertise to Field Offices, 

spearhead public education efforts, and undertake other activities to provide timely and accurate 

information about SSI and SSDI work incentives. The Panel strongly believes that the number of 

AWICs should be increased. 

We continue to receive testimony at every meeting, in letters, and through other sources that SSA Field 

Office staff—including the WILs who have been expressly trained for this task—are giving 

beneficiaries inaccurate information about the Ticket Program and a variety of other work incentives and 

earnings reporting requirements. For example, one woman was told that she could not use her ticket to 

reach her goal of self-employment; another was told that the Ticket Program was similar to the Plan for 

Achieving Self-Sufficiency (PASS). 

At its February 2004 quarterly meeting, Panel members heard testimony that many of the AWICs and 

WILs consider themselves specialized in only one program area (SSI or SSDI) and often have to rely on 

the expertise of someone else to deliver effective content outside their area of expertise. Where does this 

leave dually eligible persons? The Panel is also concerned that, historically, the WIL position has 

experienced a high turnover rate. Although the initial training issues have been addressed by this 

approach, a plan for handling turnover and training new staff has not been presented. The Panel 

understands that undertaking training in hundreds of offices across the country and realizing its full 

benefit may take some time. In keeping with this very large task, a plan to measure the effectiveness of 

the work incentives training and the impact on the quality of information provided to beneficiaries 

should be immediately developed. A quality assurance program would ensure that beneficiaries receive 

accurate information and that SSA’s approach to providing such information is working effectively. 

The training period for AWICs is not long enough to provide the technical expertise needed. The 

employment service representatives (ESRs), who served as the former work incentives specialists, 

received 6 weeks of training and were widely viewed as experts on SSA work incentives and other 

employment provisions. Training for AWICs should be comparable. Fortunately, many of the AWICs 

received the 6-week intensive ESR training; however, this makes it difficult to ascertain whether their 

expertise resulted from the initial ESR training or from the subsequent AWIC training. The WILs also 

do not receive enough training to prepare them for their role. A 2-week program is probably more 

appropriate for giving them the information they need. The Panel recognizes, moreover, that the failure 

Annual Report to the President and Congress 14 
to implement some of these recommendations stems from the meager financial resources SSA receives 

to administer the programs under this Act. 

A final training issue is the lack of information being provided to consumers about their rights under the 

PABSS Program. The Panel is disturbed that beneficiaries are not being told about their right to 

advocacy under this vital program. Another problem is that beneficiaries sometimes assign their ticket to 

a SVRA that fails to turn it into Maximus. Because the ticket was never officially assigned, SSA 

proceeds with a CDR and the beneficiary is found ineligible for benefits. These beneficiaries have also 

been told that they are not eligible for PABSS services because they are no longer beneficiaries. This is 

not accurate. Training for SSA staff and ENs should stress the importance of informing beneficiaries at 

every point of contact and on multiple occasions about the PABSS Program and the services it provides. 

The Panel recommends that Congress designate funds and direct the Commissioner to 

increase SSA’s efforts to provide accurate and timely information on the Act and on 

other work incentives available to SSI recipients and SSDI beneficiaries. Specifically, 

the Panel recommends that Congress provide funding for the Commissioner to 

1. Implement a quality assurance program to ensure that information on the Ticket 

Program and other work incentives is accurate and timely. The program should 

include the collection of baseline data on the accuracy of information consumers 

receive and the establishment of benchmarks to measure whether beneficiaries are 

receiving timely and accurate information. 

2. Increase the number of AWICs. 

3. Provide AWICs with a full 6 weeks of training. 

4. Increase the training available to WILs to 2 weeks. 

5. Conduct a study to ascertain the turnover rates for AWICs and WILs and 

incorporate findings into the quality assurance plan mentioned earlier. 

Increased Funding for the BPAO and PABSS Programs 

The Act established the BPAO Program to help beneficiaries who want to return to work negotiate the 

complex web of Social Security work incentives and other Federal, State, and local public benefits. 

Since its inception, 511 benefits planners have given information to more than 99,361 beneficiaries or 

helped them navigate these complex processes and plan to go to work. Approximately 58,000 (58 

percent) of these individuals say that they intend to find a new job or increase their work hours (National 

BPAO Data System, 2004). 

According to a customer satisfaction survey of 1,764 beneficiaries who received services from a BPAO 

provider, participants had a very positive view of the program, with 89 percent of them rating it as 

excellent, very good, or good. In addition, benefits specialists received positive ratings from more than 

90 percent of participants for the quality of the counseling services provided. Ratings reflect the 

specialist’s courtesy, the time spent with the beneficiary, helpfulness, and the information given. 

Furthermore, those reporting work activity indicated that benefits counseling had a positive impact in 

Annual Report to the President and Congress 15 
this area. Before receiving such counseling, 28 percent of participants indicated that they were working. 

The percentage reporting that they were working after their contact with the BPAO was 47 percent, an 

increase of 19 percentage points. 

In addition, States are just beginning to report data on positive outcomes for beneficiaries who receive 

BPAO services. For example, beneficiaries who receive BPAO services in New York become employed 

at a higher rate and stay employed for more quarters than those who do not (New York State Department 

of Labor, 2003). 

Vermont just released findings that beneficiaries who were attempting to go to work and received 

benefits counseling increased their earnings by $225 per quarter more than beneficiaries who did not 

receive counseling or who were members of a historical control group (The Impact of Specialized 

Benefits Counseling Services on Social Security Administration Disability Beneficiaries in Vermont, 

accepted for publication in the Journal of Rehabilitation). 

According to beneficiaries and State service delivery systems, there are still not enough benefits 

planners to address clearly documented needs. In some areas, the fact that people have to wait weeks for 

initial appointments may discourage them, or the appointments may take place too late to help them. In 

many other areas, people do not have access to a benefits planner at all because of limited numbers of 

grantees and current funding levels. 

The PABSS Program, authorized under the Ticket Program, has also proven essential in helping 

beneficiaries return to and maintain work. During the 2003 funding cycle, PABSS Programs provided 

information and advocacy services to some 11,629 people. With an expanded scope of services 

allowable in June 2003, P&A grantees have greatly increased their ability to assist beneficiaries. 

Receiving an overpayment, or the mere possibility of receiving one, can be a significant deterrent to 

attempting work. Beneficiaries who receive an overpayment because of work are very likely to 

discontinue employment and return to the rolls. Advocacy on behalf of beneficiaries who receive 

overpayments is critical to helping them continue to work and maintain their independence. After the 

restriction was lifted, PABSS assisted 99 beneficiaries with overpayment issues in 2003. 

The Panel is pleased that Congress chose to reauthorize these valuable programs, whose value is more 

and more evident. The Panel has heard from a number of State program representatives, EN providers, 

and others that the current authorization level is not high enough to meet the need. Many of the 

programs already have waiting lists, and most are simply unable to conduct the outreach and provide the 

services in the geographic areas they are expected to cover. Current funding levels are $23 million for 

the entire BPAO Program and $7 million for the PABSS Program, with most States receiving only 

$100,000. This funding is simply not sufficient to meet the demand and the documented need for these 

direct customer service programs. 

The Panel recommends that Congress fund the BPAO and PABSS Programs at the 

following levels: 

1. Increase funding for the BPAO Program to $46,000,000. 

2. Increase the minimum amount of each State grant for the PABSS Program to 

$200,000, and increase funding for the program as a whole to $14,000,000 per FY. 

Annual Report to the President and Congress 16 
Cooperation between EN Partners 

The Act directs coordination and collaboration among programs administered by SSA, ED, HHS, and 

DOL. In addition to Social Security programs, the Act references Rehabilitation Act programs, 

Workforce Investment Act programs, and the new State Medicaid Buy-In Program and Medicaid 

Infrastructure Grants. The Presidential Task Force on Employment of Adults with Disabilities was 

established to coordinate employment programs for people with disabilities across the Federal 

Government through joint policy memoranda, joint grants to the States, and other collaborative 

activities. Since this initiative ended, the Panel has observed little coordination among the various 

Federal agencies at a national policy level or at the service delivery level. Significant problems with 

coordination under the Act are surfacing, and questions arise: For example, what DOL One-Stop 

Program services would a ticket holder be eligible for if the One-Stop Program is not an EN and the 

beneficiary has deposited his or her ticket elsewhere? Can Medicaid funds be used to provide services to 

Ticket Program–eligible beneficiaries seeking employment? Can Medicaid-type services be covered 

under the Ticket Program, and, if so, what prevents Medicaid agencies from replacing traditional 

Medicaid services funds with Ticket Program funds? Negative decisions on these and other issues can 

limit the participation of consumers and ENs in the Ticket Program. 

An immediate and serious example of this problem is the tense relationship between the SVRAs and 

ENs in implementing the Ticket Program. On balance, there has not been a productive integration or 

melding of the rehabilitative expertise of SVRAs with the flexibility and community-based support 

services of ENs. There are several policy and procedural problems—SSA’s subregulatory guidance in 

Transmittal 17, questionable and inappropriate agreements between SVRAs and ENs, and SVRA 

interpretation of the ticket as a comparable service and benefit under the Rehabilitation Act—all of 

which affect the quality of services under both programs. If left unresolved, these problems will 

undermine the Ticket Program. The Panel has communicated its concerns to SSA and the RSA verbally 

and in writing. Next, we discuss each of these problems. 

Transmittal 17—Vocational Rehabilitation Providers Handbook, September 3, 2002: The SSA issued 

Transmittal 17, which provides SVRAs with policy guidance on VR clients with tickets. Transmittal 17 

states that the signature of the VR client on the Individual Plan for Employment (IPE) constitutes 

assignment of the ticket in new cases. This can, and many times does, occur without the client’s 

knowledge or consent. It is possible to follow this procedure while fully informing the client that signing 

the IPE automatically assigns his or her ticket to the SVRA. However, it seems to be the perception of 

many agencies that signing the IPE automatically assigns the ticket, even if there has been no provision 

to ensure the client’s knowledge or consent. At the same time, in a December 2003 letter, RSA asserted 

that an SVRA that follows the SSA guidance without fully informing the client of the implications of the 

IPE signature would violate the informed choice provisions of the Rehabilitation Act. 

The Panel agrees with RSA that automatic and uninformed assignment is contrary to the fundamental 

principles of both pieces of legislation. Ticket assignment should be completely separate from the 

development of an IPE with an SVRA, and an individual’s assent to one program should not be 

considered consent for participating in the other. A primary goal of the Act was to provide beneficiaries 

with real choices between employment service providers. An equally important goal was to expand the 

pool of providers far beyond SVRAs. A beneficiary who is not informed of what is happening to his or 

her ticket is being denied a choice, and, furthermore, non-VR ENs are being denied an opportunity to 

compete to provide services to the client. This effectively eliminates competition among providers. 

Annual Report to the President and Congress 17 
In addition, the question of when an SVRA can receive payment under the cost reimbursement system 

seems to be a matter of discussion between SSA and RSA. Transmittal 17 permits SVRAs to use the 

traditional cost reimbursement system for a client who assigns his or her ticket. However, the statute 

permits an SVRA to elect to receive payment under the traditional cost reimbursement program only 

when the State agency decides that the beneficiary will not participate in the Ticket Program (section 

222(d) of the Social Security Act). Moreover, the Act states that if the SVRA accepts the beneficiary’s 

ticket, it must be paid under one of the outcome-based payment systems, accepting the same risks and 

rewards as other ENs. Transmittal 17 is inconsistent with the statute both with respect to the uninformed 

use of a signature on an IPE to assign the ticket and the use of the VR cost reimbursement program for 

beneficiaries. In the December 2003 letter, RSA requested clarification from SSA on the statutory basis 

to support the removal of traditional cost reimbursement as an appropriate payment option in cases in 

which a person is a consumer of VR services but his or her ticket is not assigned to the VR agency. 

State VR and EN agreements: The Panel has received extensive public input, confirmed in the report 

titled Evaluation Design for the Ticket to Work Program (Livermore et al., 2003), about problems with a 

number of agreements between SVRAs and ENs. The agreements vary greatly from State to State and 

can significantly affect the number and variety of ENs choosing to participate. Many ENs know that 

they cannot afford to pay for front-loaded, high-cost services, but they could serve clients requiring such 

services if they could make referrals to an SVRA. For this reason, an organization will have much less 

of an incentive to sign up in a State that has an agreement unfavorable to ENs. 

The inconsistency and unfairness of such agreements is resulting in lower participation by ENs in the 

Ticket Program and thus limiting consumer choice. The Panel is pleased that RSA has recently agreed to 

provide guidance that State agencies can use in developing an agreement with an EN that refers a Ticket 

Program participant to the SVRA. Although realizing that each SVRA is a State entity and is thus free to 

enter into agreements as it sees fit, the Panel hopes that RSA will design guidance that enables SVRAs 

and ENs to collaborate as true partners in the Ticket Program. 

Comparable services and benefits: In May 2003, the Panel asked RSA for an interpretation of how the 

comparable benefits provision, a statutory requirement under the Rehabilitation Act, affects the Ticket 

Program. This provision is designed to prevent duplication and waste, requiring that an SVRA ensure 

that these services are not available through any other program before providing them to an individual. 

RSA has provided guidance to SVRAs that the Panel finds very problematic. Before the Ticket Program, 

SSA beneficiaries were presumed to be eligible for Rehabilitation Act Title I services. Since the Ticket 

Program was initiated, it is reported that some SVRAs have used the comparable benefits provisions of 

the Rehabilitation Act to deny eligibility to Social Security beneficiaries. In negotiating agreements with 

ENs, SVRAs have exacted more favorable terms under which Title I services would be provided. We 

believe RSA’s application of comparable services and benefits provisions to Ticket Program participants 

is contrary to the intent of Congress in passing the Act, as well as the intent of the Rehabilitation Act 

itself. In the Ticket Program, Congress voted for increasing variety and choice in rehabilitative and 

employment services. The Panel is convinced that Congress did not intend to make people with 

disabilities ineligible for Title I VR services by making them eligible for Ticket Program services from 

ENs. 

The Panel recommends that Congress clearly articulate its intent that the Ticket Program’s 

outcome and milestone payments should provide additional resources to help beneficiaries 

Annual Report to the President and Congress 18 
attain and retain employment; in effect, Congress did not intend to make beneficiaries 

ineligible for the full range of services from VR programs, Medicaid, or other Federal and 

State programs by making them eligible for the Ticket Program. 

The Panel recommends that the President and Congress direct the Commissioner to 

implement the Ticket Program as a complement to the traditional SSA VR Reimbursement 

Program, reimbursing State agencies for up-front services and early employment outcomes 

and paying ENs for long-term employment supports and outcomes. 

The Panel recommends that the President direct the Secretaries of ED, DOL, and HHS and 

the Commissioner of Social Security to provide leadership to increase the level of 

cooperation on implementation of the Act and true integration of services so that these 

agencies will approach the relationship tensions with a sense of shared purpose. 

Specifically that — 

1. The President direct these agencies to report back to the White House in 6 months 

on concrete steps they have taken to resolve the long-term, systemic issues that 

have arisen during implementation of the Act. 

2. The President direct the Commissioner of Social Security to amend Transmittal 17 

to end the current use of the signed IPE as documentation needed for assignment 

of a ticket for a new case. Assignments should occur only through an informed 

action on the part of the beneficiary, such as completion of Form SSA–1365. 

3. The President direct the Commissioner to make cost reimbursement payments 

available to a SVRA only when it indicates that it is not participating in the Ticket 

Program with a beneficiary. 

4. The President direct RSA and SSA to provide clear, joint guidance on the 

development of SVRA–EN agreements and to develop a model agreement for 

distribution to ENs and SVRAs. SSA and RSA should work together to ensure that 

SVRA–EN agreements provide full opportunities for ENs to participate and work 

cooperatively with the SVRAs in the Ticket Program. 

Field Training and Technical Assistance 

The Federal training of beneficiaries and service providers about employment and health support 

programs mandated by the Act is inadequate. A number of public comments received by the Panel and 

the direct experience of individual members indicate that collaborating agencies know little or nothing 

about the Ticket Program, work incentives, or the other new programs and projects authorized by the 

Act, such as the Medicaid Buy-In and BPAO Programs. 

The Act calls for a philosophical shift in providing employment supports for SSI and SSDI beneficiaries 

who want to work. For this effort to succeed, Federal, State, and private entities must be partners. An 

intensive and comprehensive training plan for all of these partners is crucial. The Panel believes that the 

resources dedicated to training and technical assistance are grossly inadequate. 

Annual Report to the President and Congress 19 
Theresa Devlin, Social Security beneficiary, public testimony, February 2004 

“In August 2002, I decided to attempt to return to work, despite a chronic mental illness 

disability. My DVR counselor asked for my Ticket to Work, which I gave her. I asked her to 

explain the benefits of the program. My counselor was unable to explain the program and 

informed me that there are no benefits for SSI recipients, but she was required to collect the ticket 

from me. 

I am proud to report that on February 20, 2003, I was hired by the organization where I work to 

this day. In June 2003, I also received a notice of continuing disability review in the mail from 

SSA. I was apprehensive about receiving the CDR at that time, because I had not been working 

long and I feared I would lose SSI and Medicaid eligibility. Despite these fears, I complied with 

the requirements of the CDR, filled out the paperwork, signed the releases, and returned the CDR. 

I learned in October 2003 that one of the benefits of the Ticket Program is exemption from 

CDRs. I contacted Maximus and learned that my ticket had never been assigned by DVR. Now I 

am working and DVR cannot assign my ticket because my case is closed. I am not eligible to 

appeal the decision because, supposedly, my ticket was never assigned. I have contacted multiple 

agencies and been unable to resolve this problem. I fully complied with all aspects of the Ticket 

Program, and yet I am being denied access to the program and its benefits.” 

Additionally, there appears to be a significant lack of training, technical assistance, and information 

available to ENs. Maximus has developed and provided training modules for ENs, but the materials 

cover only the administrative and procedural aspects of participation. Existing technical assistance and 

training resources appear to be inadequate, piecemeal, uncoordinated, and of varying quality. In 

particular, there are no coordinated ways for ENs to identify and share best practices or to obtain 

information about existing resources that might help them serve beneficiaries. 

The Panel recommends that Congress direct the Commissioner to work closely with 

other Federal and State systems to develop and implement a national training plan. 

Congress should designate the additional funds needed for training and technical 

assistance to support the successful implementation of all work incentives and 

employment support programs and projects authorized by the Act and other relevant 

legislation. 

CDR Protection 

The Panel is encouraged that Congress chose to include in the Act a provision extending continuation of 

benefits protection to beneficiaries who attempt to work using a variety of service providers beyond 

SVRAs. The Panel continues to hear testimony from beneficiaries, BPAO Programs, ENs, and other 

sources to confirm that the fear of losing benefits through a CDR because of attempting to work is also a 

powerful disincentive. It keeps many from making even an initial attempt to work. SSA has released an 

Annual Report to the President and Congress 20 
NPRM on the Continuation of Benefits to Certain Individuals Who Are Participating in a Program of 

Vocational Rehabilitation Services, Employment Services, or Other Support Services, as required by the 

Act. Subsection (a)(4) states that a beneficiary participating in “a program of vocational rehabilitation 

services, employment support services, or other support services, which is carried out under a similar, 

individualized, written employment plan with another provider of services approved by [SSA]” is 

eligible for the continuation of benefits described in this rule. The rule provides that if a CDR is 

conducted with a beneficiary participating in an approved rehabilitation plan, including an individual 

work plan (IWP) under the Ticket Program, benefits will not be terminated. Although the individual still 

receives cash benefits while participating in the rehabilitation program, benefits would be terminated as 

soon as the beneficiary completes the program. 

The Panel is pleased with this change; when it is codified by the rules in this NPRM, part of the fear of 

initiating a CDR will be removed. However, the change does not go far enough because the CDR could 

result in loss of benefits as soon as the plan is completed. The protection should be further expanded to 

eliminate CDRs as long as the individual participates in an approved rehabilitation program. 

The Panel recommends that Congress extend the CDR protection currently available 

to participants in the Ticket Program, under section 101(a), subsection (i), of the Act, 

to any and all beneficiaries who are participating in an approved program of VR, 

employment, or other employment support services designed to lead to SGA and 

competitive employment. 

Youth Issues 

In its deliberations this year, the Panel continued to emphasize youth with disabilities and their transition 

from school to work. The Panel commends SSA for the steps it has taken in this area, such as the Youth 

Preparing for Tomorrow Conferences and demonstration transition programs targeted to help youth with 

disabilities find employment. But we still have several concerns, based on deliberations, public 

testimony, and review of research reports: 

Training and outreach to youth and their families: The Panel is concerned that outreach and training 

on Ticket Program and other work incentives available to youth and their families are not reaching most 

young SSI recipients. If the cultural expectation of unemployment for people with disabilities is to 

change, we must begin with youth. The Panel applauds SSA’s efforts in this regard, but much more must 

be done to encourage young people with disabilities to attempt work rather than begin a lifelong 

dependency on benefits. The Panel urges the Commissioner to develop agency-wide training programs 

and to fund external programs to provide pro-work information and outreach to youth and their parents. 

SSA could provide additional funding through demonstration projects to BPAO grantees or Parent 

Training Information Centers or fund a new mechanism for delivering the training. Another option is an 

interagency agreement between SSA and ED to provide SSI work incentive training within the transition 

planning process. The Panel also feels that every claims representative should be working with SSI 

youth recipients and educating them about work incentives such as PASS. 

Age of mandatory redetermination: All children under 18 who receive benefits under the SSI program 

face a mandatory redetermination at age 18. The Panel believes that conducting the redetermination at 

that age is inappropriate because children do not complete their physical and mental development until 

age 22 and because it is inconsistent with every other Federal law that defines disability differently for 

Annual Report to the President and Congress 21 
children and adults. For example, a student with a disability is entitled to special education services until 

age 22; a child’s disability must have begun before age 22 to qualify for services under the 

Administration on Developmental Disabilities or to qualify as a “disabled adult child” under SSDI. 

In calendar year 2002, 54,932 redeterminations were completed, resulting in cessation of benefits for 

32,388 beneficiaries (58.9 percent). However, after all appeals were exhausted, only 26 percent of 

beneficiaries were determined ineligible (appeals are still pending in 9.5 percent of the cessations). The 

Panel is aware of the cost implications and intends to ask the SSA Office of the Actuary for a projection 

on this recommendation. This policy change makes sense, is sound public policy despite the costs, and is 

cost-effective in the long run because it enables youth with disabilities to obtain valuable work 

experience. This policy will enable beneficiaries to obtain rehabilitation and job training services to 

prepare them for employment rather than encourage lifelong reliance on benefits. 

Age limit for the Student Earned Income Exclusion: The Student Earned Income Exclusion enables 

students finishing high school and entering college to earn income with no impact on their SSI or SSDI 

benefits. Although the purpose is to enable students to gain work experience while completing their 

education, few of them use this valuable incentive. Because some students require extended periods to 

finish high school and graduate from college, they may not finish their education before they “age out” 

of the exclusion. Increasing the age limit to at least 26 might encourage more students to actually use it 

and complete postsecondary education. 

Interagency research priority: Additional research is needed on transition-age youth who have 

disabilities and receive SSI. Although research on youth with disabilities is a priority for numerous 

agencies, such as NIDRR, the Office of Special Education and Rehabilitation Services (OSERS), and 

the Office of Disability Employment Policy (ODEP), significant questions remain. For example, what 

are the connections between various types of transition services and receipt of benefits in adulthood? 

How many students who receive SSI receive services under the Individuals with Disabilities Education 

Act? How much training on work incentives do SSI youth receive? What are the factors that influence 

the use of SSI work incentives? The Panel feels that an agreement among agencies that provide services 

and conduct research on youth with disabilities (such as SSA, OSERS, NIDRR, ODEP, and various 

HHS agencies) is the preferred method for carrying out research under this priority. 

The Panel recommends that SSA identify funds for increased training and outreach 

on SSI work incentives and transition planning for parents and youth. SSA should 

significantly expand its current outreach efforts with a national campaign using a 

training module specifically designed for training youth on work incentives. 

The Panel recommends that Congress change the mandatory redetermination age 

from 18 to 22, unless SSA can show good cause why redetermination should be 

completed before age 22. 

The Panel recommends that Congress increase the age limit for the Student Earned 

Income Exclusion to at least 26. 

The Panel recommends that Congress create or encourage Federal agencies to create 

an interagency research priority on youth who have disabilities and receive SSI. 

Annual Report to the President and Congress 22 
Medicaid Buy-In 

The Panel is pleased that the problem of lack of health care as a barrier to employment is beginning to 

be addressed and applauds the CMS for conducting a study to examine the impact of alternative 

Medicaid Buy-In Programs on people with disabilities. The Panel hopes that CMS will continue this 

research, which it initiated on its own with funding from its very limited budget. Evaluating this 

program will be very useful in encouraging other States to make this important option available to 

people who have disabilities and want to return to work. 

Budget shortfalls are affecting the States’ ability to implement the Demonstration Program to Maintain 

Independence as authorized by the Act. Under this program, States must match Federal dollars to extend 

Medicaid coverage to certain working people who have disabilities but whose conditions are not yet 

severe enough to qualify them for benefits. Only Mississippi and the District of Columbia have opted to 

implement this program. The Panel understands that many States are facing difficulties allocating 

matching funds for the demonstrations because of budget shortfalls and is concerned that the usefulness 

of this demonstration project will not be sufficiently proven. 

The Panel recommends that Congress provide CMS with a mandate and funding to 

study the impact of the Medicaid Buy-In Program on employment outcomes for 

individuals with disabilities. 

The Panel recommends that Congress grant additional flexibility to States in meeting 

matching fund requirements for demonstration projects—for example, waive or 

reduce requirements for matching funds, allow States to use in-kind contributions, 

and so forth. 

Expedited Reinstatement 

Congress included in the Act an expedited reinstatement provision that enables beneficiaries who try 

unsuccessfully to work to return to the benefit rolls. The purpose of this provision was to enable 

beneficiaries to attempt to work without fear of losing benefits. The current statutory language creating 

expedited reinstatement requires that beneficiaries who apply have a CDR to determine that they still 

have the same disability. The fear of losing benefits because of a CDR is a strong disincentive to work 

and keeps many beneficiaries from making their first attempt. The CDR requirement may leave 

beneficiaries worse off than if they had not attempted to work, because they may be determined not to 

have a disability and may therefore be ineligible for benefits. If they apply for benefits later, SSI 

beneficiaries may be converted to the SSDI program because of their additional work history, lose their 

Medicaid, and be forced to wait 2 years for Medicare benefits. Some of these individuals would not have 

had a review if they had not attempted to work. 

Every person who is determined to be eligible for SSI or SSDI benefits has a diary date that specifies 

when a CDR will be performed. The date is based on the nature of the disability and other factors 

considered by the Disability Determination Service. This date could be used to decide whether someone 

who applies for expedited reinstatement is required to undergo a review to be entitled to benefits once 

again. If the person’s diary date has not yet been reached, that person should not be required to have a 

review to get back on the rolls. Had the person not attempted work, he or she would not have had a 

Annual Report to the President and Congress 23 
review during that time period. However, if the date for the originally scheduled CDR has passed, it 

poses no additional risk and would have been conducted regardless of the attempt to work. 

Another problem is that current legislation stipulates that beneficiaries can apply for an expedited 

reinstatement only if the disability is the reason for the job loss. Downsizing, lack of transportation, and 

other factors constitute equally valid reasons for losing a job. The purpose of the provision is to 

eliminate the disincentive created by the fear of losing one’s job and having to wait to get benefits again. 

Including this requirement in the statute does not allow expedited reinstatement to accomplish this goal. 

People who have benefits reinstated under the expedited reinstatement provision should not have to wait 

24 months to access certain work incentives (such as the trial work period and an extended period of 

eligibility). A beneficiary who makes a work attempt should be no worse off than someone who does 

not. Denying people who have used expedited reinstatement access to these work incentives for a full 2 

years is clearly detrimental. 

The Panel feels strongly that the expedited reinstatement provision could more effectively reduce 

the work disincentive of benefit loss if it were simplified, thereby making it easier for beneficiaries 

to understand and for SSA to administer. Positive benefits include savings to the Trust Fund or the 

General Fund while the beneficiary is working, savings in administrative costs by eliminating 

unnecessary reviews, and improvement in the beneficiary’s employability through work 

experience. 

The Panel recommends that Congress strengthen and simplify the expedited 

reinstatement provisions by 

1. Allowing SSA to use the beneficiary’s diary date to decide whether someone who 

applies for expedited reinstatement is required to undergo a CDR to be entitled to 

benefits once again. If the diary date has not yet been reached, that person should 

not be required to have a review to continue receiving benefits. 

2. Eliminating the legislative requirement that beneficiaries can apply for expedited 

reinstatement only if the particular disability is the reason for the job loss. 

3. Eliminating the 24-month waiting period so that beneficiaries who use expedited 

reinstatement can access all work incentives immediately. 

Emerging Issues 

The Panel continues to gather information and conduct reviews of programs and projects stemming from 

the Act, the Ticket Program, and related Federal agency operations and initiatives. This information 

comes from many sources, including consultants; public testimony; reports from SSA, CMS, and other 

Federal agencies; data analysis; research findings; Federal investigations; public and private analysis and 

conference presentations; hearings; testimony from beneficiaries, providers, and grantees; and feedback 

from the Panel’s Listserv and Web site. Here are some of the emerging issues the Panel is analyzing and 

following closely. 

Annual Report to the President and Congress 24 
Health care: Health care continues to emerge as the primary disincentive to employment. Although 27 

States have adopted Medicaid Buy-In Programs under the Act, some are establishing stringent 

requirements that restrict eligibility. We firmly believe that the health care access problems that people 

with disabilities face cannot be addressed by Medicaid alone. A broader perspective on health care, 

which considers general accessibility of both public and private health care for beneficiaries who want 

to work, will be necessary to truly address health care as a barrier to employment. 

Housing and transportation: The Act directs SSA to coordinate services with other employment 

programs at the Federal and State levels. This naturally includes support programs such as HUD’s 

Section 8 Housing Program and DOT’s Transit Subsidy Program. These provide critical housing and 

transportation benefits for SSA beneficiaries, and their sponsoring organizations should be partners in 

implementing the Act and the overall return to work and employment support programs operated by 

SSA. The Panel has received passionate testimony that lack of accessible, affordable housing and 

transportation still constitutes one of the most significant barriers to employment. Housing and 

transportation supports must be in place for beneficiaries to pursue meaningful employment. Thus far, 

HUD and DOT have not been invited to participate in the Panel’s work on employment issues. 

The Panel will continue to monitor, research, and analyze these and numerous other issues in the coming 

months. 

Annual Report to the President and Congress 25 
UPDATE ON EVALUATIONS AND DEMONSTRATIONS 

CONDUCTED BY SSA 

SSA has initiated evaluation and demonstration projects, several of which are mandated by the Act. 

These projects and Panel comments are described next. 

Ticket Program evaluation: This project will produce reports covering a study of the adequacy of 

incentives for providers, a net outcomes analysis, a process evaluation, a participation analysis, and 

beneficiary satisfaction with the Ticket Program. In June 2003, SSA awarded two 5-year contracts to 

Mathematica Policy Research, Inc., to conduct this evaluation. The report was due in December 2003 

and is being reviewed by SSA. Preliminary data from this evaluation are available, however, and are 

cited throughout this report where relevant. 

$1 for $2 National Demonstration: Solicitations for proposals for a national demonstration project for a 

$1 for $2 SSDI benefit offset were published by SSA in early May 2004. Four preselected companion 

State demonstration projects looking at a $1 for $2 benefit offset were awarded to Connecticut, Utah, 

Vermont, and Wisconsin. The Panel does not understand how all of these projects, separately or 

together, plan to address the issue of induced entry. 

Adequacy of Incentives Study (AOI): The Act also mandates an AOI study to evaluate how the Ticket 

Program can be used to increase employment among beneficiaries with significant disabilities. The 

Commissioner is required to report to Congress on recommendations for a method or methods to adjust 

payment rates to ENs to ensure the participation of individuals in four specific groups: those who need 

ongoing support and services, those who need high-cost accommodations, those who earn below the 

minimum wage, and those who work and receive partial cash benefits. 

In its past two annual reports, the Panel recommended that Congress approve a technical amendment to 

extend the deadline for the AOI report to make it due 49 months, rather than 36 months, after the 

enactment date. This recommendation was based on delays in issuing tickets. Because Congress failed to 

act on this recommendation, the AOI report was not submitted by the legislative deadline. 

Early intervention: Section 301 of the Act also references a demonstration on “early referral...for 

rehabilitation.” This demonstration will analyze the impact of making employment and rehabilitation 

services available at an earlier stage , before people with a disability actually become eligible for 

benefits. SSA has been working with Rutgers University in planning this demonstration, but a request 

for proposals has not been released. The Panel would like to reiterate its concern that all of these reports 

and demonstrations be completed according to schedule, since they will contain information crucial to 

the success of the Ticket Program. 

Annual Report to the President and Congress 26 
References 

The Impact of Specialized Benefits Counseling Services on Social Security Administration Disability 

Beneficiaries in Vermont, accepted for publication in the Journal of Rehabilitation. 

Livermore, Gina, Mark Nowak, David Stapleton, John Kregel, Ellen Bouchery, and Asaph Glosser. 

Evaluation Design for the Ticket to Work Program: Preliminary Process Evaluation. Falls 

Church, VA: Lewin Group, March 2003. 

Thornton, Craig, Gina Livermore, David Stapleton, John Kregel, Tim Silva, and Bonnie O’Day. 

Evaluation of the Ticket to Work Program: Initial Evaluation Report 2004. Washington, DC: 

Mathematica Policy Research, Inc., 2004 (in press). 

National BPAO Data System, a data set collected by Virginia Commonwealth University, Benefits 

Assistance Resource Center, 2004 (including data reported as of January 31, 2004). 

New York State Department of Labor. Data obtained from the New York Works Project and presented 

to the Panel, November 2003. 

Annual Report to the President and Congress 27 
Summary of Year Four Public Meeting and Panel Activities 

The Panel held four quarterly public meetings and five teleconferences in 2003, as well as hosting a 2-

day experts summit—the Employment Network (EN) Summit—on May 22–23, 2003. The purpose of 

the summit was to provide a forum for providers, consumers, and experts from government and 

academia to explore the challenges faced by ENs and to develop recommendations for enhancing 

provider participation in the Ticket Program. The primary goal was to develop specific 

recommendations that would lead to an increase in the recruitment and active participation of a national 

array of qualified, skilled, diverse, and committed ENs to support the Ticket Program. In February 2004, 

the Panel issued a report based on information learned at the summit and titled The Crisis in EN 

Participation: A Blueprint for Action. 

Monthly teleconference calls involving the two committees established to research and prioritize issues, 

to develop policy and implementation advice, and to plan the Panel’s work were also held. The Panel 

provided opportunities for more than 4 hours of public testimony and accepted ongoing written public 

comments on the implementation of the Act. Comments and communications with the public are also 

accepted at any time through the Panel’s Listserv (TWWIIAPanel@ssa.gov) or Web site 

(www.ssa.gov/work/panel), which contains all of the Panel’s publications, advisory letters, meeting 

announcements, expert papers, and meeting minutes. 

The Panel heard briefings and presentations from a number of experts at its quarterly meetings. For 

example, the Panel contracted with the Urban Institute to write briefing papers on 10 of its issue areas. 

The author of each paper delivered a presentation at one of the quarterly public meetings and discussed 

the findings with the Panel. At the August 26–28, 2003, quarterly meeting, the Panel heard presentations 

on papers titled Policy Options for Assisting Child SSI Recipients in Transition; An Evolving 

Partnership: The Role of the State Vocational Rehabilitation Agencies in Implementation of the Ticket to 

Work Program; Consumer Advocacy in the Implementation of the Ticket to Work Act; and Outcome 

Payments to ENs When Ticket Participants Receive Partial Cash Benefits: Preview of Design Options. 

The Panel is also pleased to report that SSA, HHS, and ED officials from Federal, regional, and local 

offices continue to attend its quarterly public meetings and provide implementation updates and 

specialized presentations. In 2003, in addition to reports from SSA and CMS at every meeting, the Panel 

began receiving an RSA briefing at every meeting. Moreover, the Panel continues to develop its 

relationship with the Social Security Advisory Board, attending seminars and meetings with the Board 

and providing information for this body to use in planning its seminar on the definition of disability. 

Members and staff have met with and made presentations to numerous Federal, State, consumer 

advocate, and private partners about the Panel’s ongoing work, as well as program and project 

implementation. Panel members attended the fall (November 2003) conference of the Council of State 

Administrators of Vocational Rehabilitation and made a presentation. 

 Panel members also received an invitation to participate in all meetings of the Consortium of 

Administrators of Native American Rehabilitation (CANAR), which is very interested in helping its 

member organizations participate in the Ticket Program as ENs. Panel members and staff attended 

CANAR’s fall meeting to discuss this topic. The Panel also cosponsored and participated in Florida’s 

Emerging Workforce Conference in Weston, FL, in February 2004. A number of Panel members made 

Annual Report to the President and Congress 28 
presentations at the conference, and the Chair co-hosted a hearing on employment issues with the 

National Council on Disability. 

Annual Report to the President and Congress 29 
Appendices 

A. The Panel 

The Panel consists of 12 members, appointed in equal numbers by the President, the Senate, and the 

House of Representatives. As SSI/SSDI beneficiaries, providers, veterans, employers, and employees, 

the appointees represent a cross-section of experience and expert knowledge in the fields of employment 

services, VR, and other disability-related support services. Most are people with disabilities, family 

members, or their representatives. Several have personal experience as recipients of disability benefits. 

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 for a 4-year term ending in 2006. 

Libby Child was 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, shortand 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. The President 

appointed her to a 4-year term ending in 2006. 

Berthy De La Rosa-Aponte, M.A., is the State Project Director for the Florida Family Support Project. 

She has a daughter with developmental disabilities and has been advocating for people with disabilities 

for more than 20 years. She has served on numerous boards and committees as an advocate for the rights 

of people with disabilities and has received several awards for her contributions. The House appointed 

her to serve a 4-year term ending in 2007. 

Thomas P. Golden is a member of the faculty of the Program on Employment and Disability in the 

School of Industrial and Labor Relations 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 reappointed him to finish a 4-year term 

ending in 2004. 

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 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 

Annual Report to the President and Congress 30 
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 appointed him to finish a 4-year term ending in 2004. 

Jerome Kleckley, M.S.W., C.S.W., is the Director of Hospital Services for the Eastern Paralyzed 

Veterans Association in Jackson Heights, NY. As a Navy veteran, he has been actively involved in 

veterans issues and has served as an advocate for veterans with disabilities. The House appointed him to 

a 4-year term ending in 2004. 

Bryon R. MacDonald is Project and Policy Development Manager at the California Work Incentives 

Initiative (CWII), World Institute on Disability, in Oakland, CA. CWII combines community-based 

public policy development with health and benefits training, technical assistance, and Web site 

applications. He provides State and national consulting, training, and leadership on employment support, 

health care, and benefits planning programs for persons with disabilities. The President appointed him to 

a 4-year term ending in 2004. 

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 VR, 

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 a 4-year term ending in 2006. 

Sarah Wiggins Mitchell, R.N., M.S.W., J.D., Chair, is President and Executive Director of New Jersey 

Protection and Advocacy, Inc. She is a member of the bar in New Jersey and Pennsylvania and has a 

background in nursing and social work. The President appointed her to chair the Panel for a 4-year term 

ending in 2004. 

Stephen L. Start is CEO of Steve Start Inc., a Spokane, WA, company that provides professional 

management, rehabilitation, and residential services for people with disabilities, seniors, and people who 

are economically disadvantaged. The House appointed him to serve a 4-year term ending in 2004. 

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 a 4-year term 

ending in 2006. 

Responsibilities of the Panel 

The Act established the Ticket to Work and Work Incentives Advisory Panel within SSA on December 

17, 1999. The Panel is governed by the provisions of the Act, as well as by the Federal Advisory 

Committee Act (Public Law 92–463), as amended, which sets forth standards for the formation and use 

of advisory committees, and by General Services Administration (GSA) regulations on. The original 

Annual Report to the President and Congress 31 
charter establishing the Panel was submitted to 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 2002. The Commissioner of Social Security swore in the original 

members on July 24, 2000. 

Panel duties include advising the President, Congress, and the Commissioner on issues related to work 

incentives programs, planning, and assistance for people with disabilities and the Ticket Program. 

Operating procedures governing the activities of the Panel have been developed and approved, and it 

meets quarterly, alternating locations between Washington, DC, and Ticket Program rollout 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 fourth such report. A final report is due no later than 

December 17, 2007. The Panel will cease to exist on January 16, 2008, 30 days after its final report is 

submitted. 

Annual Report to the President and Congress 32 
B. Panel Correspondence and Policy Letters 

TICKET TO WORK & WORK INCENTIVES 

ADVISORY PANEL 

June 13, 2003 

Jo Anne Barnhart 

Commissioner of Social Security Administration

6401 Security Boulevard 

Room 900 

Baltimore, MD 21244 

Dear Commissioner Barnhart: 

I am writing on behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel) to request 

that you take immediate steps to eliminate barriers to payment currently confronting Employment 

Networks (ENs) in the Ticket to Work Program and to ensure that ENs are promptly paid for services to 

SSA beneficiaries. A major barrier to EN payment is the Social Security Administration’s requirement 

that, in order to receive the total EN payment, the EN must collect pay stubs from ticket users who are 

working for a period of 60 months (five years). 

The Panel has learned that, while some ENs are going out of business due to delays in payments for 

services they have already provided, other successful ENs have stopped accepting tickets because of 

their inability to collect pay stubs. Collecting pay stubs has proven to be difficult at its best and 

operationally impossible at its worst. During the regulatory process, potential ENs warned SSA that this 

requirement would be unworkable and a great burden to EN providers. And this has proven to be the 

case. In addition, faced with the prospect of delayed payments due to difficulties in collecting pay stubs 

from former beneficiaries, some potential ENs have decided that they are unwilling to assume the risks 

of participating in the Ticket Program. 

The Panel strongly recommends that SSA immediately adopt new policies and procedures to ensure not 

only prompt EN payment, but also payment that is not contingent upon ENs collecting pay stubs from 

former beneficiaries. The EN obligation to provide evidence should be limited to an initial 

determination that the beneficiary is working at the required level of earnings and is no longer receiving 

disability benefits. If SSA requires evidence of work beyond this period, SSA, rather than the EN, 

should bear the burden of collecting it. Finally, the Panel recently learned that the accounting and 

payment system for processing payments to ENs is based on manual entry in a ledger. We strongly 

recommend that this system be fully automated at the earliest possible date. 

Annual Report to the President and Congress 33 
On behalf of the Panel, I am requesting that SSA take action to immediately address the concerns 

discussed above. Given the urgency of this matter, the Panel would appreciate a prompt formal response. 

I would also appreciate it if the Panel could receive a formal response to this letter as soon as possible. 

Marie Strahan, the Panel’s Executive Director, or I, are available at (202) 358-6430, to address your 

questions or clarify the Panel’s concerns. 

We look forward to our continued partnership with you and SSA staff to ensure the successful 

implementation and operation of the Ticket to Work and other work incentives programs for SSA 

beneficiaries with disabilities. 

Sincerely, 

Sarah Wiggins Mitchell 

cc: 

President George W. Bush 

The Honorable William M. Thomas 

Chairman, Committee on Ways and Means 

The Honorable Charles Rangel 

Ranking Member, Committee on Ways and Means 

The Honorable Charles Grassley 

Chairman, Committee on Finance 

The Honorable Max Baucus 

Ranking Member of Finance 

The Honorable E. Clay Shaw 

Chairman, Social Security Subcommittee 

Annual Report to the President and Congress 34 
TICKET TO WORK & WORK INCENTIVES 

ADVISORY PANEL 

October 21, 2003 

Martin Gerry, Deputy Commissioner for the 

Office of Disability and Income Security Programs

6401 Security Blvd., Room 100Altmeyer 

Baltimore, MD 

Robert Pasternack, Ph.D., Assistant Secretary for the 

Office of Special Education and Rehabilitative Services 

300 Independence Ave SW, Room 301 

Washington, DC 

Dear Mr. Gerry and Dr. Pasternack: 

On behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel) I want to thank 

both of you for attending the Panel’s quarterly meeting in May to discuss the implementation of the 

Ticket Program and Title I VR Program interaction. We also appreciated our dialogue with Mr. 

Gerry as well as Jennifer Sheehey and Beverlee Stafford at our most recent quarterly meeting in 

August. In May, we were very pleased to hear your views on national disability policy and on the 

implementation of the Ticket to Work and Work Incentives Improvement Act (the Act). This letter

provides a follow up on our discussion with you, requesting a joint response from the Social 

Security Administration’s Office of Disability and Income Security Programs (SSA, ODISP) and 

from the Office of Special Education and Rehabilitative Services’, Rehabilitation Services 

Administration (OSERS, RSA), to our remaining program coordination and policy questions. 

Based on public and informal comments to Panel members, we face serious problems in terms of how 

the State Vocational Rehabilitation Agencies (SVRAs) are interacting with employment networks (ENs) 

in implementing the Ticket Program. On balance, we have not seen a productive melding of the 

rehabilitative expertise of VR with the flexibility and follow-up support services of ENs. The Panel 

believes that several problems—SSA’s Transmittal 17, agreements between State VR and ENs, and 

comparable services and benefits—affect the quality of services under both programs to hundreds of 

thousands of SSI recipients and SSDI beneficiaries and that, if left unresolved, they may undermine the 

entire Ticket Program. In this letter we discuss each of these problems in some detail, making the 

following specific recommendations: 

Annual Report to the President and Congress 35 
Transmittal 17: Based on our understanding of the statute, Transmittal 17 should be amended to end the 

current use of the signed IPE as documentation needed for assignment of a ticket for a new case. 

Assignments of tickets should only occur through an informed action on the part of the beneficiary, such 

as completion of Form SSA-1365. Cost Reimbursement should only be available for use by a State VR 

Agency when SSA indicates that it is not participating in the Ticket program with a beneficiary. 

Agreements between State VR agencies and ENs: Although the Panel is aware that each SVRA is a State 

entity and free to design their agreements as they see fit, it is disappointed that no guidance has been 

given to States regarding these agreements. Due to the damaging effect on consumers and the Ticket 

program, the Panel urges SSA and RSA to formulate joint policy governing the contents of the 

agreements and dissemination of a model agreement to rectify this problem. 

Comparable Services and Benefits: The Panel is convinced that Congress did not intend to make 

persons with disabilities ineligible for Title I VR services by the very act of making them eligible 

for EN services. The Panel urges RSA to acknowledge this problem, correct the misuse of the 

comparable benefits provision, and provide substantive technical assistance to State agencies on 

the issue. 

Transmittal 17 - Vocational Rehabilitation Providers Handbook, September 03, 2002 

The Panel finds two areas in which SSA’s Transmittal 17 is inconsistent with provisions of the 

TWWIIA legislation. (1) Under Transmittal 17, in new cases the client’s signature on the IPE constitutes 

assignment of the ticket, even though this may occur without the knowledge or consent of the client. (2) 

Transmittal 17 indicates that cost reimbursement is available as a payment option for clients who have 

assigned their tickets with VR. 

A statement from an invited Iowa VR official during the Employment Network Summit and documents 

provided to us by New York State VR officials both raise serious policy questions about the subregulatory guidance issued by the Social Security Administration to State VR agencies in Transmittal 

17, dated August 30, 2002. According to Transmittal 17, for a new case “the signatures on the IPE 

indicate that: the beneficiary has decided to use the ticket to obtain services from the State VR agency, if 

the ticket is assignable . . .” It is possible to follow this procedure while fully informing the client that 

signing the IPE automatically assigns his or her Ticket. However, it seems to be the perception of many 

agencies that signing the IPE automatically assigns to ticket, even if there has been no provision to 

ensure the client’s knowledge or consent. In fact, the Panel has heard from VR officials around the 

country that if a State VR agency follows the SSA guidance they would be in violation of the informed 

choice provisions of the Rehabilitation Act. 

The Panel understands that it may be important to ensure that a new client has assigned the ticket so that 

he or she is protected from Continuing Disability Reviews (CDRs) while attempting to return to work. 

Although CDR protection is a compelling reason for assigning a ticket, there is no reason that the 

advantages of such protection cannot be explained to the client as one of the factors in his or her choice. 

The Panel believes that automatic and uninformed assignment is contrary to the fundamental principles 

of the Ticket to Work and Work Incentives Improvement Act. Ticket assignment should be completely 

separate from the development of an IPE with an SVRA, and an individual’s assent to one program 

should not be considered consent for participation in the other. A primary goal of the TWWIIA 

legislation was to provide beneficiaries with real choices between employment service providers. An 

Annual Report to the President and Congress 36 
equally important goal was to expand the pool of providers far beyond the State VR agencies. A 

beneficiary who is not informed of what is happening to his or her Ticket is being denied choice and, 

furthermore, non-VR ENs are being denied an opportunity to compete to provide services to the client. 

This effectively eliminates competition between providers. 

Ticket holders who are not currently on SVRA caseloads who approach an SVRA for services should 

have the following options: 

• Assign their Ticket to the SVRA; 

• Receive services from the SVRA, but assign their Ticket to an EN; 

• Not assign their Ticket to the SVRA or an EN – retain their Ticket for assignment at a later date; 

• Unassign their Ticket from the SVRA or an EN and reassign it to another EN. 

In addition, under Transmittal 17 if a client assigns his or her ticket to a VR agency then the VR agency 

can opt to use the traditional cost-reimbursement payment system. However the statute permits a State 

VR agency to elect to receive payment under section 222(d) of the Social Security Act, the traditional 

cost reimbursement program, only when the State agency decides that the beneficiary will not 

participate in the Ticket Program. Moreover, if the State agency accepts the beneficiary’s ticket then it 

must be paid under one of the outcome-based payment systems, accepting the same risks and rewards as 

other ENs. See Section 101 of the Act: 

. . . “(c) STATE PARTICIPATION (1) In General - Each State agency administering or supervising the 

administration of the State plan approved under title I of the Rehabilitation Act of 1973 (29 U.S.C. 720 

et seq) may elect to participate in the Program as an employment network with respect to the disabled 

beneficiary. If the State agency does elect to participate in the Program, the State agency shall also elect 

to be paid under the outcome payment system or the outcome-milestone payment system in accordance 

with subsection (h)(1). With respect to a disabled beneficiary that the State agency does not elect to 

have participate in the Program, the State agency shall be paid for services provided to that 

beneficiary under the system for payment applicable under section 222(d) and subsections (d) and 

(e) of section 1615.” (emphasis added) 

Hence, Transmittal 17 appears to be inconsistent with the statute both with respect to uninformed use of 

a signature on an IPE to assign the ticket and the use of cost-reimbursement for Ticket Program clients. 

Based on our understanding of the statute, Transmittal 17 should be amended to end the current use of 

the signed IPE as documentation needed for assignment of a ticket for a new case. Assignments of 

tickets should only occur through an informed action on the part of the beneficiary, such as completion 

of Form SSA-1365. Cost Reimbursement should only be available for use by a State VR Agency (SVRA) 

when SSA indicates that it is not participating in the Ticket Program with a beneficiary. Clear guidance 

from SSA and RSA is needed on how the State agency should document its decision to not use the 

Ticket Program and how this decision will not negatively affect future use of the ticket by a beneficiary. 

State VR and Employment Network Agreements 

The Panel has received extensive public input about problems with some agreements between SVRAs 

and ENs. To begin with, the agreements vary greatly from state to state and, in itself, this variation poses 

a problem. It can affect the number and variety of ENs that choose to participate in a given state. Many 

Annual Report to the President and Congress 37 
ENs know that they cannot afford to pay for frontloaded, high cost services, but they could serve clients 

requiring such services if they could make referrals to the SVRA. For this reason, if a state has an 

agreement that is unfavorable to ENs, an organization will have much less of an incentive to sign up as 

an EN in that state. 

The Panel is concerned that some agreements favor SVRAs at the expense of ENs, discouraging 

organizations from participating in the Ticket program as ENs and, ultimately, limiting consumer 

choice. In some cases, the ENs have had little or no input in deciding the terms of the agreement. A 

recent report (Evaluation Design for the Ticket to Work Program: Preliminary Process Evaluation, The 

Lewin Group, March 11, 2003) identifies four types of problematic agreements: 

1. Agreements that require ENs to reimburse VR for all VR costs to serve a Ticket holder who has 

assigned the Ticket to a non-VR EN (Colorado, Oregon, New York). 

2. Agreements that require all Tickets in the VR/EN partnership to be assigned to the VR agency 

(Massachusetts, Vermont). 

3. Agreements that require the EN to share income with VR over and above the VR cost to serve a 

specific Ticket holder (Connecticut). In this case the EN bears a disproportionate share of the risks 

and VR takes a disproportionate share of the payments. 

4. Agreements that require the EN to repay the VR agency for the costs of services provided before the 

EN has received any payments through the Ticket program (Delaware). Once again, in such 

agreements it is the EN that assumes the risk. 

We believe the variance and unfairness of such agreements is resulting in lower participation by ENs in 

the Ticket Program and thus limiting choice for consumers. Although the Panel is aware that each 

SVRA is a State entity and free to design their agreements as they see fit, it is disappointed that no 

guidance has been given to States regarding these agreements. Due to the damaging effect on consumers 

and the Ticket Program, the Panel urges SSA and RSA to formulate joint policy governing the contents 

of the agreements and to disseminate a model agreement to rectify this problem. 

Comparable Services and Benefits 

In May, the Panel asked RSA for an interpretation of how the comparable benefits provision, a statutory 

requirement under the Rehabilitation Act, affects the Ticket Program. Comparable benefits is designed 

to ensure against duplication and waste of program funds, requiring that, before providing 

services to any individual, the State VR agency must ensure that the services are not available through 

any other program. More specifically, the Rehabilitation Act provides: 

“Comparable Service and Benefits — 

(A) Determination of availability 

(i) In general - The State plan shall include an assurance that, prior to providing any vocational 

rehabilitation service to an eligible individual, except those services specified in paragraph 

(5)(D) and in paragraphs (1) through (4) and (14) of section 723(a) of this title, the designated 

Annual Report to the President and Congress 38 
State unit will determine whether comparable services and benefits are available under any other 

program (other than a program carried out under this subchapter) unless such a determination 

would interrupt or delay 

(I) the progress of the individual toward achieving the employment outcome identified in the 

individualized plan for employment of the individual in accordance with section 722(b) of this 

title; 

(II) an immediate job placement; or 

(III) the provision of such service to any individual at extreme medical risk.” 

RSA has recently provided the Panel with three explanations of the application of comparable services 

and benefits; the definition in the program regulations issued in 1998, an analysis from the preamble of 

those regulations by the Department of Education officials at that time, and a verbal interpretation at the 

Panel’s recent August 2003 quarterly meeting. Here are the three definitions: 

1. RSA staff responded to the Panel’s question with an interpretation and a quote from the preamble of 

recent regulations: 

“Based on that definition, it is clear that a Ticket issued by the Social Security Administration 

constitutes a comparable service and benefit.” 

2. In the appendix discussion of the regulations implementing the 1998 amendments to the 

Rehabilitation Act, the following statement appears: 

“Because Social Security recipients with disabilities are issued ‘tickets’ under TWWIIA in order to 

receive training and employment-related services from an employment network as defined in that 

act, we believe that the ticket constitutes a comparable service and benefit under the VR program. 

(emphasis added) Thus, to the extent that a ticket holder is receiving services from another entity 

that is serving as that individual’s employment network, the designated state unit (DSU) need not 

expend VR program funds on services that are comparable to the services the individual is already 

receiving. On the other hand, if the individual initially chooses that DSU as its (sic) employment 

network under TWWIIA, or otherwise transfers his or her ticket to the DSU, then the individual 

would be served solely by the DSU, and the ticket would not be considered a comparable service or 

benefit.” 

The policy in question was developed by RSA and issued without seeking the input of SSA or the 

Panel. It was issued soon after the passage of the Ticket to Work and Work Incentives Improvement 

Act legislation, prior to publication of the Ticket Program regulations and prior to implementation of 

the Ticket Program. 

3. In explaining comparable benefits at the Panel’s recent meeting, Beverlee Stafford stated that for a 

service to be a comparable benefit it must be, “. . .available if the person needs it, and if it would 

delay that person’s plan for employment it would not necessarily be a comparable benefit. And then 

it has to be commensurate with a service available through the public VR system.” 

Annual Report to the President and Congress 39 
The Panel believes these three explanations of comparable benefits are inconsistent. This is a problem in 

itself as State agency officials may shape very different policies, depending on their understanding of the 

application of comparable benefits to Ticket Program participants. However, the Panel also believes that 

using any of these interpretations to deny services is inappropriate and highly questionable. For example 

— 

State X is not under an order of selection. The individual is an SSI recipient or SSDI beneficiary and has 

been issued a Ticket. The individual chooses to assign their Ticket to a local private EN and the EN has 

an approved provider agreement with Maximus which says that they only provide case management, job 

development, job placement and follow along services. The individual in question needs high cost 

services normally provided by VR but beyond the scope of the EN. The individual also completes an 

application for VR services and fully meets all Title I eligibility requirements. 

Questions: Can the SVRA deny the individual access to high cost services that they would otherwise be 

eligible for if they had not assigned their Ticket to the EN? If a service is not “available from an 

individual’s EN, or any EN, is it truly a comparable benefit? Would a State be in violation of their 

approved State Plan if they denied services to this individual? Would a State be in violation of their 

State plan if the effect of their agreements with an EN is to deny consumers the right to exercise 

informed choice in the assignment of their Ticket? If so, doesn’t RSA already have the authority to 

enforce State Plan requirements and thus, find such agreements in violation of the law and regulations 

governing Title I? 

In summary, prior to the Ticket Program, SSA beneficiaries were presumed eligible for Title I services. 

Post the Ticket Program, some SVRAs have used the comparable benefits provisions of the 

Rehabilitation Act to deny eligibility to SSI recipients and SSDI beneficiaries so that in negotiating 

SVRA/EN agreements, SVRAs have exacted favorable terms under which Title I services would be 

provided. We believe RSA’s application of comparable services and benefits to the Ticket Program 

participants is contrary to Congress’ intent in the Ticket to Work and Work Incentives Improvement 

Act, as well as in the Rehabilitation Act itself. In the Ticket Program, Congress voted for increasing 

variety and choice in rehabilitative and employment services. The Panel is convinced that Congress did 

not intend to make persons with disabilities ineligible for Title I VR services by the very act of making 

them eligible for EN services. The Panel urges RSA to acknowledge this problem, correct the 

misapplication of the comparable benefits provision, and provide substantive guidance and technical 

assistance to SVRAs on the issue. 

Beyond addressing these specific issues, we ask that you provide leadership to increase the level of 

cooperation between SSA and RSA on these issues, so that both agencies will approach the current 

Ticket/VR tensions with a sense of shared purpose. Specifically, too much of the current SVRA/EN 

relationship reflects SVRA efforts to defend a threatened source of funding. Although the point has been 

raised at RSA conferences, there is not yet a broad recognition that constructive SVRA/EN interaction 

could create a substantial new SVRA clientele — persons needing traditional vocational rehabilitation 

services but also needing the longer-term follow along supports that ENs can provide. Persons with 

mental illness—a huge and under-served population—are a good example of a potential new clientele. 

With this letter we are extending a permanent invitation to the Commissioner of the Rehabilitation 

Services Administration and to the Assistant Secretary of OSERS to provide the Panel with quarterly 

updates on services provided to SSI and SSDI beneficiaries. The updates dould be similar to the 

Annual Report to the President and Congress 40 
implementation updates provided by the SSA and HHS on the Ticket to Work and Work Incentives 

Improvement Act programs but focussed on the SVRA activity. The Panel has also asked that two 

designated Panel members meet with the Commissioner of the Rehabilitation Services Administration 

on these and other coordination issues. Our Executive Director, Marie Strahan, will be in touch with the 

Commissioner Wilson’s office soon to set up a meeting on these concerns. 

Again, thank you both for your work with the Advisory Panel. We look forward to a continuing dialogue 

with you to promote a more productive Federal partnership on these and other issues related to 

improving rehabilitation services for people with disabilities. 

Sincerely, 

Sarah Wiggins Mitchell 

cc: 

The Honorable President George W. Bush The Honorable Max S. Baucus 

 Committee on Finance 

The Honorable Charles Grassley The Honorable John Breaux 

Chairman, Committee on Finance Chairman Social Security Subcommittee 

The Honorable John Kyl The Honorable Bill Thomas 

Social Security Subcommittee Chairman, House Ways and Means 

The Honorable Charles Rangle The Honorable Clay Shaw 

House Ways and Means Chairman, Social Security Subcommittee 

The Honorable Robert Matsui JoAnne Barnhart, Commissioner 

Social Security Subcommitte Social Security Administration 

Ramona Frentz, Acting Associate Commissioner Joanne Wilson, 

Office of Employment Support Programs Rehabilitation Services Adminstration 

Annual Report to the President and Congress 41 
TICKET TO WORK & WORK INCENTIVES 

ADVISORY PANEL 

November 20, 2003 

The Honorable E. Clay Shaw, Jr. The Honorable Charles E. Grassley 

Chairman, Social Security Subcommittee Chairman, Senate Finance Committee 

House Ways and Means Committee Room 219 Dirksen Senate Office Building 

Room B-316 Rayburn House Office Building Washington DC 20510 

Washington DC 20515 

Dear Chairmen Shaw and Grassley: 

I am writing on behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel) to urge 

the reauthorization and increased funding of the Benefits Planning, Assistance, and Outreach (BPAO) 

and Protection and Advocacy (P&A) programs created by the Ticket to Work and Work Incentives 

Improvement Act of 1999 (TWWIIA). The current authorization for these grant programs will expire at 

the end of Fiscal Year 2004. The Panel urges Congress to act before the current authorization expires to 

ensure the continuity of these critical services for people with disabilities attempting to go to work. 

These two programs, which provide benefits planning, outreach and advocacy services to SSI recipients 

and SSDI beneficiaries, are vital to people with disabilities and the success of the Ticket to Work and 

Self-Sufficiency Program. 

The decision to attempt to go to work is a complex and scary one for beneficiaries of SSDI and 

recipients of SSI. Social Security work incentives are very complicated and may appear to be 

inconsistent, especially for people receiving benefits from both programs. In addition, a work attempt 

can affect a myriad of other benefits, both state and Federal, that a person may be receiving. Having a 

well developed understanding of how to best use the work incentives available and create a plan to 

achieve self–sufficiency can make the difference between a successful work attempt and a lifelong 

dependence on benefits. 

Until the BPAO program was established by the TWWIIA, beneficiaries seeking to return to work 

lacked readily available access to assistance. Since its inception, 484 benefits planners have assisted 

over 82,000 beneficiaries, over 49,000 in the past twelve months, with information or helped them

navigate these complex processes and plan to go to work1

. This is an impressive number of people 

1

 National BPAO Data System, Virginia Commonwealth University – Benefits Assistance Resource Center, includes data 

reported as of September 30, 2003

Annual Report to the President and Congress 42 
served, but according to beneficiaries and state delivery service systems there are still not enough benefit 

planners to address clearly documented needs. 

In some areas, people have to wait weeks for initial appointments, which may discourage beneficiaries 

or be too late to help them. Many others do not have access to a benefits planner at all. Due to the 

current levels of funding for some grantees, a single benefits planner may be expected to serve an entire 

state, as is the case in Delaware and South Dakota. SSA awarded the cooperative agreement in 

Wyoming actually returned the grant because they could not begin to address the statewide need with 

the $50,000 they had been awarded. 

The number of benefits planners must be increased to ensure a better BPAO counselor to beneficiary 

ratio so that every beneficiary, no matter where they live in a state, has access to timely benefits 

planning services for return-to-work purposes. The overall funding level of the program should be 

significantly increased to accomplish this. 

The Panel has received extensive public comment in support of the BPAO program. This support has 

come from a wide variety of sources – people with disabilities, their advocates, Employment Networks, 

state agencies and Federal officials. SSA informed the Panel at its last meeting that they are about to 

release the results of the BPAO Customer Satisfaction Survey, the results of which SSA said are highly 

supportive of the program. In addition, states are just beginning to report data of positive outcomes for 

beneficiaries who receive BPAO services. For example, beneficiaries in New York who receive BPAO 

services become employed at a higher rate and stay employed for more quarters than those who do not.2 

Vermont just released findings that beneficiaries attempting to go to work who received benefits 

counseling services significantly increased their earnings as compared to beneficiaries who did not.3

 It is 

important to note that approximately one-third of the BPAO customers are SSI recipients and their 

earnings from work would be subject to the $1 for $2 benefit offset provisions in the SSI Program. The 

Panel is very encouraged by these findings and believes that, given time and the proper levels of 

funding, the BPAO program will significantly increase the independence of people with disabilities and 

decrease the public expenditures made on their behalf. The Panel urges Congress to continue this highly 

regarded and successful program and double the authorized funding level to $46,000,000. 

The Protection and Advocacy program authorized under TWWIIA has also proven essential in assisting 

beneficiaries in returning to and maintaining work. P&A programs have provided information and 

advocacy services to over 13,000 individuals as of November 30, 2002. With the expansion of the scope 

of advocacy services allowable under their grant funds, P&A grantees have greatly increased their 

ability to assist beneficiaries. In its latest Annual Report to the President and the Congress Year Three, 

the Panel expressed great concern regarding the prohibition by the Social Security Administration 

against using grant funds to provide advocacy to beneficiaries regarding overpayments. Since the 

publication of that report, the Panel is pleased to note that SSA has lifted that restriction and P&A 

programs have begun to represent beneficiaries in those matters. 

2 Data obtained from New York Works, New York State Department of Labor, November 2003 

3

 “The Impact of Specialized Benefits Counseling Services on Social Security Administration Disability Beneficiaries in 

Vermont,” accepted for publication in the Journal of Rehabilitation. The article reports findings that beneficiaries who 

received specialized benefits counseling increased their earnings $225 per quarter more than people who did not receive 

counseling or members of an historical control group. 

Annual Report to the President and Congress 43 
Receiving an overpayment, or the mere possibility of receiving one, can be the single greatest deterrent 

from attempting work. Beneficiaries who receive an overpayment due to work are very likely to 

discontinue employment and return to the rolls. According to the General Accounting Office, 

outstanding SSI debt and newly detected overpayments for the year 2001 totaled 4.7 billion dollars.4

 As 

more people return to work, the number and size of overpayments are likely to increase. Advocacy on 

behalf of beneficiaries who receive overpayments is critical to helping them continue employment and 

maintain their independence. Because the restriction against advocacy on behalf of beneficiaries facing 

overpayments was just lifted in June of 2003, statistics are not yet available on the number of 

beneficiaries who have received representation in regard to an overpayment. It is imperative that 

beneficiaries continue to have access to this representation so that overpayments do not cause 

beneficiaries to cease their work efforts because of fear. 

 The Panel has also received extensive public comment on the value of the P&A program to 

beneficiaries who wish to return to work. The continuation of the P&A program authorized under 

TWWIIA is clearly essential to ensuring the success of the Ticket Program, but the current authorization 

level is not adequate to meet the need. The current funding allocated to each project, with the majority of 

states receiving only $100,000, cannot possibly allow P&A programs to represent the beneficiaries who 

require their assistance. In many states, that grant amount will not even support the hiring of one 

attorney to provide advocacy to SSA beneficiaries. And when the Ticket Program is fully implemented, 

the need for services from the P&A projects will only increase. For these reasons, the Panel supports the 

reauthorization of this program, an increase in the minimum amount of each state grant to $200,000, and 

increased funding for the program as a whole to $14,000,000 per fiscal year. 

The Ticket Program is just entering the third phase of implementation. More than 3.5 million 

beneficiaries in 20 states will be receiving their tickets in the mail over the next 10 months. This is a 

very important time to maintain and strengthen these support programs. We know that BPAO contacts 

increase 100 percent in a state when the Ticket Program is rolled out in that state. The Social Security 

Administration is just beginning to evaluate the Ticket Program’s impact in removing some of the 

barriers and disincentives people with disabilities face when going to work. During this critical 

implementation period it is essential that the BPAO and P&A programs remain in place and receive the 

necessary resources to respond to the identified needs. 

Your consideration of these recommendations from the Ticket to Work and Work Incentives Advisory 

Panel is appreciated. 

4 General Accounting Office.2002. Supplemental Security Income: Progress Made in Detecting and Recovering 

Overpayments, But Management Attention Should Continue. 02-849. Washington, DC. 

Annual Report to the President and Congress 44 
Sincerely, 

Sarah Wiggins Mitchell, Chair 

cc: 

The Honorable President George W. Bush The Honorable Max S. Baucus 

 Committee on Finance 

The Honorable Rick Santorum, The Honorable Bill Thomas 

Chairman, Social Security Subcommittee Chairman, House Ways and Means 

The Honorable Charles Rangel JoAnne Barnhart, Commissioner 

House Ways and Means Social Security Administration 

Subcommittee 

The Honorable John Breaux The Honorable Robert Matsui 

Social Security Subcommittee Social Security Subcommittee 

Annual Report to the President and Congress 45 
TICKET TO WORK & WORK INCENTIVES 

ADVISORY PANEL 

December 18, 2003 

Jo Anne B. Barnhart, Commissioner 

Social Security Administration 

500 Virginia Ave SW, Suite 850 

International Trade Commission Building 

Washington, DC 20254 

Dear Commissioner Barnhart: 

I am writing you on behalf of the Ticket to Work and Work Incentives Advisory Panel in response to the 

Notice of Proposed Rule Making (NPRM) on the Reinstatement of Entitlement to Disability Benefits 

(Expedited Reinstatement or EXR) published in the Federal Register on October 27, 2003. The Panel 

generally supports these proposed regulations and commends the Social Security Administration for 

their clarity and overall policy direction. The Panel believes these proposed rules closely follow the 

language authorizing the EXR provision in the Ticket to Work and Work Incentives Improvement Act 

of 1999, but has concerns in two areas of the NPRM. The first relates to the interaction between the 

Ticket Program and EXR and the second is an issue of clarity regarding the definition of “special 

circumstances” in sections 404.1592e and 416.999c. 

The principal concern of the Panel regarding the NPRM is that the Ticket to Work Program is not 

mentioned at all, nor is it mentioned in the Program Operations Manual System section on EXR. It is the 

Panel’s understanding from conversations with SSA officials that an SSDI beneficiary or SSI recipient is 

eligible for a new Ticket immediately upon having their benefits reinstated pursuant to this section. 

However, this policy is not spelled out anywhere in writing. The lack of written policy may result in 

confusion for beneficiaries, SSA staff, and service providers which could result in lower participation in 

the Ticket Program by people who use EXR. The Panel urges SSA to explicitly state that a person who 

is reinstated pursuant to 20 CFR Part 404 or 416 is eligible for a new Ticket immediately. 

The Panel is very pleased that SSA chose to include the option of allowing a person to apply for EXR 

under special circumstances. The Panel believes that a person may be receiving a variety of disability 

related services and supports which are critical to work and the loss of a job that created access to these 

supports should allow him or her to be eligible for EXR. In the preamble to the regulations and the 

proposed regulations themselves in sections 404.1592e and 416.999c, only specialized transportation is 

listed as an example of a special circumstance. The Panel encourages SSA to expand the list of examples 

Annual Report to the President and Congress 46 
of special circumstances so that beneficiaries, claims representatives and services providers will 

understand that transportation is not the only support that might allow someone to meet this requirement. 

Some examples that could be used include, community supports, nearby medical support such as 

dialysis, proximity to a licensed group home, or physical accessibility of the workplace (this can be 

especially problematic in rural areas where many job sites are not accessible). 

The Panel has other significant concerns with the Expedited Reinstatement provisions that require either 

further study or statutory change. These include, but are not limited to, the 24 month initial 

reinstatement period and its relation to the use of other work incentives, the requirement that applicants 

for EXR must undergo a medical review; and the widely held misconception that EXR means an 

automatic reinstatement of entitlement to benefits when a former beneficiary loses earnings from work 

for any reason. The Panel is currently studying these issues and plans to issue recommendations 

regarding statutory changes to these provisions to Congress in their Annual Report. 

Thank you for your consideration of these comments from the Panel. 

Sincerely, 

Sarah Wiggins Mitchell, Chair 

Annual Report to the President and Congress 47 
TICKET TO WORK & WORK INCENTIVES 

ADVISORY PANEL 

January 20, 2004 

The Honorable Dale Kildee 

21st Century Competitiveness Subcommittee

House Education and the Workforce Committee 

2181 Ford House Office Building 

Washington, DC 20512 

Dear Congressman Kildee: 

On behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel), I am writing to 

express the Panel’s strong support of the legislative proposal in S. 1627 reauthorizing the Rehabilitation 

Act to continue funding for the American Indian Vocational Rehabilitation (AIVR) projects on the basis 

of performance. This would replace the current policy of requiring the AIVR projects to compete 

against each other for limited funding every five years. These projects are funded under Section 121 of 

the Rehabilitation Act. The proposed change would create a funding mechanism similar to that currently 

in place for Centers for Independent Living in section 722(e) (1) in the Rehabilitation Act. The Panel 

urges the members of the conference committee to accept the Senate language that codifies this 

legislative proposal. 

Our interest in this issue is directly related to our work as a public advisory panel mandated in Public 

Law 106-170, the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). The 

TWWIIA legislation established the Ticket to Work and Work Incentives Advisory Panel as a bipartisan appointed body of twelve citizens who represent a cross-section of rehabilitation interests as 

consumers, providers, state agency representatives, disabled veterans and employers. Members are 

appointed by the House of Representatives, the Senate and the President. The Advisory Panel’s primary 

duty is to advise the Commissioner of Social Security, the President, and Congress on issues related to 

work incentive programs, planning and assistance for individuals with disabilities including issues 

related to the implementation of the Ticket to Work and Self-Sufficiency Program (Ticket Program). 

The Panel is very interested in the stability and continuity of the AIVR projects because a number of the 

projects are also Employment Network service providers under the new Ticket Program. We hope to see 

even more AIVR grantees become Employment Networks but the current unstable funding situation 

undermines their interest in developing more services for Social Security beneficiaries. 

Annual Report to the President and Congress 48 
A significant number, approximately 40%, of the clients served by AIVR projects are individuals with 

disabilities who also receive cash benefits under the Social Security Disability Insurance or the 

Supplemental Security Income programs administered by the Social Security Administration. As such, 

they are eligible for cash benefits, Medicaid, Medicare, work incentives, a variety of employment 

support services, and for the Ticket Program. 

Native communities have documented disability rates and unemployment rates that are far higher than 

those of the general population, yet AIVR projects have performed well. The program has grown from 

one grantee in 1981 to 69 grantees located in 25 states. Last year these programs served 5,300 

consumers with a 64% rate of employment outcomes. Perhaps most notable is the fact that this success 

took place in Native communities with unemployment rates as high as 80% on some reservations. The 

AIVR programs employment rate typically exceeds 50%,a rate that is markedly higher than many State 

VR agencies. 

Native communities on and near reservations have long been un-served and under-served by State VR 

agencies because of the difficulties state VR agencies face in providing accessible, culturally appropriate 

and effective services to culturally diverse and remote tribal communities. State VR Agencies view the 

AIVR programs in their state as a vital component of the national rehabilitation program and as an 

important part of their state’s rehabilitation system. AIVR and State VR agencies have developed 

cooperative agreements and positive working relationships including joint training and cost sharing 

mechanisms. AIVR programs are successful where the State VR agencies have failed because AIVR 

programs maintain a continuous presence on the reservations, AIVR employees are familiar with and 

observe tribal customs as the staff of AIVR agencies are typically Native American and the AIVR staff 

speak the language and understand the cultural factors relevant to providing appropriate services and 

employment opportunities. These important success factors are well documented by recent national 

program evaluations and performance reports. 

Under section 121 of the Rehabilitation Act, AIVR projects are required to provide 

comprehensive VR services comparable to those provided by State VR agencies. They must 

apply the same Federal eligibility criteria and deliver services based on the same requirements 

for Individualized Plans for Employment as prescribed for State VR agencies in Section 102 of 

the Rehabilitation Act. New projects are encouraged to apply during each grant cycle because of 

the great need for services and the documented effectiveness of the projects. This year 24 Indian 

tribes applied for the new grant competition, but only 16 will be funded because there are not 

enough funds to support all of the qualified grant applicants, even though many were funded in 

the previous grant cycle, have active caseloads and have performed well. 

Finally, the termination of an AIVR project can be a tragic occurrence for Native Americans 

with disabilities and their families. When projects with strong performance reviews lose funding 

it is not uncommon for clients to drop out of the system entirely. Such disruption severely 

impacts the physical and emotional well being of the individual client and his/her family 

members. There is also no real guarantee that the closed AIVR case will be given priority for 

continuation of services by the respective State VR agency. Many states are on an Order of 

Selection or have instituted waiting lists and simply cannot pick up the AIVR cases. The current 

policy permits large numbers of eligible consumers to be abruptly terminated from service and 

their rehabilitation plans to be interrupted indefinitely. 

Annual Report to the President and Congress 49 
The Ticket to Work and Work Incentives Advisory Panel believes that Native American consumers 

should be afforded the same level of protection from interruption in their VR service plan as other 

citizens with disabilities. We strongly recommend that Congress pass the proposed legislative 

amendment to the Rehabilitation Act which will continue funding for American Indian Vocational 

Rehabilitation (AIVR) projects on the basis of performance. This would create a funding mechanism 

similar to that which is currently in place for Centers for Independent Living in section 722(e) (1) in the 

Rehabilitation Act. Each AIVR grantee that is performing appropriately should receive continued 

funding for fiscal year 2004 and the 60-month project period should be eliminated. 

Your consideration of these comments from the Ticket to Work and Work Incentives Advisory Panel is 

very much appreciated. If you have any questions regarding this letter, please contact our Executive 

Director, Marie Parker Strahan, at (202) 358-6430. 

Sincerely, 

Sarah Wiggins Mitchell, Chair 

cc. 

The Honorable President George W. Bush JoAnne Barnhart, Commissioner 

Social Security Administration 

Treva Roanhorse, President Joanne Wilson, Commissioner 

CANAR Rehabilitative Services

 Administration 

Annual Report to the President and Congress 50 
C. Advisory Panel Recommendations 

RECOMMENDATIONS DATE SOURCE SUBMITTED TO ACTION TAKEN* 

Make Ticket to Work available for all December 17, Annual Interim Progress Commissioner None 

beneficiaries 1999–December Report: Year One 

16, 2000 

Use the longest comment period possible December 17, Annual Interim Progress Commissioner Period used 60 days 

during regulatory process to allow maximum 1999–December Report: Year One 

public comment 16, 2000 

All SSI and SSDI adult beneficiaries July 23, 2001 Final Advice Report on Commissioner None 

including those designated as medical Ticket Program Notice of 

improvement expected should be eligible to Proposed Rule Making 

participate in program 

16- and 17-year-old beneficiaries should be July 23, 2001 Final Advice Report on Commissioner None 

eligible to participate in the Ticket Program Ticket Program Notice of 

Proposed Rule Making 

18-year-old beneficiaries should receive July 23, 2001 Final Advice Report on Congress None 

same protection from redeterminations as Ticket Program Notice of 

other ticket users do from CDR Proposed Rule Making 

SSA should conduct cost-benefit analysis on July 23, 2001 Final Advice Report on Commissioner None 

beneficiary receiving more than 1 ticket per Ticket Program Notice of 

period of disability Proposed Rule Making 

EN required to retain staff based on July 23, 2001 Final Advice Report on Commissioner Final Regulations 

education and experience Ticket Program Notice of 

Proposed Rule Making 

SSA should simplify EN reporting July 23, 2001 Final Advice Report on Commissioner Final Regulations 

requirements Ticket Program Notice of 

Proposed Rule Making 

Timely progress should be defined by terms July 23, 2001 Final Advice Report on Commissioner None 

and conditions of IWP Ticket Program Notice of 

Proposed Rule Making 

All beneficiaries should have access to P&A July 23, 2001 Final Advice Report on 

Ticket Program Notice of 

Proposed Rule Making 

Commissioner Improvement, 

Overpayment 

Mediation should be made available to July 23, 2001 Final Advice Report on Commissioner Pilot Program 

resolve disputes Ticket Program Notice of 

Proposed Rule Making 

All decisions made by SSA in reference to July 23, 2001 Final Advice Report on Commissioner None 

disputes should be subject to external review Ticket Program Notice of 

Proposed Rule Making 

Information on P&A services should be July 23, 2001 Final Advice Report on Commissioner Some, Letter, IWP 

accessible to beneficiaries Ticket Program Notice of 

Proposed Rule Making 

Beneficiary’s filing complaints with project July 23, 2001 Final Advice Report on Commissioner None 

manager against EN should trigger a notice Ticket Program Notice of 

to P&A Proposed Rule Making 

All notices should be in an accessible format July 23, 2001 Final Advice Report on 

Ticket Program Notice of 

Proposed Rule Making 

Commissioner None 

SSA should establish specified timeline for July 23, 2001 Final Advice Report on Commissioner None 

dispute resolution outlined Ticket Program Notice of 

Proposed Rule Making 

During appeals process, beneficiaries should July 23, 2001 Final Advice Report on Commissioner None 

receive the same level of support and service Ticket Program Notice of 

*This refers to actions the Panel has been informed of as of March 31, 2004. 

Annual Report to the President and Congress 51 
RECOMMENDATIONS DATE SOURCE SUBMITTED TO ACTION TAKEN* 

Proposed Rule Making 

All parties in disputes should have access to July 23, 2001 Final Advice Report on Commissioner Policy 

all information Ticket Program Notice of 

Proposed Rule Making 

SSA should adopt payment structure that July 23, 2001 Final Advice Report on Commissioner Improvement from 

pays four milestone payments Ticket Program Notice of two to three 

Proposed Rule Making 

SSA should interpret benefits not payable as July 23, 2001 Final Advice Report on Commissioner None 

a reduction in benefits Ticket Program Notice of 

Proposed Rule Making 

SSA should address efficacy of July 23, 2001 Final Advice Report on Commissioner None 

individualized milestones in AOI report Ticket Program Notice of 

Proposed Rule Making 

SSA should develop two milestone/outcome July 23, 2001 Final Advice Report on Commissioner None 

systems—one for SSI and one for SSDI Ticket Program Notice of 

Proposed Rule Making 

SSA should commission a full-cost benefit July 23, 2001 Final Advice Report on Commissioner None 

study to evaluate program Ticket Program Notice of 

Proposed Rule Making 

Resolve the conflict between sections July 23, 2001 Final Advice Report on Commissioner Resolved in final 

411.510 and 411.390 Ticket Program Notice of regulation 

Proposed Rule Making 

SSA should permit other service delivery July 23, 2001 Final Advice Report on Commissioner None 

plans to be used as a substitute for IWP Ticket Program Notice of 

Proposed Rule Making 

SSA should clarify that SSA beneficiary has July 23, 2001 Final Advice Report on Commissioner None: Beneficiary 

choice about assigning ticket to State VR Ticket Program Notice of must assign ticket to 

Proposed Rule Making VR if a VR client 

Swift issuance of the final ticket- November 30, Advisory Letter President Final regulations were 

implementing regulations 2001 issued in December 

2001 

Restore funding for BPAO and P&A January 7, 2002 Advisory Letter Commissioner Barnhart Funding restored 

Programs to maximum authorized in the 

statute 

Projects with Industry and Supported March 1, 2002 Advisory Letter President Bush Congress preserved 

Employment grants should be preserved at grant programs 

the Federal level 

Reauthorize the Work Opportunity Tax April 11, 2002 Letter to the Honorable Clay Clay Shaw HR 743 reauthorized 

Credit and extend it to employers who hire Shaw and extended the 

people with disabilities who used a ticket credit 

Establish ongoing structure for review of June 18, 2002 Advice Report on the Commissioner None 

emerging information for AOI Adequacy of Incentives 

(AOI) Study 

Convene an ongoing Adequacy of Incentives June 18, 2002 Advice Report on the Commissioner In 2003, convened the 

Advisory Team Adequacy of Incentives AOI Advisory Group 

(AOI) Study for 1 year 

SSA to provide Panel, Congress, and June 18, 2002 Advice Report on the Commissioner None 

President with ongoing interim reporting Adequacy of Incentives 

(AOI) Study 

Congress should pass a technical June 18, 2002 Advice Report on the Congress None 

amendment to require interim reporting Adequacy of Incentives 

(AOI) Study 

*This refers to actions the Panel has been informed of as of March 31, 2004. 

Annual Report to the President and Congress 52 
RECOMMENDATIONS DATE SOURCE SUBMITTED TO ACTION TAKEN* 

Data collected for AOI should be provided June 18, 2002 Advice Report on the Commissioner AOI data included in 

in the SSA’s overall Ticket evaluation Adequacy of Incentives Ticket evaluation 

research (AOI) Study research design 

Extend deadline for Adequacy of Incentives June 18, 2002 Advice Report on the Congress None 

Report Adequacy of Incentives 

(AOI) Study 

Identifying the four groups: SSA should use June 18, 2002 Advice Report on the Commissioner None 

other data sources Adequacy of Incentives 

(AOI) Study 

SSA’s beneficiary survey should include June 18, 2002 Advice Report on the Commissioner Survey design 

face-to-face interviews and special Adequacy of Incentives includes face-to-face 

accommodations for AOI population (AOI) Study interviews and other 

accommodations 

Review existing research and conduct June 18, 2002 Advice Report on the Commissioner Reviewed existing 

supplementary research Adequacy of Incentives research and best 

(AOI) Study practices at AOI 

technical workshop 

(May 2002) 

SSA should identify data elements ENs June 18, 2002 Advice Report on the Commissioner None 

should collect for AOI Adequacy of Incentives 

(AOI) Study 

Data collected should include attention to June 18, 2002 Advice Report on the Commissioner Study design includes 

national demographics and diversity Adequacy of Incentives information on 

(AOI) Study demographics and 

diversity 

Conduct or commission qualitative research June 18, 2002 Advice Report on the Commissioner Conducted interview 

with ENs on AOI issues including payments Adequacy of Incentives with ENs on AOI 

and wages (AOI) Study issues in evaluation 

design contract 

Implement the Employment Support July 1, 2002 Advisory Letter Commissioner Barnhart Discontinued ESR 

Representative position in SSA Field Offices position, created the 

AWIC position with 

58 staff 

$1 to $2 demonstration for current August 2002 Advice Report on $1 for $2 Commissioner Request for 

beneficiaries: Panel endorses using Benefit Offset Research information published 

demonstration projects for $1 for $2 September 2003 

Ensure that employment supports are in 

place for $1 for $2 demonstration 

August 2002 Advice Report on $1 for $2 

Benefit Offset Research 

Commissioner None 

Use SGA as disregard level for $1 for $2 

current beneficiaries demonstration 

August 2002 Advice Report on $1 for $2 

Benefit Offset Research 

Commissioner None 

Endorses SSA sample size of 5,000 in $1 for 

$2 demonstration 

August 2002 Advice Report on $1 for $2 

Benefit Offset Research 

Commissioner None 

Use monthly accounting period consistent August 2002 Advice Report on $1 for $2 Commissioner None 

with SSI accounting in $1 for $2 Benefit Offset Research 

demonstration 

Deferring the induced entry evaluation in $1 

for $2 demonstration 

August 2002 Advice Report on $1 for $2 

Benefit Offset Research 

Commissioner None 

Induced entry evaluation proposal should August 2002 Advice Report on $1 for $2 Commissioner None 

include at least five independent designs Benefit Offset Research 

from outside experts 

*This refers to actions the Panel has been informed of as of March 31, 2004. 

Annual Report to the President and Congress 53 
RECOMMENDATIONS DATE SOURCE SUBMITTED TO ACTION TAKEN* 

Induced entry should follow and report on August 2002 Advice Report on $1 for $2 Commissioner None 

parallel research projects across the country Benefit Offset Research 

that analyze determinants of return to work

Congress should direct SSA to spend more 

on public education and field training

 August 2002 Advisory Panel Annual 

Report: Year Two 

Congress None 

Employment Support Representatives August 2002 Advisory Panel Annual Commissioner Discontinued ESR 

(ESR): The statute says, “The Commissioner Report: Year Two position; created the 

should establish a corps of trained, AWIC position with 

accessible, and responsive work incentives 58 staff 

specialists within the Social Security 

Administration.” 

Beneficiaries designated as medical August 2002 Advisory Panel Annual Commissioner None 

improvement expected should be eligible for Report: Year Two 

tickets 

Transition-aged youth should be eligible for 

tickets 

August 2002 Advisory Panel Annual 

Report: Year Two 

Commissioner None 

Process monthly earning reports without August 2002 Advisory Panel Annual Commissioner None 

generating overpayments Report: Year Two 

Adequacy of incentives: delay report to August 2002 Advisory Panel Annual Congress None 

Congress and get interim reports from SSA Report: Year Two 

SSA should immediately implement a 

national marketing and public information 

program

 August 2002 Advisory Panel Annual 

Report: Year Two 

Commissioner Awarded contracts in 

2003 to analyze data 

collected from ENs, 

to develop strategies 

to increase EN 

participation, and to 

develop a strategic 

marketing plan 

targeted at 

beneficiaries by the 

end of FY 2004; third 

contract to analyze 

beneficiary data and 

develop a plan for 

maximizing 

participation of 

beneficiaries 

EN reimbursement for clients receiving August 2002 Advisory Panel Annual Commissioner SSA interprets 

partial benefits Report: Year Two “benefits not payable” 

as zero benefits 

$1 for $2 benefit offset: Congress should August 2002 Advisory Panel Annual Congress None 

amend statute to allow deferred research on Report: Year Two 

induced entry 

Congress should direct SSA to remove the 

restrictions on P&A grantee activities 

August 2002 Advisory Panel Annual 

Report: Year Two 

Congress SSA removed 

restriction, and HR 

743, signed on March 

2, 2004, removed 

others 

Reiterate the 2001 recommendations to May 2003 Annual Report: Year Three Congress None 

authorize benefits payments for reductions 

in benefits 

*This refers to actions the Panel has been informed of as of March 31, 2004. 

Annual Report to the President and Congress 54 
RECOMMENDATIONS DATE SOURCE SUBMITTED TO ACTION TAKEN* 

Conduct review and comparison of the May 2003 Annual Report: Year Three Congress None 

Ticket to Work and Work Incentives 

Improvement Act and the Social Security 

Act and the Rehabilitation Act during 

upcoming reauthorization of the 

Rehabilitation Act and take action on 

inconsistencies 

Congress should provide financial resources May 2003 Annual Report: Year Three Congress None 

for a dedicated corps of work incentive 

specialists (such as ESRs) 

Urge SSA to develop immediate national May 2003 Annual Report: Year Three Congress None (see action on 

marketing and public education campaign to marketing in Annual 

explain available programs Report: Year Two) 

Congress should direct SSA to work closely May 2003 Annual Report: Year Three Congress None 

with other Federal and State systems to 

develop a national training plan and with 

Congress to earmark funding 

Congress and SSA review EN payment 

system to adjust and enrich 

 May 2003 Annual Report: Year Three Congress None 

Congress should direct SSA to remove May 2003 Annual Report: Year Three Congress SSA removed some 

restrictions on the use of P&A grant funds restrictions, and HR 

743, signed on March 

2, 2004, removed 

others 

Request Commissioner’s support of Panel’s September 29, Letter to the Honorable Jo Commissioner Barnhart None 

recommendation to Congress to extend 2003 Anne Barnhart 

Ticket CDR protection to any and all NPRM on Continuation of 

beneficiaries who are participating in an Benefit Payments to Certain 

approved program of VR services, Individuals Who are 

employment services, or other employment Participating in a Program of 

support services VR Services, Employment 

Services, or Other Support 

Services, published in 

Federal Register in August 

2003 

Clarify that participants in other approved 

rehabilitation plans are eligible for 

continuation of benefits 

 September 29, 

2003 

Letter to the Honorable Jo 

Anne Barnhart 

NPRM on Continuation of 

Commissioner Barnhart Awaiting final 

regulations 

Benefit Payments to Certain 

Individuals Who are 

Participating in a Program of 

VR Services, Employment 

Services, or Other Support 

Services, published in 

Federal Register in August 

2003 

Amend Transmittal 17 to end the current use October 21, 2003 Advisory Letter Deputy Commissioner None 

of signed State VR IPE as documentation Martin Gerry 

needed for assignment of ticket 

Cost reimbursement should be separate from October 21, 2003 Advisory Letter Deputy Commissioner None 

the Ticket Program Martin Gerry 

SSA and RSA should formulate joint policy October 21, 2003 Advisory Letter Assistant Secretary Robert None 

governing the contents of VR-EN Pasternack 

agreements and disseminate a model 

agreement

*This refers to actions the Panel has been informed of as of March 31, 2004. 

Annual Report to the President and Congress 55 
RECOMMENDATIONS DATE SOURCE SUBMITTED TO ACTION TAKEN* 

Ticket should not be considered a 

comparable benefit under Title I of the 

Rehabilitation Act 

 October 21, 2003 Advisory Letter Assistant Secretary Robert 

Pasternack (Justesen for 

Pasternack) 

RSA interprets Ticket 

services that an EN 

provides that are 

commensurate with 

VR services as a 

comparable benefit 

and thus not available 

under Title I 

Reauthorize BPAO Program and double 

funding to $46,000,000 

 November 20, 

2003 

Advisory Letter Clay Shaw HR 743 reauthorized 

Reauthorize the P&A program, increase the November 20, Advisory Letter HR 743 reauthorized 

minimum amount of each State grant to 2003 the P&A Program 

$200,000, and increase funding for the 

program as a whole to $14,000,000 per FY 

Explicitly state that a person entitled to December 18, Advisory Letter on the Commissioner Barnhart Awaiting final 

benefits pursuant to expedited reinstatement 2003 Reinstatement of Entitlement regulations 

is immediately eligible for a ticket to Disability Benefits (EXR) 

Notice of Proposed Rule 

Making 

Clarify special circumstances by example December 18, 

2003 

Advisory Letter on the 

Reinstatement of Entitlement 

to Disability Benefits (EXR) 

Notice of Proposed Rule 

Making 

Commissioner Barnhart Awaiting final 

regulations 

Congress should develop statutory language February 2004 Advice Report on Congress None 

that articulates its original intent that the Employment Networks 

Ticket is a supplemental funding source 

Congress should direct Commissioner to February 2004 Advice Report on Congress None 

implement Ticket Program as a complement Employment Networks 

to SSA VR Reimbursement Program

Commissioner should conduct an assessment February 2004 Advice Report on Commissioner None 

of the Ticket Program and State VR Employment Networks 

Program running in combination 

Modify EN payment system to move more 

payment up front

 February 2004 Advice Report on 

Employment Networks 

Commissioner None 

Test two or three creative approaches that February 2004 Advice Report on Commissioner None 

increase EN and beneficiary participation Employment Networks 

Amend statute to permit Ticket Program to February 2004 Advice Report on Congress None 

increase sum of payments for SSI to equal Employment Networks 

SSDI 

Commissioner implement modified EN February 2004 Advice Report on Commissioner None 

payment system consistent with Employment Networks 

recommendations of AOI Advisory Group 

Commissioner should implement the Panel’s February 2004 Advice Report on Commissioner None 

recommendations related to payment Employment Networks 

systems and claims administration 

Commissioner and Congress make clear that February 2004 Advice Report on Commissioner/Congress None 

payments to ENs should supplement funding Employment Networks 

from other public programs, consistent with 

AOI group recommendations 

*This refers to actions the Panel has been informed of as of March 31, 2004. 

Annual Report to the President and Congress 56 
RECOMMENDATIONS DATE SOURCE SUBMITTED TO ACTION TAKEN* 

Once beneficiary is certified as employed, February 2004 Advice Report on Commissioner In 2003, SSA initiated 

Commissioner should continue to pay the Employment Networks a quarterly regime for 

EN on a monthly basis unless beneficiary paying ENs that 

status changes usually would not 

require reporting 

earnings 

Commissioner should refine EN payment February 2004 Advice Report on Commissioner None 

processing time to meet business standards Employment Networks 

Panel and Commissioner should convene February 2004 Advice Report on Commissioner None 

meeting with stakeholders to develop Employment Networks 

national training and communication 

conference for all ENs 

Congress should amend statute to permit February 2004 Advice Report on Congress None 

American Indian VR programs to be ENs Employment Networks 

without application and be eligible for SSA 

reimbursement program

*This refers to actions the Panel has been informed of as of March 31, 2004. 

Annual Report to the President and Congress 57 
D. Ticket to Work and Work Incentives Advisory Panel Advice Report to Congress 

and the Commissioner of the Social Security Administration 

The Crisis in EN Participation: A Blueprint for Action 

Issued February 2004 

Executive Summary 

Thousands of people with disabilities and their advocates shared a dream that the Ticket to Work and 

Work Incentives Improvement Act of 1999 (the Act) would greatly expand employment opportunities 

for people on the Social Security Administration (SSA) disability rolls. Three years after enactment of 

the law, it is clear that their dream is faltering. The Ticket to Work and Self-Sufficiency Program (Ticket 

Program) is failing to recruit the anticipated numbers of new employment service providers, called 

Employment Networks (ENs). In addition, those enrolled as ENs are serving only a fraction of the 

beneficiaries thought to be interested in participating in the Ticket Program. Nearly 1,000 providers have 

enrolled in the program, but only about one-third of those operating have accepted any tickets. The 

Panel believes that without immediate attention to the very real problems affecting EN participation, the 

Ticket Program will fail. The Panel urges Congress and the Commissioner to act quickly on the 

following recommendations. 

Issues and Recommendations 

Ticket Program as a Supplemental Funding Source -- ENs are uncertain about whether and how they 

can use funds from other public sources to serve ticket holders and have chosen not to actively 

participate in the Ticket Program because of fear of losing other stable funding sources. 

Recommendations 

• Congress should develop statutory language that clearly articulates its original intent that the Ticket 

Program’s outcome and milestone payments should provide additional resources to assist 

beneficiaries in attaining and retaining employment. In general, the Panel believes that Congress did 

not intend to make beneficiaries ineligible for the full range of services from vocational 

rehabilitation (VR) programs, Medicaid, or other Federal and State programs by making them 

eligible for the Ticket Program. 

• Congress should direct the Commissioner to implement the Ticket Program as a complement to the 

traditional SSA VR Reimbursement Program, paying State VR agencies for up-front services and 

paying ENs for long-term employment outcomes. 

• As part of the mandated evaluation of the Ticket Program, the Commissioner should conduct an 

assessment of the Ticket Program and the SSA VR Reimbursement Program, running in 

combination, to determine whether that approach produces better long-term, cost-effective outcomes 

than the historical VR Reimbursement Program alone, and to ensure the financial viability of 

running the two programs in combination. 

Annual Report to the President and Congress 58 
The EN Payment System -- Two problems in the EN payment system discourage the active participation 

of many providers: (1) the payment system places too much financial risk on ENs and (2) the payment 

system provides significantly lower reimbursements to ENs for serving Supplemental Security Income 

(SSI) recipients than for serving Social Security Disability Income (SSDI) beneficiaries. 

Recommendations 

• The Commissioner should immediately modify the EN payment system to move more of the 

payment into the first 12 months of employment and reduce the difference between the milestone 

and outcome payments. 

• The Commissioner should test two or three creative approaches that place more up-front financial 

risk on SSA but, if successful, could significantly increase Ticket Program participation by both ENs 

and beneficiaries, thereby increasing long-term savings to SSA. 

• Congress should amend the statute to permit payments to ENs to be set at a level greater than 40 

percent of average benefits for both SSDI and SSI beneficiaries and after the statutory change the 

Commissioner should implement an increase in EN payments for beneficiaries of both programs. 

• Congress should amend the statute to permit the Ticket Program to increase the sum of payments 

available for serving SSI recipients to a level equal to the sum of payments available for serving 

SSDI beneficiaries. 

• The changes to the EN payment system should be implemented as quickly as possible. 

Adequacy of Provider Incentives -- Because little is known about outcome payments for providers, the 

Act authorizes the Commissioner to review, refine, and alter the payment system to ensure that it 

provides adequate incentives for ENs to serve beneficiaries and produce savings to the program. 

Despite major problems with the payment model, no alterations have been made to the original program 

payment system. The Commissioner has established an advisory group on Adequacy of Incentives (AOI) 

to assist SSA with the design of a workable payment system, including financial incentives to serve four 

groups of beneficiaries with special needs that were referenced in the Act. 

Recommendations 

• The Commissioner should implement a modified EN payment system that generally incorporates the 

principles outlined in the AOI Advisory Group’s interim report. (The Panel supports the principles in 

the report but has not endorsed a specific model.) 

• For any new payment system to be successful, the Commissioner must first implement the Panel’s 

recommendations relating to the EN payment system and EN claims administration. 

• The Commissioner and Congress should make clear in statute and in program regulations that 

payments to ENs must supplement funding from other public programs (such as State VR, Mental 

Health, Medicaid, Housing and Urban Development, Department of Labor) and should not pay for 

services for which beneficiaries are already eligible. 

Annual Report to the President and Congress 59 
EN Payment Claims Administration --Two factors compound the financial risk and working capital 

problems of Employment Networks: (1) long-term tracking of beneficiary earnings is labor intensive and 

administratively burdensome for ENs and (2) there are often long delays in processing EN claims for 

payment. 

Recommendations 

• Once a beneficiary has been certified as employed above the substantial gainful activity (SGA) level 

or leaves cash benefit status, the Commissioner should continue to pay the EN on a monthly basis as 

long as the beneficiary remains in zero benefit status and the EN has not yet received 60 months of 

outcome payments, or until the beneficiary requests a new EN. 

• The Commissioner should refine the EN payment claims processing system to ensure timely 

payments to ENs within businesslike timeframes. A widely accepted business standard for 

turnaround time on receivables is 30 days. 

Marketing to ENs and to Beneficiaries --To date, there is no national marketing plan for the Ticket 

Program and the Program is not well understood by the vast majority of beneficiaries or by those who 

influence a beneficiary’s decision to attempt work. Further, ENs spend considerable time explaining the 

Program and dispelling misconceptions. Also, the lack of marketing contributes to the insufficient 

demand for EN services. However, SSA has recently awarded contracts to support development of a 

strategic marketing plan and EN marketing and recruitment efforts. The Panel has made numerous 

recommendations to the Commissioner on this issue in past reports. 

Recommendation 

• The Commissioner should create opportunities for the Panel to (1) review the work plans and 

proposed activities under the strategic marketing plan contract and the project designed to improve 

EN participation and (2) engage in a dialogue with the contractors and relevant SSA staff so that the 

Panel can provide timely and substantive input on these marketing activities. 

EN Training and Communication --There is inadequate training, technical assistance (TA), and timely 

information available to ENs. Existing TA and training resources are inadequate, nonuniform, 

piecemeal, uncoordinated, and of varying quality, with no coordinated means for ENs to identify and 

share best practices. 

Recommendations 

• The Panel, in partnership with the Commissioner, should convene a meeting of key stakeholders to 

develop a national training and communications conference for all ENs. 

• The Commissioner should appoint a working committee to develop the plan for this training 

conference and to develop the overall strategy for bringing together a broad-based coalition of 

stakeholders to oversee and sponsor the event. Panel members should be active participants. 

American Indian VR Program Eligibility for the SSA VR Reimbursement Program --Despite having to 

meet the same service standards as State VR agencies, American Indian Vocational Rehabilitation 

(AIVR) programs operated by Tribal Nations programs are not exempt from the Ticket Program EN 

Annual Report to the President and Congress 60 
application process and are excluded from the traditional SSA Reimbursement Program for State VR 

agencies. 

Recommendation 

• Congress should amend the statute to permit AIVR programs operating under section 121 of the 

Rehabilitation Act to participate in Ticket to Work in a manner equivalent to State VR agencies; that 

is, they should be exempt from the EN application process and be subject to the same reimbursement 

rules. 

Annual Report to the President and Congress 61