Statement of Thomas P. Golden, Member, Ticket to Work and Work Incentives Advisory Panel

Testimony Before the Subcommittee on Social Security
of the House Committee on Ways and Means

March 18, 2004

Introduction

The Ticket to Work and Work Incentives Advisory Panel (the Panel) would like to thank Chairman Shaw for holding this hearing. The Panel appreciates the Committee’s high level of interest in ongoing oversight regarding the Ticket Program and the other important programs and policies of the Ticket to Work and Work Incentives Improvement Act. The Panel would also like to take the time to recognize the support this committee demonstrates for people with disabilities and the Social Security Administration Disability programs.  

Good News

The Panel believes that the Ticket Program is a very popular program with still much unrealized potential.  Advocates for people with disabilities at the national and grassroots levels are very supportive of this program and are working with their Federal partners to make the program succeed.

Positive Sign: Consumer Interest

Consumers are also showing great interest in the program. Forty thousand people have assigned their tickets to receive vocational rehabilitation and employment support services. While only about 4000 of those are with Employment Network providers, or what we call ENs, that is a big number for the short time that the Ticket Program has been around. This is especially true given the fact that the roll out of the Ticket program was delayed and is not yet completed. The rest of the Tickets have been assigned to State Vocational Rehabilitation agencies.

Even beneficiaries who have not assigned a Ticket are very interested in finding out about the program. The Program Manager, Maximus, received over 23,000 calls in the month of February alone. Almost 20,000 of those were inquiries made by or on behalf on beneficiaries with interest in the Ticket program. In addition, MAXIMUS reports that during calendar year 2003, over 10 million hits were made to the Ticket to Work website.

TWWIIA Support Programs are Excellent

The support programs established by the Ticket to Work and Work Incentives Improvement Act are also proving to be very successful. Almost 100,000 beneficiaries have sought information and assistance from the benefits planning assistance and outreach program, or BPAO. The results of the customer satisfaction survey that were just released by the Social Security Administration supports what the Panel has been hearing from beneficiaries across the country: BPAO services are excellent and essential to people with disabilities who want  to work. Eighty nine percent of those surveyed rated the service they received as excellent, very good, or good. And, the percent of the people who reported they were working jumped by 19 % subsequent to their contact with the BPAO.  The Panel is pleased that the BPAO program was reauthorized in HR743 and thanks this Committee for their hard work in passing that legislation.

Positive Implementation Step: Area Work Incentive Coordinator

The establishment of the Area Work Incentive Coordinator, or AWIC, position within SSA is a very positive development in implementation of the Ticket program, as well as in the overall administration of work incentives. The Panel is very pleased that SSA decided to create a position that is permanent and devoted full time to work incentive duties as part of their internal corps of work incentives specialists. The Panel has repeatedly heard very positive testimony and comments regarding the dedicated and skilled SSA employees that fill the AWIC positions.  As we all know, the provision of accurate and timely information on work incentives is a critical factor in making people feel secure in their attempt to go to work. AWICs help to make that happen for SSA beneficiaries. The Panel hopes that SSA will expand the number of AWIC positions to meet the enormous demand for their services.

Three Areas of Concern

While the Agency is making good progress, the Panel has serious concerns in three key implementation areas that threaten the success of the Ticket Program. Of most concern to the Panel is the current low participation of ENs. Second, we are concerned about the lack of public education and marketing of the Ticket Program to beneficiaries, their families, and ENs. A third major area of concern is the inadequate training provided to SSA field staff about work incentives in general, and the Ticket Program specifically.

Concern One: EN Participation  

As you probably know, the Panel issued a report last month on the crisis in EN participation and its potential impact on the Ticket Program. The Executive Summary of that report is included at the end of this statement (beginning on page 8). 

Central to this report is the assumption that recruiting and retaining a large number of active ENs is a critical factor in accomplishing the primary stated goal of Ticket Program – giving people with disabilities a real choice in rehabilitation and employment services.  Our report identified a number of issues related to the structure of the Ticket Program that are causing providers not to participate as ENs or to drop out altogether. These are: the need for Congress to clarify that the Ticket Program should be used as a supplemental, rather than a substitute, funding source; the design of the EN payment system; the inadequacy of provider incentives; the administration of claims for payment; marketing; EN training;  and the treatment of  American Indian VR programs.

Finally, the Panel is concerned and puzzled that in the fourth year of the Ticket Program, SSA has yet to undertake a demonstration or pilot project addressing some of these issues especially the payment issue. The problems outlined below in the Executive Summary must be addressed without delay to make the Ticket Program more attractive to current and potential ENs and to ensure that current ENs to remain in the program.

Concern Two: Marketing and Public Education

The second major area the Panel believes maybe hindering the success of the program is the lack of marketing and public education being conducted by SSA in support of the program. The Panel has repeatedly recommended that SSA undertake a national coordinated marketing and public education campaign in order to increase awareness of and interest in the Ticket program. Currently, beneficiaries are informed only once about the Ticket Program and they may not be informed at all about other TWWIIA provisions and work incentives.  The only marketing material most beneficiaries receive on the Ticket Program is a letter describing the program when the Ticket is being rolled out, or when they first become eligible for benefits.

The Panel is pleased that SSA has awarded a contract for the designof a strategic marketing plan for the program that will be completed this year. However, in the meantime, many ENs report having trouble finding people willing to assign their Tickets and many beneficiaries and local advocates remain completely in the dark about the Ticket program and the other work incentives. Although these SSA contracting efforts are very positive steps, the Panel is concerned that the next year or two will be devoted to planning marketing efforts rather than actual marketing of the Ticket Program.  Extensive planning activities may delay implementation of a national marketing plan even further.  The Panel believes it is reasonable to expect that marketing would occur prior to, or during, the rollout of a new program, not after.  

The Panel urges SSA to move forward quickly with other marketing activities, such as sending reminder letters to all people who have received but not yet used their ticket.

Concern Three: Training

The final area that is of most concern to the Panel is the insufficient training SSA field staff receive about work incentives and the Ticket Program. The Panel has heard in public testimony across the country, stories of beneficiaries who have received inaccurate information about work incentives from SSA staff in the field office. Receiving bad information can cause a person not to make a job attempt, to receive an overpayment, or to be forced to stop working. It also increases mistrust and fear. This situation is unacceptable to the Panel and Americans with disabilities. Every SSA field office should have accessible and available staff that possess a thorough understanding of the work incentives and be able to provide accurate basic information to SSA beneficiaries with disabilities who want to work.

On that note, the Panel wants to again recognize the very positive step the Agency took in the creation of the AWIC position as part of their internal corps of work incentive experts. This represents the best type of customer service. The AWICs received good basic training (two full weeks) and many of them were former Employment Support Representatives (with six weeks of training). AWICS are reported to be very knowledgeable and highly regarded in the field and by beneficiaries.

There are not nearly enough AWICs to be available to answer every question beneficiaries have but the training that AWICs have received on SSA work incentives and the Ticket Program is exemplary. SSA cannot, however, rely on AWICs to provide all information and advice to beneficiaries on work incentives and the Ticket Program. SSA created a filter down, train the trainer approach to build their corps of internal work incentive specialists.  AWIC’s train Work Incentives Liaisons (or WILs), the people who provide information on work incentives on top of their regular duties in the field office. WILs receive their limited training from the AWICs and then are expected to train the remainder of the field office staff. SSA work incentives and their interaction with the Ticket Program are very complicated and technical topics. The problem with SSA’s current strategy is that the necessary knowledge does not seem to filter down to the claims representatives and service representatives who are answering beneficiary questions about work incentives on a day-to-day basis. We trust that SSA will make more intensive training, along the lines of what AWICs receive, available to all SSA field staff.

Conclusion

The Panel believes the Ticket Program has great potential to help many people with disabilities improve their lives by going to work. This statement outlines a number of concerns the Panel has about SSA’s administration of the Ticket Program. While it is still early in the implementation process of this new program, the failure of SSA to take steps immediately to address these concerns may have a dire effect on the success of the program.

The Crisis in EN Participation: A Blueprint for Action  (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.

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.

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 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.