The Public Vocational Rehabilitation Program:
The Economic Impact of The Ticket to Work and Self-Sufficient Program
The Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) was designed to increase employment opportunities for individuals with disabilities who receive cash benefits under the Social Security Disability (SSDI) and Supplemental Security Income (SSI) programs to encourage them to enter or re-enter the workforce. According to the U.S. General Accounting Office, less than one percent of these individuals leave the SSDI and SSI rolls each year as a result of paid employment. Of those leaving the rolls, about one-third return within three years. State VR agencies have been serving thousands of these individuals each year. Nevertheless, a majority of these individuals have chosen not to seek assistance from the Public VR Program for fear of losing needed health care coverage.
In the past, the Social Security Administration (SSA) would reimburse VR for their expenses and administrative costs when VR was successful in placing individuals on SSDI and SSI in employment that is sustained over a nine-month period and results in the discontinuation of cash benefits. The Ticket to Work Program expands SSA’s authority to provide compensation when the provision of services and supports results in an individual working and earning enough to get off Social Security disability benefits. Private providers can apply to SSA for approval to serve beneficiaries with tickets and receive compensation, either through outcome payment or milestone and outcome payments combined, when a beneficiary’s earnings from work result in the discontinuation of cash benefits. Approved providers are referred to as employment networks (ENs).
Since VR is the only program that will be automatically approved to provide services to beneficiaries under the Ticket Program, the impact on the Public VR Program is likely to be dramatic. Over the next two years, tickets will be mailed to eligible beneficiaries along with information on how to use the ticket to obtain vocational rehabilitation, employment services and other support services. Many beneficiaries will call local VR agencies to find out more about the Ticket Program. With the complementary work incentives provisions in TWWIIA, it is expected that larger numbers of beneficiaries will be willing to attempt work than in the past.
Since the structure of the Ticket Program does not provide any upfront funding to serve beneficiaries, ENs will have to absorb considerable costs pending payments for SSA after the beneficiaries they serve obtain and maintain employment at earnings high enough to discontinue cash benefits. In some states, the State VR Agency is working with various providers to form a coalition of providers to function as a single EN. In other states, the State VR Agency will be operating independently and in competition with other ENs. In both cases, the VR agency is one of the few service providers that has a source of funding that does not depend solely on long term reimbursement strategies. Consequently, any increased interest in seeking employment among these beneficiaries will likely increase the demand on State VR agencies.
Under the 1998 amendments to the Rehabilitation Act, individuals receiving SSDI and SSI are presumptively eligible for services under the Public VR Program. In states where VR funding is inadequate to meet the needs of all those who will potentially apply for and be eligible for services, the State VR agency is “required” to implement an order of selection, a system whereby services are prioritized for those individuals with the most significant disabilities. Thirty-seven VR Agencies implemented an order of selection in FY 2002. Data has shown that VR Agencies operating under an order of selection serve a higher percentage of individuals on SSDI and SSI than VR Agencies that are not under an order.
Beneficiaries eligible to receive tickets have more significant disabilities and higher average service costs. Since ENs serving under the Ticket Program are permitted to choose who they want to serve, many beneficiaries with costly service needs (e.g., expensive assistive technology) will end up seeking assistance from VR Agencies who are required by the Rehabilitation Act to serve all eligible individuals. This will place yet another burden on the inadequately funded Public VR Program and will result in fewer persons with disabilities receiving services, and fewer people becoming employed.
