[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
THE SOCIAL SECURITY ADMINISTRATION'S
MANAGEMENT OF THE
TICKET TO WORK PROGRAM
=======================================================================
HEARING
before the
SUBCOMMITTEE ON SOCIAL SECURITY
of the
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
__________
MARCH 18, 2004
__________
Serial No. 108-58
__________
Printed for the use of the Committee on Ways and Means
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COMMITTEE ON WAYS AND MEANS
BILL THOMAS, California, Chairman
PHILIP M. CRANE, Illinois CHARLES B. RANGEL, New York
E. CLAY SHAW, JR., Florida FORTNEY PETE STARK, California
NANCY L. JOHNSON, Connecticut ROBERT T. MATSUI, California
AMO HOUGHTON, New York SANDER M. LEVIN, Michigan
WALLY HERGER, California BENJAMIN L. CARDIN, Maryland
JIM MCCRERY, Louisiana JIM MCDERMOTT, Washington
DAVE CAMP, Michigan GERALD D. KLECZKA, Wisconsin
JIM RAMSTAD, Minnesota JOHN LEWIS, Georgia
JIM NUSSLE, Iowa RICHARD E. NEAL, Massachusetts
SAM JOHNSON, Texas MICHAEL R. MCNULTY, New York
JENNIFER DUNN, Washington WILLIAM J. JEFFERSON, Louisiana
MAC COLLINS, Georgia JOHN S. TANNER, Tennessee
ROB PORTMAN, Ohio XAVIER BECERRA, California
PHIL ENGLISH, Pennsylvania LLOYD DOGGETT, Texas
J.D. HAYWORTH, Arizona EARL POMEROY, North Dakota
JERRY WELLER, Illinois MAX SANDLIN, Texas
KENNY C. HULSHOF, Missouri STEPHANIE TUBBS JONES, Ohio
SCOTT MCINNIS, Colorado
RON LEWIS, Kentucky
MARK FOLEY, Florida
KEVIN BRADY, Texas
PAUL RYAN, Wisconsin
ERIC CANTOR, Virginia
______
SUBCOMMITTEE ON SOCIAL SECURITY
E. CLAY SHAW, JR., Florida, Chairman
SAM JOHNSON, Texas ROBERT T. MATSUI, California
MAC COLLINS, Georgia BENJAMIN L. CARDIN, Maryland
J.D. HAYWORTH, Arizona EARL POMEROY, North Dakota
KENNY C. HULSHOF, Missouri XAVIER BECERRA, California
RON LEWIS, Kentucky STEPHANIE TUBBS JONES, Ohio
KEVIN BRADY, Texas
PAUL RYAN, Wisconsin
Allison H. Giles, Chief of Staff
Janice Mays, Minority Chief Counsel
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Ways and Means are also published
in electronic form. The printed hearing record remains the official
version. Because electronic submissions are used to prepare both
printed and electronic versions of the hearing record, the process of
converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
Page
Advisory of March 11, 2004, announcing the hearing............... 2
WITNESSES
U.S. Department of Education, Troy R. Justesen, Acting Deputy
Assistant Secretary, Office of Special Education and
Rehabilitation Services........................................ 28
Social Security Administration, Martin H. Gerry, Deputy
Commissioner, Disabiltiy and Income Security Programs.......... 21
______
Arizona Employment Network Association, Susan Webb............... 80
Benjearlene Nelson, Ticket to Work Participant; accompanied by
Ron Rattay, Gulfstream Goodwill Industries, Inc................ 8
Charmaine Teri Hancock, Ticket to Work Partcipant................ 10
Consortium for Citizens with Disabilities, Paul J. Seifert....... 66
Health and Disability Advocates, John Coburn..................... 84
Integrated Disability Resources, Inc., Tom Foran................. 71
Ticket to Work and Work Incentives Advisory Panel, Sarah Wiggins
Mitchell....................................................... 55
Ticket to Work and Work Incentives Advisory Panel, Thomas P.
Golden......................................................... 55
VR Services, Richmond Area Arc, Quintin M. Mitchell.............. 76
SUBMISSIONS FOR THE RECORD
California Department of Rehabilitation, Sacramento, CA,
Catherine Campisi, letter...................................... 97
Council of State Administrators of Vocational Rehabilitation,
Chicago, IL, Robert Kilbury and Louis Hamer, statement......... 98
Indiana Vocational Rehabilitation Services, Indianapolis, IN,
Mike Hedden, statement......................................... 99
Louisiana Rehabilitation Services, Department of Social Services,
Baton Rouge, LA, James Wallace, statement...................... 99
Maryland Division of Rehabilitation Services, Baltimore, MD,
Robert A. Burns, letter........................................ 100
Massachusetts Rehabilitation Commission, Boston, MA, Elmer C.
Bartels, statement............................................. 100
Oklahoma Department of Rehabilitation Services, Oklahoma City,
OK, Dan O'Brien, statement..................................... 102
Pennsylvania Office of Vocational Rehabilitation, Harrisburg, PA,
Stephen R. Natsui, letter...................................... 104
South Carolina Vocational Rehabilitation Department, West
Columbia, SC, Larry C. Bryant, statement....................... 105
Tennessee Division of Rehabilitation Services, Nashville, TN,
Carl Brown, letter............................................. 106
Texas Department of Assistive and Rehabilitative Services,
Austin, TX, Terrell I. Murphy, statement....................... 107
Utah State Office of Rehabilitation, Salt Lake City, UT, Blaine
Petersen, letter............................................... 107
Washington Department of Social and Health Services, Division of
Vocational Rehabilitation, Lacey, WA, Michael O'Brien,
statement...................................................... 109
West Virginia Division of Rehabilitation Services, Charleston,
WV, statement.................................................. 110
THE SOCIAL SECURITY ADMINISTRATION'S
MANAGEMENT OF THE
TICKET TO WORK PROGRAM
----------
THURSDAY, MARCH 18, 2004
U.S. House of Representatives,
Committee on Ways and Means,
Subcommittee on Social Security
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:08 a.m., in
room B-318, Rayburn House Office Building, Hon. E. Clay Shaw,
Jr. (Chairman of the Subcommittee) presiding.
[The advisory announcing the hearing follows:]
ADVISORY FROM THE COMMITTEE ON WAYS AND MEANS
SUBCOMMITTEE ON SOCIAL SECURITY
CONTACT: (202) 225-9263
FOR IMMEDIATE RELEASE
March 11, 2004
No. SS-8
Shaw Announces Hearing on
the Social Security Administration's
Management of the Ticket to Work Program
Congressman E. Clay Shaw, Jr. (R-FL), Chairman, Subcommittee on
Social Security of the Committee on Ways and Means, today announced
that the Subcommittee will hold a hearing on the Social Security
Administration's (SSA's) management of the Ticket to Work Program. The
hearing will take place on Thursday, March 18, 2004, in room B-318
Rayburn House Office Building, beginning at 10:00 a.m.
In view of the limited time available to hear witnesses, oral
testimony at this hearing will be limited to the SSA, the U.S.
Department of Education, and other invited witnesses. However, any
individual or organization not scheduled for an oral appearance may
submit a written statement for consideration by the Subcommittee or for
inclusion in the printed record of the hearing.
BACKGROUND:
The Ticket to Work and Work Incentives Improvement Act of 1999
(P.L. 106-170), signed into law on December 17, 1999, established the
Ticket to Work and Self-Sufficiency Program, expanded the availability
of health care coverage, and provided for demonstration projects and
studies. The Ticket to Work Program, administered by the SSA, increases
choice in obtaining rehabilitation and vocational services, and
provides greater opportunities for Disability Insurance (DI) and
Supplemental Security Income (SSI) recipients to receive assistance to
help them return to work.
As part of the program, individuals receive a ``ticket'' from the
SSA, which they may voluntarily assign to their State Vocational
Rehabilitation Agency (SVRA) or to an Employment Network (EN) of their
choice. An EN is a public agency or private organization that provides
employment services, vocational rehabilitation services, or other
support services necessary to achieve a vocational goal. The ENs are
paid by the SSA for results, and choose between two payment systems--
one based on the individual no longer receiving cash benefits because
of work, the other based on attainment of certain vocational
milestones. The program is being phased in over a 3-year period and
will be in place nationwide in September 2004.
Most Social Security DI and SSI adult disability beneficiaries are
automatically eligible to receive tickets, and to date, almost 7
million tickets have been issued. Some 40,000 beneficiaries have chosen
to assign their tickets to service providers. Of these, 10 percent have
been assigned to one of more than 1,100 ENs and 90 percent have been
assigned to a SVRA.
The bipartisan Ticket to Work and Work Incentives Advisory Panel,
established in law to advise the President, the Congress, and the
Commissioner of Social Security on issues related to work incentive
programs, is monitoring the implementation of the ticket program. It
has expressed growing concerns about the SSA's management of the
program. In particular, the panel is deeply concerned that too few ENs
are willing to accept tickets and assist beneficiaries to return to
work. It's recently issued report to the Congress and the Commissioner
entitled, ``The Crisis in EN Participation--A Blueprint for Action,''
http://www.ssa.gov/work/panel/panel_documents/pdf_versions/
CrisisEnParticipation.pdf made a number of recommendations, including:
clarify the Ticket Program as a funding source that supplements, rather
than displaces, other existing funding sources; improve the EN payment
system and EN claims administration; expand EN and beneficiary
marketing; and improve EN training and communication.
In addition, unresolved issues between ENs and many SVRAs may also
be discouraging ENs from participating in the Ticket Program. These
issues include: questions regarding automatic ticket assignments to
SVRAs; pressure for ENs to contract with SVRAs rather than accepting
tickets themselves; ineffective cooperative agreements between SVRAs
and ENs; and lack of consumer information.
In announcing the hearing, Chairman Shaw stated, ``Work--essential
for individuals with disabilities to achieve their goals and support
their families--won't happen without an effectively run Ticket to Work
Program. The Social Security Administration's management of this
important program must fully meet the needs of those wanting to return
to work as well as those assisting them in this effort.''
FOCUS OF THE HEARING:
The Subcommittee will review the SSA's management of the Ticket to
Work Program, including results achieved to date and challenges
hampering program success.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Please Note: Any person or organization wishing to submit written
comments for the record must send it electronically
[email protected] along with a fax copy to
(202) 225-2610, by close of business Thursday, April 1, 2004. In the
immediate future, the Committee website will allow for electronic
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sealed-packaged deliveries to all House Office Buildings.
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Note: All Committee advisories and news releases are available on
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The Committee seeks to make its facilities accessible to persons
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noted above.
Chairman SHAW. Good morning. Today our Subcommittee will
examine the Social Security Administration's (SSA's) management
of the Ticket to Work Program. The Ticket to Work and Work
Incentives Improvement Act (P.L. 106-170) was signed into law
in December 1999. The goal of this landmark legislation is to
remove barriers and increase incentives for individuals with
disabilities to seek work. These incentives empower
beneficiaries with choices of job training and placement
services.
Prior to enactment of the bill, less than 1 percent of the
individuals with disabilities receiving Social Security
Disability Insurance (SSDI) or Supplemental Security Income
(SSI) left the rolls to return to work. Now the SSA is reaching
the end of its three-phase implementation plan of this program.
To date almost 7 million tickets to individuals with
disabilities in all 50 States have been distributed and all
program components are operational. This has been no small
effort and I commend the agency for extraordinary efforts.
I have a sample of a ticket right here and you can see that
it allows the ticket holder to obtain employment services by
turning the ticket to a State Vocational Rehabilitation (VR)
agency or Employment Network (EN). So far 40,000 tickets have
been assigned yet 90 percent of these tickets have been
assigned to State VR agencies and only 10 percent have been
assigned to ENs. In the Ticket to Work Program choice is
paramount. To continue to grow the success of the program we
need to understand why a market of ENs has failed to
materialize.
[The information follows:]
[GRAPHIC] [TIFF OMITTED] T3796A.001
The bipartisan Ticket to Work and Work Incentives Advisory
Panel has been examining issues relating to the service
providers marketplace since it first convened. Today we will
hear the panel's latest recommendation, along with the
testimony from three ENs that are currently accepting tickets
and helping the individuals return to work. Although the low
number of ENs participating in the Ticket to Work Program is
troubling, we must not lose sight that this program is having a
positive impact on the lives of many individuals who do have
disabilities.
Therefore, I think it is only fitting that our hearing
begin with the testimony of two individuals who have changed
their lives by taking advantage of the Ticket to Work Program.
Following their testimony, we will hear from representatives of
the SSA and the U.S. Department of Education, and then from
other key stakeholders. Taking the first step to try to work is
one of the most difficult decisions someone with a disability
can make. Our challenge is to ensure that the Ticket to Work
Program helps make this decision easier, not harder. I look
forward to hearing the thoughtful counsel of each of our
witnesses today and I thank you for joining us. Now I would
yield to the gentleman from Maryland, Mr. Cardin.
[The opening statement of Chairman Shaw follows:]
Opening Statement of The Honorable E. Clay Shaw, Jr., Chairman, and a
Representative in Congress from the State of Florida
Good morning. Today, our Subcommittee will examine the Social
Security Administration's management of the Ticket to Work Program.
The Ticket to Work and Work Incentives Improvement Act was signed
into law in December of 1999. The goal of this landmark legislation is
to remove barriers and increase incentives for individuals with
disabilities to seek work. These incentives empower beneficiaries with
choices for job training and placement services.
Prior to enactment of the bill, less than 1 percent of individuals
with disabilities receiving Social Security Disability Insurance or
Supplemental Security Income left the rolls to return to work. Now, the
Social Security Administration is reaching the end of its three-phase
implementation plan of this program.
To date, almost seven million tickets to individuals with
disabilities in all 50 states have been distributed and all program
components are operational. This has been no small effort, and I
commend the Agency for its extraordinary efforts.
I have a sample of a ticket here and you can see that it allows the
ticket holder to obtain employment services by turning in the ticket to
a State Vocational Rehabilitation Agency or an Employment Network. So
far 40,000 tickets have been assigned, yet ninety percent of these
tickets have been assigned to State Vocational Rehabilitation Agencies
and only 10 percent have been assigned to Employment Networks.
In the Ticket to Work Program, choice is paramount. To continue to
grow the success of the program, we need to understand why a market of
Employment Networks has failed to materialize.
The bipartisan Ticket to Work and Work Incentives Advisory Panel
has been examining issues related to the service provider marketplace
since it first convened. Today, we will hear the Panel's latest
recommendations, along with testimony from three Employment Networks
that are currently accepting tickets and helping individuals return to
work.
Although the low number of Employment Networks participating in the
Ticket to Work Program is troubling, we must not lose sight that this
program is having a positive impact on the lives of many individuals
with disabilities.
Therefore, I think it is only fitting that our hearing begin with
testimony from two individuals who have changed their lives by taking
advantage of the Ticket to Work program. Following their testimony will
we hear from representatives from the Social Security Administration
and the Department of Education and then from other key stakeholders.
Taking the first step to try work is one of the most difficult
decisions someone with a disability can make. Our challenge is to
ensure that the Ticket to Work Program helps make this decision easier,
not harder. I look forward to hearing the thoughtful counsel of each of
our witnesses today, and thank them for in advance for joining us.
Mr. CARDIN. Let me thank Chairman Shaw for calling this
hearing. It is very important that this Committee follow-up on
the Ticket to Work Program. I thank you for convening this
hearing and for calling these panels so that we can hear from
all of the different stakeholders, from people who are in the
program, to the agencies that administer it at the Federal
level, as well as other interested parties.
The Ticket to Work Program was one of the major
accomplishments passed by Congress in 1999. It was an effort to
reward individuals who were willing to take a risk to work.
They had certain protections while on the disability rolls and
they would have to give up to enter the employment market. We
recognized that and passed the Ticket to Work Act to give them
more opportunity for VR and to provide certain safety nets,
particularly in regard to their health care benefits. We passed
the law in 1999. It is now 2004. In my own State of Maryland,
we just started receiving the tickets in November of 2003. So,
Mr. Chairman, we do not yet have a lot of experience as far as
people who are participating in the program. One of our
objectives today is to determine how we can expedite the
program and make it as effective as possible.
When we look at the individuals who are participating in
the ENs, we find that the success rates are pretty much what we
had predicted. Yet we think those rates can be even higher, if
we improve the program's effectiveness.
So, there is more that we need to do. We have to encourage
greater participation in the program. We have to provide
necessary administrative support to the agencies. I am
concerned that the agencies' budgets have not been realistic
for carrying out this mission. It has been reported to us that,
in some instances, the ticket may be replacing access to VR
services rather than supplementing those programs. That
certainly was not the intent of Congress.
No amount of outside assistance can convince beneficiaries
to attempt to work if they believe that working will lead to a
loss of vital health benefits and income support before they
are financially ready. The Ticket Act recognized the importance
of these incentives in helping beneficiaries work and the
importance of SSA administering the work rules promptly and
accurately. Although the SSA has taken some steps in the right
direction, much remains to be done. Beneficiaries can not yet
be confident that if they go to work, the SSA will adjust their
checks in time to prevent a large overpayment of benefits.
Some of the obstacles can be addressed by the SSA and the
Department of Education, which are charged with the
administrative responsibilities. Others may require direction
or clarification from Congress. This hearing will give us an
opportunity to hear firsthand how the program is being
implemented, so that the agencies can take the appropriate
steps and we, in Congress, can carry out our oversight
responsibilities.
Mr. Chairman, I want to raise one additional issue that was
recently brought to my attention. It is my understanding that
nearly a decade ago, officials at the SSA were made aware of a
situation involving more than 500,000 SSI recipients who
subsequently became eligible for Social Security disability
benefits. Due to a computer error, these recipients were never
identified. So, for over the last 10 years there have been
literally thousands, hundreds of thousands of SSI recipients
who were entitled to additional payments, but did not receive
them.
The SSA is now trying to identify these individuals, but
because of the lack of administrative support they have had to
prioritize the group they are going after in trying to correct
the situation. As a result, in some cases, these corrections
will not take place for many, many years to come, obviously
causing a major problem for the people who are entitled to
additional benefits. I might point out it also affects our
States, because if these beneficiaries were eligible for SSA
disability they would have been covered by the Medicare Program
rather than the Medicaid program. This means that our States
are overpaying and are entitled to some adjustments.
Mr. Chairman, I would hope that in the future we would have
an opportunity to review this issue and to try to expedite the
process of correcting this error since it has been 10 years and
we really need to clear up this record and do what is right for
the beneficiaries and for our States. I look forward to hearing
the testimony of all the witnesses today and working with the
Chairman and the Members of this Committee to carry out our
very important oversight responsibility and to see what we can
do to make the Ticket to Work Program as effective as possible.
Thank you, Mr. Chairman.
Chairman SHAW. Thank you, Ben. We now have our first panel.
I will introduce Ms. Nelson, and Mr. Collins will introduce Ms.
Hancock. Benjearlene Nelson is a Ticket to Work participant
from my own area of West Palm Beach, Florida and she is
accompanied by Ron Ratty, who is with Gulfstream Goodwill
Industries (GGI), West Palm Beach, Florida. Ms. Nelson has had
some pretty rough sledding. She has shown a tremendous amount
of courage and I think her story should be an inspiration to
all of us. Mr. Collins?
Mr. COLLINS. Thank you, Mr. Chairman. It is my pleasure to
welcome Ms. Teri Hancock from Newnan, Georgia. I spoke with Ms.
Hancock briefly before the hearing began and she has a very
impressive resume that I have already read. Just listening to
her, talking to her, the things that she has overcome based on
a problem that she had several years ago and would not let it
be something that would end her desire to be a career person
again, because she has, as I say, a very impressive resume. She
also is a very special strong advocate for this program, the
Ticket to Work, and we appreciate that very much. I think you
are going to find her testimony very interesting.
I regret to say, though, that she may be leaving Georgia in
the very near future. She is formerly from the Washington area
here and she may be moving back to the city rather than staying
in some of the rural areas of Georgia. That will be our loss
but it will be Washington's gain. Ms. Hancock, thank you very
much for being here and for your testimony. It is very
impressive, and your background is very impressive, and I know
your future will be very impressive. Thank you.
Chairman SHAW. Mr. Rattay will be our first witness.
STATEMENT OF RON RATTAY, GULFSTREAM GOODWILL INDUSTRIES, INC.,
WEST PALM BEACH, FLORIDA
Mr. RATTAY. Thank you. First, let me say that I am
extremely privileged in having Benjearlene ask me to escort her
here today. The GGI became an EN in November of 2001; it has
been in the business of changing people's lives for
approximately 105 years. We have many programs that are suited
to individual's specific needs. Basically our mission is, and
always will be, to help people with disabilities and other
barriers to return to employment and become working members of
our communities. So, becoming an EN was a natural transition
for us. Approximately 7 months ago GGI engaged a fill team to
implement and launch the Ticket to Work self-sufficiency
program. We have researched, we have studied, and we learned
the Ticket to Work self-sufficiency program in order to better
it toward self-sufficiency.
With the support of our program manager, Maximus, national
Industries for the Severely Handicapped (NISH), and,
specifically, the local West Palm Beach Social Security office
and the advisory panel, we have moved forward. Today we hold 26
people, all of whom want to become self-sufficient. Ten of
these people have succeeded far beyond Substantial Gainful
Activity (SGA), either in the milestone or outcome status. The
others are only a job away, and we have yet to scratch the
surface. We recognize the concerns and issues of the Ticket to
Work Program but for now GGI continues to be proactive and
place the needs of our participants first. With this said,
please allow me to introduce one of our heroes and
participants, Ms. Benjearlene Nelson.
Chairman SHAW. Ms. Nelson?
STATEMENT OF BENJEARLENE NELSON, TICKET TO WORK PARTICIPANT,
WEST PALM BEACH, FLORIDA
Ms. NELSON. Thank you. I am very honored to be here today.
My name is Benjearlene Nelson. I am 33 years old. I am a mother
of two wonderful children, a loving mother--I have a loving
mother, and I am also the loved one of a very supportive
family. I am here today to testify for the Ticket to Work
Program and to let you know how the Ticket to Work has worked
for me. I am also a Social Security beneficiary. Because of my
disability, I have had a lot of downfalls in life. It has
affected me mentally, emotionally and physically
I am here to let you know that I have always been a striver
to reach for the hills. Because of my disability, it has taken
a lot from me, but with the Ticket to Work and GGI, I tell you
they have given me an inner strength to continue to go on. Back
in 2002 I was faced to pull out my Ticket to Work. I had
received it 9 months ahead of time. I looked at it and put it
away. At the time I was married, had a husband that was
supporting the family. Because of my disability, I did not feel
the need to work or to experience the outside world. I had kind
of put myself in a closet and just felt that I did not need to
be exposed to the world.
Back in 2002 my husband, who is an alcoholic, attempted to
set the house on fire while my children and I were sleeping. By
the grace of God I am here today. I want to say that at that
time he was taken away I knew that I had to stand up and step
out and stand on my own to support my family. I used my Ticket
to Work. I went to GGI. I told them what my situation was and
they were there with open arms. Goodwill has given me the
strength that I needed to stand up. They have encouraged me.
They have given me confidence and motivation to continue to go
on and to lead my family as the head of the household.
I also want to say that I have come to some very low points
in life where I did not feel that I could accomplish different
things and in certain areas. I just did not feel that I was
good enough. Being encouraged through the Ticket to Work and
GGI, they have just inspired me. A lot of times I went in there
feeling down and did not know what I can do. I know that I have
a disability with my eyes, as well, and I had a long road ahead
of me and I could not even see it. Goodwill has guided me in
the direction that I needed to be in. Together, I know that
they are a great team and I also want to say that through the
Ticket to Work I have achieved a position at Crystal Marketing
where I am working now, where I am the top seller. I enjoy
working there. I look forward to moving on and going to better
places.
I also want to let you know that without the Ticket to
Work, I do not think that I would have stepped forward. I do
not know where I would have been at this point in my life. The
Ticket to Work gave me courage. They explained the Ticket to
Work with me. It sounded like a great idea. They have backed me
the whole way and I just want to say that the Ticket to Work is
such a great program. It lets you know that they are standing
behind you. You do not have to worry. I just think that more
people should know about the Ticket to Work Program who are
disabled so that they can get their life on the road and
accomplish some of the things that I have in life.
[The prepared statement of Ms. Nelson follows:]
Statement of Benjearlene Nelson, Ticket to Work Participant, West Palm
Beach, Florida; accompanied by Ron Rattay, Gulf Stream Goodwill
Industries Inc., West Palm Beach, Florida
Let me first say I'm privileged in having Benjearlene ask me to
escort her and be with her on this very important day.
Gulfstream Goodwill become an Employment Network in November of
2001, Goodwill Industries has been ``in the business of changing
peoples lives'' for about 105 years. We have many programs that are
geared to the individual's specific needs. Basically, our mission is to
help people with disabilities and other barriers to employment to
become self-sufficient, working members of our community. So becoming
an Employment Network was a natural transition.
Approximately seven months ago GGI engaged a full time team to
launch the TTW program. We have researched and studied the TTW program
in order to make it geared toward self-sufficiency. With the support of
Maximus, NISH, the local WPB SSA office, and the Advisory Panel we have
moved forward. Today we hold 26 tickets for people who want to become
self sufficient. Ten of these people have succeeded far beyond SGA and
are in the ``milestone'' or ``out-come'' status; the others are only a
job away.
We recognize that there are concerns and issues with the TTW
Program, but for now GGI continues to be proactive and place the needs
of our participants first.
With this said, please allow me to introduce to you one of our
participants Benjearlene Nelson.
How Gulfstream Goodwill Industries and Ticket to Work Helped Me
It was the night in 2002 that changed my life forever. My husband
attempted to set our house on fire while my children and I were
sleeping.
I am not a person that likes to talk a great deal about misfortune.
I am not a negative person. It is because of this, and my loving
Mother, that I have stayed strong.
I became disabled in 1991. It wasn't until I came down with
pneumonia in 1995 that the reality of my condition hit me. I lay in the
hospital and heard the shocking words from my doctor, ``Prepare a
Living Will. You are not expected to live.'' Because I want to hang on
long enough for my two children to be able to live without me, I
fought. And I survived. But I was exhausted, both physically and
emotionally. I hadn't worked a steady job in fifteen years. The burden
of supporting Adrian (then 8 years old) and Greivondra (then 6 years
old) in a fire-ravaged home was overwhelming. To add to this, my
children and I were forced to jail ``Dad,'' which meant an additional
fight and family upheaval.
I reached my lowest point after the arson and attempted murder by
my husband. I had no energy, no direction, and no future. Looking about
my room I saw a ``Ticket to Work'' certificate on my dresser that I had
received about eight months before the fire. I don't believe it was a
coincidence that I hadn't thrown it away. And it wasn't a coincidence
that I knew about Goodwill either. I know Goodwill has a reputation for
``doing good things,'' and I know they help people find jobs.
I took control again. Meeting with Elizabeth Jennings at Goodwill
in May of 2003 was a good experience. She gave me encouragement and
told me that I could get a job right away. I was in an emergency
situation because I really needed to get a job and fast. There were
bills to pay and no food to eat. It had to be a job with good pay, but
one that would allow me to keep my Social Security benefits. To add to
my worry, I don't have a high school diploma. It felt like I was
walking another tight rope, and I was scared.
Goodwill was there for me. Judy Roy took over once Elizabeth
completed the paper work. I told Judy about my work experience and how
I always wanted a better education. (I have taken several courses from
local universities.) Goodwill gave me benefits counseling, and Judy's
job search produced three job opportunities for me within the first
week. I decided that I wanted to go to the job interviews alone, even
though Judy told me that she would go with me. I wanted to prove to
myself that I COULD! I was offered all three jobs, and I took the one
that paid the best: a telemarketing job at Kristel Marketing where I
invite people to a vacation resort in the Poconos.
Today I look forward, not backward. I have a good job, and achieved
``Best Sales'' within my company last year. I have two wonderful
children who know the importance of a good education, and a fantastic
mom, who has been supportive in the worst of times. And I have my
Goodwill family.
It is important to have my Goodwill family because my fight isn't
over. To keep my disability at bay I am forced to take medication that
has attacked my joints and liver. I have been diagnosed with Avascular
Necrosis of the hip and a chronic liver disease. Hip replacements are
in my future, and I know Goodwill will be there for me again.
The ``Ticket to Work'' program has proved invaluable to me. Because
I didn't believe in myself after all that happened to me, I really
needed a helping hand. I think of Goodwill as offering me a much-needed
hand up. The Ticket to Work program and Goodwill people gave me a lift
so I could get up, work and support my children on my own.
Chairman SHAW. Thank you, Ms. Nelson. Ms. Hancock?
STATEMENT OF CHARMAINE TERI HANCOCK, TICKET TO WORK
PARTICIPANT, NEWNAN, GEORGIA
Ms. HANCOCK. Good morning, everyone. I am Teri Hancock and
my story is a shade different. I, on the other hand, was at the
height of my career when my injury happened, and because of
that, I was in rehabilitation for about 4 years. I was in a
wheelchair, couldn't walk, and I had to develop my muscles at
the bottom of my body all over again. Having to learn how to
walk is quite a task, believe me.
When you are young and you think you are invincible and you
have everything to live for, your life goes from sugar to poop,
and that is the thick of it. When you find yourself in a
situation where everything is a gray area, you look around--I
looked around because I wanted my old life back and I was
willing to do anything to get that old life back. The problem
was, society would not allow me to have that life back. There
was no one there to listen, because I had a big white brace at
the time. Mind you, I have had seven surgeries to correct my
injury.
You would be surprised at how you are viewed when you have
a handicap. Employers do not listen to you. People ignore you.
You are ostracized. While working at the national Cancer
Institute after my return to work after the initial injury, I
was ridiculed, taunted, made fun of, poked fun at, the butt end
of a joke. For someone that has come from my background, which
is radio-television, behind the camera, in front of the camera
mostly, talk show host, it was devastating. My self-esteem went
to just about zero.
With my will and determination, I wasn't going to stay
there long. I was looking for an out. I was looking for a
helping hand. I was looking for an avenue to stroll that would
bring me back to where I was. Actually, in the fifth year, I
got a letter in the mail from Ticket to Work, Social Security.
I said to myself, hmmm, a government agency. That means they
are going to be around. I said to myself, an opportunity for
the government to take a listen to what I have to say. Somebody
is finally paying attention. I was very happy about that, very
elated.
To find the right program--you get a list when you get your
letter. When I got my list, I went through four--three agencies
before I found the fourth one. Now, Integrated Disabilities
Resources (IDR) in Connecticut--I live in Georgia--but not all
Ticket to Work Program vendors are good, and I will have to
tell you that. Not everybody does what they are supposed to do.
There are some that do what they are supposed to do, and they
are superior. For a win situation for myself, people like
myself, we need the program to come back into life, to be
reborn again.
Now, I worked with a woman by the name of Meg Moran, and
Meg Moran understood where I was going, where I had come from,
my level. Others may say to you, well, I want to teach you how
to write a resume. I can teach you how to write a resume. You
don't need to teach me that. I can set up an interview. I can
set up my own interview. I didn't need that. I needed contacts.
I needed somebody to listen. I needed a voice. They supplied
the voice. Social Security backed it. The IDR was there to make
the contacts. I went forward, got it done.
When you are called terrible names because of your handicap
or made fun of, which I cannot even repeat the things I was
called, the only thing you want to do is show them they are
wrong. Well, I was able to show them that they were wrong with
Ticket to Work. Not only do I counsel, not only do I counsel
other people, not only have I written a book, not only do I
tour with my book, but my self-esteem is back up to 100
percent. No more big white brace. Ticket to Work listened. They
heard my cry. There are thousands, probably millions of people
like myself out there. They need Ticket to Work. They need a
voice. They need an entry. I am here to say, thank God for
them, and if you have a position for me at Ticket to Work,
Social Security, you had better come get me because here I am.
[Laughter.]
I can say nothing except the program is a viable program.
You have, as I said, a million intelligent people out here that
want to go to work. Yes, we do have people that don't want to
go to work, but we have so many that still want life. I am
crying for life for these people, for myself, and I am saying,
whatever you do, God bless Ticket to Work and that is where we
want to be. Thank you.
[Applause.]
[The prepared statement of Ms. Hancock follows:]
Statement of Charmaine Teri Hancock, Ticket to Work Participant,
Newnan, Georgia
The challenge to move forward in life and live it as you once knew
it after the affects of serious illness or injury, brings about idle
yet common reflections of what could have been. Living and adjusting to
life as it now presents itself, challenges the will to live, the
necessity to thrive, the purpose of one's being and poses the age-old
question of devastation--why? Or why me?
One never knows what may lie ahead in life, we live each day in
health as if it will be there forever. We often times choose to close
our eyes and minds to what does not directly effect us at that given
moment but when the unexpected happens and life turns a sharp and
warningless curve the cold hard vengeance of reality can hit you like a
brick.
Which brings us to my own reality. After having had a massive
cerebral hemorrhage totally out of the blue, while at the height of my
success, life for me went from sugar to poop! On top of the world one
day and flat on my back the next, helpless with no relief or hope in
sight.
Once I was finally lucid enough to understand the condition I was
left in immediate depression consumed me, leaving me breathless, lost
and very alone. I really did not know who I was or what life held for
me.
Well, after countless years of rehab, pain staking surgeries,
endless therapies, never ending questions and people treating you like
a mangled yarn, I ventured to pick myself up and get back I the race.
For over four years I tried to break back into the work force on my
own. Between operations (seven to be exact) the healing process, the
rehabilitation's, the weakness and the struggle to exist. But at many
points because of how I was treated by others I viewed myself as less
than whole, even a waste, and certainly not the person I use to be. I
questioned who or what had I become anyway? Moreover why was this
foreigner living in my body invading my wonderful life and when was it
leaving?
I wanted to get back in the work force, but doors are often close
to cripples, people seen as less than perfect, people who's presence
one might find disturbing. During my period of healing I was indeed one
of those people.
Although I held a wealth of knowledge, experience and information,
it did not matter because my physical presentation was less than
acceptable (hard on the eye) the public viewed me as less than whole,
less than perfect.
I tried to get back into Telecommunications at MCI only to be
taunted, laughed at and made fun of, always the butt end of a crippled
joke.
My self-esteem totally destroyed, my sprit broken. Over and above
all of this, I was still there inside of this broken body, no one would
listen or give me the time of day.
TTW came in my life at a time when I had exhausted every avenue,
literally. So for me this program was a ``God send'' my rescue from the
hell of disablement. A real voice, a real person to join forces with.
After receiving my ticket I view my options, spoke with four venders
and settled on Integrated Disabilities Resources (IDR). Understand, not
every ticket holding agency is equipped nor do they really understand
their job. So IDR was the right choice for me.
This outfit seemed to understand my level and mindset really
connecting with me. This is where I linked with an individual who
seriously wanted to support me and understood my cry for help. This
woman was Meg Moran of IDR, she saw me as a crop that simply needed to
be harvested, a bountiful land full of nutrients and aid to bestow.
I started working Meg at IDR and soon people started listening
because I now had a connected voice. Using IDR's connections,
assistance and referral systems, new avenues of opportunity were made
available.
In fact, working with one of their consultants (Dan T. Mcaneny)
opened up a whole new world. Mr. McAneny helped me realize just how
much I did have to offer; I was amazed with myself once we explored
just what jewels I did posses. I realized that I had allowed society to
beat me down like a bush in a rainstorm.
After working with IDR I took on new challenges and capitalized on
what I had already had under my belt. As an air personality, I had
lectured and counseled on radio and television before my injury and
developed quite a following. While these people were still out there
and hundreds more, people who needed my help as much as I needed to
help them for my own esteem. With the help of Dan McAneny I turned my
lectures into a book, did something constructive and came back into the
forces of life. Thank goodness for the TTW program.
Much like myself there are thousands of people who have so much to
give, so much to share, teach, produce, contribute, so much life to
still live but with no practical means to display or showcase their
abilities. Therefore they sit and waste, many are so beat down by the
barriers of society until they have lost their fight or so terrified of
rejection until they simply give up and concede.
So, Social Security developed an incentive program for the
displaced, handicapped and physically challenged individuals to display
their capabilities as to redeem their self worth. I think their
original idea or mindset may have been to get able-bodied people back
to work, off the system and help relieve the deficit. However the real
gem of this program is that millions of Americans that lost who they
use to be before that devastating injury or illness can once again
become viable, productive, happy salary earning individuals!
Thus still helping with the world's deficits and financial crunch.
Which leads into just what having a ticket has done for my life.
The Ticket to work Program provides an entry back to a productive
life. It supplies one with direction, hope and guidance granting a
solid home base to rise from. Because TTW is part of our Government its
stability speaks for itself, the injured can trust and take refuge in a
program such as this. Therefore, We really do need TTW and agencies
with caring hard working advocates for the disabled such as IDR. TTW/
IDR helped save my sanity and got me on track because I certainly could
not do it alone.
Please, help me help others get their life back and be productive,
whole individuals who contribute to the face of this universe.
Save TTW, help Social Security help its contributors and please
save the agencies that give human beings back their dignity and self
worth.
Chairman SHAW. I can tell you that applause applies to both
of you ladies. I can't recall a single time in my 24 years of
Congress where a panel has been applauded.
[Laughter.]
Social Security, if you need somebody to sell your stuff, I
think you have found her.
[Laughter.]
Mr. Collins?
Mr. COLLINS. I told you, Mr. Chairman, she was going to be
very impressive. I really have no questions other than just to
thank each of you for being here. You have very humbling
stories to tell and we appreciate the fact that you had the
will not to take these roadblocks and let them stand before
you, but knock them down and get things done, and I would
appreciate your support for the program and we wish you the
best in the future, which I know it will be. Thank you.
Chairman SHAW. Mr. Cardin?
Mr. CARDIN. Let me join the Chairman in thanking you for
coming before our Committee. The SSA tells us there are 40,000
people who have taken advantage of the Ticket to Work. That is
a small fraction of the number of people who could benefit from
the Ticket to Work. A lot of times in Congress, we debate
numbers. We debate dollars. Your testimony has really put a
face on the issue to us, that we are dealing with real people
and their lives and affecting their lives. So, we very much
appreciate your testimony and what it means to us when we work
for programs that we think can make a difference in people's
lives. The two of you come from different backgrounds, but it
was the same program that benefited both of you. You were able
to take advantage of this program, and I very much appreciate
the manner in which you expressed that.
Ms. Nelson, it was very courageous of you to get into this
program because you knew there were certain risks involved. You
gave up certain safety nets that were available to you, but the
importance of work, the importance of being the head of your
household and taking care of your family, the Ticket to Work
gave you a chance to use that and to use those talents and we
thank you for having the courage to move forward. Ms. Hancock,
as you said, your case was different. You needed the bridge to
bring you back to be able to use your talents, and the Ticket
to Work worked for both. So, I think that is really a testament
to the flexibility of this program, and exactly what we
intended in Congress. We intended this program to be a ticket
to be used outside the conventional rehabilitation services
that were available through the States, that you could use it
to get the help that you needed to be able to reenter the
employment marketplace.
We wanted to be flexible. We wanted to have a variety of
vendors out there that were available, and I think you have
raised a very good point, one that I want to make sure we
follow up on, and that is there are different types of ENs that
are out there. Some are better than others for your particular
needs. One of the things we have to make sure that we have
adequate information so that the ticket is used by the
recipient in the most effective way in order to accomplish the
results, and I think your testimony has helped us to focus in
on that. So, to both of you, we thank you for being here. We
thank you for your testimony. I can tell you it has a major
impact on our work.
Ms. NELSON. Thank you.
Ms. HANCOCK. Thank you.
Chairman SHAW. Thank you, Ben. Mr. Hayworth?
Mr. HAYWORTH. Thank you, Mr. Chairman. Again, let me thank
the witnesses. Just a couple of questions, and we appreciate
the testimony. Ms. Nelson, do you have any piece of advice for
others who are receiving benefits who are just now thinking
about getting back to work? Is there anything that is just
really important for people to remember as they take a look at
this Ticket to Work Program?
Ms. NELSON. I think that it is very important that they
look at the Ticket to Work Program, also that it will also
protect their benefits, their medical. The Ticket to Work is
there so that you don't have to worry about your benefits or
your medical. So, that is one thing that is very important if
they decide to use the Ticket to Work. They don't have to worry
that their medical will be taken away from them.
Mr. HAYWORTH. So, the real thing is to emphasize the
message and expand, and that leads me to Ms. Hancock, a fellow
broadcaster. I worked in television and many a television news
director said I had a face for radio. Maybe that is how I ended
up in the Congress.
[Laughter.]
I think we get into the real challenge we are confronting
today with these hearings, because as our colleague from
Maryland pointed out, we passed this program in 1999. Now, Mr.
Chairman and my colleagues, witnesses and others gathered here,
this is a critical time because we have the irony of some
really gratifying success stories and we appreciate the
presence of television cameras here today, and yet the ability
of folks to take advantage of this seems to be the real
challenge, to make sure the word gets out.
Ms. Hancock, I could not help but notice in your testimony
your willingness, your invitation to the SSA and others to take
advantage of your background in broadcasting and of your story
to get the message out. It is a bit unfair, but we have both
been in the broadcasting business, and sometimes in Washington,
we get involved in--I am not here to castigate, it is just
sometimes in the order of doing things. We introduce pilot
projects to get the word out, and sometimes things are very
laudable on the surface, but the results are projected a year
or two down the road, and there may be a lag time that is not
at all satisfactory. As a fellow broadcaster, what is the best
way to get the message to the people who are qualified for the
Ticket to Work? What do you think would be the most effective
means of communication?
Ms. HANCOCK. I am so glad you asked that, because I do have
an answer, and that answer is when people go to apply for their
disability and you see your counselor there, the Ticket to Work
needs to be introduced at that juncture because they need to
know--for example, if you are on short-term disability, we have
got a program called Ticket to Work. You don't lose anything.
You don't lose your benefits. You get to work. You have got a
trial work period. If you can't succeed, you lose nothing. You
start over. Disability benefits stay. If you go past the 9
months, then we take the Social Security away. You get back
into the mainstream of life. It is a win-win situation for all.
You are helping to stop the deficit in terms of all the moneys
going out to people that don't really need to be on Social
Security.
Let us face it. We have got people, excuse me, that don't
need to be on Social Security. They are there because they are
afraid to come back into the workforce, or it is just plain
easier not to go back to work because you are getting that
money. You have some people that will stay at that safe house
because they are lazy. You have got other people, such as the
two people you have here. We want to get back into society. We
want to do the right thing.
If it was simply introduced when you had your review or
when you had your initial interview, it is an option that is
open without passing any type of legislative law. It is already
there. The counselors can simply do it at that point, and let
you know what your options are. Many people do not read the
mail. I read the mail. She reads the mail. Many people don't
open the mail, so the ticket goes in the drawer. The Ticket
goes in the trash. So, to get it out, you have got to have a
one-on-one communication with a human being, so the person will
understand what the ticket is.
Mr. HAYWORTH. So, job one of the counselor is to bring up
Ticket to Work?
Ms. HANCOCK. Absolutely, and the benefits of Ticket to
Work.
Mr. HAYWORTH. Ms. Nelson, you want to make a comment on
that?
Ms. NELSON. I just want to make a comment as to what she
said. She is telling the truth, because when I received the
Ticket to Work, the first place I put it was in the filing
cabinet. At the time, my husband was there. I didn't read it
over. I didn't think that I needed it. Nine months later is
when I pulled it out, and at the time, I wasn't even sure if it
had expired, or if I was still able to use it. So, I agree with
her.
Mr. HAYWORTH. Thank you both very much. Thank you, Mr.
Chairman.
Chairman SHAW. Thank you. Just to follow up on that, in
looking at the Ticket to Work, I don't know whether the Members
have it in their back-up material, but it is a pretty cold
document. I think we can do a better job of making it more
consumer-friendly. When you read it, you don't know if you are
getting in trouble or what.
[Laughter.]
Whether to put it in the filling cabinet or in the round
filing cabinet.
[Laughter.]
I think it is a little intimidating, and I think maybe we
can do something to help that out. Ms. Tubbs Jones?
Ms. TUBBS JONES. Thank you, Mr. Chairman. Ms. Nelson, Ms.
Hancock, on behalf of all of the folks who are receiving SSI
across this country, I want to thank you for your wonderful
commentaries and reports. I am interested, even though you are
not here for this purpose, how, when you made an application
for disability, how long that took for you. Was it a long
process? Was there delay? What happened for you? I hate to go
to another part, and maybe it is not as glorious as your
commentary, but I need to know that if you could help me out.
Ms. HANCOCK. Yes. For me, it was short. This is a true
story. My mother was visiting me in Atlanta, Georgia. We were
at a CHU facility and a woman saw me, and I was limping. She
said to me, ``Excuse me, are you receiving Social Security,''
and I really ignored her, because I was trying to ignore the
condition. In fact, I was a little hurt, and I said, ``No, I am
not receiving,'' because it was one of those things where you
don't want to be bothered. The injury was too new. So, to make
a long story short, my mother says, ``Listen to what this woman
has to say,'' and I did.
Ms. TUBBS JONES. Mothers always say that, don't they?
[Laughter.]
Ms. HANCOCK. So, the woman worked at Social Security and
she said, ``You need to see me at my office.'' It was almost
like a Godsend, like a little blessing. I went in and mine
actually didn't take long at all. When people say they are
denied, I just went through the process fairly quickly. Within
3 months, I was getting Social Security. So, I didn't have a
bad time at all.
Ms. TUBBS JONES. Where are you from, again?
Ms. HANCOCK. Washington, D.C.
Ms. TUBBS JONES. Okay. Thank you. I thought they had some
other State on there.
Ms. HANCOCK. I live in Newnan, Georgia.
Ms. TUBBS JONES. That is what I am saying. Okay. I am not
totally confused. Great. What about you, Ms. Nelson?
Ms. NELSON. For me, it didn't take long at all. I was in
the hospital for about a month and they weren't expecting me to
live. When I did start to recover, to get better, they did it
in the hospital so when I returned home, I was eligible for
Social Security.
Ms. TUBBS JONES. So, tell me what you are doing right now,
Ms. Nelson. What type of work are you doing?
Ms. NELSON. Right now, I work for a marketing company. I
invite people to a vacation resort in the Poconos, the
Pennsylvania and New Jersey area.
Ms. TUBBS JONES. What about you, Ms. Hancock?
Ms. HANCOCK. Right now, I am mediating, mostly divorce
cases. Daily, I teach, and I am a master's candidate for
counseling.
Ms. TUBBS JONES. If there was one thing, and I am almost
done, Mr. Chairman, if there was one thing that you would
improve in addition to how people are noticed of Ticket to
Work, what would that proposal be for either one of you?
Ms. NELSON. I would say a lot of people watch television.
Put it on television.
Ms. HANCOCK. Yes, they do. That is good.
Ms. TUBBS JONES. Ms. Hancock?
Ms. HANCOCK. For me, again, I would build a campaign, an
actual campaign, because when we campaign and we get things
done through campaigns, we stir up, again, from the
broadcasting, we stir up interest.
Ms. TUBBS JONES. If there was an opportunity for either of
you to serve on an advisory Committee to the Ticket to Work
Program, would you consider that?
Ms. HANCOCK. I would be your girl.
Ms. NELSON. Yes.
Ms. TUBBS JONES. Okay.
[Laughter.]
Thank you very much, Mr. Chairman.
Chairman SHAW. Thank you. Mr. Hulshof?
Mr. HULSHOF. Thanks, Mr. Chairman. I promised Mr.
Hayworth--he had to step out just for a moment, and I promised
that we would not ask for a recorded roll call vote on whether
we believe he has a face for radio.
[Laughter.]
Chairman SHAW. We are still wondering if he has a face for
politics.
[Laughter.]
That will teach him to leave the hearing.
[Laughter.]
Mr. HULSHOF. I am sure he will be back any minute now. I
certainly don't have the breadth of experience as the Chairman
as far as the number of hearings, but I do look around the
room, and I think of the number of hearings that this
Subcommittee has had regarding this issue, and I see some
familiar faces here in the hearing room who have been with us
working on this issue, actually even back to 1997. I think is
when we began under a former Chairman, and now Senator, Jim
Bunning of Kentucky, when he chaired this Subcommittee.
We have a very active disability community in Central
Missouri. I will confess that before they brought this issue to
my attention about things like the income cliff, and things
like losing health insurance, and things like the barriers and
obstacles in place to keep people who want to return to the
workforce and be productive, and the self-esteem and all those
things, they are the ones who brought it to my attention. So,
it is great that we can come and talk about a successful
program, but also then to see what we need to do to make sure
that this program continues, that we go and recruit others and
tell others about this very successful program.
This was an interesting political lesson for me because
this was the first time I actually got to be on a Conference
Committee, that is, to work with Senator Kennedy and Rick Lazio
of New York, again, a former Member, and we were trying to work
the details of this out. I know that when the bill, the final
version, there were folks that were concerned about the final
version, but I think we had a good product. There is my friend
back.
[Laughter.]
So, again, whatever suggestions that you have, and I
applaud each of you and I know, Ms. Hancock, just as a final
question, I know you are not here for self-promotion, but where
can I get your book?
Ms. HANCOCK. I will send you a copy.
Mr. HULSHOF. Okay. Thank you, Mr. Chairman.
Chairman SHAW. Thank you. Mr. Becerra?
Mr. BECERRA. Thank you, Mr. Chairman, and thank you very
much for what was compelling testimony. I think you bring real
life to what we try to do sometimes, so it is nice to see that
oftentimes policy is put in practice, and it is great to see
that. I know we are going to have an opportunity to talk to the
folks from the agencies that are equipped and empowered to
administer these programs, and hopefully what we can do is try
to perfect them, because we know that there have been some
difficulties, whether it is not the best providers being out
there or just not having the access and to beneficiaries not
knowing about them. So, we thank you for the testimony and
appreciate that you shared your stories. Just so you know, my
understanding is that there is an opening right now with the
Ticket to Work Program for the Director, so if any of you are
interested in applying, you might want to consider submitting
your resume.
[Laughter.]
I think Congresswoman Tubbs Jones asked a question that I
wanted to ask, which was give us your on-the-ground impressions
of what we should do, and you mentioned two very good ones, the
publicity campaign, doing something on television, maybe
through public service announcements. Any other thoughts about
what we should know about making the program more user
friendly? The simplest things, just so we know how you all need
to access the program.
Ms. NELSON. I think one thing to make the program more user
friendly is to emphasize on the medical part of it protecting
medical benefits. That was one of my biggest issues of even
beginning to work and to continuing to work. We are always
going to need medical help, and me personally, I know that I am
going to have hip replacements soon. I never know when I am
going to need another eye surgery. So, that is always a major
concern as far as me working at this time.
I am in training to become supervisor on my job, but at the
same token, I am afraid to take the position because I know
with a certain amount of money, the medical benefits are taken
away and that is one of my biggest concerns. Even with the
medications I take, it is really a big concern of mine. So, if
there is some way that you can assure Social Security
beneficiaries that they will be protected in that aspect, I am
sure that a lot of people will take advantage of the Ticket to
Work.
Mr. BECERRA. Ms. Nelson, have you had or do you have a good
experience that you can tell us about with regard to VR
services? Has that continued? Now that you have used the Ticket
to Work Program, are you still accessing the VR services?
Ms. NELSON. Yes. Goodwill has helped me. Everything that I
need, I went to GGI, any encouragement, counseling. Regardless
as to what it was, I have been to GGI. I consult GGI. I always
consult Ron Rattay, who has answered all of my questions. If he
didn't know the answer, he found the answer, and this made me
feel confident.
Mr. BECERRA. So, you had a pretty good experience working
with the agencies involved?
Ms. NELSON. Yes.
Mr. BECERRA. Good. Ms. Hancock, I don't know if you have
anything you would like to add.
Ms. HANCOCK. I think I have probably said enough. I do want
to say that she is absolutely right. If we could just alleviate
the fear of, ``Are we going to lose this?'' People just don't
understand that you can benefit in a win-win situation, and
that everything is not taken away from you at once. They think
if they are working 4 or 5 months, that is 4 or 5 months into
their ticket period, not understanding that if you start over,
the whole process starts over, so you are losing nothing. I
think that should be made more clear. Other than that, I am
done.
[Laughter.]
Mr. BECERRA. Thank you for coming. Mr. Chairman, thank you.
Chairman SHAW. Thank you. I am going to just read something
into the record off of an actual Ticket to Work ticket. It has
been a successful program, I am not knocking it, but I think
there are many people out there like you two who would avail
themselves of this instead of being too quick just to throw it
away or being intimidated by it.
I am reading right from the ticket. It says, ``This ticket
is issued to you by the SSA under the Ticket to Work and Self-
Sufficiency Program.'' Now, that has got to mean a lot to
people who are on disability. ``If you want help in returning
to work or going to work for the first time, you may offer this
ticket to an EN of your choosing or take it to your State VR
agency for services. If you choose an EN and it agrees to take
your ticket, or if you choose your State agency and you qualify
for services, these providers can offer you services to help
you go to work. An EN provides the services at no cost to you.
The SSA will pay the EN if you assign your ticket to it, and
the EN helps you go to work and complies with the other
requirements of the program. An EN serving under the program
has agreed to abide by the rules and regulations of the program
under the terms of its agreement with the SSA for providing
services under the program. Your State agency can tell you
about its rules for getting services.''
Now, if you are going to be informed about the program
after reading this, you have got a sense that I think is rather
remarkable. I do understand there is a letter accompanying
this, but I don't have a copy of it. I am sure it gives us a
lot more information, but, all of us here on this panel have
been involved in advertising ourselves in political campaigns
and we would never send out something like this, because it
would never be read. I think that we must become a little more
imaginative if we are going to get more people into the
program. You people have demonstrated, Ms. Nelson and Ms.
Hancock, you have demonstrated what you can do for yourself.
This Subcommittee and the entire Committee on Ways and
Means has, I think, done some wonderful things, and Ticket to
Work, I think, is another program in which we show that we have
faith in the human spirit if we just let it fly. You have
certainly proven that to us. Ms. Nelson, I am really very proud
to have you. I think you just live outside of my congressional
district. I checked you out. I don't think you live in my
district.
[Laughter.]
You do live in the West Palm Beach area, which I do
represent a portion of, and I am very proud to--I will claim
you as a constituent, even if you live out of the district.
Mr. BECERRA. So do we.
[Laughter.]
Chairman SHAW. California is a stretch.
[Laughter.]
I have heard of gerrymandering----
Mr. BECERRA. We stretch a lot of things in Congress.
Chairman SHAW. I have heard of gerrymandering, but it
doesn't go from Palm Beach to Los Angeles.
[Laughter.]
Ron, do you have a question?
Mr. LEWIS. No.
Chairman SHAW. I want to thank you for being here and
sharing your story. Hopefully, it will be an inspiration to
many, and Mr. Rattay, just keep up what you are doing. You are
obviously doing the right thing and we very much appreciate
your being here with us this morning.
Ms. HANCOCK. Thank you for having us.
Ms. NELSON. Thank you.
Mr. RATTAY. Thank you.
Chairman SHAW. Our next panel is made up of Martin Gerry,
who is Deputy Commissioner, disability and Income Security
Programs, SSA, and Troy Justesen, who is the Acting Deputy
Assistant Secretary, Office of Special Education and
Rehabilitation Services at the Department of Education. We
welcome both of you back to this panel and we look forward to
your testimony. As both of you know, we have your full
testimony and it will be made a part of the record. You may
proceed as you see fit. Mr. Gerry?
STATEMENT OF MARTIN H. GERRY, DEPUTY COMMISSIONER, DISABILITY
AND INCOME SECURITY PROGRAMS, SOCIAL SECURITY ADMINISTRATION
Mr. GERRY. Thank you, Mr. Chairman. Mr. Chairman and
Members of the Subcommittee, as you know, Mr. Chairman, the SSA
administers both the SSDI, and the SSI programs. These programs
provide benefits to about 10.5 million Americans with
disabilities. The Ticket to Work Program allows these
beneficiaries greater flexibility and expanded choice in
obtaining the rehabilitation, employment, and other support
services that they need in order to go to work and to attain
their employment goals.
Mr. Chairman, I would like to express my thanks to you, Mr.
Matsui, and to the other Members of this Subcommittee for all
of the hard work and support that you have provided in making
the Ticket to Work Program a reality. I look forward to
continuing to work together closely with the Subcommittee to
strengthen the program in a way that builds on our early
experience and significantly expands participation in the
program by both our beneficiaries and by ENs.
In his New Freedom Initiative, President Bush pledged that
his Administration will work tirelessly to help Americans with
disabilities become fully integrated into the American work
force so that they may realize their dreams for meaningful and
successful careers. The Ticket to Work Program will help us
tear down many of the barriers that currently prevent Americans
with disabilities from full participation in the economic
mainstream of American society.
With the Ticket to Work Program, beneficiaries have more
opportunities to obtain employment support services to help
them reach their employment goals. In addition, the program
will help us fulfill the promise of the Americans with
Disabilities Act. Commissioner Barnhart and I are deeply
committed to achieving the goals of this very important
program.
Mr. Chairman, I would like to begin by briefly describing
how the Ticket to Work Program operates and making some
comments on where we are in implementation of the program. The
SSA currently provides benefits under the SSDI and SSI
Programs, as I said, to approximately 10.5 million Americans
with disabilities. Under current agency regulations, an SSDI or
SSI beneficiary with a disability receives a Ticket to Work if
he or she is between the ages of 18 and 64 and has a medical
condition that is not expected to improve in the near future.
Approximately 9.2 million, or a little over 85 percent of the
10.5 million of all our current beneficiaries with disabilities
meet this standard.
Under the act, the SSA enters into agreements with ENs, and
State VRs. The ENs are qualified State, local, or private
organizations that offer employment support services. A
beneficiary who receives a Ticket to Work can choose to assign
it to the State VR agency or to any EN that provides services
within his or her community. Together, these agencies serve as
ticket providers under the program. The act does require that a
ticket provider accept a measure of risk whenever it agrees to
provide services to a beneficiary. The ENs and State VR
agencies may only be paid under the program based on success in
assisting beneficiaries to secure and maintain employment and
to move off the disability benefit rolls. An EN might never be
paid if a beneficiary's cash benefits do not stop as a result
of work. An EN may decide whether or not to accept the
assignment of a ticket. State VR agencies incur less risks than
ENs do because those agencies are already funded and fully
capitalized through the Rehabilitation Act (P.L. 93-112).
Once a ticket is assigned by a beneficiary to a ticket
provider, the beneficiary and the provider jointly develop and
implement a plan of employment, vocational, or other support
services designed to lead to and maintain employment. Providers
may offer these services directly or by entering into
agreements with other organizations or individuals to provide
the appropriate services at no cost to the beneficiary. The
Ticket to Work Act provides three additional incentives to
encourage work activity by beneficiaries. First, the SSA will
not schedule a periodic continuing disability review (CDR), for
a beneficiary who is receiving services from a ticket provider.
Second, work activity by a beneficiary will not trigger a CDR
if the beneficiary has received benefits for at least 24 months
under the Disability Insurance program. Finally, an individual
whose benefits terminated because of work activity can request
that benefits start again without having to complete a new
application for benefits.
Mr. Chairman, as you know, we have implemented the Ticket
to Work in three phases and it is currently available in all
States and U.S. territories. Through February 2004, tickets
have been mailed to over 6.9 million disabled beneficiaries,
and by September of this year, the remaining 2.2 million
eligible beneficiaries will have received a Ticket to Work. As
of the beginning of this month, 40,441 beneficiaries who had
received Tickets to Work had assigned them to ticket providers.
Of this total, 36,525, or approximately 90 percent, have been
assigned to a State VR agency, and 3,916, or 10 percent, have
been assigned to an EN. It is interesting, however, to note
that 30 percent of the ticket assignments have been made in the
last 5 months. This suggests to me, Mr. Chairman, that there is
a significant acceleration going on in the use of tickets and
the assignment of tickets.
The first milestone payment was made by Maximus in May of
2002, and the first outcome payment was paid in July of 2002.
We now have more than 1,600 payments based on the work of 450
beneficiaries going to 116 ENs and totaling over $530,000. Over
the last few months, we have received valuable information from
several sources regarding the initial implementation of the
Ticket to Work Program. The Ticket to Work Act requires the
Commissioner to submit periodic evaluation reports of the
Ticket to Work Program to the Congress. The SSA has contracted
with Mathematica Policy Research to evaluate the impact of the
Ticket to Work Program.
Mathematica has provided a draft of the first in a series
of evaluation reports, and while Mathematica notes in its draft
report that, overall, the SSA has made great progress in
developing a system to assist individuals with disabilities to
find work and to remain in the work force, it points out that
most beneficiaries who use the Ticket to Work have assigned
them to traditional State VR agencies and the ticket
assignments to ENs have been concentrated among a few. It
reports that ENs as a group feel that the SSA needs to move
quickly to make the process friendlier to providers, and I will
be happy, both to provide the Subcommittee with a copy of the
final version of this report, which we expect to be available
shortly, and to brief Members and staff as to its findings.
The Ticket to Work Act also identifies four groups of
beneficiaries with disabilities as potentially at risk and
requires the Commissioner to study the adequacy of incentives
for ENs to serve people in these populations. To this end, the
SSA formed an Adequacy of Incentives Advisory Group that has
been meeting quarterly and will complete its work this spring.
I think I have attended all but one half-day of their meetings.
Last fall, the Advisory Group issued an interim report
recommending regulatory and administrative changes. The
Advisory Group will also issue a final report, we believe by
the end of next month, that proposes projects to evaluate the
effectiveness of adjusted incentives and provides
recommendations regarding the most promising of these
incentives. The Ticket to Work Advisory Panel has been a
valuable partner in studying the Ticket to Work Program and
making recommendations for improvements. The panel has been
concerned about the balance between State VR agencies and other
ENs and about ways in which we can encourage more beneficiaries
to assign their tickets to ENs. It has also advised us on ways
to improve our marketing of the program to both beneficiaries
and potential ENs, provided specific recommendations with
respect to establishing a core of work-incentive specialists,
and offered suggestions on a way to reduce the incidence of
overpayments caused by work.
Commissioner Barnhart and I believe that it is our mission
to see that the ticket program lives up to its potential, and I
think it has great potential to return people to work. Based on
all of the information that we have received, we have already
taken a series of actions to improve our return to work
service. These include steps to simplify the payment process
for ENs, to increase the pool of ENs, and to improve our wage
reporting process. We have jointly funded with the U.S.
Department of Labor new positions in the One-Stop Career
Centers to help people with disabilities increase their
employment opportunities and have expanded the pool of SSA
field employees who are available to answer questions relating
to return to work, including the employment of 58 full-time
employees who serve as Area Work Incentive Coordinators.
I want to thank the Subcommittee for its advice and
guidance as we work closely with you to develop this approach.
In summary, Mr. Chairman, our early experience and the
preliminary evaluation, analyses, and recommendations that I
summarized earlier have shown us both that the Ticket to Work
Program can provide beneficiaries with more opportunities to
obtain employment support services to help them reach their
employment goals, and also that we need to do more to increase
program participation and build on program success.
Finally, I want to thank you, Mr. Chairman, Mr. Matsui, and
all the other Members of the Subcommittee for showing continued
dedication to the program. Thanks to that commitment, we look
forward to providing more beneficiaries with additional
opportunities and the tools that they need to enter or reenter
the workforce.
In addition, I would also like to thank the Subcommittee
for its work to pass H.R. 743, the ``Social Security Protection
Act'' (P.L. 108-203). With the provisions in that bill
regarding SSA demonstration projects, we can move forward with
our agenda of projects designed to provide alternative return
to work services. We look forward to working with the
Subcommittee as we continue our efforts to make the Ticket to
Work Program a success. I would be happy to answer any
questions.
[The prepared statement of Mr. Gerry follows:]
Statement of Martin H. Gerry, Deputy Commissioner, Disability and
Income Security Programs, Social Security Administration
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me today to discuss implementation by the
Social Security Administration (SSA) of the Ticket to Work and Self-
Sufficiency Program (the ``Ticket to Work program'') authorized by The
Ticket to Work and Work Incentives Improvement Act of 1999 (the
``Act''), PL 106-170.
As you know, Mr. Chairman, SSA administers both the Social Security
Disability Insurance (SSDI) and Supplemental Security Income (SSI)
programs. These programs provide benefits to about 10.5 million
Americans with disabilities. The Ticket to Work program allows these
beneficiaries greater flexibility and expanded choice in obtaining the
rehabilitation, employment and other support services that they need to
go to work and attain their employment goals.
I would like to express my thanks to you, Mr. Chairman, Mr. Matsui,
and members of the Subcommittee, for your hard work and support in
making the Ticket to Work program a reality. I know we will continue to
work together closely to strengthen the program in a way which will
build on our early successful experience and expand the participation
we have already seen in the program.
Commissioner Barnhart and I have been fortunate to participate in
Ticket to Work program activities throughout the nation. I know that
she has especially fond memories of kicking off the Ticket to Work
program in February 2002 alongside the late Senator William Roth. Among
the other Ticket events she attended that year was one in
Representative Hayworth's district. In addition, senior agency staff
have traveled throughout the country to help introduce this program to
the American people. Today I would like to provide an update on the
implementation of the Ticket to Work program, and touch on a few
related issues.
An Overview of the Ticket to Work Program
First, let me briefly describe how the program works. SSA currently
provides benefits under the SSDI and SSI programs to approximately 10.5
million Americans with disabilities. Under current agency regulations,
an SSDI or SSI beneficiary with a disability receives a Ticket to Work
if he or she is between the ages of 18 and 64 and has a medical
condition that is not expected to improve in the near future.
Approximately 9.1 million, or over 85 percent, of all beneficiaries
with disabilities meet this standard.
Under the Act, SSA enters into agreements with Employment Networks
(ENs) and with State Vocational Rehabilitation Agencies (``State VR
Agencies''). ENs are qualified State, local, or private organizations
that offer employment support services. These organizations include
One-Stop Career Centers established under the Workforce Investment Act
of 1998; single providers of services; or groups of providers organized
to combine their resources into a single entity.
A beneficiary who receives a Ticket to Work can choose to assign it
to any EN that provides services within the community or to the State
VR Agency. Together, these organizations are referred to as ``Ticket
Providers.'' An EN may decide whether or not to accept the assignment
of a Ticket. The Act requires that an EN accept a measure of risk
whenever it agrees to provide services to a beneficiary. ENs may only
be paid based on their success in assisting beneficiaries to secure and
maintain employment and move off the disability benefit rolls. An EN
might never be paid if a beneficiary's cash benefits do not stop as a
result of work. State VR Agencies are receiving approximately $2.6
billion from the Department of Education for the primary purpose of
providing employment services to individuals with significant
disabilities. VR agencies are therefore better capitalized than small
or new ENs and incur less financial and actuarial risk than ENs serving
smaller numbers of individuals.
Once a Ticket is assigned by a beneficiary to a Ticket Provider,
the beneficiary and the Provider jointly develop and implement a plan
of employment, vocational, or other support services designed to lead
to and maintain employment. Providers may provide these services
directly or by entering into agreements with other organizations or
individuals to provide the appropriate services at no cost to the
beneficiary.
Ticket Providers may be paid based only on their success in
assisting beneficiaries to secure and maintain employment and move off
the disability benefit rolls. Where this occurs, an EN may elect to
receive payment under one of two systems. Under the Outcome Payment
System an EN will be paid for each month, up to sixty months, in which
a beneficiary it is serving does not receive cash benefits due to work
or earnings. Under the Outcome-Milestone Payment System, an EN will
receive payment when a beneficiary it is serving reaches one or more
milestones toward self-supporting employment. Under this second
payment system, the EN will also receive reduced outcome payments
for each month, up to sixty months, that a beneficiary does not receive
cash benefits due to work or earnings. The agency has provided up to
four milestones for which an EN can be paid.
The Ticket to Work Act provides three additional incentives to
encourage work activity by beneficiaries. First, SSA will not schedule
a periodic continuing disability review (CDR) for a beneficiary who is
receiving services from a Ticket Provider. Second, work activity by an
SSDI beneficiary will not trigger a CDR if the beneficiary has received
benefits for at least 24 months. Finally, an individual whose benefits
terminated because of work activity can request that benefits start
again without having to complete a new application for benefits.
Implementation of the Ticket to Work Program
SSA is implementing the Ticket to Work program in three phases.
During the first phase of the program, from February through October
2002, about 2.4 million beneficiaries with disabilities in 13 states
received Tickets to Work. During the second phase, which ran from
November 2002 through September 2003, we mailed Tickets to
approximately 2.6 million beneficiaries in 20 additional States and the
District of Columbia. Then beginning in November 2003, we started
releasing Tickets to the approximately 4.1 million beneficiaries in the
remaining 17 States and the U.S. Territories during the third and final
implementation phase.
Through February 2004, Tickets have been mailed to over 6.9 million
disabled beneficiaries. By September 2004, the remaining 2.2 million
eligible beneficiaries will have been mailed a Ticket to Work, and any
eligible beneficiary who has yet to receive a Ticket to Work in the
mail can obtain one by asking for it. To date, we have certified almost
1,100 ENs to participate in the Ticket program.
The Act calls for the Commissioner to enter into agreements with
Program Managers to assist the Agency in administering the Ticket to
Work program. Among the duties of our Program Manager, Maximus, Inc.,
are recruiting, recommending, and monitoring the ENs selected by SSA to
provide services; facilitating beneficiary access to the ENs;
facilitating payment to Ticket Providers; and resolving disputes
between beneficiaries and Ticket Providers under the program.
Ongoing Operation of the Ticket to Work Program
As of the beginning of this month, 40,441 SSDI and SSI
beneficiaries who had received Tickets to Work (``Ticket Holders'') had
assigned them to Ticket Providers. Of this total, 36,525 (90%) were
assigned to a State VR Agencies and 3,916 (10%) were assigned to other
ENs. Approximately 30 percent of ticket assignments have been made in
the last 5 months.
The first milestone payment was made by Maximus during May 2002.
The first outcome payment was paid in July 2002. Through February 2004
we have made more than 1,600 payments to nearly 120 ENs totaling over
$530,000 based on the work of 450 beneficiaries.
Our early experience shows us that the Ticket is already proving it
can provide beneficiaries with more opportunities to obtain employment
support services to help them reach their employment goals. It is our
mission to see that the ticket lives up to its potential to return
people to work
Evaluation of the Ticket to Work Program
Section 101(d) of the Ticket to Work Actrequires the Commissioner
to submit periodic evaluation reports of the Ticket to Work program to
Congress. SSA has contracted with Mathematica Policy Research, Inc.
(``Mathematica ``) to evaluate the impact of the Ticket to Work
program. Mathematica has provided a draft of its first in a series of
evaluation reports. I will be happy to provide the Subcommittee with a
copy of the final version of this report which we expect to be
available shortly, and will also be happy to brief you on its findings.
Mathematica's preliminary findings are generally consistent with
our experience with the program. Most beneficiaries who use Tickets to
Work have assigned them to traditional State VR agencies. Ticket
assignments to ENs have been concentrated among a few ENs, and the ENs
as a group feel that SSA needs to move quickly to make the process
friendlier to providers.
As Mathematica notes in the draft report, overall, it is clear that
SSA has made great progress in developing such a system to assist
individuals with disabilities to find work and remain in the workforce.
This undertaking, which required SSA to develop new capabilities to
integrate information
from the SSI and DI programs, so that beneficiaries work could be
appropriately considered in determining theirs and their service
providers eligibility to benefits.
The Work of the Adequacy of Incentives Advisory Group
The Ticket to Work and Work Incentives Improvement Act of 1999
identified four groups of people with disabilities as potentially ``at
risk.'' These groups are: 1) individuals with a need for ongoing
support and services; 2) individuals with a need for high-cost
accommodations; 3) individuals who earn a sub-minimum wage; and 4)
individuals who work and receive partial cash benefits.
The Act requires the Commissioner to study the adequacy of
incentives to Employment Networks in the Ticket to Work program for
serving these four groups of beneficiaries. SSA formed an Adequacy of
Incentives Advisory Group to help determine the best approach for
conducting a targeted, in-depth analysis of the ``at risk'' groups. The
Advisory Group has been meeting quarterly, and will complete its work
this spring 2004. Last fall, the group issued an interim report,
``Recommendations for Improving Implementation of the Ticket to Work
and Self-Sufficiency Program (Regulatory and Administrative Changes).''
The group will also issue a final report, which will propose projects
to evaluate the effectiveness of adjusted incentives and
recommendations regarding the most promising adjusted incentives.
Recommendations of the Ticket to Work Advisory Panel
The Ticket to Work Advisory Panel has been a valuable partner in
studying the program and making recommendations for improvements. They
too have been concerned about the balance between State VR agencies and
other ENs, and about ways in which we can encourage more beneficiaries
to assign their Tickets to ENs. They also advise us on ways to improve
our public education of the program and how to market the program to
both beneficiaries and potential ENs.
We have carefully considered the recommendations of the Panel with
respect to establishing a corps of work incentive specialists, who will
be available to advise beneficiaries on the effects of work on benefit
payments, and on ways to reduce the incidence of overpayments caused
by work. They recognize, as do we at SSA, that the fear of creating
overpayments is a powerful disincentive to returning to work that our
beneficiaries face.
The $1 for $2 Benefit Offset Demonstration
The Ticket to Work legislation required SSA to test a DI benefit
offset similar to what is provided in the SSI program. Generally, SSI
benefits are reduced $1 for every $2 earned over the $65 earned income
monthly exclusion. Because there is no parallel provision for the DI
program, DI beneficiaries are often reluctant to attempt work because
of the abrupt loss of all cash benefits faced if they engage in
substantial gainful activity.
Therefore, we plan to conduct a national demonstration project to
test a $1 reduction in benefits for every $2 in earnings over a certain
level in the DI program in combination with interventions that offer a
range of ongoing employment supports, which may include some
combination of employment services, health care services,
transportation assistance, training, and other similar supports.
In addition, we plan to conduct a small-scale process demonstration
of the benefit offset in four sites. We expect this project to begin
enrolling participants this fall.
Program Improvements
I would now like to discuss a number of initiatives we have already
put in place on a number of fronts to improve our return to work
services based on all the information that we have received. They
include simplifying the payment process for ENs, increasing the pool of
ENs, improving our wage reporting process, and jointly funding with the
Department of Labor a new position to help people with disabilities
increase their employment opportunities. I will discuss these in more
detail.
Work Incentive Specialists
Section 1149 of the Social Security Act, as enacted by Section 121
of the Ticket Act requires SSA to establish a corps of specialists
devoted to issues related to work incentives. We have worked closely
with Subcommittee staff to develop and implement this concept.
Commissioner Barnhart has expanded the pool of field employees who
would be available to answer questions relating to return to work,
while establishing a dedicated number of employees in each area of the
region who will serve full time as Area Work Incentive Coordinators
(AWICs), for a total of 58 employees nationwide. I want to thank the
Subcommittee for its advice and guidance as we worked closely with you
to develop this approach.
AWICs are the focal point of contact for advocates area-wide, and
serve as ombudsmen. They monitor the area employment support workloads
and work with the Area Directors to ensure that we effectively manage
work incentive workloads. In addition, we have trained all of our
public service employees, including staff in all local Social Security
offices, on SSA employment support programs. AWICs work with other
staff to develop any area training needs to maintain the level of
expertise on work incentives for all direct contact employees and they
are a ready resource for providing accurate information to those
employees when questions arise.
An Improved EN Payment Process
Because many ENs found the payment process too cumbersome, we have
developed a new, simpler process for paying them. Under the new
process, SSA will pay ENs upon receiving a certification from the EN
that a Ticket Holder is still working, provided that the EN initially
submits return to work evidence. Prior to this change, ENs were
required to send in evidence of the work, such as pay stubs, monthly.
Now ENs have several options for requesting payments on either a
monthly or quarterly basis without needing to submit pay stubs.
Expanded Choice of Employment Networks
In order to attract sufficient providers of employment services and
in concert with Maximus, we have conducted 90 Employment Network
Opportunity Conferences across the country. We did this so
beneficiaries will enjoy the degree of choice when selecting an EN that
the Congress envisioned when the Act was passed. These events were
attended by more than 8,000 individuals, representing 6,100
organizations. To date, 483 conference attendees have applied to become
employment networks. In addition, Maximus has made presentations about
the Ticket to Work program at nearly 300 events nationwide and
delivered the message to 20,000 different organizations and 50,000
individuals through 250,000 distinct contacts. We will continue to seek
out EN recruitment opportunities and process improvements so we may
offer more choices for our beneficiaries who want to work.
Because we learned that the lack of upfront funding was a barrier
to EN participation, SSA has developed an EN capitalization initiative
that helps ENs locate and apply for additional funding to support their
efforts.
Eliminating Barriers and Disincentives
Overpayments to beneficiaries with disabilities attempting to work
are a major barrier to participation in the Ticket to Work program.
Disability recipients who try to return to work deserve to know that
their work information will be processed right away to prevent large
overpayments that are a burden to the recipient as well as an important
program integrity issue. Accurate and prompt wage report processing is
critically important.
The Social Security Protection Act of 2004 (P.L. 108-203) imposes a
requirement for a work report receipt, and we expect that our current
software, known as the Modernized Return to Work, or MRTW, and our PC-
CDR processes that field offices have been using, should be able to
fulfill that requirement. The issue of handling work reports is a major
priority of Commissioner Barnhart, and we expect several new processes
to have a positive impact on the problem, reducing both overpayments
and the work disincentives caused by the threat of such overpayments.
In January 2004, we began a phased rollout of our eWork application
for controlling and processing disability work activity and work CDR
workloads. It replaces the stand-alone MRTW and PC-CDR that I have just
mentioned. The eWork system automates and simplifies the processing of
work issues in Title II disability cases; its key functional areas are
workload management and control, case development, adjudication and
decision-making, notices and forms, and automated mainframe systems
inputs. In summary, eWork connects all of the separate pieces to the
whole through an electronic interface usable by authorized personnel
nationwide and work to minimize the occurrence of overpayments due to
work..
Expansion of Work Opportunities
Over the last 18 months, SSA has worked closely with the Department
of Labor's Employment and Training Administration and its State and
local partners to jointly fund the establishment of a new position, the
Disability Program Navigator. Approximately 110 Navigators have been
hired to work in DOL One-Stop Career Centers in 14 states. A key role
for Navigators is to help people with disabilities to increase their
employment opportunities. Locating of the Navigator in the One-Stop
Career Centers provides an important link to local employers in
fulfilling this role. Navigators will also facilitate access to
programs and services that impact successful entry or reentry into the workforce. This includes access to housing, transportation, health care,
and assistive technologies as needed to effectively participate in training services or for successful placement in employment.
SSA is also continuing to use the Employer Assistance Referral
Network (EARN) managed by the Department of Labor's Office of
Disability Employment Policy and the Ticket to Hire, a specialized
subunit of EARN that matches employers with job ready candidates from
the Ticket to Work program.
Conclusion
Finally, I thank you, Mr. Chairman, Mr. Matsui, and all the members
of the Subcommittee, for showing continued dedication to the Ticket to
Work program. Thanks to that commitment, we look forward to providing
more beneficiaries with the additional opportunities and tools they
need to enter or reenter the workforce.
In addition, I would like to thank you for your work to pass H.R.
743, the Social Security Protection Act of 2004(P.L. 108-203). Because
of the provisions in the bill regarding SSA demonstration projects,
including ensuring that projects can continue to move beyond this
December, we can move forward with our agenda of projects designed to
provide alternative return to work services.
I would also like to acknowledge the valuable input we have
received from the Ticket Advisory Panel and the Social Security
Advisory Board. We are committed to achieving the goal set by Congress
to improve access to jobs for Americans with disabilities. I believe,
and I am sure you will agree, that the nation benefits greatly when all
of its citizens have the opportunity to make the most of their talents.
We look forward to working with you as we continue our efforts to make
the Ticket to Work program a success.
Chairman SHAW. Thank you. Mr. Justesen?
STATEMENT OF TROY R. JUSTESEN, ACTING DEPUTY ASSISTANT
SECRETARY, OFFICE OF SPECIAL EDUCATION AND REHABILITATION
SERVICES, U.S. DEPARTMENT OF EDUCATION
Mr. JUSTESEN. Thank you, Mr. Chairman and the Committee for
having me here today and for having me join my colleague,
Martin Gerry from SSA, of which we are developing a very strong
relationship between the SSA and the Department of Education to
implement the success of the ticket program with the VR
Services Program.
The State VR Program is the Nation's longest-running public
employment program serving people with disabilities. In its 80-
plus-year history of the program, over 10 million individuals
with disabilities have achieved employment through the VR
Program. Each year, approximately 220,000 individuals go to
work with the help of the VR Program. Based on a recent study
of this program, approximately 85 percent of individuals with
disabilities who get jobs maintain employment at least 3 years
after they have been employed and their hourly wage increase
over this same 3-year period is over 78 percent.
Social Security recipients and beneficiaries presently
account for about one-fourth of the total VR caseload
nationwide, but each State agency's caseload varies depending
on the unique characteristics of the State, the flexibility of
the VR Program, and referral sources within the State. For
example, in California 43 percent of its individuals with
disabilities served through the VR Program, there are also SSDI
and SSI beneficiaries, whereas in Wisconsin, only 8.6 percent
of individuals whose cases were closed received SSI or SSDI
benefits.
Other factors, such as VR's requirements to serve
individuals with the most significant disabilities when there
are insufficient funds to serve all eligible individuals may
also have an impact on the number of SSI and SSDI beneficiaries
served by the VR Program. Further, the 1998 amendments to the
Rehabilitation Act requires VR agencies to presume eligibility
for individuals who have already been determined eligible for
SSI and SSDI services. State VR agencies are a significant
partner in implementing the options available in the Ticket to
Work Program for many individuals with disabilities. As of this
March, and you know this, Mr. Chairman, you said this earlier,
40,950 tickets have been assigned by SSI and SSDI recipients.
Over 90 percent of those issued tickets are assigned to VR
agencies.
Since the passage of the Ticket to Work legislation, the
Office of Special Education and Rehabilitative Services
(OSERS), the office within the Department of Education charged
with working with VR State agencies, has held training programs
for State VR agency staff during SSA's roll-out phase of the
ticket program in order to facilitate success of the program.
In addition to providing ongoing training to State VR agencies,
OSERS is committed to continuing its work with the SSA to help
evaluate the ticket program and the role State VR agencies play
in this overall program.
To this end, we at the Department of Education have been
working very closely with the SSA to complete a Memorandum of
Understanding which will be allow for both agencies to share
and link valuable data concerning individuals with disabilities
who are served by both of these programs. We are doing this
because we can better determine the long-term benefits of the
VR Program and its relationship to the overall ticket program.
We know there are several issues that have arisen regarding the
program interactions between VR Programs and private and public
ENs. One complication is that the Rehabilitation Act requires
VR agencies to seek comparable services and benefits from other
providers, which may include ENs. The issue of comparable
services is discussed in greater length in my written
testimony, but let me just say that we recognize the importance
of collaboration on this issue and we will work with all of our
partners to provide guidance on this issue and to resolve the
concerns.
Second, many of our private ENs have expressed concern
regarding agreements that are required when private ENs refer
ticket holders to a State VR agency for services. It is our
understanding at the Department of Education that in the
majority of cases, these agreements are regarded by both
parties as fair and inclusive of the principle of shared risk
and reward. However, we recognize that some agreements may not
reflect the principles of true partnerships and fairness. We
are committed to continuing our work with the SSA to provide
guidance to the State agencies and other ENs on this issue and
are hopeful that we can continue to work together to be able to
resolve issues regarding these agreements.
Third, we, and particularly I, Mr. Chairman, want you to
know that we have heard of many concerns about ENs competing
with State VR agencies for ticket assignments. It is important
to recognize that State VR agencies have a long history that
predates the ticket program with most ENs operating today.
Without the assistance of Community Rehabilitation Programs
that are now ENs, the success of the program I mentioned
earlier would not have been possible. I would like to highlight
a couple of beneficial aspects of our continuing dialog between
the advocacy community regarding the ticket program. Since its
inception, the Ticket Advisory Panel continues to be a main
conduit of information for us at the Department of Education.
From the panel, we have learned what is working and what needs
to be improved.
For example, as a result of our work with the panel, we
have seen a need to more closely monitor the cooperative
agreements between the State agencies and private ENs and we
are working with the initial 13 States in the program to
examine their agreements and provide feedback to Social
Security and with Social Security and with the Members of your
Committee. As we are learning more about the implementation of
the ticket program, we understand that there is more that needs
to be done to improve the participation of both beneficiaries
in the program and private and public ENs. This is a vital
effort. It is an area particularly important to the Department
of Education and we hope this information that we have provided
you today in my extended written comments and our continuing
work with Social Security will improve the ticket program, and
more importantly, improve the lives of people with
disabilities. I am happy to be here, and I am also happy to
take any questions you have. Thank you, Mr. Chairman.
[The prepared statement of Mr. Justesen follows:]
Statement of Troy R. Justesen, Ed.D., Acting Deputy Assistant
Secretary, Office of Special Education and Rehabilitation Services,
U.S. Department of Education
Mr. Chairman, members of the Committee, thank you for the
opportunity to appear before you today to discuss the Ticket-to-Work
program. I am pleased to join you and my colleague, Martin Gerry, to
discuss the Ticket-to-Work program and its relationship to the State
Vocational Rehabilitation (VR) Services Program administered by the
Department of Education. The Office of Special Education and
Rehabilitative Services (OSERS) is committed to working with the Social
Security Administration (SSA) to ensure the effective implementation
and success of the Ticket-to-Work program.
The State VR Services Program is the nation's longest-running
public employment program serving individuals with disabilities. In our
80-plus year history, over ten million individuals served by VR have
achieved employment. Each year, approximately 220,000 individuals go to
work with the help of VR. Based on a recent longitudinal study of the
State VR Services Program, approximately 85 percent of the individuals
who obtain jobs maintain employment for at least three years after
leaving the program. The longitudinal study also found that these
individuals increased their average hourly wage from $7.56 to $13.48
per hour, a 78 percent increase in earnings over the same three-year
period.
As you may know, Social Security beneficiaries account for
approximately one-fourth of the total VR caseload. It should be noted,
however, that the Rehabilitation Act of 1973, which authorizes the
State VR program, provides substantial flexibility to States. Because
of this flexibility, the referral sources and the characteristics of
each State agency's caseload vary. For example, in California, 43
percent of individuals whose cases were closed in Fiscal Year 2002
after receiving VR services were Supplemental Security Income
recipients and/or Social Security Disability Insurance (SSI/DI)
beneficiaries, while in Wisconsin, only 8.6 percent of individuals
whose cases were closed in Fiscal Year 2002 after receiving VR services
received SSI and/or SSDI. Other factors, such as the Rehabilitation
Act's requirement that States give priority to individuals with the
most significant disabilities when there are insufficient funds to
serve all eligible individuals, may have an impact on the number of SSI
recipients and SSDI beneficiaries served.
The 1998 Amendments to the Rehabilitation Act reflected Congress'
desire to provide seamless access to VR services for SSI recipients and
SSDI beneficiaries. The Amendments required State VR agencies to
presume VR eligibility for individuals who receive SSI and/or SSDI.
Presumed eligibility allows individuals who have already gone through
the arduous Social Security benefit-eligibility process to avoid
providing similar information to State VR agencies in order to be
determined eligible for VR services.
Since the start of the Ticket program, State VR agencies have been
a significant partner in implementing options under the Ticket program
for individuals with disabilities. As of March 8, 2004, a total of
40,950 tickets have been assigned by SSI recipients and SSDI
beneficiaries. Just over 90% of those Tickets (36,972) were assigned to
VR agencies. It is clear how important the State VR Services Program is
to the success of the Ticket-to-Work program.
Since the passage of the Ticket-to-Work and Work Incentives
Improvement Act (TWWIIA), we have held training programs for State VR
agency staff as Social Security conducted its three-phase ``roll-out''
of the Ticket program. At each training session, we brought together
SSA staff, SSA's Ticket Program Manager (Maximus), and State VR agency
staff to discuss emerging issues and to build long-term relationships
designed to facilitate the return to work of individuals with
disabilities. We have recognized throughout the early implementation
phases of the Ticket-to-Work program that there is a critical need for
on-going discussions across Federal programs and we are committed to
keeping the dialogue open. We monitor and provide updates via several
listservs that are dedicated to the interaction between State VR
agencies and the Ticket program. We are hopeful that, in the future,
joint training opportunities for State VR agency staff and private
Employment Networks (ENs) will be possible.
In addition to providing ongoing training to State VR agencies,
OSERS is committed to working with SSA to conduct research and
evaluation of the Ticket program and the involvement of State VR
agencies in the program, as well as other issues affecting the ability
of individuals with disabilities to achieve employment outcomes. To
this end, we are completing a Memorandum of Understanding, or MOU, with
SSA, which will allow both agencies to share and link data concerning
individuals with disabilities served by both the VR program and SSA. By
linking this data, SSA and OSERS can better determine the long-term
outcomes for SSI and SSDI beneficiaries who receive services through
the VR and Ticket programs.
The Ticket program unquestionably presents new challenges to OSERS
and the State VR Services Program, and we have a great deal more work
to do as we attempt to redefine our role and those of our State
partners. Several issues have arisen regarding program interactions
between the VR programs and the private Employment Networks (ENs) and
we are working with SSA to address these issues.
First, many private ENs are concerned about the impact of the
``comparable services and benefits'' requirement under the
Rehabilitation Act when they and the State VR agency are jointly
serving the same individual. With only a few exceptions, section
101(a)(8)(A)(i) of the Act requires the State VR agency to determine
whether a comparable service or benefit is available from any other
program to an eligible individual with a disability prior to providing
a VR service. The VR Regulations (34 CFR 361.5(b)(10)) define a
``comparable service or benefit'' as a service available from another
public source, health insurance or employee benefit that is (1)
available when the individual needs it, and (2) is commensurate with
the service that the individual otherwise would receive from the VR
agency. Therefore, if an individual is served by both the State VR
agency and a public-funded EN, then VR can consider services provided
by the EN that are available and commensurate with the services that
would be provided by the VR agency to be a ``comparable benefit or
service.'' Let me give you an example. An EN that receives public
funding may provide general job-placement services. However, if that EN
does not have experience in providing job-placement services to
individuals with severe and persistent mental illnesses, then the EN's
job-placement services may not meet the specific needs of such an
individual. In that circumstance, the State VR agency may not consider
the EN's job-placement services to be ``commensurate'' and, therefore,
not a comparable benefit or service. So, VR could then provide the job-
placement service to the individual. We will continue to work with SSA
to provide guidance to State VR agencies on this issue.
A second issue is that many private ENs have expressed concern
regarding agreements that are required when a private EN refers a
Ticket holder to a State VR agency for services. These agreements are
called for by TWWIIA. It is our understanding that, in a majority of
States, these agreements are regarded by both parties as fair and
inclusive of the principle of shared risk and reward. However, we also
recognize that some agreements may not reflect the principles of true
partnership and fairness. We are committed to working with SSA to
provide State agencies and other ENs with guidance on this issue.
Office of Management and Budget Circular A-87 may affect these
agreements in regard to proportionality of effort by various parties.
However, we are hopeful that together SSA and OSERS will be able to
resolve issues that arise in this regard.
Third, some private ENs have made statements that they do not wish
to ``compete'' with State VR agencies for Ticket assignments. It is
important to recognize that, typically, State VR agencies have long
histories that pre-date the Ticket program with most ENs operating
today. Without the assistance of community rehabilitation programs that
are now ENs, the successes of the VR program that I mentioned earlier
would not have been possible. We value our EN partners and recognize
the need for their participation, not only for the services they
provide, but also for the choice of service provision that their
participation ensures Ticket holders.
Now that I have enumerated some of the challenges we face in moving
forward with the implementation of the Ticket program, I would like to
take a moment to highlight what I consider to be a truly beneficial
byproduct of continued dialogue with the advocacy community regarding
this new program. Since its inception, the TWWIIA Advisory Panel has
been a main conduit of information for us. From the Panel, we at OSERS
have learned about what in the VR/EN relationship is working and what
needs to be improved. Without the meaningful exchange that occurs
regularly between OSERS and the Panel, we would be at a distinct
disadvantage in determining areas of concern as well as aspects of the
VR/Ticket interface that are working well.
As a result of our interaction with the Panel, we have seen a need
to more closely monitor the cooperative agreements between State VR
agencies and private ENs. We have just started that effort. We are
working closely with the 13 State VR agencies that were involved in the
first-phase roll-out of the Ticket-to-Work Program and we are examining
their agreements with ENs and providing feedback on those agreements.
We hope to provide our findings to both SSA and the TWWIIA Advisory
Panel.
What we are all learning as we implement the new Ticket program is
that more needs to be done to improve the participation of both
beneficiaries and private ENs in this vital effort. I hope that the
information I have provided today will assist you in your work with the
Ticket program. Again, I thank you for the opportunity to share our
experiences to date. OSERS and our partners in the State VR Services
Program stand ready to do our part to facilitate the successful
employment of Ticket holders.
I will be happy to answer any questions that you may have.
Chairman SHAW. Thank you very much. Mr. Gerry, you heard
Ms. Nelson, her testimony, and one of the things that she was
emphasizing was making these programs known to other people and
she mentioned that it would be good to put some of this stuff
on television. Now, I don't know what extent you can. People
are griping about us talking about Medicare and the drug bill
on television. Has any thought been given to, in some way,
getting more of this information out through the media?
Mr. GERRY. Yes, Mr. Chairman. Perhaps what I might do is
explain. We have entered into a contract with Fleischman-
Hillard, which is a large public relations consulting firm, to
design--and they are in the process of creating, a strategic
plan for this very question of how we effectively communicate,
not only with beneficiaries, but also potential ENs.
Over a 2-year period they are conducting telephone
interviews with beneficiaries and with other stakeholders. They
are trying to figure out the most effective way, and it goes to
your comments earlier about the design of the ticket and the
kind of language that is used. They are really trying to figure
out how to get the message across in the most effective way.
Now, part of that would obviously be what medium you would use
and part of it would be what you would say in terms of the
content. They are developing a national marketing strategy and
materials that we would use.
We really believe that given the importance of this task
and the ticket itself, it was important to get people who are
really experts to help us do this design. So, that is the
process that we are involved in. That task order was met on
September 30 of last year, so we are about 6 months into the
process now. My sense of what is going on is it has been very
positive. I think we are getting some insights, and we are
continuing to have dialogs with other organizations, which we
do believe is very important. On the other hand, as you
mentioned, without getting people with that kind of expertise
to give us advice, television advertising is very expensive and
it has, at least recently, become somewhat controversial. So,
we thought it important to do it as quickly as we could, but to
do it prudently, as well, and so we are trying to balance these
two tasks.
Chairman SHAW. I would say one of the things you have to do
is to try to make a determination of people with disabilities
that are not in the work force, how do they spend their day. I
would say that you will probably find out that a large part of
that day is sitting in front of the television set. Then, what
are they watching? That would be something. So, you can be very
selective as to where you put it. Of course, cable is always an
inexpensive option. I think, too, I think one of the most
effective ways you can do it is to get people like Ms. Nelson
and Ms. Hancock to get on the television and say, ``If I can do
it, you can do it.'' It just gets people thinking.
Mr. GERRY. Like everyone else in the room, I was very much
moved by what they had to say and I certainly would agree with
that point. We are not going to sit and wait for this period to
go by. We expect to get feedback throughout the process from
Fleischman-Hillard and I would certainly be happy to take up
that specific topic with them.
Chairman SHAW. I think the ticket--I have been very
critical of this, and in all fairness, I don't know what else
is in the envelope, but just looking at this, it is a document
that I think is not very understandable in the verbiage and I
think it can be jazzed up considerably with some kind of
illustration on it, such as somebody gainfully employed while
sitting in a wheelchair or with crutches or showing obvious
signs of blindness or another type of disability.
Mr. GERRY. I have to say, Mr. Chairman.
Chairman SHAW. I applaud you for getting the advertising
agency or public relations agency involved in it because these
programs have to be sold to people and they are getting
courage. I can tell you, if you are on disability, probably
every time you get something from the Social Security office
that you know is not a check, you probably hold your breath
when you open the envelope. It is kind of like getting
something from the IRS that is unexpected. I think we all have
experienced having to open that envelope to see what is in
there. I just think that we can go a long way toward helping
them. Mr. Collins?
Mr. COLLINS. Thank you, Mr. Chairman. I just wonder what
the postage is to mail those. Mr. Gerry, what did you think
about Ms. Hancock's idea that when an individual files, that
they be given the information at that point of contact with
Social Security?
Mr. GERRY. Well, I thought it was an interesting idea. The
Ticket to Work Program, of course, applies to beneficiaries so
that we could explain when someone filed an application, what
their options would be if they were to become a beneficiary.
Under the statutory language, I think we can only actually make
the program available to beneficiaries.
Now, we do have an early intervention demonstration which
we have been in the process of designing and will actually
start in the next 3 or 4 months that really focuses on
applicants and is designed to try to help people who might not
wish to continue even to pursue their application because they
might be able to go to work through a somewhat parallel
structure. I think the only problem right now would be,
although we could explain the Ticket to Work, there is no way
that we could offer the ticket itself until someone actually
became a beneficiary. Although we heard good stories about how
long it took from the panelists, sometimes, obviously, it takes
a much longer period of time.
I think everything we know about the psychology of people
in the population that we serve would strongly argue that the
earlier we can make an offer of assistance in returning to
work, probably the better in terms of what will happen, but we
would be somewhat constrained right now by the statutory
requirement that only beneficiaries can be served.
Mr. COLLINS. You don't have to be a beneficiary to be given
the information.
Mr. GERRY. Absolutely not.
Mr. COLLINS. All right. That is probably too simple. Ms.
Hancock also mentioned that she went through three ENs before
finally finding one in Connecticut, I believe it was, that
would actually listen to her. What kind of feedback have you
had from others in this same area?
Mr. GERRY. We certainly have had all kinds of feedback. We
have had people who are very happy with the EN, and that was
true of obviously one of the panelists who preceded us, and
others who were dissatisfied and changed. I think it is
inherent in the choice model. I think what the Congress wanted
us to do is to maximize the opportunity for people to choose,
and as a result of that, although we do through Maximus review
the applications from people who are ENs, there is likely to be
a pretty significant variation out there in terms of not just
the ability of people to relate to particular beneficiaries but
the kinds of services and strategies that they offer. That
seems to me to be kind of inherent in the way the program was
designed, in that the idea was to get as much competition and
choice as possible.
Mr. COLLINS. Do we have any method, are we putting in place
any method to keep some statistics on these ENs?
Mr. GERRY. Yes. We do collect information about the ENs and
we are developing strategies for tracking payments. What we
haven't attempted to do, and again, it would be a question of
how consistent it is with the overall goal of the statute, is
to try to do any kind of qualitative assessment of ENs. Now,
these are risk-bearing activities, so when the ENs accept
tickets, they do put money out to provide services, which, if
they are not successful, they wouldn't receive payment.
Of course, we also have in our regulations rules that say
that not only do ticket holders have a choice of ENs, but they
can discharge them, and as the witness testified, can change.
So, we have really been, frankly, looking at the market as the
primary way in which ENs who would better serve our
beneficiaries would be the ENs people choose and keep. We have
also assumed that if they are not successful in providing those
services, they won't be paid, so that their incentive should be
for ENs to be as responsive as they can. I am not arguing that
is always true.
Mr. COLLINS. You mentioned Ticket Tracker. I was just
looking at the Georgia statistics here earlier. There have been
285,000-plus tickets issued in Georgia. Assigned to State VR
agencies, 780; assigned to ENs, 181, for a total of 961, or
0.34 of 1 percent.
Mr. GERRY. I am looking at the same numbers, Mr. Chairman.
Mr. COLLINS. The number I don't see is how much success
have we had with the 961?
Mr. GERRY. I don't have that information--I would be happy
to provide it for the record--broken down by State. I can talk
about.
Mr. COLLINS. This is broken down by State.
Mr. GERRY. That is, and I don't know specifically.
Mr. COLLINS. Would that be an important statistic, to keep
track of that?
Mr. GERRY. I think it sounds to me like it would be an
important statistic----
Mr. COLLINS. It would be some good information. Is Ms.
Hancock the only one in Georgia?
Mr. GERRY. As I indicated, Mr. Collins, I don't know.
Mr. COLLINS. You don't know, do you?
Mr. GERRY. No, I don't.
Mr. COLLINS. Well.
Mr. GERRY. I will find out and make it available.
[The information follows:]
The following information is through March 29, 2004:
----------------------------------------------------------------------------------------------------------------
SVRA Payments
for Work EN Payment
Tickets Tickets Activity Tickets for Work
State Issued Assigned to *(Cost Assigned to Activity/#
SVRA Reimb.)/# ENs Beneficiaries
Beneficiaries
----------------------------------------------------------------------------------------------------------------
Alabama 89,065 160 2 22 0
----------------------------------------------------------------------------------------------------------------
Alaska 14,770 70 0 2 0
----------------------------------------------------------------------------------------------------------------
Arizona 167,662 463 4 272 81
----------------------------------------------------------------------------------------------------------------
Arkansas 136,370 97 5 100 0
----------------------------------------------------------------------------------------------------------------
California 369,343 968 13 156 1
----------------------------------------------------------------------------------------------------------------
Colorado 102,854 385 1 36 5
----------------------------------------------------------------------------------------------------------------
Connecticut 94,787 530 2 28 3
----------------------------------------------------------------------------------------------------------------
Delaware 26,990 493 5 14 5
----------------------------------------------------------------------------------------------------------------
District of Columbia 20,729 61 1 25 0
----------------------------------------------------------------------------------------------------------------
Florida 581,072 2,836 58 463 45
----------------------------------------------------------------------------------------------------------------
Georgia 287,627 911 22 184 11
----------------------------------------------------------------------------------------------------------------
Hawaii 11,016 8 0 4 1
----------------------------------------------------------------------------------------------------------------
Idaho 14,851 126 0 7 0
----------------------------------------------------------------------------------------------------------------
Illinois 389,456 4,850 65 256 45
----------------------------------------------------------------------------------------------------------------
Indiana 191,759 365 0 53 1
----------------------------------------------------------------------------------------------------------------
Iowa 86,467 755 13 59 11
----------------------------------------------------------------------------------------------------------------
Kansas 71,129 251 1 63 3
----------------------------------------------------------------------------------------------------------------
Kentucky 252,598 353 6 45 5
----------------------------------------------------------------------------------------------------------------
Louisiana 200,537 1,246 2 67 4
----------------------------------------------------------------------------------------------------------------
Maine 24,086 92 0 6 0
----------------------------------------------------------------------------------------------------------------
Maryland 51,688 60 8 32 0
----------------------------------------------------------------------------------------------------------------
Massachusetts 240,821 694 29 125 16
----------------------------------------------------------------------------------------------------------------
Michigan 358,958 3,061 8 154 16
----------------------------------------------------------------------------------------------------------------
Minnesota 47,910 102 1 29 0
----------------------------------------------------------------------------------------------------------------
Mississippi 160,833 233 0 138 9
----------------------------------------------------------------------------------------------------------------
Missouri 213,754 485 1 154 11
----------------------------------------------------------------------------------------------------------------
Montana 28,265 156 1 2 0
----------------------------------------------------------------------------------------------------------------
Nebraska 17,052 103 0 2 0
----------------------------------------------------------------------------------------------------------------
Nevada 57,053 251 0 115 419
----------------------------------------------------------------------------------------------------------------
New Hampshire 37,339 33 1 11 1
----------------------------------------------------------------------------------------------------------------
New Jersey 219,116 398 1 87 7
----------------------------------------------------------------------------------------------------------------
New Mexico 64,345 67 1 19 2
----------------------------------------------------------------------------------------------------------------
New York 721,629 7,844 24 426 59
----------------------------------------------------------------------------------------------------------------
North Carolina 125,719 244 0 19 0
----------------------------------------------------------------------------------------------------------------
North Dakota 15,289 16 0 7 0
----------------------------------------------------------------------------------------------------------------
Ohio 148,667 1,594 1 20 0
----------------------------------------------------------------------------------------------------------------
Oklahoma 132,799 1,597 7 20 48
----------------------------------------------------------------------------------------------------------------
Oregon 108,967 282 0 75 8
----------------------------------------------------------------------------------------------------------------
Pennsylvania 173,216 432 0 32 0
----------------------------------------------------------------------------------------------------------------
Rhode Island 16,290 12 0 4 0
----------------------------------------------------------------------------------------------------------------
South Carolina 185,861 1,461 21 95 8
----------------------------------------------------------------------------------------------------------------
South Dakota 20,327 347 0 1 0
----------------------------------------------------------------------------------------------------------------
Tennessee 256,261 1,041 6 330 13
----------------------------------------------------------------------------------------------------------------
Texas 209,248 186 6 99 0
----------------------------------------------------------------------------------------------------------------
Utah 15,321 105 0 0 0
----------------------------------------------------------------------------------------------------------------
Vermont 22,643 500 1 4 2
----------------------------------------------------------------------------------------------------------------
Virginia 222,186 621 3 154 12
----------------------------------------------------------------------------------------------------------------
Washington 68,673 76 0 45 125
----------------------------------------------------------------------------------------------------------------
West Virginia 48,671 48 0 5 0
----------------------------------------------------------------------------------------------------------------
Wisconsin 162,498 2,044 1 150 33
----------------------------------------------------------------------------------------------------------------
Wyoming 4,979 4 0 0 0
----------------------------------------------------------------------------------------------------------------
*data for the period 1/01/2002 through 2/29/2004
Mr. COLLINS. Well, one-third of 1 percent assigned to
either one the EN or the State VR agency, but that leaves 99
and two-thirds percent tickets issued and never followed up on.
Mr. GERRY. Well, they haven't been assigned. Let me just
suggest that----
Mr. COLLINS. They have been issued.
Mr. GERRY. They have been issued. It is accurate, they
haven't been assigned. They may still be assigned. We do note,
and one of the findings that Mathematica had in its preliminary
report is that for a variety of reasons, people do wait, and
actually, we heard that from one of the witnesses, often many
months, I think an average of 10 or 11 months, before they
actually use the ticket. So, it isn't necessarily true that
that is going to be all of the tickets that are assigned.
Mr. COLLINS. The whole goal of the whole program is to get
people back to be active in the workplace if that is their
desire to do so, but the follow-up oftentimes to something that
is in the mail, follow-up like I believe it was Ms. Nelson put
hers on the dresser and found it after the fire.
Mr. GERRY. We are planning.
Mr. COLLINS. I think there are a lot of loose ends that you
learn as you go. You are learning. I appreciate your time.
Mr. GERRY. Thank you.
Chairman SHAW. Mr. Gerry, I got a little bit of
clarification from Kim Hildred while you were answering Mr.
Collins's questions. Obviously, you can't offer someone a
Ticket to Work if they are not a beneficiary, because by
definition, you have got to be a beneficiary before you can get
a ticket, and that is certainly a reasonable part of the
legislation. However, when somebody is advised that they have
been approved for disability, are they advised--now, I assume
they are advised through the mail?
Mr. GERRY. Yes, they receive a notice.
Chairman SHAW. At that point, do they receive any
information on the Ticket to Work?
Mr. GERRY. I don't believe so.
Chairman SHAW. This would be a good time to let them know
that this doesn't have to be a permanent part of their life and
that we do have ways for them to escape the dependency of SSI
if they feel able to go into the workplace.
Mr. GERRY. I would like to check on that, Mr. Chairman. I
am not sure of the answer to that, that is, whether we----
Chairman SHAW. I would say when somebody is advised that
they have been approved, you have got their attention, and they
are probably going to read very carefully anything you send to
them and I think that is important. Ms. Tubbs Jones?
Ms. TUBBS JONES. Mr. Chairman, thank you very much. Mr.
Gerry, Mr. Justesen, good morning. I wasn't here at the early
part of your testimony because I took a few moments to call the
Vocational Guidance and Rehabilitation Services Center in
Cleveland, Ohio, to kind of get a feel for what is going on
with them and their ability to provide Ticket to Work. They
said they were referred 25 Ticket to Work folks but were only
able to take 1 because of the situation of the other 24 people
that were referred, but a young woman by the name of Nora Owens
gave me about 7,000 things she wanted to tell you, but I told
her I didn't have that much time.
[Laughter.]
Before I get to what Nora talked about, I understand how
difficult it is sometimes to administer large programs like
this particular program. What I might suggest to you, that you
find the media agency that the Administration used to do
prescription drug benefits and have them do the work that you
need to do to do media for the people on disability, because
they were able to turn it out real quick. I believe that this
issue is as important as the prescription drug benefit, and the
people who are receiving disability across this country would
love to hear about Ticket to Work as quickly as the others did.
I say that tongue-in-cheek, but I really am sincere about it. I
am confident that the people who are representatives in this
audience kind of agree with me, as well.
From the Cleveland Vocational Guidance and Rehabilitation
Services, one of the issues raised is that, for example, if
they receive a person referred for a particular service, they
get a fee-for-service for whatever the referral is. Very seldom
will they get a referral like a State agency referral where
they have the opportunity to get a longer term payment and that
the reason that a number of the smaller agencies are not ENs is
because the payment is so long in coming, you deliver a service
and it is 9 months, 2 years down the line, that they are not
able to get the service. I am going to just put on two or three
of these points and then you can use the rest of my 5 minutes
to respond.
The other problem that they seemed to say, for example, the
need for someone who is ultimately given a Ticket to Work to be
able to do a Medicaid buy-in. They gave me, for example, a
young man who was an excellent computer person, but his medical
service needs far exceeded anything that he would be able to
pay or receive in their health care program and that he ought
to be able to work as many hours as he would like to work and
they ought to be able to employ him as many hours as they can
without him being put in the position to be removed from the
program because there are a limited number of hours he can work
and a limited amount of money that he could pay. They said that
if he, in fact, could work full-time, he could make $40,000 or
$50,000 a year, but he still would need the supplemental
benefit of a Medicaid buy-in.
I talked about the small agencies. I talked about the
Medicaid. The first point they made was that the way it is
operated or the payment for the services through Ticket to Work
makes it exceptionally costly to provide some of the services
and that a review of how services are provided and how they are
paid might make a better use of dollars.
Finally, she said to me that if, in fact, you got, for
example, 10 Ticket to Works, that the referral to a Ticket to
Work EN really reduces the number of dollars that a State
agency actually gets to provide VR services so that, in
essence, instead of providing additional services for those
with disability, we are supplanting some of those services with
these services instead of extending the service. I asked a lot
of questions, put a lot out there, but you are free to use the
rest of the time to do what you can do to respond to my
questions.
Mr. JUSTESEN. Thank you.
Ms. TUBBS JONES. I used all my time, Mr. Chairman? Doggone
it.
[Laughter.]
Maybe you can write back to me.
Chairman SHAW. Go ahead.
Mr. JUSTESEN. First of all, Congresswoman, I counted 15
questions.
[Laughter.]
Ms. TUBBS JONES. I am a trial lawyer.
[Laughter.]
Mr. JUSTESEN. Well, first of all, the State of Ohio is
under an order of selection with regard to the VR Services
Programs which, in a nutshell, means that when the State
agency's funds are not sufficient enough to serve all
potentially eligible consumers of the VR system, the State must
prioritize a service to those individuals with the most
significant disability. In addition, I want to say that.
Ms. TUBBS JONES. Are any other States like that?
Mr. JUSTESEN. I think there are--it is in the early
twenties. We can supply you with those exact facts.
[The information follows:]
ORDER OF SELECTION STATUS FOR STATE VR AGENCIES
2004--FINAL
------------------------------------------------------------------------
TOTAL 80
agencies ORDER OF SELECTION 42 agencies NO ORDER 38 agencies
------------------------------------------------------------------------
Region I Connecticut G; Maine G & B; Connecticut B;
Massachusetts G; Rhode Island; Massachusetts B;
Vermont G New Hampshire;
Vermont B
------------------------------------------------------------------------
Region II New Jersey G; Virgin Islands New Jersey B; New
York G & B; Puerto
Rico
------------------------------------------------------------------------
Region III Delaware B; Maryland; Delaware G; District
Pennsylvania; Virginia G & B; of Columbia
West Virginia
------------------------------------------------------------------------
Region IV Georgia; Kentucky G & B; Alabama; Florida G &
Mississippi; North Carolina G; B; North Carolina
Tennessee B; South Carolina G
& B
------------------------------------------------------------------------
Region V Indiana; Illinois; Minnesota G; Michigan G & B;
Ohio; Wisconsin Minnesota B
------------------------------------------------------------------------
Region VI Arkansas G & B; Louisiana; New New Mexico G; Texas
Mexico B; Oklahoma G & B
------------------------------------------------------------------------
Region VII Iowa G; Kansas; Missouri G; Iowa B; Missouri B;
Nebraska G Nebraska B
------------------------------------------------------------------------
Region VIII Colorado; North Dakota; Wyoming Montana; South
Dakota G & B; Utah
------------------------------------------------------------------------
Region IX Arizona; California; Hawaii American Samoa;
CNMI; Guam; Nevada
------------------------------------------------------------------------
Region X Oregon B; Washington G Alaska; Idaho G & B;
Oregon G;
Washington B
------------------------------------------------------------------------
Changes from previous year: Indiana, Virginia G, and Virginia B moved to
an order.
Of the 24 general VR agencies: 14 (58 percent) were on an order
Of the 24 agencies serving blind individuals: 7 (31 percent) were on
an order
Of the 32 combined VR agencies: 21 (66 percent) were on an order
Revised Dec 2004
Ms. TUBBS JONES. Thank you.
Mr. JUSTESEN. John Connelly is the State VR Director for
the State of Ohio and is a very good resource with us at the
Federal level and with Social Security in working through some
of these challenges that are unique to the State of Ohio. Let
me also say before Martin answers more of the technical
questions, since I am 2 months on the job from moving over from
the White House that individuals with disabilities who receive
SSI--who are recipients of SSI or SSDI beneficiaries are
presumed eligible for VR services. That is regardless of their
choosing to use their ticket for other public or private EN
providers. In other words, individuals in Ohio with significant
disabilities, or the most significant disabilities, are
entitled to the services that the State ER agencies provide and
make available regardless of their use or choice to use the
ticket options that they have available to them. I will turn it
over to Martin to be more specific on your questions.
Mr. GERRY. Thanks, Troy. The first point that I wrote down
was that agencies don't become ENs because it takes too long to
get paid, and that is a serious problem. That is to say that
there is risk involved in this program and there is a need, of
course, for agencies that are providing services who accept a
ticket to finance the initial provision of those services in
hopes that they will be paid later when an individual achieves
SGA, then goes off benefits and then for a period of time
payments are made. So, it is, in fact, fairly common to hear
from smaller agencies that might be interested in becoming ENs
that the period of time and the way in which payments are set,
the amount of those payments, is a disincentive.
The issue of capitalization, obviously, what the VR
agencies have is an advantage in that they have money. They
have a flow of money under the Rehabilitation Act that allows
them to, in effect, front the cost of some of these services in
the hopes that they will collect under the program. So, I think
one of the things that we have been looking at and one of the
things we have been getting advice on from several of the
organizations that I mentioned, the Advisory Panel and others,
is the need to really look carefully at the payments, the way
we have set the payments, the amounts of the payments, things
that we could do that would make it at least more attractive
for ENs, where they could be paid at least earlier.
The capitalization problem is a much tougher one for us in
that we want to help, we want to see if we can provide as many
inducements to others to provide initial capital, but it is not
something that we are really able to do under the statute as it
is drafted. I do think it is a significant problem, and I think
that what you heard on the telephone, which was probably
something we could have heard in several other States----
Ms. TUBBS JONES. Mr. Chairman, Mr. Gerry, thank you very
much. In deference to my colleagues, you have been very
generous with time. I would be willing to accept my answers in
writing at a subsequent time, Mr. Chairman. Thank you, Mr.
Gerry.
[The information follows:]
Ms. Tubbs Jones: And that the reason that a number of the smaller
agencies are not ENs is because the payment is so long in coming. You
deliver a service, and it's 9 months, 2 years down the line, that
they're not able to get the service.
The SSA has taken aggressive steps to address the need to get
timely payments to ENs by establishing a Certification Payment Request
Process. The Certification Payment Request Process allows ENs to submit
a signed written statement that the ticket holder's work and earnings
are sufficient to warrant outcome payments, in lieu of having to
provide proof of the ticket holder's earnings, ENs can request payments
under the Certification Payment Request Process after a ticket holder
meets specific work requirements and has achieved a level of earnings
from employment to qualify an EN for outcome payments. This new process
can be used either on a monthly or quarterly basis. The SSA will pay
outcome payments based on the EN's certification, unless our records
indicate that the Ticket holder is receiving cash disability benefits.
In addition, the SSA launched the Employment Network Capitalization
Initiative in September 2002. Through this initiative, our Program
Manager, MAXIMUS, has been training ENs on how to identify and secure
alternative funding sources. Such funding can be used by ENs to cover
the costs of services to beneficiaries under the ticket program until
such time as the EN receives payments based on the employment outcomes
achieved. In addition to offering training online, MAXIMUS has
conducted a series of regional seminars (with five completed, and 3
more planed for 2004) and distributed an Employment Network
Capitalization Resource Directory to all ENs.
Ms. Tubbs Jones: The other problems that they seem to say--for
example, the need for someone who is ultimately given a Ticket to Work
to be able to do a Medicaid buy-in.
An SSI beneficiary may keep Medicaid benefits while he/she is
working if his/her earnings e insufficient to replace SSI cash
benefits, Medicaid benefits, and publicly funded healthcare that would
be lost due to those earnings. We use a formula that includes the SSI
Federal benefit rate (FBR) plus the average per capita Medicaid
expenditures for each state to calculate the amount of earnings that is
considered sufficient to replace all benefits that could be lost, The
resultant figure is called the threshold amount and is different for
each State. As long as a person earns under their state's threshold
amount, he/she will keep Medicaid eligibility. In some states, a person
could earn $40,000 and still be under the threshold amount.
If a person's earnings are higher than the threshold amount for
his/her State, we can calculate individualized threshold amount if he/
she has medical expenses that are higher than the State's average per
capita Medicaid expenditures. In calculating an individualized
threshold, we use the person's actual medical expenses instead of the
state's per capita Medical expenditures to determine the amount of
earnings that are sufficient to replace all benefits. If that person's
earnings are below his/her individualized threshold amount, he/she will
keep Medicaid benefits.
States have the option of providing Medicaid coverage to people
with disabilities whose earnings are too high to qualify under other
rules (such as under the SSI threshold amount). A state may extend
Medicaid coverage to working people with disabilities between ages 16
and 65 who have income limits to allow a working person with a
disability to buy into Medicaid. At least 27 states have a Medicaid
buy-in program.
Ms. Tubbs Jones: the way it's operated, or the payment for the
services through Ticket to Work, makes it exceptionally costly to
provide some of the services and that a review of how services are
provided and how they're paid might make it better--a better use of
dollars.
Section 1148(h) of the Social Security Act provides that ENs will
be paid under the Ticket to Work Program on the basis of outcomes and/
or milestones achieved by beneficiaries using their tickets in going to
work and achieving self-sufficiency. The total payment available to an
EN is limited to the amount of outcome payments available over 60
months, in addition tomilestone payments (and reduced outcome payments)
if the EN elects the outcome-milestone payment system.
Section 1148(c) of the Act provides a State VR agency witha choice
of receiving payment for serving beneficiaries using their tickets
either on the same basis as an EN, or on the basis of reimbursement for
the cost of services provided to beneficiaries by the State VR agency.
e total reimbursement payable to a State VR agency under the cost
reimbursement system is limited to the estimated savings to the trust
funds and general revenues which will result in the rehabilitated
beneficiary leaving the beneficiary rolls. This choice is not available
under the Act to ENs.
Ms. Tubbs Jones: the referral to a Ticket to Work EN really reduces
the number of dollars that a State agency actually gets to provide VR
services. So that, in essence, instead of providing additional services
or those with disability, we're supplanting some of those services with
these services instead of extending the service.
The Ticket to Work and Work Incentives Advisory Panel and other
observers of the Ticket to Work Program have noted that services and
supports provided by other programs should. be combined with, rather
than offset by, services and supports provided by the Ticket to Work
Program.
We are working with the Office of Special Education and
Rehabilitation Services in the Department of Education, as well as
other agencies including the Center for Medicare and Medicaid Services,
to ensure that the Ticket to Work, State VR programs, and other
programs work together to ensure that our beneficiaries are provided
with the services and supports they need to return to work and attain
self-sufficiency.
Chairman SHAW. Thank you. Mr. Hayworth?
Mr. HAYWORTH. Thank you, Mr. Chairman. Deputy Commissioner
Gerry, Mr. Justesen, thank you both for being here. Deputy
Commissioner Gerry, please extend my good wishes to
Commissioner Barnhart. It was great, because she came to
Arizona. We had the first Tickets to Work in Arizona. If could
just say, and we all lived happily ever after, that would be
delightful, but we are in, as we documented earlier, really the
challenging phase, from the notion of drafting a bill, seeing
the good work of folks, and on conference Committees, having it
voted out of both Houses, having it signed into law, and now
implementation.
We heard from the previous panel the challenges of letting
people know the word and emphasizing what has happened here.
You touched on in answering the question, Deputy Commissioner
Gerry, about the marketing firm or the firm that is developing
a marketing strategy, but I have heard from representatives of
ENs on our next panel, there is a real concern that even with
this contract, it will take at least 2 years for the SSA to
implement a full-blown marketing campaign.
Now, here is the problem we have in Arizona. We have
already seen the number of ENs accepting tickets drop from 27
to just a handful, in part because there seems to be no demand.
The ENs need help now. I appreciate the professionalism that a
marketing firm can bring, but is there not an interim step that
could be taken? What can be done now to get the word out to the
folks about Ticket to Work?
Mr. GERRY. Thank you, Mr. Hayworth. There are things that
we are doing now. I think it is a combination of both you
mentioned the ENs that are dropping out and it is a concern
that we have. Part of it is the whole question of what
beneficiaries now--the whole question of providing information
and prompting beneficiaries.
I think we also have to look at the other problem I was
just talking about with Ms. Tubbs Jones, which is that one of
the things we have envisioned, of course, was ENs coming in who
had contacts with beneficiaries because they were organizations
that routinely served those beneficiaries. So, the more we
could bring ENs that had those kinds of contacts, the more
likely we would be able to get beneficiaries. So, I think it is
both of those issues together.
The other thing I would have to say, having worked with the
populations of people for many years who are being served by
the program, is that there is a trust factor that we have to
overcome. The history of the relationship between the SSA and
some of our beneficiary groups has not necessarily engendered
trust in the likelihood of what is going to happen and we have
to sell the reality of the ticket, as we know it really is to
people who have had reasons to be concerned about what will
happen. So, we have to overcome that.
I think word of mouth is probably something that is going
to have to go a long way in doing that. I think what really
happens when you have those kinds of problems often is you need
successes and then you need people talking to other people
about the successes. So, I think it is all three of those
things. I didn't mean to suggest that we were going to wait 2
years to do anything about it. What I really wanted to suggest
is that we are 6 months into a 2-year activity to really come
up with a national marketing plan. Now, we have been doing a
lot of conferences around the country. We have been doing a lot
of talking to organizations. I won't read the numbers. I would
be happy to provide them for the record.
[The information follows:]
The SSA has been working on outreach and marketing
activities to raise the public's awareness about the Ticket to Work
Program through;
Partnering with the Department of Labor's Office of
Disability Employment Policy to use their Employer Assistance Referral
Network (EARN) and a specialized subunit of EARN, named Ticket to Hire,
which specializes in matching employers with job ready candidates from
the Ticket to Work Program. Ticket to Hire links employers to
Employment Networks in their community that have job-ready candidates.
Partnering with other agencies to expand awareness and
understanding of the Ticket legislation, Ticket to Hire, and other
employment supports, including the Office of Personnel Management, the
U.S. Chamber of Commerce, and the Department of Education.
Publishing Ticket to Work success stories in newsletters,
electronic publications and on websites such as the Office of
Employment Support Program's ``Work Site'' and MAXIMUS' Web site. We
also share success stories with numerous disability organizations for
use in their publications and websites.
Participating in conferences, meetings and forums that
promote the hiring of people with disabilities.
Maintaining the Internet ``Work Site'', http://
www.socialsecuritv.aov/work, that educates and provides resources to
people interested in the Ticket to Work and other employment supports
for people with disabilities. The ``Work Site'' has an entire section
dedicated to Ticket to Work information for beneficiaries, advocates
and service providers. This includes Frequently Asked Questions,
statistics on Ticket assignments and directories of ENs, Benefits
Planning, Assistance, and Outreach organizations and Protection and
Advocacy organizations.
Contracting with The Arc of the United States to provide
an analysis and evaluation of beneficiary data to determine how to
segment markets and target beneficiaries with marketing efforts to
maximize participation in the Ticket to Work Program.
In addition, MAXIMUS, the SSA's Program Manager for the Ticket to
Work Program, is Marketing the ticket program to prospective employment
networks. Their primary marketing vehicle has been the Employment
Network Recruitment Fair. Through December 00.3, MAXIMUS had held 90 of
these events, at least one in every State and Puerto Rico, employment
Network Recruitment Fairs allowed MAXIMUS to reach more than 8,000
individuals representing nearly 6,400 different organizations. In
addition, by invitation
MAXIMUS made presentations at more than 200 other events. The
combination of onsite marketing with direct mail and telephone outreach
has resulted in MAXIMUS delivering the ticket program message to about
50,000 individuals, representing approximately 20,000 different
organizations. In total, MAXIMUS has made over 250,000 distinct
contacts. This presents a ratio of about 200 direct outreach contacts
to each Employment Network proposal received.
Maximus has made a lot of presentations, and we are
significantly working on our field offices. That is a place
where we can have right now some significant impact--it has
come up two or three times already. As we talk to our
beneficiaries, we could be saying more about the ticket. We
could be giving out more information.
I mentioned in both my written and oral testimony that we
have hired 58 Area Work Incentive Coordinators. Those are in
our areas within the 10 regions that we have, and one of their
major tasks is to train our staff in the field offices who come
into daily contact with our beneficiaries to talk about the
ticket and to answer questions about the program. That is
pretty important, and probably ultimately one of the crucial
things we need to do, which is to change the culture of our
field offices so that these capabilities are there. Is it going
to happen overnight? I wish I could say yes. I think where we
have these people in place, we see significant differences. I
think that is an important strategy, as well. I would be very
interested in any other specific things that we can do as we
get this marketing plan. It is not that we don't have an
interest in it or that we aren't willing to devote resources to
it, but it is not clear to me precisely how we should do it.
Mr. HAYWORTH. I thank you for that, and as I was listening
to you talk, I thought about a marketing slogan for a certain
sports attire firm that is three words that I think is really
important here. ``Just do it.''
[Laughter.]
Just do it. The most basic things are here, and I have to
admit we understand Congress is a deliberative body. You talked
about the trust factor. One of the problems we have is if
Congress is a deliberative body, I don't know how we describe
the pace of the bureaucracy. It is glacial. Despite the best of
intentions, we have a glacial pace here. So, to the extent that
we bring, I like to think, light and maybe a little heat from
Arizona, we appreciate the efforts, but my friend Susan Webb
will be on the following panel. For purposes of full
disclosure, she is my friend from Arizona and obviously part of
ENs and part of the EN Association in the State of Arizona, but
she made this point to me earlier this morning.
If Binder and Binder and other Social Security attorneys
can advertise on television day in, day out, over and over
about getting people onto benefits, why can't the SSA advertise
at least as often to get people off benefits and back into the
world of work? A comment, a thought on that from either of you
gentlemen?
Mr. GERRY. I tried to address earlier the question of
television advertising, which is not without controversy and
also not without expense. I don't mean that in some penny-
pinching sense, but as a practical matter. One of the things I
hope that we will get is a recommendation on how to do that. It
would not be difficult to spend $50 or $100 million to do
ineffective television advertising.
Mr. HAYWORTH. Maybe I will just talk to the Arizona
Association of Broadcasters saying, hey, if you are receiving
Social Security disability and need to go back to work, why not
find out about the Ticket to Work Program? You can keep your
medical benefits and go back to work. Contact your counselor
for more information. Ta-dah. There it is, and it didn't take
me 2 years to explain that, and I can get that right to the
Arizona Broadcasters Association. I appreciate the good
efforts, and I am not here to beat you up. I really do. I just
believe we have got to get moving to get the word to folks, and
I thank you.
Chairman SHAW. We are going to have to move on to Mr.
Becerra.
Mr. BECERRA. Thank you, Mr. Chairman. Commissioner Gerry,
Mr. Justesen, thank you very much for your testimony. Let me
ask a quick question. How much did the Fleischman and Hilliard
contract cost the SSA and the taxpayers?
Mr. GERRY. It is about $900,000 for 2 years.
Mr. BECERRA. You might want to explore paying Fleischman
and Hilliard the way you pay the ENs. Maybe they will act a
little faster and give us more outcome if they know that they
don't get paid until they have some outcome.
Mr. GERRY. If we can get it consistent with the statute, I
am sure we will do that.
Mr. BECERRA. It might be tough. I know that you receive no
resources to administer this Ticket to Work Program. First, I
want to mention something that I mentioned to the Commissioner
when she was last here. You all do yeoman's work. You have what
is a large agency, but you deal with tens of millions of people
and beneficiaries, so first and foremost, to all the people who
work very hard at the SSA, we want to say thank you very much.
In that hearing that we had last week with the
Commissioner, she mentioned that her budget request was half-a-
billion dollars higher than what the Bush Administration
allocated in its budget. Obviously, tough times. We are in
deficit so everyone is having to tighten the belt, but given
that the SSA is receiving less money than it asked for from the
Administration and given that you never received any new
resources to try to administer the Ticket to Work Program, how
can you tell us that you will be able to deal with some of the
bureaucratic delays that have been raised by my colleagues and
others and that you have identified with fewer resources?
Mr. GERRY. First, let me just say for the record, although
I wasn't present during the Commissioner's testimony, actually,
had the agency received what the President requested from the
Congress, this budget problem that you are talking about
wouldn't have existed. The problem was not what we received
from the Administration or from the Office of Management and
Budget but, frankly, what we received from the Congress.
Mr. BECERRA. So, we need to do.
Mr. GERRY. The President's budget request for 2004 was
significantly higher than that approved by Congress.
Mr. BECERRA. So, a clear message, then. I hope all of us
then in Congress will hear that.
Mr. GERRY. I just wanted to clarify where the shortfall
came from.
Mr. BECERRA. Clarion call. Make sure we are clear.
Mr. GERRY. We appreciate very much the efforts of this
Subcommittee.
Mr. BECERRA. I want to make sure there is no doubt. Let the
buck stop where it should. If you are not getting the resources
that you should have, then Congress has to do more to allocate
resources so you can have the personnel to administer the
programs properly.
Mr. GERRY. Well, I certainly would agree with that. I think
the Commissioner has also testified that she is very pleased
with the 2005 budget as proposed by the President, which is a
substantial increase, 6.5 percent----
Mr. BECERRA. Well, remember, she also said that she is
going to have to put off implementing some of her programs to
try to reduce the backlog in disability determinations because
she is not getting what she asked for. So, while she may be
pleased, I suspect if we had a chance to give her a couple of
drinks in private times, she would probably tell us something a
little differently, as well.
[Laughter.]
Mr. GERRY. I think if she is displeased, it may be with the
outcome of the appropriations process in the Congress, not with
the President's request.
Mr. BECERRA. The whip has to be used both ways.
Mr. GERRY. As far as your question about our ability to do
the work, I think we have the resources. I would not want to
leave the impression with the Subcommittee that the problems
that we are encountering in the ticket program that we need to
overcome are resource-driven. I don't think that is the
situation.
Mr. BECERRA. I want to make sure, then. You are not going
to come back to us later on and say, we just didn't have the
personnel. So, let me get to another question. Is it correct to
say that for the last 7 months, the Ticket to Work Program has
been without a Director?
Mr. GERRY. No. It would be incorrect to say that. There has
been an acting Associate Commissioner throughout that entire
period.
Mr. BECERRA. Not a permanent Director.
Mr. GERRY. That is right, and we are.
Mr. BECERRA. How long have we had an Acting Director?
Mr. GERRY. We have had an Acting Director since, I believe,
September.
Mr. BECERRA. When do you think we will have someone?
Mr. GERRY. Actually, it is an acting Associate
Commissioner, to be accurate.
Mr. BECERRA. When do you think, Commissioner, that we will
have a permanent individual in that position?
Mr. GERRY. We have permanent people there, Mr. Becerra, but
the position will be filled, I think as a result of the posting
we have right now. The position is being posted. I think it was
alluded to earlier in the hearing. I am not sure whether it
closes tomorrow or a week from tomorrow, but that is roughly
the timeframe.
Mr. BECERRA. Okay. Do you think?
Mr. GERRY. I would anticipate we would have an Associate
Commissioner who would be selected within the next month.
Mr. BECERRA. That is good to know. The ENs, a question for
you. Of the 1,100 that have participated, how many of them are
nonprofits?
Mr. GERRY. I don't know that. I would have to provide that
for the record.
[The information follows:]
Approximately 75% of the 1,137 Employment Networks currently
available to assist beneficiaries are not-for-profit.
Mr. BECERRA. Could you get that for me, because it seems
that one of the difficulties that we are having, and I am not
sure if there is an easy way to resolve it, is that the ENs
don't get paid until after they have a positive outcome, and
for a lot of folks, it is tough to go that long before you get
some dollars in for the services you have been providing.
Now, I don't want to put a further burden on a nonprofit,
but nonprofits tend to run under very tight budgets and often
they get their funding from various sources in lump sums, so
they sometimes have to go periods without a regular source of
income flowing in. Since they are nonprofits, their status
depends on their abiding by Federal laws.
I am wondering with a nonprofit as opposed to a for-profit,
which has to generate the moneys to continue to pay employees
and stay in business, that maybe there is an opportunity to
work with nonprofits where you can come up with a creative
system of payment where you might not be able to do it with a
for-profit, because if a for-profit ultimately goes under, we
all lose because they can claim bankruptcy and we will never
get the money, but a nonprofit, if it goes under, chances are
it is going to have a tough time ever reenergizing itself and
asking for nonprofit status from the Federal Government again.
So, I am wondering if there may be some work that we can
do. Obviously, Goodwill Industries does tremendous work in so
many different areas, and I bet you they could use 10 times the
budget they do all the work on. Again, not to impose something
on Goodwill or any of these other noble nonprofits, but maybe
there is a way to address the payment problems you have with
the EN by working with the nonprofits that aren't trying to
make the buck to make a living but are doing this because of
the charitable and noble purpose behind it and work out a
creative way to find a way to fund these ENs in a way that
keeps them going and adds more of these ENs to the system,
because it seems like if you are only going to live with 1,100
of them, it is always going to be tough nationwide to let the
beneficiaries have that full sense of who is out there, who can
help them. I put that out there. Maybe if you can let us know
later on how many of these nonprofits are out there, that would
be very helpful.
Mr. GERRY. If I can just make one comment.
Mr. BECERRA. Yes, sir.
Mr. GERRY. You mentioned in passing about living with the
1,100, and I am not satisfied that we have adequately recruited
ENs. I think that the number is perhaps less crucial than the
reality of what is actually available to our beneficiaries.
There are still significant areas of this country where there
isn't a good competitive market available. The 1,100 are not
evenly distributed around the country and they don't serve all
of the beneficiary groups.
So, I just didn't want to pass by the idea that that is
enough or that I would imply that it is enough. I think we have
to really do a better job of reaching out to ENs. The other
observation I make is that I don't believe anywhere in the
statute Congress differentiated within the category of ENs, and
that could create some difficulty in trying to come up with
separate payment schemes, but I am perfectly willing to look at
the options.
Mr. BECERRA. Just to look at it. I don't know, either, but
I am just wondering if because they operate under different
scenarios, that maybe we can do that. Mr. Chairman, if I can
ask one last question, I will make it very quick. The notice to
beneficiaries, I thought Ms. Hancock made a great suggestion of
providing the information upon first point of contact, which is
when the then-applicant for benefits first reaches the SSA, no
telling whether the person will actually qualify for the
benefits. It seems to make perfect sense to just give the
notice up front and say, by the way, should you end up
qualifying for these benefits, we hope that you will consider
the possibility of returning to work at some point soon and
here is your Ticket to Work. Maybe you don't have the authority
right now, but is there any reason why the SSA would not want
to consider that?
Mr. GERRY. I don't think it is a question of authority. I
think it is an interesting idea and I would be happy to look
into it. I think we have the legal authority to do it. I would
be happy to pursue it and give you a more complete answer.
[The information follows:]
While we cannot issue a ticket to an individual who is not yet a
beneficiary, we believe that providing information about the program as
early as possible to applicants who might later become eligible for the
Ticket program is an excellent idea and are considering various ways to
ensure that accurate information is offered to individuals so that they
can make sound decisions about work activity.
Mr. BECERRA. Mr. Chairman, thank you very much.
Mr. HULSHOF [presiding]. Let me announce there are votes
upcoming and there are some Members on the next panel that
actually have flights to catch, so, if Members could try to
confine their remarks to the time allotted, I would appreciate
it. I am going to make a quick comment and a question, taking
my time. I appreciate, Mr. Justesen, in your testimony you
recognize--you are absolutely correct that State VR agencies do
have long histories that predate the ticket program and most of
the ENs today, but I also appreciate that you in that same
paragraph on page 6 of your testimony state unequivocally that
you value the EN partners and recognize the need for their
participation, not only for the services that they provide, but
for the choice of service provisions that they offer.
If you mention in Columbia, Missouri, the name Advent
Enterprises, everybody immediately understands that this is a
private VR service that has a good relationship with the State
VR, and so I appreciate that. Mr. Gerry, I know that we have
beaten you up a bit about the fact that 90 percent of the
tickets are being assigned to the State VR agencies, only 10
percent to the ENs. The only comment I would have, and you set
out a number of reasons why that is the case, what I wanted to
just reiterate in anticipation of the next panel, there are
those that are expressing the burdens of the payment process.
One referred to it as, I think, quote, ``administrative drag,''
and I enlisted that term from the next panel, which forces
these ENs to spend time and their resources dealing with
Maximus, and/or the agency rather than helping the
beneficiaries, and a couple of examples that seemed to be a bit
egregious, let me ask if you agree.
Twenty-thousand dollars due from the agency 3 to 12 months
or longer. I recognize what you said earlier about
capitalization and some of the smaller networks, and yet
waiting for that amount of funds for any private agency seems
to be a pretty substantial burden, or some citing the fact that
they spend more money and staff time to collect the payment
than the payment amount. I know, again, you have talked about
Maximus briefly. What can you do or the SSA do to address their
concerns on administrative drag?
Mr. GERRY. We actually have been doing several things, and
in my written testimony, I provide a little more detail about
this. On the payment collection issue, I think we have done
some things that make it much easier, much less time consuming,
and, frankly, less expensive for ENs. We have changed our
administrative procedures. We used to require a much more
rigorous verification of ongoing employment. In other words, we
had the issue of pay stubs. We had expectations that
beneficiaries would continue to provide evidence on a monthly
or quarterly basis that they were continuing to be employed.
Now, many beneficiaries, once they are employed, don't
particularly want to go back and forth to the EN and that makes
perfectly good sense. So, we have actually changed our
administrative procedures to allow some of the good faith
verification that the EN is not aware of any change in the
employment status rather than requiring the collection of pay
stubs.
Now, that is a big change in terms of the amount of work
that has to go on. So, the first time that a payment is
claimed, we want some proof that the individual went to work,
but we are not requiring that kind of documentation for all of
the payments, and we have also created three or four different
ways in which payments can be made, either quarterly or
monthly, and we have given choices to the ENs of how to
basically manage the payment process.
So, those are efforts to try to make it easier, and I think
on the pay stub collection of information front, we have done a
pretty good job of eliminating a lot of the problems. The
staggering and the timing of payments, the amounts of the
payments, those are problems that we are actively reviewing. I
think Congress intended in the legislation that the
Commissioner look at that, and we are doing that right now.
Mr. HULSHOF. A last comment and then I will yield briefly
to Mr. Pomeroy, then Mr. Brady. Even before the ticket program
was signed into law, this Subcommittee has actually been
concerned about overpayments. We have had hearings on this
issue. Each time, overpayments has been one of the serious
concerns, and so I also wanted to, at least on the record,
express that matter. Mr. Pomeroy?
Mr. GERRY. If I can just comment, and I will do it briefly.
Mr. HULSHOF. Okay.
Mr. GERRY. I have a lot of detail about what we are doing
right now in terms of some of the systems changes, but I want
to say for the record that this is a matter of the highest
priority to the Commissioner and to me personally. I think we
have to move and we have to move extremely quickly on the
overpayment problem. I think it is one of the most serious
barriers to getting people to work and I think that even though
it has been accelerated, it is something that we cannot just
leave to the routine changes of our systems, and wait for that.
I think we are looking at as many different ways as we can
right now to make that problem disappear because I think it is
a serious problem.
Mr. HULSHOF. There are those in the audience nodding their
heads in assent to that statement. Mr. Pomeroy?
Mr. POMEROY. Thank you, Mr. Chairman. Years ago, I spoke to
the North Dakota Mental Health Association and a young woman
followed me out and explained to me her situation. She was a
nurse who no longer could work because of a bipolar disorder
and she desperately needed an SSA disability determination for
the medicine that she required, but when she didn't work, her
condition got worse and she was just desperate to get to work.
So, when we passed this Ticket to Work, I thought of her and I
thought of that situation and I was thrilled about the
potential.
I look at the chart. North Dakota has got 22 people that
have actually been able to access this, and needless to say,
that is so far short of what my hope and expectation was for
this program. I don't recall a program where I have been as
excited about the launch of it and disappointed about the mid-
term implementation of it.
So, from both sides of the dais here, we have given one
message, and that is we can do a better job of getting this
program available to people whose lives will turn around if
they have access to it and can fully implement it. I couldn't
have been more impressed by the initial panel this morning as
an indication of what can happen to people when they can get
back to work. I am looking at the Advisory Committee's
recommendations to you and among their recommendations, they
call for congressional action to make it clear that Congress
did not intend to make beneficiaries ineligible for the full
range of services from VR, Medicaid, or other Federal and State
programs. To me, that ought not take an additional act of
Congress. Isn't it pretty clear from Ticket to Work legislation
that this is to be additive, not a zero-sum game in terms of
these benefits?
Mr. GERRY. I am a recovering lawyer, Mr. Pomeroy, and I
don't want to give you a legal opinion about it, particularly
because I think it applies probably partly to the
Rehabilitation Act. In other words, I think when Troy was
talking earlier about provisions of the Rehabilitation Act,
which we don't administer, the Department of Education
administers, there are provisions there about comparable
benefits that have been interpreted in different ways. It is up
to the Department of Education, of course, to interpret that
statute, but it is, of course, up to the Congress what the
content of that statute is and what that means.
So, the question which you are raising involves partly the
SSA and Ticket to Work, but it also involves the question of
what acceptable practice under the Rehabilitation Act would be,
and that is really a question that I am not prepared to answer.
I think it is an important question, and Troy, I don't know if
you want to try to respond, or----
Mr. JUSTESEN. You asked a complex question, Congressman,
and one which is very important to the Rehabilitation Services
Administration that is under my office and its interaction
between that statute, the Rehabilitation Act, and the Ticket to
Work and Work Incentives Improvement Act, and that is one in
which we would be happy to supply for the record a more----
Mr. POMEROY. I actually will want from both agencies a
clear explanation of where Congress needs to clarify, if
clarification is needed. Just specifically on this one, Mr.
Justesen, to follow up, if I can get this straight. If a
beneficiary assigns a ticket to an EN, is he or she still
entitled to VR services under the Rehabilitation Act if the
EN's services are not comparable to what was being provided by
VR?
Mr. JUSTESEN. As I understand your question, the answer is
yes.
Mr. POMEROY. They are still entitled to compensation,
because the education.
Mr. JUSTESEN. They are entitled to services and benefits
under VR.
Mr. POMEROY. Services, right. I am sorry, wrong word.
Services and benefits. Are you monitoring States to make
certain that they are implementing the VR Act (P.L. 105-220) in
that fashion?
Mr. JUSTESEN. Yes, and it is important for us, as I said in
my comments earlier, that we are valuing the input from the
Advisory Board, the Ticket Advisory Board, and our
collaboration with Social Security. Anecdotally, we have
received in the Department of Education communications,
concerns expressed by advocates and others throughout the
country that this is an issue in which we in the Rehabilitation
Services Administration under the Department of Education need
to pay particular attention to. We are doing that.
Mr. POMEROY. Great.
Mr. JUSTESEN. It is important for us to make sure that each
of the three phases, and we are beginning with the first 13, of
review of the agreements between the State VR agencies and
other public and private ENs, to make sure that individuals
with disabilities are protected under the Rehabilitation Act as
well as the opportunity for them to benefit under the ticket
program.
Mr. POMEROY. That is terrific, because what this is about
is an additional level of support to get people back to work,
not just another source of funding to then have other funding
withdrawn.
Mr. JUSTESEN. As I said, I will be happy to submit for the
record a clear explanation of this issue. Individuals with
disabilities, regardless of their option of exercising the
ticket, if they are individuals who receive SSI benefits or
SSDI benefits, those individuals are presumed eligible for VR
services without the need in the past to have completed a great
deal of extra paperwork to be eligible for both programs.
Mr. POMEROY. As you do supply that information, I would
like you to reference the Advisory Committee's recommendation.
I am not trying to at all point fingers at anybody. If Congress
has more clarification to do, let us go ahead and do it. I am
not, frankly, at all certain that we do. I believe that it is
relatively clear on what has been enacted already.
Mr. JUSTESEN. Perhaps. I would be happy to submit it for
the record.
Mr. POMEROY. All right.
[The information was not received at the time of printing.]
Mr. JUSTESEN. Let me tell you, I don't think, and we don't
take in any way your questions to be those of criticism. These
are areas of partnership building for us at all of the Federal
agency levels and one of the efforts we need to do at the
Federal agency levels is model interaction and interagency
implementation of the ticket program even better than we have
done in the past, and I think we are making efforts to do that.
Mr. POMEROY. The only final question--I asked a lot of
questions, comments--this business of getting this marketed in
an effective way so that people that might avail themselves of
these services know that they can is just terribly important. I
right now extend an invitation to SSA to have a meeting with me
in North Dakota. Hopefully, with media coverage, we will be
able to get the word out on it. We have about the lowest rate
of participation in the entire country, and I know that does
not reflect the work ethic of North Dakotans on disability
payments. They want to get off. We have got a program to get
them off. I will personally work with you to do that.
Mr. JUSTESEN. I would be happy to accept your invitation
right now. I have actually worked in North Dakota on the
Special Education Program and know a little bit about the
population. I certainly would be happy to do that. I am sure
Commissioner Barnhart would.
Mr. POMEROY. Terrific. We look forward to it, and we are
coming into springtime, so it is not even that bad of a draw.
[Laughter.]
Thank you very much. I yield back.
Mr. BRADY [presiding]. Thank you, Congressman.
Commissioner, Secretary, the Ticket to Work Program is a great
concept. It is real important that it succeed and it is
appropriate at this hearing that we focused a lot because of
the roll-out on process, but let us conclude the panel with
this question. We are at different phases in different areas.
For our customers, for our clients, for the ones we really want
to serve, what are the results so far for those especially
choosing ENs? Are the disabled getting services more tailored
to their individual needs? Are they getting them better or
faster or in a way that helps them get to the workplace sooner?
For those, we are really concerned. They happen to be our
employers, as well. What are the results for them so far?
Mr. GERRY. Let me see if I can set the stage to answer that
question by going back to where we were before the ticket and
where we had consistently two-tenths of 1 percent of our
beneficiaries leave our rolls for reasons other than death. I
can't testify they all went to work, but some significant
number of the two-tenths of 1 percent. That is where we were.
That is where we have been for 20 years. That was the status
quo that the ticket changed.
I think it is important to remember that that is where we
were because the ticket has, I think, had significant effects
on that as demonstrated. Specifically, we have about 670 people
that we are paying, that have generated EN payments. So, it is
people who are working, that have been working for some time,
that are off cash benefits. While that doesn't sound like a
huge number of people, even out of the 40,000, we have to
remember where we are in the process, because in order to be
paid, you have to have worked for a significant period of
time--in the case of VR, it is 9 months, and in the case of the
ENs, it is an even longer period of time. So, I expect that
number to expand fairly significantly over the next year or
two.
Now, I think that is impressive compared to where we
started. Is it what Congress looked for as the outcome or the
final effect? No. I think we have to work on a lot more things
in order to make this program work. I think in reading the
statute, as I read it anyway, and looking at the legislative
history, I think Congress knew that we were going to learn a
lot as we implemented the statute, and what the Commissioner is
dedicated to, and I am, too, is to make changes as soon as we
learn, not to wait, not to hesitate, but to do it and to do it
with this Subcommittee. There may be things that ultimately
have to come back to the Subcommittee and say, these are
statutory issues.
We are, at this point, trying to do everything we can
within the Commissioner's regulatory authority, and in some
cases, I mentioned even changing administrative procedures. So,
I think, yes, there are real people who are getting real
benefits and I think that there is real promise and that the
vision that this Subcommittee had when it passed the ticket is
the right vision and one that we can reach. I just think we
are, as you say, we are at a critical point in time and I think
that we have to do--and I can pledge to you on the behalf of
the agency what we are doing is trying to think about all the
changes we can make or recommend to the Congress that would
really make this program work more successfully.
I think the one concern I have is that we have to keep
going back to who the program is supposed to work for, and that
is the beneficiaries. The fundamental issue is the choice of
beneficiaries of different kinds of services that will allow
them to achieve their employment goals, and that is what I keep
reminding myself of, because we can get drawn off on other
interests.
Now, to have a vibrant and an active set of ENs and to have
VR agencies become competitive. What we really want is not to
repeat the two-tenths of 1 percent experience that we had
before, but through competition to see good things happening.
So, instead of seeing VR agencies as associated with a program
that hasn't produced much in the past, they would become part
of a new program where they actively compete and cooperate. I
think that is what we want and what we want to achieve, but I
am very optimistic that we are going to get there. I just don't
want to over-promise or over-commit. At the same time, we
couldn't be more dedicated to getting there.
Mr. BRADY. Thank you, Commissioner. I appreciate it. Mr.
Secretary?
Mr. JUSTESEN. It is important for the Committee to
understand, and I know that you do, but I want to reemphasize
this, that the success of the Ticket to Work Program is not
solely on the shoulders of the SSA. They are the lead. We at
the Department of Education look to the SSA to provide us with
guidance on how to best implement the Ticket to Work Program.
The VR Services Program administered at the Department of
Education is a very important partner, together with the
Department of Labor's efforts, that are new in terms of our
understanding how this evolution has evolved for us to all
begin to work together at the Federal level.
The VR Program has an important component and access in the
advocacy community that may well be the primary access for
entry into the world of employment. The Social Security may not
always be in all cases. We have a large Independent Living
Advocacy Program in which we partner that with the VR Services
Program that is a vital first entry point for many individuals
who may later become recipients of SSI or SSDI in which we are
looking to build on that partnership and, frankly, we haven't
done as well as we could, but the Secretary of Education,
Secretary Paige, is very interested in our efforts to increase
the employment opportunities for people with disabilities and
we look forward to doing that.
Mr. BRADY. Thank you. I think this is important because my
experience is everything looks perfect on paper in Washington,
D.C. How it works in life is usually a whole different matter.
Staying on top of it to make it work the right way is our job,
so, thank you, panelists. We appreciate it.
Mr. BRADY. The next panel, I would like to invite up at
this point. Thank you for being here today. We have with us
Sarah Wiggins Mitchell, who is Chair of the Ticket to Work and
Work Incentives Advisory Panel; Tom Golden, who is a member of
the same panel; Paul Seifert, Social Security Task Force,
Consortium for Citizens with Disabilities (CCD); Tom Foran,
Vice President of Integrated Disability Resources (IDR);
Quintin Mitchell, who is Director of VR Services in Richmond;
Susan Webb with the Arizona Employment Network Association; and
John Coburn, Staff Attorney for Health and Disability Advocates
in Chicago, Illinois. In that order, why don't we begin with
Sarah Wiggins Mitchell for her 5-minute statement.
STATEMENT OF SARAH WIGGINS MITCHELL, CHAIR, TICKET TO WORK AND
WORK INCENTIVES ADVISORY PANEL; AND THOMAS P. GOLDEN, MEMBER,
TICKET TO WORK AND WORK INCENTIVES ADVISORY PANEL
Ms. WIGGINS MITCHELL. Thank you, Mr. Chairman, and good
afternoon. On behalf of the Advisory Panel, we would like to
thank you for this opportunity to speak to you today. The panel
appreciates the support this Committee demonstrates for people
with disabilities and the SSA disability programs. We have
submitted written testimony for the record and now will simply
be highlighting some of the points we made in that testimony.
The panel believes that the ticket program has much
unrealized potential. Beneficiaries are showing interest in the
program in two ways. Forty thousand people have assigned their
tickets to receive VR and employment support services. In
addition, the program manager, Maximus, received over 23,000
calls about the ticket in the month of February alone and over
10 million hits were made to their Ticket to Work website in
the calendar year 2003.
The support programs established by the Ticket Act are also
proving to be very successful. Almost 100,000 beneficiaries
have sought information and assistance from the Benefits
Planning and Assistance and Outreach Program (BPA&O). The SSA's
customer satisfaction survey supports what the panel has been
hearing from beneficiaries across the country. The BPA&O
services are excellent and essential to people with
disabilities who want to work. The panel was pleased that the
BPA&O and PABS Programs were reauthorized in H.R. 743 and
thanks this Committee for their hard work in passing that
legislation.
The establishment of the Area Work Incentive Coordinator
(AWIC) position within the SSA is a very positive development.
The panel was 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 core of work
incentive specialists. The panel has heard positive testimony
and comments regarding the AWIC positions and hopes that SSA
will expand the number of AWIC positions to meet the enormous
demand for their services.
Mr. GOLDEN. While the SSA is making some progress in a
number of areas, the panel has serious concerns in three key
areas which threaten the success of the ticket program. Of most
concern to the panel is the current low participation of ENs.
As you are aware, the panel issued a report last month
entitled, ``The Crisis in EN Participation: A Blueprint for
Change.'' Central to this report is the assumption that
recruiting and retaining a large number of ENs is crucial to
accomplishing the primary Stated goal of the ticket program,
giving people with disabilities a real choice in rehabilitation
and employment.
Our report identified a number of issues that are causing
providers not to participate or to drop out of the program
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. While all of
these issues are important, I will briefly discuss only two.
The design of the payment system for the ticket program and
the administration of claims for payment by ENs pose immediate
threats to the success of the program, placing too much
financial risk on ENs, who must make large investments up front
and wait a long time for payments. The panel has recommended
moving more of the payment into the first 12 months of
employment, increasing the payment to greater than 40 percent
of the average benefit amount, reducing the difference between
milestone and outcome payments, and increasing the sum of
payments for SSI to equal that of the payments for SSDI.
Second, the requirements SSA places on ENs to make a claim
for and receive payment are burdensome and costly. SSA not only
does not make payments to ENs in a timely manner, sometimes
taking up to 120 days, but also has established a quarterly
payment schedule. Finally, the panel is concerned that SSA has
yet to undertake a demonstration project addressing any of
these issues. These administrative problems must be addressed
without delay.
The second major area hindering the success of the program
is the lack of marketing and public education about the program
itself. Over the past 3 years, the panel has repeatedly
recommended that SSA undertake a national coordinated marketing
and public education campaign to increase awareness of and
interest in the program. While the panel is pleased that SSA
has awarded a contract for the design of a strategic marketing
plan, no actual marketing plan will have been implemented until
the plan is completed. The panel urges SSA to move forward
quickly with other interim marketing activities such as
possibly sending a reminder letter to beneficiaries who have
received a ticket in the past and not used them, or other
suggestions that were made by our esteemed panel earlier today.
Finally, the panel is concerned about the insufficient
training SSA field staff receive about SSA work incentives and
the ticket program. The panel continues to hear stories of
beneficiaries who received inaccurate information about work
incentives from SSA field staff. Receiving bad information can
cause a person not to make a job attempt, to receive an
overpayment, or to be forced to stop working altogether. It
also increases mistrust and fear. This situation is
unacceptable to the panel and Americans with disabilities.
The Ticket Act requires the SSA to have staff available and
accessible that possess a thorough understanding of the work
incentives and are able to provide this information to
beneficiaries who want to work. As Stated earlier, AWICs
represent the best type of customer service. However, the
training received by AWICs does not seem to filter down to the
Work Incentive Liasons and other field staff. We urge SSA to
expand the training available to all SSA field staff and put in
place quality assurance measures.
Ms. WIGGINS MITCHELL. In conclusion, the panel believes the
ticket program has great potential to help many people with
disabilities improve their lives by going to work. While it is
still early in the implementation process, the failure of SSA
to take steps to immediately address the concerns outlined in
this statement could have a dire effect on the success of the
program. Thank you again for your opportunity to speak with you
today. Normally, I would say we would be happy to stay and
answer questions, but my colleague and I need to be in other
areas of the country and are going to have to leave.
Mr. BRADY. That is fine.
Ms. WIGGINS MITCHELL. We would be glad to answer in writing
any questions that you would have for the panel.
Mr. BRADY. Thank you. Have a safe trip.
Ms. WIGGINS MITCHELL. Thank you.
Mr. BRADY. I noticed that I don't think either of you took
a breath during your----
[Laughter.]
I thought, man, things are speeding up in this room now.
[Laughter.]
So, anyway, we appreciate you being here. Thank you.
Ms. WIGGINS MITCHELL. Thank you very much again.
[The prepared statement of Ms. Wiggins Mitchell follows:]
[The prepared statement of Mr. Golden follows:]
Statement of Sarah Wiggins Mitchell, Chair, Ticket to Work and Work
Incentives Advisory Panel
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 design
of 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.
Statement of Thomas P. Golden, Member, Ticket to Work and Work
Incentives Advisory Panel
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 design
of 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.
Mr. BRADY. Mr. Seifert?
STATEMENT OF PAUL J. SEIFERT, SOCIAL SECURITY TASK FORCE,
CONSORTIUM FOR CITIZENS WITH DISABILITIES
Mr. SEIFERT. Thank you, Mr. Chairman. I am testifying today
on behalf of the CCD and Work Incentives Task Forces. The CCD
is a national organization representing over 100 disability
organizations, membership organizations of people with
disabilities, provider organizations, a good many people who
are participating in the ticket program and a good many
organizations providing those services as ENs. It was with a
great deal of support from the disability community and, of
course, bipartisan support from Congress that the ticket
legislation passed in 1999. However, an array of factors, we
believe, have kept the ticket program from meeting its full
potential and we have four areas of concern that we would like
to mention today.
As previously mentioned, the reimbursement schedule for ENs
is wholly inadequate, and is creating a major barrier to ENs
who want to participate in the program. There are issues
between State VR agencies, ENs, and beneficiaries that have
resulted in many potential ENs not participating in the program
and beneficiaries unknowingly assigning their tickets to VR,
overly burdensome reporting requirements on EN and State VR
agencies in order to receive reimbursement, and as I think has
been gone over in great detail, poor marketing to ENs in terms
of recruitment and a lack of awareness about the ticket among
SSA beneficiaries, not to mention the other work incentives.
I want to talk about the reimbursement scheme, and just
skip right to our proposals. First of all, we think Congress
should eliminate the statutory requirement that the milestone
outcome payment system pay less than the outcome payment only
system. Congress should clarify that a partial reduction of
benefits under the SSI Program for working SSI beneficiaries
is, in fact, an outcome, deserving a payment to an EN, maybe
not the full amount, but certainly that is something we want to
reward and not penalize.
Congress should shorten the period in which outcome
payments are made and should raise the percentage of the
average monthly benefit used to determine payments to ENs.
Waiting 60 months for the full repayment is just too long for
most small nonprofits to capitalize expenses over that period
of time. Fourth, the SSA should increase the value of the
milestone payments and allow the partial payment for some work
that is under the SGA level. Again, we endorse the
recommendations of the Employment Network Work Group that the
panel put together and also the Adequacy of Incentives Work
Group report which will be coming out shortly.
The interplay between State VR agencies and beneficiaries
and ENs is another area of concern to us and has been a concern
ever since this legislation was developed. Quite frankly, we
believe Congress needs to repeal the language that requires
agreements between ENs and VR agencies. Second, we think that
the legislative language should be enacted that prohibits VR
agencies from collecting ticket payments from ENs who refer
beneficiaries to State VR agencies. We think that Social
Security ought to pay VR its cost reimbursement under its
current situation, and keep the ticket intact so ENs can regain
or at least get reimbursed for the payments and services that
they provide over the 60-month period for which a beneficiary
has deposited that ticket.
The marketing issue is one that we discussed with Social
Security in the early rollout of the ticket, and one that we
had several concerns with. First of all, we were worried that
the tickets would roll out before enough ENs were signed up,
and part of the reason why so few tickets are being deposited
or so many are being deposited with VR agencies is we rolled it
out so fast that there aren't enough ENs to potentially provide
enough services to all the people who may want them.
Number two, mailing the ticket to beneficiaries was
probably not the best marketing device. Beneficiaries get
essentially two things from Social Security, a check and bad
news, and probably since this was not a check, at best it was
probably kept in a drawer or on top of a dresser somewhere
where it might be gotten later or forgotten. So, that was
probably not the best technique. In addition, the cost of
mailing out millions of these tickets was probably prohibitive
and not the best use of the agency's resources. We believe that
use of the advocacy community to advertise the ticket as well
as the other work incentives, the use of television and radio
public service announcements would do a lot to promote the use
of the ticket among beneficiaries, and a more aggressive
strategy for signing up ENs plus a modification of the payment
and reimbursement schedule will convince more smaller
nonprofits to get involved in the program.
It was touched on briefly by Mr. Hulshof, but the issue of
overpayments is a staggeringly frightening phenomena for anyone
who has ever experienced it and it has got to be dealt with. It
not only affects ENs in the sense that when an overpayment is
made, a payment to an EN is not being made when it should be,
but perhaps most significantly, beneficiaries are stuck having
to repay at times tens of thousands of dollars of benefits they
were not supposed to get even when they have reported their
earnings to Social Security in accordance with the statute.
Worse than that, beneficiaries have to pay taxes on the
overpayment that they get and they can't pay it out of the
benefits they get. So, we have imposed an additional tax burden
on a working beneficiary for getting an overpayment they are
not supposed to get. Now, they can always file for
reimbursement in a later tax year, but do we really have to do
this to people who are trying to work?
In conclusion, we believe the ticket has a great deal of
potential. We think these modifications will go a long way to
help the ticket realize that potential. We applaud the agency
for its rapid and extraordinary rollout and we hope that some
adjustments are forthcoming. Thank you.
[The prepared statement of Mr. Seifert follows:]
Statement of Paul J. Seifert, Social Security Task Force, Consortium
for Citizens with Disabilities
Mr. Chairman, Mr. Matsui, members of the Subcommittee, my name is
Paul J. Seifert. I am the Director of Government Affairs for the
International Association of Psychosocial Rehabilitation Services
(IAPSRS) and today I am testifying on behalf of the Consortium for
Citizens With Disabilities (CCD) Work Incentives and Social Security
Task Forces. CCD is a coalition of nearly 100 national organizations
advocating on behalf of people with physical, mental, and sensory
disabilities. On behalf of CCD I thank you for this hearing to examine
the Social Security Administration's management of the Ticket to Work
program.
With a great deal of support from the disability community and near
unanimous, bi-partisan support in both the House and Senate, Congress
enacted and President Clinton signed into law the Ticket to Work & Work
Incentives Improvement Act (TWWIIA) in December 1999. This legislation
was designed to expand the rehabilitation services and health care
coverage for Social Security beneficiaries who want to go back to work.
A key component of the TWWIIA legislation is the Ticket-to-Work
Program.
There are high expectations in both the disability community and
among members of Congress for the Ticket to Work program. And though
those expectations have not been fully realized, a couple of key
positive points should be mentioned. First, SSA should be recognized
for their rapid regulatory development and rollout of the Ticket
program. The first tickets were issued to beneficiaries a little over
two years after passage of the legislation, and today just four years
after the final regulations were approved, beneficiaries in every
state, the District of Columbia and the territories are able get a
Ticket to Work. This is an extraordinary accomplishment given that the
Ticket to Work is a brand new program that required the creation of a
new Office of Employment Support Programs within SSA and the hiring or
reassignment of many SSA staff.
Second, while much criticism has been leveled at the Ticket Program
for its real or perceived failures the fact is, when compared to the
old SSA Alternate Provider (AP) Program, more people are using the
Ticket and SSA is making payments to more Employment Networks for
serving more beneficiaries than they did under the old AP program. The
numbers speak for themselves. Under the AP Program only 428 private
agencies participated. Today 1,100 Employment Networks are
participating in the Ticket. Under the old AP program only about 15
successful outcomes were achieved resulting less than $50,000 in
payments to providers. As of March 17, 2004, the Ticket has paid
$583,000 in payments have been made to 160 ENs for serving 473
beneficiaries.
However, the standard for success was not merely to do better than
the AP program, but rather to significantly expand the array of
employment services for people with disabilities and increase the
resources available to provide those services. Unfortunately, an array
of factors has kept the Ticket from reaching its full potential. Those
factors are 1) a wholly inadequate EN reimbursement schedule that is
keeping potential ENs from participating and keeping most of those who
do participate from taking Tickets, 2) issues between State Vocational
Rehabilitation Agencies and ENs and beneficiaries have resulted in many
potential ENs deciding to not participate and has beneficiaries
unknowingly assigning their Tickets to State VR, 3) overly burdensome
reporting requirements on ENs seeking reimbursement, and 4) poor
marketing to ENs and a lack of awareness about the Ticket among SSA
beneficiaries.
REIMBURSEMENT IS INADEQUATE
Reimbursement under the Ticket to an EN occurs when a beneficiary
who has assigned their Ticket goes to work and no longer receives cash
benefits. Small milestone payments are available to the EN and paid
when the beneficiary's work effort reaches Substantial Gainful Activity
for a certain period of months. The outcome payments are spread out
over 60 months, payable for a month whenever the beneficiary is not
receiving cash benefits. The payments are calculated as forty percent
of the average monthly SSI and SSDI benefit.
SSA's payment methodology has several flaws. ENs who choose to
receive milestone payments (all but a couple have chosen milestones)
have their total payment cut by fifteen percent compared to the
outcome-only payment scheme. No upfront funding means ENs must
capitalize all the costs until the person is working above SGA and then
completely off cash benefits and the milestone payments are too small
to be attractive to ENs. The policy of requiring SSI beneficiaries to
go completely off cash benefits ignores that many SSI beneficiaries who
offset much of their SSI benefit through work generate much savings
that ENs get no credit for under the current payment scheme developed
by SSA.
Participation by ENs will continue to be weak unless they can
foresee a more reasonable level of payment made in a more timely
fashion.
We propose several improvements: 1) Congress should eliminate the
statutory requirement that the milestone-outcome payment system pay
less than the outcome-only payment system, 2) Congress should clarify
that a partial reduction of benefits under the SSI program is an
``outcome'' deserving of some reward to ENs, 3) Congress should shorten
the period in which outcome payments are made and raise the percent of
average monthly benefit used to determine payments to ENs, and 4) SSA
should increase the value of the milestone payments and allow partial
payment for some work that is under the SGA level.
STATE VR AGENCIES, ENs and BENEFICIARIES
The interplay between State VR agencies, ENs and beneficiaries was
a concern from the day the first Ticket legislation was developed.
State VR agencies have developed stand alone, take it or leave it, one
size fits all agreements for ENs in their states. These agreements all
contain one common provision--the full and total repayment of all of
VR's costs out of the ENs ticket payment by an EN who refers a
beneficiary to VR. In two states we found the VR agency demanded a
percentage of the ENs ticket reimbursement ABOVE the state VR agencies
actual costs. In two other states the VR agency has required ENs to
join the state VR agency's ``Employment Network.'' It was hoped by
advocates that the Ticket would supplement existing VR funds for
employment services, not supplant those funds.
In addition, in one state we found examples of state VR counselors
who had failed to file the beneficiaries Ticket when the beneficiaries
went to VR for services. As a result, the beneficiary was not eligible
the Continuing Disability Review (CDR) protections Congress
incorporated into the Ticket and the person was denied that protection.
Fortunately the action taken by local Protection and Advocacy program
was able to stop the CDR and restore the protection afforded under the
Ticket.
Finally, in an SSA document known as ``Transmittal 17,'' SSA has
essentially allowed state VR agencies to involuntarily assign a
beneficiary's ticket apparently without their knowledge or signed
consent. Furthermore, we just discovered that the Florida state VR
agency is going back through their case files and retroactively
assigning the Tickets of every person who had received VR's services
after February 2002 without notice to the beneficiary and regardless of
whether the beneficiary had intended to assign that Ticket to VR or
not.
It is abundantly clear that, after more than two years of Ticket
roll out, no resolution of the issues between state VR agencies and ENs
and beneficiaries is in sight. Further, the Rehabilitation Services
Administration (RSA) and SSA have been unable to resolve matters at the
federal level. However, we want to also be clear that it would be
unfair to vilify VR agencies. The Federal-State VR Program remains
woefully under funded given its broad mission and the number of people
who seek VR services. One example of the strain on the system is the
number of cases VR counselors must handle. It is not uncommon for a
state VR counselor to be assigned 150 to 200 cases. This strain is
unlikely to ease as state budgets tighten. Consequently, we hope the
recommendations below will both make the Ticket more successful and
help State VR agencies play a more significant part.
We urge Congress to amend the Ticket program by eliminating the
requirement that there be agreements between ENs and state VR agencies
when the EN refers a beneficiary to VR. Congress should adopt language
prohibiting state VR agencies from requiring ENs who refer clients to
state VR from demanding repayment from the EN. Most significantly, a
recommendation of the Adequacy of Incentives Work Group that was
created under the TWWIIA law would allow cost reimbursement for state
VR agencies separately from the Ticket program, and would thus keep
intact the Ticket for the beneficiary's use.
EN REPORTING REQUIREMENTS and OVERPAYMENTS
Payment under the Ticket program occurs when the beneficiary is no
longer receiving benefits. Because SSA is unable to verify in a timely
way the wages and income of working beneficiaries or former
beneficiaries, SSA is requiring ENs to produce the beneficiary's wage
verification for each month the EN is requesting a payment. The EN
payment request system leaves major difficulties for the vast majority
of ENs. Those ENs who are using the Milestone/Outcomes payment system
still must turn in copies of pay stubs until the beneficiaries reach
zero cash benefit. This means that they may be faced with one to two
years or more of collecting pay stubs. Current ENs and potential ENs
need to know that a reliable system exists to provide payments for
their successful efforts.
In addition, because SSA does not stop checks to working
beneficiaries in a timely fashion, many beneficiaries continue to
receive benefits that SSA should have stopped, even when the
beneficiary has reported their income to SSA. The few people who figure
out this problem just put the money in the bank and wait for SSA to ask
for it back, a request that may come years later. The vast majority of
beneficiaries simply believe the money is theirs and spend it, then
don't have it when SSA demands repayment. Often times calls to SSA
offices are of little help or the wrong information is given. These
overpayments often go one for months and sometimes years and total tens
of thousands of dollars. More astounding is the fact that beneficiaries
must pay taxes on the overpayments they receive. An adjustment can be
made in later tax years, but must we really put beneficiaries though
this?
Public Law 108-203, which President Bush recently signed on March
2nd, calls on SSA to issue ``receipts'' whenever a beneficiary reports
earnings to SSA. This receipt may well help a beneficiary waive an
overpayment, but it does not solve the tax problems facing
beneficiaries or the payment issues facing ENs. Worse, overpayments
reinforce the fears that many beneficiaries have about returning to
work.
We call on Congress to allocate resources to SSA to put an end to
their inability to process earnings reports. With overpayments causing
massive problems for beneficiaries and ENs, it is time to act
decisively on this issue.
PROMOTING THE TICKET and RECRUITING ENs
SSA's plan to mail Tickets to beneficiaries was viewed skeptically
by advocates. The cost was high and we know that beneficiaries would be
apt to ignore the mailings without knowing more about the work
incentives, vocational services and employment options. Also, to date
while the TWWIIA legislation has provided over seventy-five million to
states to start their Medicaid Buy-in programs, all ENs received was a
burdensome application form, a fight with their state VR agency, and a
stingy reimbursement scheme. The wonder isn't that too few ENs have
signed up or that they are taking too few Tickets, the real wonder is
that any signed up at all and that they take any Tickets.
To do better SSA must make real changes in the program. SSA should
make use of the networks of advocacy groups and PSAs on radio and TV to
advertise the Ticket to beneficiaries and non-traditional potential
ENs. Most of all, more must be done to explain the Ticket and the work
incentives to beneficiaries. Early results show that the Benefits
Planning Outreach and Assistance program, as well as the Protection and
Advocacy program, are a success. It is time for Congress to
dramatically increase funding for these effective programs. Finally,
Congress unintentionally excluded Vocational Rehabilitation Programs
for American Indians from participating in the Ticket program.
Disabled Adult Child Benefits
KWe want to thank this Subcommittee and Congress for resolving a
problem in the way the Title II work incentives, including the Ticket
program, affect people who receive Disabled Adult Child (DAC) benefits.
P.L. 108-203, has a provision to extend indefinitely the time-frame for
a DAC beneficiary to re-enter the Title II program with DAC benefits if
the individual is still disabled and the termination was due to work
over the SGA level. When this provision becomes effective in October
2004, people receiving DAC benefits will no longer be faced with the
potential permanent loss of DAC benefits if they are at first
successful in leaving the rolls due to work but later need to return to
the Title II program.
We urge the Subcommittee to consider addressing the situation of
people who are on the SSI program who are likely to receive DAC
benefits in the future when their parents retire, die, or become
disabled. If the individual with disabilities earns income above the
SGA level before applying for DAC benefits, access to DAC benefits may
be permanently barred. This is a substantial work disincentive for
people who are severely disabled during childhood and who may need the
benefits earned for them by their parents. But for the fact that their
parents have not yet retired, died, or become disabled, they stand in
the same position as those for whom the provision was included in P.L.
108-203. We would be happy to work with the Subcommittee to explore
possible solutions to this problem.
There is one remaining work disincentive for people who qualify for
DAC benefits that could be resolved through regulatory change. We
understand that SSA's interpretation regarding the value to be placed
on a worker's work effort (regarding whether it exceeds SGA or not) is
different for people in supported employment depending upon whether the
individual is supported directly by an employer or whether the
individual is supported by services from an outside source, such as a
state-funded supported employment agency. As a result, an individual's
work effort could be found to exceed SGA when the support is from a
third party while that same work effort could be found not to exceed
SGA when the support is from the employer. From the perspective of the
individual, this is an arbitrary distinction. Further, there may be
additional complications in that the nature and scope of the support
provided to the individual may be misunderstood when making the
valuation of work effort. For instance, while the individual may be
performing the actual task (bagging groceries, assembling a package,
etc.), it may be that the individual would be unable to perform the
task without the help of the job coach in ensuring that the individual
arrives at work on time properly attired, that he/she interacts
appropriately with customers and co-workers, and that he/she remains
focused on the assigned job tasks, among other things. We believe that
this is an area that needs further examination if work incentives are
to work as intended by TTWWIIA. We urge the Subcommittee to collaborate
with SSA to ensure resolution of this problem.
In conclusion, the Ticket program is full of potential, but that
potential can only be realized with action by Congress and SSA to make
the necessary changes. We knew that it would take time to shape this
program into a successful effort and that changes large and small would
be needed. We are on the right track but it is time make those changes
as mentioned earlier.
Again thank you Mr. Chairman, and members of the Committee, for the
opportunity to testify on this important issue.
Mr. BRADY. Thanks for racing through that and giving us a
lot of good information. Tom?
STATEMENT OF TOM FORAN, VICE PRESIDENT, INTEGRATED DISABILITY
RESOURCES, INC., BLOOMFIELD, CONNECTICUT
Mr. FORAN. Thank you. I represent IDR. We are the EN that
Ms. Hancock worked with. I would like to share with you some of
our experiences with the ticket program to date which is a bit
of a good news/bad news scenario. Currently, we have about 162
active tickets from 30 different States. We are negotiating
ticket assignments with an additional 400 beneficiaries. We
have 65 people currently employed, 35 of them over SGA. We are
on target to return an additional 120 beneficiaries back to
work by the end of 2004. We have received over 5,000 inquiries
from beneficiaries interested in returning to work and we have
invested over $1.3 million into the ticket to Work Program
structure to allow us to handle a large number of
beneficiaries.
On the bad news side, we have earned about $50,000 in
payments to date. We have only been paid about $22,000. We have
several outstanding payments due from November of 2002. We
spend in many instances as much in time and energy to collect
our first payment as the first payment amount. Administrative
drag can be mind-numbing at times. Due to the negative cash
flow and the administrative burden that we experience on a day-
to-day basis, we have had to turn away over 4,000 beneficiaries
who wanted to return to work that we just could not afford to
provide services to.
Without some change in the payment structure and the
administration of the program, we may be forced to shut down in
the near future, at least for beneficiaries who our only source
of revenue is from the Ticket to Work Program. However, given
all that, we do think this program has tremendous potential.
You heard this morning from individuals who have been served
already. We are regularly serving folks. This is an exciting
program. It really hurts my staff personally to have to turn
people away. They get very, very upset with me when I tell them
we can't work with certain folks.
We fully support the recommendations that were laid out in
the Ticket to Work and Work Incentives Advisory Panel report,
``The Crisis in EN Participation: A Blueprint for Action.'' We
would actually suggest taking the recommendations a step
further by implementing the payment structure that was outlined
from the Adequacy of Incentives Group in the interim report
from September of 2003, basically moving about 25 percent of
the payments into the first year of service, which is when the
majority of expenses are incurred.
We feel the key to success of this program is really
basically a demand and supply issue. The first piece,
obviously, is creating demand amongst beneficiaries for return
to work services, and Susan Webb will be talking a bit more
about that. So, I am not going to touch on that right now. On
the supply side, we currently have over 1,000 ENs. However,
only about a third of them are actively taking tickets and I
would like to know what the definition of actively taking
tickets is. If it is one or two tickets, I would not call that
being an active EN.
Two critical issues that we have already heard today are,
one, the amount and the duration of the negative cash flow that
is created. As I said before, we have invested over $1.3
million and we have only earned about $50,000. If we shut down
today and only served the people that we would be working with
and they were successful in returning to work or remaining at
work for the full 60 months, we probably would be almost close
to break even, but trying to convince an investor to wait 60
months is a pretty hard thing to do. They get very impatient.
The other issue is the lack of access to capital for ENs.
Typically, an EN has no collateral to take to a bank and get a
loan. Additionally, the risk is too great, the negative cash
flow too high, and there is no history to the program to show
demonstrated success to attract venture capital. Our suggestion
would be, one, to adopt the changes in the payment structure.
Two, create some type of loan guarantee program or tax credit
program whereby investors who take the risk in this program are
rewarded down the road with tax credits.
There are many other improvements that can be made to this
program. However, without addressing these two critical issues
for ENs, which is really the supply side of the whole equation,
addressing those issues is tantamount to fixing or setting an
individual's broken leg after an accident when they are
actually in cardiac arrest. The ENs will not be here 6 months
from now. I know I won't be. I don't think Susan Webb will be
if some changes aren't made soon. I think this would be a
tremendous loss to the program, to have the experienced ENs who
have already gone through the process drop out of the programs
because they can no longer fund it.
Some of the other suggestions we have are, again,
increasing the administrative efficiency. Help Maximus change
their focus from purely recruiting new ENs, that ultimately
don't become active, into the system, to making the existing
ENs successful. I think that is a critical thing. Reducing the
administrative drag, increasing the efficiencies, increasing
the supports to them. Educating beneficiaries on the quality
active status of ENs. Right now, a beneficiary gets a list of
about 20 to 30 ENs that are serving their area with no idea
whether those ENs are actually taking tickets or what their
track record is. I don't look at that as choice. I look at that
as a bunch of phone calls that a beneficiary has to make and
just get disappointed over and over again.
So, in conclusion, if we can provide more information to
the beneficiaries about what is out there and provide them with
successful ENs, I think you will start seeing a significant
amount of momentum being generated, and again, success always
breeds success. Thank you very much.
[The prepared statement of Mr. Foran follows:]
Statement of Tom Foran, Vice President, Integrated Disability
Resources, Inc., Bloomfield, Connecticut
Thank you for the opportunity to provide testimony today.
Integrated Disability Resources (IDR) is one of the largest national
Employment Networks (EN). IDR's experience with the Ticket to Work
program to date is a good news/bad news story.
The good news is, we:
Have 161 active tickets assigned from beneficiaries in 30
different states
Are negotiating ticket assignment with over 400
additional beneficiaries
Have returned 65 beneficiaries (40% of active tickets) to
work with 35 of them already over SGA
Are on target to return an additional 120 beneficiaries
to work by 12/31/2004
Have invested over $1,300,000 in the TTW program to date
Have received over 5,000 inquiries from beneficiaries
interested in returning to work
On the surface, this appears to be a very successful program.
However, without some significant changes in the program's design and
administration we will be forced to stop accepting tickets resulting
from new inquiries, which of course is the bad news side of our story.
Given our success rate in helping individuals return to work, this
would also be bad news for the SSA. To date, we:
Have earned only $50,000 compared to the $1,300,000
investment mentioned above. Of this $50,000
$7,000 is on beneficiaries who will not provide us
with their pay stubs
$21,000 has been received from Social Security
$20,000 is due from Social Security much of this has
been outstanding for three to twelve months or longer (as of our last
EN payment report from Maximus we have 2 open requests for payment that
are with the SSA field office from November of 2002)
.Often have had to spend more money in staff wages to
physically collect the first payment than the amount of the payment
itself.
Have spent an enormous amount of time managing
unrealistic beneficiary expectations (e.g. ``buy me a $100,000 tractor
trailer'' or ``pay for my college education'')
Have experienced an incredible amount of ``administrative
drag'' that requires us to spend valuable resources dealing with
Maximus and or the SSA, instead of helping beneficiaries execute their
individual work plans. We suggest implementing:
On-line access to information from Maximus for:
Status of a ticket regarding its ability to be
assigned
Past history of a beneficiary's ticket to
determine if multiple ENs will need to share payments
Status of payment requests
Automated reimbursement processes
Currently, each EN must create its own billing
and ticket tracking system instead of having Maximus maintain one
online system.
Follow-ups with SSA field offices are sporadic
and not automated
The milestone portion of the payment process
still requires pay stubs as documentation.
Have had to ``screen out'' over 4,000 interested
beneficiaries. Initially, we were willing to work with a much higher
percentage of interested beneficiaries but have determined that due to
capital restraints caused by the reimbursement structure and process,
we need to limit the scope of our program.
Will soon have to stop working with beneficiaries for
whom our only source of revenue is the Ticket to Work program. This
represents about 90% of our active tickets.
While our situation and current level of participation is tenuous,
it is important to note that we feel with some relatively moderate
changes, the TTW program can be a tremendous success for both the SSA
and its beneficiaries.
We strongly support the changes suggested in the Ticket to Work and
Work Incentives Advisory Panel's February, 2004, Advice Report to
Congress and the Commissioner of the Social Security Administration The
Crisis in EN Participation--A Blueprint for Action. In fact we
recommend taking it one step further, and suggest adopting the payment
system outlined in the Adequacy of Incentives (AOI) Advisory Group's
September, 2003 Interim Report.
The AOI Advisory Group suggested moving a significantly greater
portion of the TTW payments into the first 12 months and decreasing the
threshold of success for milestone payments to a $600 earnings level.
Modeling the AOI suggested payment structure revealed that our
earned revenue to date would have been closer to $80,000. While this is
still nowhere near our overall investment in the program, it
dramatically reduces our negative cash flow on any one beneficiary
allowing us to reinvest in serving more beneficiaries sooner.
What follows is IDR's perception of the issues diminishing the
success of the program and our suggestions for change. It is our belief
that the success of the Ticket to Work program comes down to its
ability to create both demand and supply.
Demand for return to work services must be created within the
beneficiary population. Once created, there needs to be an adequate
supply of return to work services from quality employment networks.
Demand
Experience has shown us that the mailing of tickets to
beneficiaries creates a significant amount of interest and demand for
return to work services. We regularly see a dramatic spike in inquiries
for services from beneficiaries seven to fourteen days after each batch
of ticket mailings.
For states in which the mailings are completed (phase one and two
states) we see a drop in the volume of inquiries that correlates
closely with the amount of time since the last mailing.
Given the success of the mailings to date, we suggest regular re-
mailings to beneficiaries encouraging them to consider returning to
work. These mailings could be as simple as a postcard including success
stories and reminding them of the incentives in place to help them in
the return to work process.
For EN's that are limited to serving phase one and two states, the
time to execute these re-mailings is now. Without them, the few
successful ``local'' EN's may go out of business.
Supply
While the demand for return to work services appears to be
relatively easy to create, the supply is critically low. In general,
beneficiaries tend to identify the list of EN's serving their area and
begin contacting EN's at the top of the list (typically an alphabetical
listing) to see what is available.
IDR is typically mid-way through an alphabetical listing of 30 to
50 EN's serving a beneficiary's area. By the time they get to us, 75%
of the beneficiaries are completely frustrated by the process. With 2/3
of EN's listed not actively taking tickets, a beneficiary has typically
received no response from 12 to 30 EN's before reaching IDR!
Supply Issues
The overwhelming issues driving EN's to either stop or never begin
serving beneficiaries are:
The negative cash flow created by the current program
design; and
The lack of access to working capital.
Most EN's do not have the collateral to qualify for a loan and the
payback time, lack of historical results and overall risks are too
great to attack venture capital.
The Solution
To ensure an adequate and effective supply of return to work
services for motivated beneficiaries the negative cash flow and overall
risk to EN's needs to be dramatically reduced, while increasing access
to working capital. Implementing the AOI Advisory Group's suggested
payment structure, or something similar, will go along way in reducing
the negative cash flow issue.
Access to capital can be accomplished through the use of loan
guarantees and or tax credits for qualified investments in the TTW
program. For example, the State of Connecticut has a program in place
that provides a dollar for dollar tax credit to investors that invest
in new businesses that create insurance jobs within the state.
Other Suggested Improvements
Providing more information and/or education to
beneficiaries would facilitate greater participation in the program and
help improve its overall effectiveness. Areas of concern are:
Each EN's status in regard to its ability to accept
new tickets and its track record in serving beneficiaries
What a beneficiary can expect from an EN
Clarity regarding the types of return to work
services to expect from and EN. We have found that many individuals
request unrealistic programs, such as funding a four-year college
education or the purchase of a $100,000 tractor-trailer, and feel that
managing expectations would improve the success of the program and save
time on the part of the EN.
Change Maximus' focus from recruiting more EN's to making
the existing EN's more successful, which will in turn make recruiting
EN's easier. Areas to consider are:
Improve the administrative efficiency of the program
with more on-line reports and processes
Provide training by successful EN's to inactive EN's
improving their likelihood of success
Establish and support regional EN associations to
foster communication and the sharing of best practices
Congress should set a clearly defined target for reducing
the Social Security roles and identify the entities that are
accountable for attaining this goal. We suggest setting the goal for
job placements at a minimum range of 5 to 10% of the current
beneficiary population with incentives in place for success above this
level.
Thank you again for the opportunity to testify today.
Mr. BRADY. Thank you, sir. Quintin, welcome. The microphone
is yours, sir.
STATEMENT OF QUINTIN M. MITCHELL, DIRECTOR, VR SERVICES,
RICHMOND AREA ARC, RICHMOND, VIRGINIA
Mr. MITCHELL. Thank you. I am Quintin Mitchell. Thank you
for the opportunity, Mr. Chairman. I am Director of
Rehabilitation Services for Richmond Area ARC in Richmond,
Virginia. Our agency became a--upon reviewing the Ticket to
Work incentive, one of the motivating factors of ARC to become
an EN was having the opportunity to provide employment services
to individuals who want to work and become self-sufficient,
additionally, provide a non-traditional referral base to ticket
holders or individuals who have the appropriate skill set to
filing the positions we have open and other jobs in the
community.
Our agency has traditionally serviced the Mentally Retarded
population. However, other areas of service provision includes
individuals with diagnoses of mental illness, autism,
developmental delay, brain trauma, and individuals with
physical disability. Our agency's NISH contracts have provided
the opportunity to service a vast array of individuals.
Individuals' backgrounds include undergraduate and graduate
degrees as well as persons who are Ph.D. candidates. When
positions become available within our organization, individual
ticket holders are encouraged to apply when their skill set
matches the advertised position.
Since ticket participants don't have to use their tickets,
we have found that those who elected to do so really have the
incentive to work because they aren't forced to. There are many
participants who want to get off the benefit rolls and this
desire benefits not only participants, but also other sources,
as well. Employees who are in need of skilled, reliable
employees, ENs who have the resources to provide employment and
other related services, and the reduction of benefits being
paid out by SSA are all win-win situations.
Richmond ARC's initial experience with the Ticket to Work
Program was that of being bombarded by ticket holders wanting
employment services. We began providing services in March of
2003. To date, we have screened over 340 calls from individuals
who wanted us to provide employment services. While this may
not be an astronomical number by comparison with other ENs,
however, in Virginia, we have billed for the most milestones,
which is 15, which Tina Chang, Financial Director for Maximus,
provided me with the information the day before yesterday.
We have accepted and have been assigned so far, 90 ticket
holders. Holding orientation twice per month at two locations
has resulted in meeting the needs of individuals who don't have
the means to come to our facility. As of this date, the need to
conduct intakes more frequently has resulted in weekly one-on-
one consultations as well as screenings. In order to meet the
various needs of the ticket holders, we have elected to
implement features in the orientation to expedite the process.
Initially, as tickets began to roll out in Virginia, calls
jammed the switchboard. Now all inquiries are routed either to
the employment specialist or me with an extension just for
ticket holders. ARC makes it a policy to return calls promptly.
Additionally, recruitment is not limited to just call ins.
We also are viewing the monthly disk of ticket holders that
Maximus supplies and send letters of introduction to a random
sampling of the unassigned ticket holders, specifying what
services we provide and inviting them to an orientation.
Employment specialists also post flyers at the local SSA office
or to the Metro Richmond networking meeting, participates in
focus groups and job fairs, and have been fortunate enough to
be the recipient of marketing expertise by the leadership of
Metro Richmond organization. Additionally, an advertisement is
placed in the Employment Guide publication by our agency at our
expense.
It should also be noted that no additional staff was hired
in order to meet the undertaking. Even though no additional
staff was hired, the ARC still meets the presenting needs of
all inquiries and works toward effectively and efficiently
addressing areas of concern that most have about their benefits
and how they may be affected. Maximus has provided much support
and endless help in maneuvering through the maze of red tape we
have encountered in many instances.
While there are many positives in the Ticket to Work and
Self-Sufficiency Program, there are also obstacles that impede
and deter ticket holders from participating in this program.
Unfortunately, some ticket holders have elected, after having
gone through the screening, the interviewing, counseling,
placement on the job, to leave their jobs in some cases, decide
against being employed at all because of the lack of critical
information having been provided to them by SSA.
It has been our experience that most ticket holders are
unaware of the most basic information concerning their benefits
and how they can be affected and/or knowledge of work
incentives. This information now has become part of our
orientation process when we meet with the ticket holder.
Some of the problems that impede and interrupt the
provisions of services for our agency to the ticket holders
revolve around the lack of information provided to them by the
SSA. A few examples that we have encountered and continue to
encounter are SSA has provided inaccurate and sometimes
inconsistent information to the ticket holders. An example is a
ticket holder was told that there was an application for the
1619(b) by an SSA individual but they couldn't find it, while
another person told the ticket holder there was no such
application.
Inconsistency of providing EN payment processing report so
as not to know the status of receiving payment for services
already rendered. ticket holders who have been working before
contracting services with our agency have not been informed
that they were required to turn in their pay stubs. This lack
of information causes the individual to be in overpayment and
the EN doesn't receive payment. Not notifying beneficiaries
that they are not eligible for benefits, but a check is still
mailed and/or deposited in the beneficiary in overpayment. The
lack of advertising or marketing in the SSA office about the
Ticket to Work Program. Our agency has taken initiatives to go
down to the SSA buildings and place flyers and posters at our
own expense.
The Ticket to Work Self-Sufficiency Program is a viable
entity to beneficiaries who want to work. However, identifying
and rectifying the problems that impede a successful placement
of individuals in jobs has to be addressed. The potential for
other agencies becoming an EN is sometimes thwarted by the lack
of manpower, resources, and investment coupled with the slow
turnaround time and being paid for the services that they
provide. Having had the opportunity to provide services to wide
range of individuals who have the desire and initiative to be
gainfully employed and the continuation of inquiries regarding
our employment services are all indicators that the ticket
program can be a success. In order to facilitate this success,
it is absolutely essential that all stakeholders work
collaboratively and consistently.
In closing, I thank you for this opportunity to share our
agency's experiences with the Ticket to Work Self-Sufficiency
Program. It is my hope that after identifying these areas of
concerns that impact the ticket holder in an adverse manner, we
can move forward toward a resolution.
[The statement of Mr. Mitchell follows:]
Statement of Quintin M. Mitchell, Director, Vocational Rehabilitation
Services, Richmond Area Arc, Richmond, Virginia
Mr. Chairman, Members of the Committee, my name is Quintin M.
Mitchell and I am Director of Rehabilitative Services for the Richmond
Area Arc in Richmond, Virginia. Thank you for the invitation for me to
comment on Social Security Administration's management of the Ticket to
Work and Self-Sufficiency Program.
I would like to take a brief moment to provide some background
information on how our agency elected to become a participating
Employment Network (EN).
Upon reviewing the Ticket to Work initiative, one of the motivating
factors of Richmond Area Arc to become an EN was having an opportunity
to provide Employment Services to individuals who want to work and
become self-sufficient. Additionally, it provides a non-traditional
referral base and the Ticket-holders are individuals who have the
appropriate skill set for filling positions that we have open, and
other jobs in the community. Our agency has traditionally serviced the
M.R. population. However, other areas of service provision includes
individuals with diagnosis of M.I., autism, developmentally delayed,
brain trauma and individuals with physical disabilities.
Our agency's NISH contracts have provided the opportunity to
service a vast array of individuals. Individual's backgrounds include
undergraduate and graduate degreed persons as well as Phd. Graduates.
When positions become available within our organization individual
Ticket-holders are encouraged to apply when their skill set matches the
advertised position.
Since Ticket participants don't have to use their Ticket we have
found that those who have elected to do so really have the incentive to
work because they aren't forced to. There are many participants who
want to get off the benefit rolls and this desire benefits not only the
participants but other sources as well. Employers who are in need of
skilled, reliable employees, ENs who have the resources to provide
Employment and other related services and the reduction of benefits
being paid out by the Social Security Administration (SSA) are all win-
win situations.
Richmond Area Arc's initial experience with the Ticket to Work
Program was that of being bombarded by Ticket-holders wanting
Employment Services. We began providing services in March of 2003. To
date we have screened over three (340) hundred forty calls from
individuals wanting us to provide Employment Services. While this may
not be seen as an astronomical number by comparison with other ENs,
however, in Virginia, we have billed for the most Milestones, fifteen
(15). (Tina Chang, Financial Director for Maximus). We have accepted
and have been assigned, so far, ninety (90) Ticket-holders. Holding
Orientation twice per month at two (2) locations has resulted in
meeting the needs of individuals who do not have the means to come to
our facility. As of this date the need to conduct Intakes more
frequently has resulted in weekly one-on-one consultations/screenings.
In order to meet the various needs of the Ticket-holders we have
elected to implement features in the orientation to expedite the
process. Initially, as Tickets began to rollout in Virginia, calls
jammed the switchboards. Now all inquiries are routed either to the
Employment Specialist or me with an extension just for Ticket-holders.
ARC makes it a policy to return all calls promptly. Additionally,
recruitment is not limited to call-ins of inquiries. We also, after
viewing of the monthly disk of Ticket-holders, that Maximus supplies,
sends letters of introduction to a random sampling of the unassigned
Ticket-holders, specifying what services we provide and inviting them
to an orientation. Employment Specialists also post flyers at the local
SSA office, attend the Metro Richmond networking meetings, participates
in focus groups and job fairs and have been the fortunate recipient of
marketing expertise by the Leadership Metro Richmond organization.
Additionally, an advertisement is placed in the Employment Guide
publication.
It should also be noted that no additional staff was hired in order
to meet this undertaking. Even though no additional staff was hired,
the ARC still meets the presenting needs of all inquiries and works
towards effectively and efficiently addressing areas of concerns that
most have about their benefits and how they will be affected.
Maximus has provided much support and endless help in maneuvering
through the maze of red tape we have encountered in many instances.
While there are many positives in the Ticket to Work and Self
Sufficiency Program there are also obstacles that impede and deter
Ticket-holders from participating in the program. Unfortunately, some
Ticket-holders have elected, after having gone through screening,
interviewing, counseling and placement on the job, to leave their jobs
and in some cases, decide against being employed at all because of the
lack of critical information having been provided to them by S.S.A.
It has been our experience that most Ticket holders are unaware of
the most basic information concerning their benefits and how they can
be affected and/or knowledge of Work Incentives. This information, now,
has become a part of the orientation process when we meet with the
Ticket-holder.
Some of the problems that impede and interrupt the provision of
services, for our agency, to Ticket-holders, revolve around the lack of
information provided to them by the Social Security Administration. A
few examples that we have encountered, and continue to encounter are:
1. S.S.A. has provided inaccurate and sometimes inconsistent
information to Ticket-holders. Ex.: Ticket-holder was told there was an
application for 1619b by S.S.A. but they couldn't find it while another
person told the Ticket-holder there was no application.
2. Inconsistency of providing EN Payment Processing Report so as
not to know the status of receiving payment for services rendered.
3. Ticket-holders, who have been working before contracting
services with our agency, have not been informed that they were
required to turn in their pay stubs. This lack of information causes
the individual to be in overpayment and the EN doesn't receive payment.
4. Not notifying beneficiary that they are not eligible for
benefits, but check is mailed/deposited and beneficiary is in
overpayment.
5. The lack of advertisement/marketing in the S.S.A. office
building about the Ticket to Work Program.
The Ticket to Work Self Sufficiency Program is a viable entity to
beneficiaries who want to work. However, identifying and rectifying the
problems that impede the successful placement of individuals in jobs
has to be addressed.
The potential for other agencies becoming an E.N. is sometimes
thwarted by the lack of manpower, resources, and investment coupled
with the slow turnaround time of being paid for the services they
provided.
Having had the opportunity to provide services to a wide range of
individuals, who have the desire and initiative to be gainfully
employed, and the continuation of inquiries regarding our Employment
Services are all indicators that the Ticket Program can be a success.
In order to facilitate this success it is absolutely essential that all
stakeholders work collaboratively and consistently.
In closing, I thank you for this opportunity to share our agency's
experiences with the Ticket to Work Self Sufficiency Program. It is my
hope that after identifying
areas of concerns, that impact the Ticket-holder in an adverse manner,
we can move towards resolution.
Ticket to Work can be a beneficiary's best option.
Mr. HAYWORTH [presiding]. Thank you, Mr. Mitchell, for your
testimony from someone from Virginia. I turn to a fellow
Arizonan, Susan Webb. Welcome.
STATEMENT OF SUSAN WEBB, ARIZONA EMPLOYMENT NETWORK
ASSOCIATION, PHOENIX, ARIZONA
Ms. WEBB. Mr. Chairman from the great State of Arizona, it
is always good to see you. My name is Susan Webb and I am the
Director of Arizona Bridge to Independent Living (ABIL)
Employment Services in Phoenix, Arizona, and I am here today on
behalf of the Arizona EN Association. I want to thank you for
the opportunity to testify today on behalf of the association.
In general, our association agrees with the outcomes and
recommendations of the EN Summit that was sponsored last May by
the Ticket to Work Advisory Panel. We believe that several
issues that were identified during that summit contribute to
the current lack of participation among ENs nationwide.
Those issues are, first, high capitalization costs and
risks; second, inadequate payment structure and pay stub
processing burdens; third, the need for comprehensive training
and technical assistance for EN staff; and fourth, the need for
a national marketing campaign conducted by SSA to motivate
beneficiaries to contact ENs about the program. We believe that
all of these issues are equally important and their solutions
must be implemented concurrently for the ticket program to
sustain itself and achieve the goals that you, Mr. Chairman,
were very, very adamant about when this legislation first
passed. However, my testimony today is designed to focus solely
on the marketing issues.
I, however, would remind you, as some of my colleagues have
been testifying, I feel the need to say that some of the
information that has come forward, for example, there has been
$523,000 paid out in payments to ENs nationally, there are
1,100 existing ENs. We understand about a third are accepting
tickets in some form. I want to make the point that our little
agency, 1 EN out of 1,100, has received $71,000 of that
$523,000 and we have about another $20,000 pending. For one EN
to be representing that much of the outcome is very disturbing.
There is something wrong. Even though I feel very fortunate to
be here to give my opinion, I think that somehow we are in the
trenches here and I think we need to be heard in terms of what
we are saying about these four major areas, and they need to be
solved concurrently and right now. So, I just wanted to make
that point very strongly.
Arizona is one of the first 13 States to implement the
Ticket to Work Program. It is now more than 2 years since the
tickets were first distributed in our State. I would disagree
with some of the comments made about--I think Martin Gerry may
have made this comment, actually. During the initial phases of
the ticket rollout, there were approximately 27 ENs signed up
in our State. Today, there are only a handful left that are
accepting tickets. I talked to one of my colleagues in Tucson
just before coming here and he told me he accepted one ticket
last month. Is that an active EN out of the handful? That is
certainly not going to get those 150,000 ticket holders in
Arizona off the rolls and back to work.
We believe the reasons for this statewide rescission are
several. However, many have simply stopped taking tickets due
to the lack of sufficient demand by beneficiaries to justify
maintaining the qualified staff they need to do this work.
Since the initial ticket mailing, beneficiary inquiries to ENs
have dropped to just a trickle. They are just not even on the
radar screen with this anymore.
I guess this is where I probably want to take issue with
Martin Gerry, and that is that we are seeing in the trenches,
honest-to-goodness ENs out there doing this work. As a Center
for Independent Living, our center since 1981 has served
primarily people with significant disabilities. Those are not
the people coming forward in the ticket program. It is the
people that have job skills and experience and much to offer an
employer. They are coming forward. They are not the ones that
go to organizations like ours. They don't go to disability-
related stuff. They don't hang out at the field offices, as I
believe one of the--in fact, I believe it was Clay Shaw who
said that, in fact, these people are sitting in their living
rooms and that is where we need to get to them, hence the
reason for my testimony today.
The members of our EN association recognized this problem
more than a year ago and we decided to pool our resources to
market the program. We began by making cold calls from the
compact disk we receive monthly from Maximus. Unfortunately,
this yielded very, very little return on our investment.
Beneficiaries refused to talk to us because they thought we
were telemarketers and they wanted us to take them off our call
list. Then, those who did talk to us were totally unfamiliar
with the program and required an average of 15 minutes per
call, which is very, very expensive for any EN to be able to
undertake that kind of activity. Even though there is benefit
to that, it is not a solid return on investment because very
few of those people end up being actual ticket users.
We then decided to approach the SSA about a piggyback
approach. We knew that the SSA was going to be doing something
and we were very, very pleased that they were very willing to
work with us and to talk with us, and we have been doing that
systematically. As a result of those teleconferences we have
had, we conducted some focus groups and I would have to again
disagree with my colleague, Paul Seifert, that, in fact, from
the focus group what came out loudly and clearly was that if
they get a letter from the SSA, they do read it, even if it is
only because they fear bad news.
So, our association recommends the following: that the SSA
be allocated the resources to send reminder letters or
postcards about the Ticket to Work Program at least once
annually and to stagger those in one-twelfths, so, that it
doesn't create this up front demand and then nothing toward the
end of the year.
Second, we believe the notices should direct ticket holders
to contact their local BPA&O Program and should be specific
about that BPA&O Program in their area. The reason for that is
because our local BPA&Os contact which ENs are currently
accepting tickets and so that beneficiaries are not forced to
call from a long list of ENs just to be told, ``I am sorry, we
are not participating anymore.'' Thirdly, we believe that the
SSA should begin distributing the interim reminders to
beneficiaries in the year one rollout States no later than June
this year. Year two States could begin in June of next year,
and year three States in 2006 if SSA hasn't begun a national
campaign by that time.
I want to make one final comment, and that is that we have
read the statement of work for the 2-year marketing contract to
Fleischman-Hillard. We believe it is excellent. The problem is,
2 years will mean 3 and a half years into this program and we
will only have a pilot done by then. We will be dead in the
water. We will not be an EN by that time without something done
in the interim.
Although I applaud the response from the SSA, I applaud the
statement of work in that contract, we are a rollout State in
year one; and last month, I received 24 inquiries from 150,000
tickets, and we are the number one EN in the country. Something
has got to be done, and I encourage SSA and this body to work
together to find the money to do that. Thank you, Mr. Chairman.
[The prepared statement of Ms. Webb follows:]
Statement of Susan Webb, Arizona Employment Network Association,
Phoenix, Arizona
Thank you for the opportunity to provide testimony on behalf of the
Arizona Employment Network (EN) Association. In general, our
association agrees with the outcomes and recommendations of the
Employment Network Summit sponsored last May by the TWWIIA Advisory
Panel. We believe that several issues identified during that Summit
contribute to the current lack of participation by ENs nationwide.
Those issues are 1) high capitalization costs and risks; 2) inadequate
payment structure and pay stub processing burdens; 3) the need for
comprehensive training and technical assistance for EN staff; 4) the
need for a national marketing campaign conducted by SSA to motivate
beneficiaries to contact ENs about the Ticket to Work Program.
We believe all of these issues are equally important and their
solutions must be implemented concurrently for the TTW Program to
sustain itself and achieve the goals Congress intended when it
overwhelmingly passed the TWWIIA legislation. However, my testimony
today will focus solely on the marketing issues.
Arizona is one of the first 13 states to implement the TTW Program.
It is now more than two years since tickets were first distributed in
our state. During the initial phases of ticket rollout there were
approximately 27 ENs on the approved list. Today there are only a
handful left who are accepting tickets. There is only one ENs in the
Tucson metropolitan area accepting only a small number of tickets any
longer. Tucson is the second largest metro area in our state with more
than 850,000 residents and 16% of our state's population. We believe
the reasons for this statewide rescission are several; however, many
have stopped taking tickets due to the lack of sufficient demand by
beneficiaries to justify maintaining the necessary qualified staff to
do so. Since the initial ticket mailing beneficiary inquiries to ENs
have dwindled to a trickle.
The members of our EN Association recognized this problem more than
a year ago. We decided to pool our resources to market the program. We
began by making cold calls from the CD we receive monthly from MAXIMUS.
Unfortunately, this yielded very little return on our investment.
Beneficiaries refused to talk to us and asked us to take them off our
``call lists'' as they thought we were telemarketers. Those who did
talk with us were not familiar with the ticket program and required an
average of 15 minutes per call. While there is value in such calling as
it certainly gives beneficiaries good information, it does not result
in solid return on investment for the EN in terms of signed-on,
qualified ticket users.
We then decided to approach SSA about a ``piggyback'' approach;
that is, if SSA did some sort of marketing, our ENs could follow up
with the necessary contacts. That approach would strengthen SSA's
marketing efforts and be less resource-intensive for ENs. We are
pleased that SSA staff has been very responsive to us in this regard
and we have participated in several teleconferences with them to pursue
the idea. From those teleconferences our association's marketing
committee agreed to conduct focus groups among our existing ticket
users to determine what marketing activities caused or would cause them
to respond to the program. We completed those focus groups, and our
final report of the outcomes is attached to this testimony.
Last September SSA awarded a two-year contract to a marketing firm
to design a marketing plan. We have reviewed the statement of work and
believe the end result will be a good one. However, at the end of the
two-years of that contract, only a pilot program will have been
completed. There is no time frame stipulated as to when an actual full-
blown national campaign will be implemented. Arizona and the other
first-year rollout states will have been implementing the ticket
program for 3\1/2\ years when the pilot is completed. Without an
effective, interim marketing campaign we fear the TTW program will be
dead by then.
Our Association recommends the following:
1. SSA should be allocated the resources to send reminder letters
or post cards about the TTW Program at least once annually to all
current ticket holders. \1/12\ of the notices should be distributed
monthly to even out the demand upon MAXIMUS, ENs, BPAOs, PABBS and SSA
Field Offices. This will ensure better service to beneficiaries.
2. The notices should direct ticket holders to contact their local
BPAO program and should include the specific BPAO contact information
for their area/state. The BPAOs will track which ENs in their
communities are currently accepting tickets and will give contact
information to beneficiaries only for those ENs who have indicated that
they are currently accepting tickets. The BPAOs should be allocated
appropriate resources to accommodate this additional demand.
3. SSA should begin distributing the interim reminders to
beneficiaries in the year-one rollout states no later than June of this
year. Year two states could begin in June of next year and year three
states in June of 2006 if there is no comprehensive, national marketing
campaign developed and implemented by that time.
We believe an interim plan as outlined above will have the
following benefits:
1. Rekindle beneficiary demand and interest in the Program. The
initial mailing generated significant inquiries from beneficiaries. We
believe periodic reminders will generate at least as much response and
will capture potential participants who might not have been ready to
work during the initial rollout.
2. Increased beneficiary demand could create interest by ENs to
accept tickets again, thus improving the choice among providers as
originally envisioned by Congress.
3. Periodic reminders will help beneficiaries accept the ``new''
SSA culture that Social Security Disability programs are not early
retirement, but are in fact offering ways for individuals and their
families to become self-supporting.
4. Provide TTW Program information in beneficiaries' living rooms
rather than requiring them to go to disability-related or public
service-related locations to get the information. Our focus group
respondents stressed the fact that they always read mail they get from
SSA, even if it is only because they fear bad news.
5. Having local BPAOs be the initial point of contact will relieve
that burden from MAXIMUS and will take advantage of the excellent
training and skills that have been demonstrated by the BPAOs across the
country.
In conclusion, I am posing a question to the Social Security
Subcommittee that I have asked many times and have yet to receive an
answer:
If Binder and Binder and other social security attorneys can
advertise on TV day in, day out, over and over about getting people
ONTO benefits, why can't SSA advertise at least as often to get people
OFF benefits? This is especially puzzling since the money that pays for
those attorneys' ads comes directly from the SSA Trust Fund.
Once again, on behalf of the Arizona Employment Network Association
we thank you for the opportunity to comment.
Mr. HAYWORTH. I thank you very much for your testimony,
Susan. Now we turn to Mr. Coburn.
STATEMENT OF JOHN V. COBURN, STAFF ATTORNEY, HEALTH AND
DISABILITY ADVOCATES, CHICAGO, ILLINOIS
Mr. COBURN. Thank you, Mr. Chairman. Thank you for the
opportunity to share our organization's recommendations on how
to improve the Ticket to Work Program. I actually as I got up
here realized going last, I get to tie up some of the loose
ends and get us going so that we can continue on.
The Health and Disability Advocates is my employer and they
are the convener of the Midwest Employment and Training
Partnership. The Partnership currently has roughly 80 active
members and is comprised of employment and training service
providers participating in the Ticket to Work Program in Region
V, which includes Illinois, Indiana, Michigan, Minnesota, Ohio,
and Wisconsin. Also participating in the Partnership are the
SSA-funded BPA&O projects and the Protection and Advocacy for
Beneficiaries of Social Security projects.
As you might suspect, our first policy recommendation is to
enhance the payment system for ENs. This is key to the
viability of this program, and you heard on the panel today
that recommendation. The Partnership fully endorses the
recommendations of the Adequacy of Incentives Advisory Group
and the EN Summit which is mentioned in the panel report you
received. Second, the Partnership strongly recommends that SSA
abandon its sub-regulatory Transmittal 17 and completely
disconnect cost reimbursement to State VR agencies from ticket
assignment. This is a clear point that I want to make today. We
believe that this policy is directly contrary to the intent of
Congress and the authorizing statute. State VR agencies rely on
a projected amount of SSA reimbursement as a base for their
annual budgets. As a result of Transmittal 17 and SSA policy,
many State VR agencies have been put into the position of
having to aggressively seek tickets from beneficiaries just to
meet their annual budget.
I think this explains the enormous differential, with 90
percent VR ticket assignment and 10 percent private EN, along
with the payment system. I think it also, I suspect, may
account for the increase recently in ticket participation. I
think that the State VR agencies have been assigning more
tickets and I would submit that we need to look into that to
see, is it that there are more ticket participants coming
forward to participate in this program, or has the State VR
agency under Transmittal 17 submitted the tickets for
assignment, and that is accounting for the increase.
The problem with not separating cost reimbursement from the
ticket assignment is that you have a system right now as it
stands with these statistics that 10 percent of the
beneficiaries are participating in, which is the system
Congress intended to create, a system that is designed to
assist beneficiaries in leaving the Social Security rolls. The
other 90 percent are potentially--we don't know--participating
in the pre-Ticket Act cost reimbursement system, which does not
have as its ultimate goal the leaving of the beneficiary rolls.
Cost reimbursement has a different standard for payment. If
this continues, the Ticket Act will never come close to
reaching its goal of doubling the number of beneficiaries
leaving the Social Security rolls because of employment.
Another recommendation from our Partnership which was
mentioned today is that SSA has to immediately address this
problem with overpayments. We heard testimony today about how
long it is taking on claims administration. I think that
Maximus and SSA have been doing a good job on their part in
claims administration by passing some new policies that deal
with quarterly reporting. However, in order to get paid, that
still has to go through the SSA reporting system at the local
offices, which still is not modernized and still is not up to
date in all circumstances.
The Partnership recognizes that SSA is working toward
modernizing the current worker reporting system and that this
will take time. In the interim, SSA can make minor operation
changes to speed up this process. We heard mention today about
the recently retooled Work Incentive Liaison in the local SSA
offices. The Partnership believes that it should become a
specific job duty of each of these Work Incentive Liaisons to
take the ticket participant work histories and work on those
cases. The Partnership also recommends that SSA set up a system
for itself where claims with proper documentation have a 30-day
turnaround in order to keep them viable.
Since launching the Midwest Employment and Training
Partnership in June of 2003, Health and Disability Advocates
has received an overwhelming number of requests for training or
technical support from employment service providers on topics
ranging from what is the ticket program, what are these
regulations, how does this work, to requests for assistance in
building a service model that ensures successful and
financially feasible participation in the Ticket to Work
Program. Fortunately, we do have some private foundation
funding to do some of this, but our limited funding will not
meet this need. Based on this experience, the Partnership
recommends that a technical assistance and training system
built off of the current existing SSA-funded technical
assistance and training systems be created.
Finally, I want to briefly mention the Chicago Ticket to
Work Pilot Program that we are going to be starting here in a
few months. We created this pilot and secured funding for it
from the City of Chicago and the Illinois Division of
Rehabilitation Services. The pilot is designed to demonstrate
to you as a committee, SSA, and others how an adequate payment
system with up front funding can result in the positive
outcomes that the Ticket to Work legislation intended. The
project's payment system is based upon and resembles the up
front payment system recommended by the AOI Advisory Group and
the EN Summit. We have created this project to put into action
what everybody has been saying about the payment system, and we
hope that SSA will follow our lead. Thank you.
[The prepared statement of Mr. Coburn follows:]
Statement of John Coburn, Staff Attorney, Health and Disability
Advocates, Chicago, Illinois
Chairman Shaw and Members of the Committee--
I thank you for the opportunity to share our organization's
recommendations on how to improve the Ticket to Work program. I work
for the Health & Disability Advocates, a national policy and advocacy
group headquartered in Chicago, Illinois. The Health & Disability
Advocates (HDA) is the convener of the Midwest Employment and Training
Partnership (Partnership). The Partnership currently has roughly 80
active members and is comprised of employment and training providers
and state Vocational Rehabilitation agencies (VR) that are
participating as Employment Networks (ENs) in the Social Security
Administration's (SSA) Region V, which includes Illinois, Indiana,
Michigan, Minnesota, Ohio and Wisconsin. Also participating in the
Partnership are the SSA-funded Benefits Planning Assistance & Outreach
(BPAO) and Protection & Advocacy for Beneficiaries of Social Security
(PABSS).
Today I am going to share with you policy recommendations developed
by the Partnership. I will also talk to you about the Chicago Ticket to
Work Pilot, a project that our organization has developed to
demonstrate a more integrated and responsive payment model for
Employment Networks.
As you might suspect, our first policy recommendation is to enhance
the payment system for Employment Networks. You will hear from many
today about the need to change the payment structure, so I will not
dwell on this in my testimony. The Partnership fully endorses the
recommendations of the Adequacy of Incentives Advisory Group for
structuring the payment system on gross wages, with some payment upon
job placement, and allowing payment for partial self-sufficiency. It is
our belief that you will never get adequate participation from
employment and training providers outside of the traditional state
vocational rehabilitation model without changing the current payment
system. The current payment structure provides no financial incentives
for providers to become active ENs. Until the Ticket Work Program
payment structure is on par with how state vocational rehabilitation
services are funded and how services under the Workforce Investment Act
are funded, the Ticket to Work Program will always be subpar.
As our second policy recommendation, the Partnership strongly
recommends that SSA change how it compensates state VR under the Ticket
to Work Program. The current SSA policy--explained in SSA Transmittal
17--often only allows cost reimbursement to state VR agencies on those
cases in which individuals have assigned their Ticket to that state VR
agency. We believe that this policy is directly contrary to the intent
of Congress and the authorizing statute.
State VR agencies rely on a projected amount of SSA reimbursements
as a base for their annual budgets. As a result of Transmittal 17, many
state VR agencies have been put into the position of having to
aggressively seek Tickets from beneficiaries just to meet their annual
budget. This creates an employment and training services environment
where state VR is given little or no encouragement, nor reward, for
creating innovative partnerships with other employment training service
providers or the private sector.
The numbers bear this out--there are 3,978 (10%) beneficiaries
participating in a system that Congress intended to create, a system
that is designed to assist beneficiaries in leaving the Social Security
roles. The other 36,972 (90%) beneficiaries are potentially (and most
likely) participating in the pre-TTWWIIA cost reimbursement system, a
system that does not base payment upon assisting a beneficiary in
leaving the roles. If this continues, TWWIIA will never come close to
reaching its goal of doubling the number of beneficiaries leaving the
Social Security roles because of employment.
Our next policy recommendation is that the SSA immediately address
the inadequacy of its work reporting system to eliminate problems with
overpayments. The work reporting system must be drastically improved to
assure the maintenance of up-to-date records on work history. If it
does not improve, Employment Networks can face significant payment
delays. It only takes a few experiences with payment delays and
complications for a service provider to decide continued participation
in the Ticket to Work Program is not worth it. In addition, problems
with this work reporting system continue to discourage beneficiaries
from seeking employment, which diminishes interest in seeking services
from the Ticket to Work Program.
The Partnership recognizes that SSA is working toward modernizing
the current work reporting system and that this will take time. Prior
to achieving full modernization, the Partnership believes SSA can make
minor operation changes to improve EN claims administration. We suggest
that SSA give the recently re-tooled Work Incentives Liaisons in the
local SSA offices the specific job duty of maintaining ticket
participant's work activity. Upon assignment of a ticket, the EN should
be notified of the name and contact information of the local Work
Incentive Liaison assigned to that ticket holder's case. With this
information, the EN could follow up with the local Work Incentive
Liaison if payment is not made in a timely manner. The Partnership also
recommends that SSA provide payment on EN claims with proper
documentation within 30 days of submission.
The last recommendation I will share with you today deals with the
lack of technical assistance and support available to those Employment
Networks currently trying to make a success of the Ticket to Work
program. Since launching the Midwest Employment and Training
Partnership in June of 2003, HDA has received an overwhelming number of
requests for training or technical support from employment service
providers on topics ranging from the Ticket to Work Program regulations
to building a service model that ensures successful and financially
feasible participation in the Ticket to Work Program. Fortunately, we
have private foundation funding to do some of this, but our limited
funding will not meet the need. Based on this experience, the
Partnership recommends that a technical assistance and training system
built off of the existing SSA-funded technical assistance and training
system be created. The system must be built on a regional and local
level so that employment service providers can receive services without
extensive travel costs and lost staff time. Such a model will also
foster information sharing and replication of promising practices among
ENs.
Chicago Ticket to Work Pilot
I will use the balance of my time to talk the Chicago Ticket to
Work Pilot Project designed to demonstrate to you, SSA, and others how
an adequate payment system can result in the positive outcomes that the
TWWIIA legislation intended. Health & Disability Advocates and other
members of the Partnership have successfully engaged the Chicago
Mayor's Office for People with Disabilities, Chicago Mayor's Office of
Workforce Development, and the Illinois Department of Human Services--
Division of Rehabilitation Services to pilot an up-front payment system
for ENs in the city of Chicago.
The Chicago Ticket to Work pilot is slated to begin in April or May
of 2004, and will be the only project of its kind in the country that
combines municipal and state dollars. The purpose of this pilot is to
demonstrate a payment system that provides ENs with guaranteed payment
within the first year of placement, encourages active participation by
ENs and, more importantly, results in successful transitions to self-
sufficiency. The Pilot Project will be implemented as follows. Through
a neutral application process, three ENs serving residents of Chicago
will be chosen to participate in the Project. These three ENs will be
eligible to receive payment on 8 to 10 of their assigned tickets. Upon
placing one of these ticket holders in competitive employment, the EN
will receive $2000. After 6 months of successful placement, the EN will
receive another $2000. Upon completion of one year of successful
employment, the EN will receive $1000. After this, the Employment
Network will continue to be paid by the Social Security Administration
through the current payment system.
Each EN will be assigned to work closely with one of the Department
of Labor/Social Security Administration-funded Disability Program
Navigators (DPN) and/or the Department of Labor-funded Work Information
Navigator (WIN). The DPN and/or WIN will provide recruitment and
referral services to the EN. The EN will only be paid under the Pilot
Project for tickets assigned as a result of a referral from the DPN
and/or WIN. Through this requirement, the Project hopes to build new
and lasting relationships between the Employment Network and the One-
Stop Center system.
Many stakeholders and experts have stated that the payment
structure needs to change for TWWIIA to meet its goals. We have created
this Project to put into action what so many have said and hope that
SSA will follow our lead.
Mr. Chairman, and members of the committee, I thank you for your
time and welcome any questions you may have.
Mr. HAYWORTH. Thank you, Mr. Coburn. I appreciate that you
appreciate the importance of going last and the advantage of
tying everything up. All of you on this third panel should
know, and I think you do after listening to the discussion
today, your testimony, all of your testimony, is very important
to us and was used to inform us as we brought your issues to
Mr. Gerry and Mr. Justesen. As we continue to move through this
process to the implementation and to ensure the effectiveness
of Ticket to Work, we will be continuing to monitor and be
calling on you again in the future, because we are at a
critical juncture in this program. Your testimony today is very
much appreciated and we thank you for it. With that, this
hearing of the Subcommittee on Social Security is adjourned.
[Whereupon, at 12:52 p.m., the hearing was adjourned.]
[Questions submitted from Chairman Shaw to Mr. Gerry, Mr.
Justesen, Mr. Foran, Mr. Mitchell, and Mr. Coburn, and their
responses follow:]
Questions from Chairman E. Clay Shaw, Jr. to Mr. Martin H. Gerry
Question: Why are 90 percent of tickets being assigned to State VR
(VR) agencies and only 10 percent to Employment Networks (ENs)? The
Subcommittee has heard concerns about the payment system for ENs since
the SSA first proposed it over 2 years ago. When will the SSA address
this and how?
Answer: Section 1148(h)(5) of the Social Security Act requires the
Commissioner to review the EN payment systems and alter them to better
provide incentives for ENs to assist beneficiaries to enter the
workforce, while providing for appropriate economies. Based on this
authority, we are considering changes in the payment system.
The SSA also h as taken aggressive steps to address the need to get
timely payments to ENs by establishing a Certification Payment Request
Process. The Certification Payment Request Process allows ENs to submit
a signed written statement that the ticket holder's work and earnings
are sufficient to warrant outcome payments, in lieu of having to
provide proof of the ticket holder's earnings. ENs can request payments
under the Certification Payment Request Process after a ticket holder
meets specific work requirements and has achieved a level of earnings
from employment to qualify an EN for outcome payments. This new process
can be used either on a monthly or quarterly basis. SSA will pay
outcome payments based on the EN's certification, unless our records
indicate that the ticket holder is receiving cash disability benefits.
Question: A procedural directive, known as ``Transmittal 17'' from
the SSA requires VR agencies to be assigned a ticket before they can
receive any reimbursement for costs from the SSA. Many argue that this
requirement denies ticket holders the right to make an informed choice.
Also, since the budgets of VR agencies often rely on income from the
SSA, many believe that VRs are aggressively seeking ticket assignments,
rather than creating partnerships with ENs so that beneficiaries can
receive services from both a State VR provider and an EN. What is the
SSA doing to resolve this issue?
Answer: The operating guidelines issued to the State VR agencies in
Transmittal Number 17 are based on the policies in the Social Security
Regulations. The Social Security Regulations require that each State VR
agency must participate in the Ticket to Work Program by accepting
ticket assignments if it wishes to receive payments from SSA for
serving beneficiaries who are issued tickets. (A State VR agency can
receive payment under the cost reimbursement system for the cost of
reasonable and necessary services provided to a beneficiary who has not
been issued a ticket.) This ensures that all beneficiaries with tickets
receiving services from State VR agencies will receive the same
protection from continuing disability reviews based on their employment
that are provided to beneficiaries receiving services from ENs.
The pamphlet that we provide to beneficiaries with their tickets
allows them to make an informed choice by explaining that they will be
assigning their tickets when they sign a plan. Beneficiaries also
receive a letter after they assign their ticket. This letter tells them
their ticket has been assigned and includes a fact sheet with
information about continuing disability review protection. In addition,
a beneficiary whose ticket has been assigned to a State VR agency
retains the opportunity under the Social Security Regulations to choose
to unassign the ticket and reassign it to receive services from an EN.
We are working with the Rehabilitation Services Administration to
foster better partnerships between the State VR agencies and ENs when
they provide services to beneficiaries with tickets.
Question: Given that less than 1 percent of disabled beneficiaries
return to work, it is easy to understand why field office staff in
1,800 offices across the country, buried in other work, can't stay
current with their understanding of how work and work incentives affect
benefits. Given advances in technology, why doesn't the agency
centralize expertise in a cadre of experts to ensure beneficiaries get
the right answer the first time? Couldn't these individuals also help
address work reports to avoid overpayments?
Answer: Since the Ticket to Work and Work Incentives Improvement
Act was implemented, SSA has worked to establish a corps of trained,
accessible, and responsive specialists within the agency who specialize
in disability work incentives. At the Regional level, the Plan for
Achieving Self Support (PASS) cadre members have been participating in
this effort, along with Public Affairs Specialists and other field
personnel.
In May 2003, the Area Work Incentives Coordinator (AWIC) position
was established. The AWIC position is a full-time permanent position
and is part of SSA's approach to assist beneficiaries with disabilities
to obtain accurate and timely information regarding work, and to
expeditiously process work reports and other disability work-issue
workloads.
Work Incentives Liaison (WIL), located directly in local offices,
train all direct-service personnel on SSA's disability employment
support programs. WILs have the technical background to provide
improved service and information related to SSA's employment support
programs to SSA beneficiaries, applicants, advocates and service
providers.
The SSA has ongoing automation enhancements directed to improving
work incentive workloads. SSA is currently in the process of
implementing an application called eWork, which will enable SSA to
provide better, more timely service by consolidating work reporting and
documentation on one, universally available system. eWork will also
generate a work report receipt and provide improved management
information, workload controls and processing tools for work incentive.
Our automation enhancements c ombined with our establishment of a
network of experts will help ensure work reports will be addressed
timely, thereby avoiding overpayments.
Question: The Ticket Advisory Panel recommends that Congress
clarify in law that the ticket program should be used as a
supplemental, rather than a substitute-funding source. In other words,
that 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. Can you
provide more details about the genesis of this recommendation and your
reactions to it?
Answer: The Ticket to Work and Work Incentives Advisory Panel has
noted that services and supports provided under other programs should
be combined with, rather than offset by, services and supports provided
by the Ticket to Work Program. They also reported that some ENs have
chosen not to participate in the Ticket to Work Program because they
are uncertain about whether and how they can use funds from these other
sources to service ticket holders. We are working with other agencies,
including the Rehabilitation Services Administration and the Centers
for Medicare and Medicaid Services, to ensure that the guidance they
provide is clear and does not unnecessarily restrict the use of their
program funds when the Ticket to Work Program offers additional
assistance to a beneficiary.
Questions from Chairman E. Clay Shaw, Jr. to Dr. Troy R. Justesen
Question: A procedural directive, known as ``Transmittal 17'' from
the SSA requires State VR (VR) agencies to be assigned a ticket before
they can receive any reimbursement for costs from the SSA. Many argue
that this requirement denies ticket holders the right to make an
informed choice. Also, since the budgets of State VR agencies often
rely on income from the SSA, many believe that State VR agencies are
aggressively seeking ticket assignments, rather than creating
partnerships with employment networks (ENs) that allow a beneficiary to
receive services from both a State VR provider and an EN. What is the
Department of Education doing to resolve this issue and encourage
partnerships between State VRs and private ENs?
Answer: For purposes of this question, SSA's ``Transmittal 17''
requires two things: 1) VR can assign an individual's ``ticket'' to
itself if the individual has been determined eligible for the VR
program, has signed an agreed-upon Individualized Plan for Employment
(IPE) with the VR agency, and has not yet assigned the ticket to
another Employment Network (EN); and 2) VR (or any EN) must have an
assigned ``ticket'' before VR can receive payment, including the
traditional cost-reimbursement payment method, for VR services rendered
under the Ticket-to-Work program. My answer to your question is lengthy
and technical because the issues you have raised involve complicated
interrelationships between two complex programs. I would like to assure
you that ``Transmittal 17'' and its various implications and effects as
they are now understood are under close joint review by the Department
and SSA. Above all, we must remain focused on the larger purpose of
enabling and assisting consumers with disabilities to achieve the
dignity, sense of self-worth and capacity for social and economic
contributions to society. Good policies will lead to good jobs.
The Ticket to Work and Work Incentives Improvement Act (TWWIIA) is
designed to give consumers more options when seeking employment-related
services. To this end, TWWIIA gives consumers the right to assign the
ticket to the EN of their choice. This means that the individual can
assign the ticket to the VR agency or to an EN that will accept it.
However, Transmittal 17 removes this choice in certain circumstances,
namely when the individual has a ticket that he/she has not yet
assigned and seeks services from the VR agency. Transmittal 17 advises
the VR agencies that individual consent is not required to make the
assignment in this scenario. To accomplish the assignment of the ticket
in this case, Transmittal 17 advises VR agencies to submit the
signature page of the IPE to Maximus, the contractual program manager
for the Ticket-to-Work program. Maximus then treats the assignment as
voluntary on the basis of the signed IPE. This situation has caused
some advocates to argue that individuals are being denied the ability
to choose an EN as required by TWWIIA.
The principle of informed choice is a central theme throughout the
State VR services program. section 102(d)(4) of the Rehabilitation Act
1973, as amended (Rehabilitation Act), requires that a State VR
agency's written policies and procedures must ``provide or assist
eligible individuals in acquiring information that enables those
individuals to exercise informed choice under this title in the
selection of--(A) the employment outcome; (B) the specific VR services
needed to achieve the employment outcome; (C) the entity that will
provide the services; (D) the employment setting and the settings in
which the services will be provided; and (E) the methods available for
procuring the services.'' Because of these requirements of the
Rehabilitation Act and an individual's right to choose an EN under
TWWIIA, we have advised State VR agencies to discuss openly the options
available to the individual with regard to choosing an EN. We have
advised State VR agencies to inform SSI recipients and SSDI
beneficiaries holding unassigned tickets that the IPE signature can be
interpreted as the individual's willingness to assign his or her ticket
to the State VR agency. In doing this, we believe the State VR agencies
are operating within the requirements of both the Rehabilitation Act
and TWWIIA in ensuring that the individual has the opportunity to
exercise informed choice.
The issue of payment is interrelated to the issue of ticket
assignment because TWWIIA authorizes payment for services rendered to
the EN holding the assigned ticket. The payments are incentives for ENs
and VR agencies to assist SSI recipients and SSDI beneficiaries to
become employed. ENs can choose to receive payments under the Outcome
system or the Milestone/Outcome system. VR agencies have a third
payment option; that of receiving payment pursuant to the traditional
cost-reimbursement method authorized by the Social Security Act.
However, Transmittal 17 appears not to distinguish among these three
payment methods. It requires that the EN or VR agency have the assigned
ticket before being able to seek any payment (including cost-
reimbursement) from SSA. For this reason, ENs and VR agencies are
anxious to get a ticket assigned as soon as possible.
Certainly some State VR agencies have come to rely on income from
the traditional cost reimbursement payment system, as you mention. VR
agencies use this income to supplement the formula grant funds received
from the Department of Education. The amount of SSA cost
reimbursements, as a percentage of the overall VR agency budget is
relatively small, however, the level of such reimbursements varies
widely among VR agencies as a percentage of the total agency budget. A
few agencies, particularly active and successful in SSA
rehabilitations, receive higher levels of reimbursement. Because
Transmittal 17 seems to have subsumed the traditional cost
reimbursement option under the Ticket-to-Work program, VR agencies are
on an equal footing with the other ENs with regard to needing an
assigned ticket in order to be eligible for payment at a later date.
Thus, VR agencies and other ENs need to make concerted efforts to
inform individuals about the ticket assignment process.
Question: The Ticket to Work Advisory Panel has found that some
State VR agencies have determined that the ``comparable services and
benefits'' requirement under the Rehabilitation Act prevents them from
providing services to Social Security Disability Insurance and
Supplemental Security Income recipients who assign their ticket to a
private EN. Can you explain how the Department of Education will work
with State VR agencies to provide the maximum amount of services
available under the law? Do you believe that any legislative changes
are needed to the Rehabilitation Act to allow for ENs and State VR
agencies to coexist and complement each other as envisioned under the
Ticket to Work Act, or can needed change be accomplished through
regulation?
Answer: We are not aware of any State VR agency that has refused as
a general practice to provide services to an SSI recipient or SSDI
beneficiary who has assigned his/her ticket to a private EN. However,
we are aware that State VR agencies in certain circumstances are asking
that the private ENs holding the ticket provide some of the necessary
services as a ``comparable service and benefit.''
Section 101(a)(8)(A)(i) of the Rehabilitation Act requires the VR
agency, except in very limited circumstances, to determine whether
comparable services and benefits exist prior to providing services to
an eligible individual. The VR regulations define ``comparable services
and benefits,'' in pertinent part, as those services and benefits
``that are--(A) provided or paid for, in whole or in part, by other
Federal, State, or local public agencies. . . .; (B) available to the
individual at the time needed to ensure the progress of the individual
toward achieving the employment outcome. . . .; and (C) commensurate to
the services that the individual would otherwise receive'' from the
State VR agency (34 CFR 361.5(b)(10)). This means that VR must
determine whether another appropriate source can provide the services
that VR otherwise would provide in accordance with the individual's IPE
in a timely manner. As you know, the intent behind this requirement was
to ensure that VR funds could be maximized in order to meet the needs
of more eligible individuals, especially those with the most
significant disabilities.
We do not view a ticket by itself as representing a comparable
service and benefit. Nor do we consider the fact that an individual has
assigned his/her ticket to a private EN by itself as constituting a
comparable service and benefit under the Rehabilitation Act. However,
we do consider the ticket as being a comparable service and benefit
under the Rehabilitation Act when: 1) the individual has assigned the
ticket to an EN; 2) the EN has listed the service in its own
individualized work plan (developed between the EN and the individual)
pursuant to TWWIIA requirements; 3) the EN is capable of providing a
service that is listed on the individual's IPE; 4) the service offered
by the EN is commensurate to the service that otherwise would be
provided by the State VR agency; and 5) the EN is capable of providing
the service when it is needed by the individual. If any of the above
factors are not met, the ticket does not constitute a comparable
service and benefit for purposes of the VR program. In that instance,
assuming comparable services and benefits do not exist from another
source, the State VR agency should provide the services pursuant to the
IPE.
Our interpretation encourages a cooperative effort between both the
VR agencies and the ENs to serve individuals as effectively as possible
while maximizing funds from each program. We will continue to provide
technical assistance to the State VR agencies to ensure that the search
for comparable services and benefits does not result in a delay in
services to individuals. We also will continue to remind State VR
agencies that the requirement for seeking comparable services and
benefits should be done in such a manner to ensure cooperation among
programs serving individuals with disabilities.
As a policy matter we recognize that the intent of the Ticket
program is to establish a cadre of rehabilitation service providers, in
addition to the traditional VR services program present in every State
that can provide multiple opportunities and pathways for SSI recipients
and SSDI beneficiaries to obtain the services necessary for gainful
employment. For decades, the VR program has been essentially the sole
public program assisting individuals with disabilities to achieve
gainful employment. The current situation in which the potential for
competition between VR agencies and ENs for both clients and payments
from SSA is new and the implications are not fully understood.
The Department has not taken a position on the need for a
legislative change. However, we are aware the current Senate Bill (S.
1627) reauthorizing the Work force Investment Act 1998 (which includes
the Rehabilitation Act in Title IV) proposes clarifying language on
comparable benefits.
We must defer to SSA concerning regulatory changes governing the
Ticket program, but we will of course work with SSA if changes are
proposed.
Question: It has been reported that private providers perceive that
if they sign up to be an EN, their current relationship with their
State VR agency may be jeopardized. It has also been reported that some
current VR clients were threatened with termination from VR if they did
not assign their ticket to the VR agency, or worse, weren't informed
that they could be better served by taking their ticket to elsewhere
versus staying on a waiting list at the VR agency. This is deeply
disappointing and completely opposed to the goals of the ticket
program. Have you heard similar allegations? Are they true? If so, what
are you doing to address the situation?
Answer: I am not aware of any individual threats concerning
termination of clients or willful ``noninformation'' about ticket
options being provided to VR clients. However, if complaints are
brought to our attention we will certainly respond to them.
State VR agencies have typically had longstanding cooperative or
purchaser-vendor relationships with many, if not most ENs. Thus, it is
understandable that some providers could be concerned about the
potential for jeopardizing their relationship with the VR agency.
However, perceptions that a relationship ``may be jeopardized'' provide
little basis for investigation in the absence of specific complaints. I
have heard anecdotal references similar to the allegations you have
mentioned. However, no documented and specific examples have been
brought to my attention. However, we will work with our colleagues at
SSA to address any specific complaints that may be presented.
Question: As you mention in your testimony, many EN perceive that
negotiated agreements they have entered into with the State VR agencies
do not reflect the principles of true partnership and fairness. This is
especially a concern given the low percentage of tickets assigned to
ENs. When do you plan to complete your review of all agreements between
the State VR agencies and ENs?
Answer: TWWIIA authorizes ENs and VR agencies, when serving mutual
consumers, to share payments received from SSA when the two entities
have developed an agreement that outlines how services will be provided
and income shared. ENs and VR agencies may, of course, enter into a
wide range of agreements for various purposes for their mutual benefit.
We are aware that some ENs, including some VR agencies, believe the
agreements they have developed do not reflect the principles of true
partnership and fairness. This has prompted OSERS to begin reviewing
these agreements. Although there is no legal requirement for us to
conduct this review or for the VR agencies to submit these agreements
to us, we believed such a review would be helpful in order to get a
better understanding of the actual working relationships between State
VR agencies and ENs.
We are currently reviewing agreements that were developed by ENs
and VR agencies in the 13 first-phase States. We hope to review all
available agreements within the next 6 months. We will provide the
Subcommittee with a report of our findings once our review and analysis
are completed.
Questions from Chairman E. Clay Shaw, Jr. to Mr. Tom Foran
Question: Can you share with me on average, what are the costs of
returning an individual to employment? Even with adjustments to the
milestone payments, can employment networks cover their costs and still
make a reasonable profit, given the potential total payment of $16,740
for Social Security beneficiaries and $10,620 for Supplemental Security
Income beneficiaries?
Answer: Because of the tremendous variation in costs, at the
individual level, giving an average cost may be less meaningful than
focusing on the second part of this question. We've seen beneficiaries
that are able to return to work with an outlay of only several hundred
dollars. We've also seen others that would require more than $50,000
and even at that level the success is not guaranteed.
When looking at the second part of your question it is important to
understand the effects of:
The time value of money on payments,
The cost of Maximus and SSA imposed administrative costs
(drag),
Success rate in returning beneficiaries to work,
Once at work the effect of beneficiaries dropping out of
the work force due to death, economy related work force reductions,
choice and worsening of their physical state.
Additionally, we need to define ``reasonable profit'' which is
directly tied to the source and cost of capital.
Once all of these parameters are determined a present value of
future cash flows can be created to determine the amount of resources
that can be provided to any one individual in the return to work
process. An employment networkthen looks for beneficiaries that can be
returned to work with that level of resources.
Taking into account the above items, IDR has estimated the present
value of future payments per successful ticket as follows:
SSDI current milestone structure = $2,800
SSI current milestone structure = $1,420
SSDI with AOI workgroup suggested changes $3,800
SSI with AOI suggestions (diff. Reflects lower success
rate) $3,000
With the current dramatically lower payments for SSI beneficiaries,
we feel the risk/reward is too great and therefore do not work with SSI
only beneficiaries. Under the current milestone structure only 1 in 25
beneficiaries that contact us meet our screen of being a SSDI
beneficiary with a 75% likelihood of successful full-time return to
work for $2,800 in time and services.
We believe it is dangerous to use a cost figure that represents an
average per individual placement, however. We fear that policy makers
will use such a number to reduce payouts for the program without
realizing the actual costs to operate the program include far more than
just the cost of an individual placement. The aggregate program costs
for screening all the people who never actually deposit their ticket as
well as the people we are never actually able to place represents the
majority of the costs incurred to operate a successful employment
network.
Additionally, for the reasons mentioned above, a significant
percentage of those who are placed for whom we are eligible for a
milestone/outcome payment will never actually achieve 60-72 months of
employment. It is also impossible to compute the total cost of any
placement at this time since the ticket program is so new. For example,
we do not know the cost or amount of future services that will be
required to help those ticket users who are working now stay at work.
Consequently, the total possible payout for any one beneficiary (i.e.
$16,750 for SSDI and $10,620 for SSI) not only has to cover our costs
and generate a reasonable profit for those we actually place but also
must cover the aggregate costs incurred for all the people we do not
place.
We believe placement rates could be increased by restructuring the
payment system. By changing to the AOI workgroup recommended payment
structure we estimate we would be able to work with 1 in 10 to 1 in 15
beneficiaries. By removing much of the administrative drag we would
likely be in 1 in 8 to 1 in 12 ranges. Improving access to capital
(reducing cost) would also allow us to work with more beneficiaries.
So, yes it is possible for an employment network to earn a fair
profit at the $16,740 (or current $17,170) total payment for SSDI
beneficiaries. The question is how many beneficiaries is an employment
network able to serve?
When IDR decided to become an employment network, we planned to do
so on a significant scale. Our initial plans were to serve 2,000 plus
beneficiaries per year. Our infrastructure was built to handle at least
that amount.
Unfortunately, given the level of screening we have to do to deal
with unexpected issues like administrative drag and lack of appropriate
education given to beneficiaries on the Ticket to Work Program it is
unlikely we will come anywhere near our goal without improvements in
the program.
Question: What has been your experience in working with the State
VR agencies? What suggestions do you have for improvements?
Answer: Our main office is in Connecticut and we have had a very
positive experience in dealing with Connecticut's Bureau of
Rehabilitation Services. The problem we face in dealing with other
State VR agencies is that each state takes a different approach with
different agreements in dealing with EN's. To be honest, we made the
decision early on that it was not worth the time and expense to enter
into negotiations with each state and simply refer beneficiaries to
their State VR agency if we can't help them.
We would be much more likely to work on a collaborative basis with
other State VR agencies if there was a uniform agreement applicable to
all states.
It is important to note the comments we get from beneficiaries
about their experiences with State VR agencies. In general, they
revolve around frustrations the beneficiaries have with not being
served by State VR for the following reasons:
Lack of funding
The beneficiary not having a disability ``severe'' enough
to be assisted
The waiting list for services is ``years'' long
Rehab Counselors don't get back to the beneficiary for
months on end
Another suggestion would be to more strongly encourage State VR to
focus their limited resources on providing services designed to get
beneficiaries ``job ready'' under the existing cost reimbursement
program and to rely on EN's to provide the placement services under the
ticket program.
Although some more traditional ENs have recommended operating the
ticket program payment system similarly to the cost-reimbursement
scheme currently in use with State VR, we believe that such a plan
would create more administrative burden ``proving'' to SSA that the
costs for which we are requesting reimbursement are legitimate.
Further, it would designate a bureaucratic approach to the types of
services provided rather than the ``whatever it takes'' approach we are
free to use under the current Ticket structure. This has been
demonstrated clearly by the Projects with Industry programs that exist
today. Originally, they were intended to be more community and
employer-focused. However, because of the manner in which PWIs are
funded and monitored their programs today are so restricted that they,
too, are not able to place as many people as they could if their
program contained more flexibility.
Question: What can be done to assist recipients who want to use
their Ticket in selecting one employment network from the often long
list of employment networks available to recipients?
Answer: Provide adequate and timely information on each employment
network servicing their area. Examples of information/services to
provide include items currently tracked by Maximus such as:
Tickets assigned to date
Tickets unassigned by ENs
Tickets unassigned by beneficiary
Number of successful placements to date
Regularly updated (at least monthly) list of what EN's are still
active
Offer workshops via the BPAOs on how to choose an EN and what an EN
and a consumer can offer each other.
I want to emphasis that the information provided needs to be
readily available information that Maxims is ALREADY collecting. Asking
EN's report and track additional statistics will only add to the
administrative drag and reduce resources available to provide services
to beneficiaries.
Questions from Chairman E. Clay Shaw, Jr. to Mr. Quintin M. Mitchell
Question: Can you share with me on average, what are the costs of
returning an individual to employment? Even with adjustments to the
milestone payments, can employment networks cover their costs and still
make a reasonable profit, given the potential total payment of $16,740
for Social Security beneficiaries and $10,620 for Supplemental Security
Income beneficiaries?
Answer: On average the costs of returning an individual to
employment, for our agency, is $15,819.00. This figure is at the low
end. Even with adjustments to the milestone payments, it is a very slim
margin for our agency to cover cost and still make a profit.The profit
is really not a reasonable one.
Question: What has been your experience in working with the State
VR agencies?What suggestions do you have for improvements?
Answer: Our agency has opted not to work with the State VR agencies
in our area. From the start of this initiative we decided that working
with the State Voc Rehab would not be in our best interest,
economically or providing the Ticket participants with expedient
service delivery.
Question: What can be done to assist recipients who want to use
their Ticket in selecting one employment network from the often long
list of employment networks available to recipients?
Answer: One approach to assist recipients who want to use their
Ticket in selecting one employment network from the often long list of
EN.s available is to narrow the list to their service area within 30
miles. We are finding that more and more Ticket holders are contacting
our agency, which is outside of our service delivery area. To
accommodate these individuals we have set up satellite meeting space in
that area and travel to meet them on an as needed basis. Because of
fewer E.N. participation and more Ticket participants, slim margin of
profit and already stretched staff it is becoming increasingly more
challenging to ensure that the program is successful.
Questions from Chairman E. Clay Shaw, Jr. to Mr. John V. Coburn
Question: Can you share with me on average, what are the costs of
returning an individual to employment? Even with adjustments to the
milestone payments, can employment networks cover their costs and still
make a reasonable profit, given the potential total payment of $16,740
for Social Security beneficiaries and $10,620 for Supplemental Security
Income beneficiaries?
Answer: The cost of returning an individual to employment can vary
greatly depending on many factors, including but not limited to, the
nature of the individual's disability, the individual's employment
history, and the individual's education and experience. In addition to
the costs expended to assist a particular individual in returning to
work, there are general overhead costs associated with actively
participating as a provider in the Ticket to Work Program. These costs
may include staff costs associated with performing intake, staff costs
associated with assessing an individual's service needs prior to
accepting their ticket, marketing of the Ticket to Work Program, and so
forth. These costs are incurred on all individuals who contact the
agency, including individuals who the agency may ultimately decide not
to serve under the Ticket to Work Program.
In order to develop response to your questions, I polled members of
the Midwest Employment and Training Partnership (Partnership). I have
received several different responses with a range of costs for
employment and training services One Employment Network, which serves
exclusively blind individuals, stated that the average cost per
individual to train, educate, and place the individual in competitive
employment ranged from $35,000 to $40,000. This was the highest amount
reported. On the lower end, another agency that works with a cross-
disability population reported that it was currently costing about
$2000 per individual to place a person in competitive employment
through the Ticket to Work Program. This figure does not include what
it may or may not cost to keep the person in competitive employment
throughout the Ticket to Work payment timeline, nor does it include
some of the overhead costs mentioned previously. A third agency that
works with younger adults reported an average cost of between $5000 and
$6000 to obtain employment, with follow-up services costing
approximately $3000 per year. Finally, another agency, which works with
a cross-disability population, reported a range of $5200 to $12,000 to
assist an individual in returning to work with 3 months of intensive
follow-up services.
So, our experience has been that there is a great variance in
expenditures needed to assist a person in securing and maintaining
employment. However, in almost all cases, the greatest percentage of
these expenditures are incurred by agencies prior to and upon placement
in competitive employment. Therefore, adjustments in the milestone
payments to further increase the funds available during the beginning
of the employment services process will increase the ability of
Employment Networks to accept more Tickets.
The current total payment system under the Ticket to Work Program
will not make it possible to serve all beneficiaries. For some
beneficiaries, payments of $16,740 or $10, 620 will never cover the
expenditures required in order to return them to employment. However,
these amounts, if paid out in a greater percentage during the first
year, would make it financially feasible for Employment Networks to
accept more Tickets and increase their participation over time.
Question: What are the one or two most significant benefits of the
upcoming City of Chicago Pilot that represent an improvement over the
current Ticket to Work payment systems for employment networks?
Answer: In the Midwest, we have learned that Employment Networks
have been hesitant to meaningfully participate in the Ticket to Work
Program because the agency must bear all the costs associated with the
placement of the individual in employment. And, even after incurring
these costs, the Employment Network may never receive payment if it is
not successful, or the EN receives payments over a significant period
of time at very low rates. Quite simply, the current system of payment
requires agencies to incur costs that it cannot carry for the period of
time it must wait in order to be reimbursed. To be frank, the current
Ticket to Work milestone and outcome payment model is not a strong
business model that will bring new players into the system much less
attract many of the experienced employment and training providers to
this new program.
First and foremost, the City of Chicago Pilot (CCP) provides the
Employment Networks with a significant income to cover their cost of
service within the first year of a ticket participant's employment. The
Employment Networks can be assured of reimbursement of at least some of
their costs at placement ($2000), when the greatest costs have been
incurred. In addition, subsequent payments of $2000 at 6 months and
$1000 at 1 year allow the Employment Networks to recoup a larger amount
of their overall costs within a short period of time. This is done
without discouraging the Employment Networks from continuing to work
with the individual over the next 5 years as Employment Networks will
continue to receive payments from the SSA system after the first year
if the individual maintains employment.
Second, the CCP allows for payment to the Employment Network within
the first year without requiring the individual to earn Substantial
Gainful Activity (SGA) or greater within that first year. Employment
Networks believe that the process of returning an individual to full-
time employment at or above SGA can often be accomplished over time.
For some individuals, particularly those receiving SSI benefits with no
work history, securing employment at or above SGA can best be
accomplished by first gaining some work experience, sometimes at a
part-time level. For other individuals, the best way to return them to
work at or above the SGA level is to first allow them to work at any
level, gain confidence in their ability to maintain employment, and
address their fears about returning to work and losing their cash
benefits. Once this is done, the transition to full-time, self-
sustaining employment is the next natural step and the Employment
Networks can realistically assist them in getting there.
The current payment system will not pay the Employment Networks
during the time in which they are gradually assisting the individual in
gaining full-time employment. Therefore, it is not financially feasible
for the Employment Networks to work with the large group of
beneficiaries described above. On the other hand, the CCP makes
payments to Employment Networks when they assist the individual in
gaining competitive employment, regardless of that person's employment
income. This is done without losing sight of the ultimate goal---self-
sustaining employment. The Employment Networks must still create a plan
for returning the individual to self-sufficiency, as required by
current SSA regulations, and will receive payments through the SSA
system when they do so.
__________
[Questions submitted from Mr. Matsui to Dr. Justesen, and
his responses follow:]
Question: If a Social Security beneficiary assigns a ticket to an
Employment Network, is he or she still entitled to services and
benefits under title I of the Rehabilitation Act? Please describe the
interpretation of ``comparable benefits and services'' as it relates to
the ticket program. Are state agencies complying with this requirement
of the Rehabilitation Act with respect to Social Security beneficiaries
who have been assigned tickets? Is your agency monitoring state's
compliance with this requirement?
Answer: VR is an eligibility program rather than an entitlement
program but Social Security beneficiaries are deemed presumptively
eligible. Assignment of a ticket to an employment network does not
limit an individual's potential eligibility for VR services. That
eligibility is governed by the Rehabilitation Act.
Section 101(a)(8)(A)(i) of the Rehabilitation Act requires the VR
agency, except in very limited circumstances, to determine whether
comparable services and benefits exist prior to providing services to
an eligible individual. State VR agencies must comply with this
requirement as a matter of law, and it is to the advantage of the
agencies to do so because use of third-party resources allows the
agencies to serve more clients or provide enhanced services. The
Rehabilitation Services Administration is currently reviewing
agreements that were developed by ENs and VR agencies in the 13 first-
phase States and hopes to review all available agreements within the
next six months. The reviews will necessarily involve consideration of
the use of comparable benefits.
The VR regulations define ``comparable services and benefits,'' in
pertinent part, as those services and benefits ``that are--(A) provided
or paid for, in whole or in part, by other Federal, State, or local
public agencies. . . .; (B) available to the individual at the time
needed to ensure the progress of the individual toward achieving the
employment outcome. . . .; and (C) commensurate to the services that
the individual would otherwise receive'' from the State VR agency (34
CFR 361.5(b)(10)). This means that VR must determine whether another
appropriate source can provide the services that VR otherwise would
provide in accordance with the individual's IPE in a timely manner. As
you know, the intent behind this requirement was to ensure that VR
funds could be maximized in order to meet the needs of more eligible
individuals, especially those with the most significant disabilities.
We do not view a ticket by itself as representing a comparable
service and benefit. Nor do we consider the fact that an individual has
assigned his/her ticket to a private EN by itself as constituting a
comparable service and benefit under the Rehabilitation Act. However,
we do consider the ticket as being a comparable service and benefit
under the Rehabilitation Act when: 1) the individual has assigned the
ticket to an EN; 2) the EN has listed the service in its own
individualized work plan (developed between the EN and the individual)
pursuant to TWWIIA requirements; 3) the EN is capable of providing a
service that is listed on the individual's IPE; 4) the service offered
by the EN is commensurate to the service that otherwise would be
provided by the State VR agency; and 5) the EN is capable of providing
the service when it is needed by the individual. If any of the above
factors are not met, the ticket does not constitute a comparable
service and benefit for purposes of the VR program. In that instance,
assuming comparable services and benefits do not exist from another
source, the State VR agency should provide the services pursuant to the
IPE.
Question: A number of concerns have been raised about whether the
ticket program may be replacing, rather than supplementing,
other pre-existing publicly funded services such as VR services
provided under Title I of the Rehabilitation Act. The intent of
Congress in enacting the ticket program was not to deny access
to these other services. Does Congress need to clarify the law?
If so, where?
Answer: State VR agencies are serving the great majority of persons
holding tickets and seeking services. Experience to date with
implementation does not support concerns about the ticket program
replacing services such as VR. This is unsurprising because the VR
agencies are well-established entities with operating capital provided
by their formula grants from the Department. The Department has not
taken a position on the need for any legislative change. We would in
any event expect to work closely with but defer to SSA as the
administering agency if legislative recommendations are to be
developed.
[Submissions for the record follow:]
California Department of Rehabilitation
Sacramento, California 95815
March 30, 2004
Chairman E. Clay Shaw, Jr.
Subcommittee on Social Security
1102 LHOB
Washington, DC 20515
Dear Congressman Shaw:
As the Director of the California Department of Rehabilitation
(DOR) I want to take this opportunity to provide written testimony for
the official record of the above referenced hearing. This testimony
will provide some information on DOR's activities relevant to the
implementation of the Ticket to Work Program specifically as they
relate to Transmittal 17 of the SSA VR Provider Handbook and the
development of agreements between DOR and Employment Networks (EN).
Several months prior to Ticket rollout in California, DOR convened
a Ticket to Work Workgroup that consisted of field and management
staff, community partner agencies and several constituency groups
representing a unified approach to DOR's role in the Ticket to Work
Program. The workgroup was charged with the task of extensively
reviewing Social Security Administration's Ticket to Work (TTW)
regulations and policies related to TTW including the Transmittal 17
document. In addition, the workgroup carefully researched, studied and
compared policies implemented by first and second round ticket states.
As a result, the workgroup developed guidance and procedures consistent
with the TTW regulations and Title I of the Rehabilitation Act of 1973,
as amended.
Transmittal 17 of Social Security Administration's (SSA's) Vocation
Rehabilitation (VR) Provider Handbook allows for the ``automatic''
assignment of a Ticket to State VR agencies when a consumer signs the
Individualized Plan for Employment (IPE). The SSA's position has been
that if a beneficiary receives a Ticket and then enters into an IPE
they have decided to use their Ticket. California DOR does not practice
this ``automatic'' ticket assignment. A statement has been added to our
IPE template to emphasize the voluntary nature of the Ticket and
consumer informed choice. All consumers eligible or potentially
eligible for a Ticket are provided verbal and written information on
TTW program including a fact sheet that emphasizes that TTW is a
voluntary program. Finally, guidance has been developed so that DOR
counselors review and revisit TTW with each consumer at the time of
progress and annual reviews.
Concern has been raised about the various EN/VR agreements
requiring full repayment of the entire VR costs out of the EN ticket
payments and the reported ``one size fits all agreements.'' State
Vocational Rehabilitation (VR) agencies have been working with SSA
beneficiaries under a reimbursement program legislatively authorized by
the Social Security Act since 1981. Under this reimbursement program
SSA reimburses State VR agencies for reasonable and necessary service
costs incurred in assisting consumers who engage in employment with
earnings equal to or above SSA's standard for substantial gainful
activities (SGA) for at least 9 months. Indirect and tracking costs are
also reimbursed. The annual SSA Reimbursement report for Federal Fiscal
Year 2003 indicates SSA realizes savings from this program. In FY 2003
$84.6 million dollars were reimbursed to VR agencies nationwide. SSA
projected the savings in benefits to be $458.7 million dollars.
As is true for many state VR agencies, DOR has come to rely on
these reimbursements to maintain ongoing programming. The TTW program
has introduced a new way of doing business. With an estimated 1,000,000
Tickets scheduled to be released in California by September 2004, DOR
certainly supports increased consumer choice and the addition of EN's
to provide services. California's EN Agreement only requires the EN to
reimburse DOR at the rate of 50% of each payment received from SSA
until DOR's direct costs (not indirect and tracking costs) are
reimbursed or until DOR has received 50% of all payments, whichever is
first. Furthermore, DOR does not ask for more than 50% of the total
payments the EN receives.
Finally, California DOR supports the proposals that have been made
by others to this hearing and the Ticket to Work Advisory Panel for SSA
to create a dual payment system in which state VR agencies continue to
be reimbursed for services provided to assist beneficiaries in
preparing for and entering the labor market. EN's then will be paid for
the long-term follow up and support for beneficiaries to maintain their
employment and freedom from reliance on cash benefits.
California DOR appreciates this opportunity to provide testimony.
We look forward to future collaboration in improving the TTW program
and support your ongoing efforts to help make this program a success
for beneficiaries with disabilities.
Sincerely,
Catherine Campisi
Director
Statement of Robert Kilbury and Louis Hamer, Council of State
Administrators of Vocational Rehabilitation, Chicago, Illinois
In Illinois there are 60 ENs with 32 ENs having an active agreement
with State VR. Since the Ticket program started two years ago in
Illinois we have gone from 73 ENs to 60 ENs now. Many ENs have stopped
taking the Ticket assignment from customers. Most community based
providers have attributed the lack of Tickets accepted due to the
payment system. In Illinois we do have an agreement that was developed
with cooperation with community providers. The EN agreement calls for
State VR to pay for services and to eventually receive payment back for
its cost once the EN receives payment from SSA. The EN will keep any
monies received over State VR's cost. In most cases it could be a large
sum. Illinois does not ask for any cost reimbursement above what it
pays out.
"Transmittal 17" allows State VR to submit the Ticket Registration
Form (TRF1365) along with a copy of the signed IPE signature page for
assignment when the customer does not sign the TRF1365. The customer is
informed by State VR that by signing the IPE (Plan) they are assigning
their Ticket to VR. In Illinois we only submit in this manner with the
customer's approval. This is no different than when a customer goes to
an EN and signs a Individual Work Plan (IWP), they are in essence
assigning their Ticket to that EN. This happens and not all customers
are informed they have assigned their Ticket to that EN. In Illinois
over 98% of all Tickets to date have been submitted with customer
signature on the TRF1365.
It is very unfair to vilify State VR agencies over the Ticket
program. In Illinois not every customer that comes through the door is
a SSA recipient. The funds captured from SSA reimbursement goes back
into the pool to pay the cost for all it's customers, including SSA
recipients. State VR does indeed continue to be woefully under-funded.
The amount of reimbursement has been steadily shrinking over the last
two years with a large reduction expected again this year.
We disagree with the recommendation of eliminating the requirement
that there be agreements between ENs and State VR agencies when the EN
refers a beneficiary to VR unless SSA allows cost reimbursement for
State VR agencies separately from the Ticket program.
Illinois State VR spent significant resources the first year
training staff, hiring Ticket operators, setting-up a Ticket Cost
Center and meeting with ENs in development of the EN agreement. We
continue to spend large amounts training staff on SSA revisions and
communicating with Maximus and customers who have no intent to return
to work. This program would be most effective if there were unlimited
funding for State VR with some additional funds for ENs. Since there is
no endless trail of money, SSA should not consider changing the system
to reward ENs that are able to cherry-pick it's customers. We must
remember that State VR must work with every customer that comes through
the door.
Making further changes to provide more incentives to return to work
would benefit customers more. Give the customer to try to work for a
year if they assign there ticket and allow them to keep all their
benefits would open the door to more customers making a real attempt to
get off benefits, not making ENs rich on the backs of the customer.
Statement of Mike Hedden, Indiana Vocational Rehabilitation Services,
Indianapolis, Indiana
In regard to the Hearing on March 18, 2004, the testimony given
does not accurately reflect the situation in Indiana. Indiana has
invested significant resources in its training of Vocational
Rehabilitation Counselors. We have held several training seminars
explaining the Ticket program as well as developing detailed intake
procedures, flow charts and updating our computer system. We do not use
a ``stand alone, take it or leave it, one size fits all agreement''
with the ENs with whom we have Memorandums of Understanding. Our
agreement with ENs states that ``both the IWP and the IPE will be
written by the respective party in a manner, consistent with law, to
reinforce common goals, policies and procedures for Ticket customers
referred by the EN to VRS.'' Our agreements do not necessarily require
full and total repayment of all of VR's costs. Our reimbursement
agreement states that VRS will be reimbursed by the EN for all actual
service costs provided through VRS at the rate of 50% of all outcome or
milestone payments to the EN until VRS is reimbursed for all actual
service costs (these costs do not include the costs associated with VR
Counselor time or in support of the VR Counselor). In other words, once
an EN begins to receive payments, VR is entitled to 50% of each payment
received until service costs are paid in full or until no further
payments are made to the EN. The EN, in other words, will always
receive 50% of the total payments and may receive more than 50% once
VR's costs are reimbursed. If payments to the EN stop prior to full
service costs being reimbursed to VR, VR expects no further
reimbursement from the EN.
Statement of James Wallace, Louisiana Rehabilitation Services,
Department of Social Services, Baton Rouge, Louisiana
Louisiana Rehabilitation Services (LRS) has taken a very active
role in promoting Ticket to Work (TTW) in the state of Louisiana. Our
agency, which is located in a second phase Ticket rollout state, began
training our personnel statewide in 2001. The agency has done follow-up
training in 2002. Louisiana Rehabilitation Services (LRS) personnel
also participated in providing training to beneficiaries, potential
Employment Networks (ENs), and other entities in 2002 in conjunction
with the Medicaid Buy In (MBI) program. The MBI training was repeated
in 2003 with LRS participation. Furthermore, the agency was involved in
statewide teleconference training in 2003.
In our agency training, beneficiary options with special emphasis
on informed choice to the consumers was stressed. Additionally, the
training stressed that Rehab Act guidelines preclude denying services
to any eligible consumer even if a Ticket is assigned to another
entity.
The LRS does have EN agreements with four Employment Networks
throughout the state. The agreements do call for Ticket assignment to
LRS and payment to the EN on typically a fee-for-service basis. LRS
would be reimbursed under the traditional cost method. Any excess
payments from Social Security would be split on a 50/50 basis.
The LRS has neither solicited ENs nor coerced them into
partnerships to ``control competition.'' ENs in the state appear to be
reluctant to accept Ticket assignments because of the uncertainty and
duration in payment and tracking. ENs and LRS negotiated so that in
instances where the EN can independently serve the recipient, that
recipient will not be referred to LRS. That said, current TTW
procedures do allow appeals to Maximus and Social Security when Ticket
assignment and payment is in question.
The LRS, as a whole, is as well trained or in many cases better
trained on Ticket issues, including informed choice, as any other
entity in the state. In our state, as in many others, LRS has over 90%
of the Ticket assignments. It is our viewpoint that Ticket indifference
is due to the payment system for ENs and the burdensome administrative
and tracking system. Further the lack of marketing to recipients by ENs
contributes to the very low number of cases handled through them.
Thank you for the opportunity to respond to this very topical
subject.
Maryland Division of Rehabilitation Services
Baltimore, Maryland 21201
March 31, 2004
The Honorable Benjamin L. Cardin
Member of Congress
2207 Rayburn HOB
Washington, DC 20515
I want to respond to testimony that was provided by the Consortium
of Citizens with Disabilities (CCD) at the March 18th hearing convened
by the House Social Security Subcommittee on SSA's Ticket-to-Work
program. The comments of Paul Seifert stating ``State VR agencies have
developed stand alone, take it or leave it, one size fits all
agreements for ENs in their states'', comes as a shock to this
administrator of the Maryland VR program. Let me assure you that Mr.
Seifert's statement could not be further from the reality of what has
occurred in our state.
First, Maryland Division of Rehabilitation Services (DORS)
implementation planning was guided by the following principles:
Persons with disabilities in Maryland are entitled to the
opportunities, rights and remedies afforded under Title I of the
Rehabilitation Act regardless of ticket status or assignment.
Maryland DORS implementation will foster the goals of the
Ticket-to-Work legislation: to expand service delivery capacities; and
provide greater choice to ticket-holders to prepare for and obtain
employment.
Implementation will occur in a manner that is fiscally
responsible and fair to ticket-holders, our community partner agencies
and DORS.
We have steadfastly adhered to those principles throughout the
process.
Second, Maryland DORS initiated an interagency implementation team
to ensure that our roll-out strategies were consistent with our
principles. Representatives from a number of community rehabilitation
programs participated on the state team in addition to representatives
from Maryland's benefits planning assistance and outreach (BPAO)
organizations; the Client Assistance Program; and the state's
protection and advocacy program.
Third, Maryland does not have a ``one size'' agreement with ENs but
rather varies the agreement based on which entity will provide the
Ticket-to-Work administrative functions. We also tailor specific
elements of the agreements to the unique relationship we have with each
provider.
While disagreeing categorically with Mr. Seifert's comments
regarding implementation of the Ticket-to-Work for Maryland, I agree
with his support of a recommendation of the Adequacy of Incentives Work
Group. The current design of Ticket-to-Work by the Social Security
Administration is seriously flawed. I strongly support the Work Group
recommendation to reestablish cost reimbursement for state VR agencies
separate from the Ticket-to-Work program and thereby keep intact the
Ticket option for the consumer.
I appreciate your consideration of these comments, and would ask
that this letter be submitted as part of the official record of the
hearing. Please do not hesitate to call me if you need additional
information. Thank you.
Sincerely,
Robert A. Burns
Assistant State Superintendent in Rehabilitation Services
Statement of Elmer C. Bartels, Massachusetts Rehabilitation Commission,
Boston, Massachusetts Introduction
The Massachusetts Rehabilitation Commission (MRC) thanks Chairman
Shaw for the opportunity to provide the Committee with its comments
concerning the implementation of the programs of the Ticket to Work and
Work Incentives Improvement Act, with particular attention focused upon
the Ticket Program. Massachusetts was among the first states to roll
out the Ticket Program and the MRC has actively worked to fashion a
collaborative system of specialized training, support, and placement
services with the state's community rehabilitation program providers,
working as Employment Networks, in an effort to maximize choice and
value for its consumers.
BPAO Program Success
The Benefits Planning Assistance and Outreach Program (BPAO) has
been an unqualified success in Massachusetts. The MRC operates its
``Project IMPACT'' BPAO program in partnership with state independent
living programs, non-profit community based organizations, and One-Stop
Career Centers. The collaboration has resulted in referrals exceeding
expectations and the development and implementation of over 1600
benefits plans. Reauthorization of the Program in HR 743 will have a
direct and positive impact on the employment efforts of hundreds of
individuals with significant disabilities in the Commonwealth.
Traditional Cost Reimbursement and the Ticket Program
A tension has existed in the Ticket program since the issuance of
the first SSA instructions concerning State Vocational Rehabilitation
Program participation in the Ticket Program and the continued relevance
of the SSA/VR cost reimbursement program. That tension has continued to
grow during the first several years of program implementation and it
threatens to undermine the Ticket Program's potential for success.
From the time the idea of the Ticket Program was first discussed in
Congress, the CSAVR and interested state programs have emphasized the
need to preserve the successful and vitally important SSA/VR cost
reimbursement program. We believe that the SSA has promulgated policy
regarding the administration of the Ticket Program, through its
regulations and Transmittal 17 that is contrary to the intent of
Congress, the language of TWWIIA, and the law as it relates to the
administration of the VR cost reimbursement program. The Ticket Program
has great potential to stimulate creative collaboration among community
rehabilitation providers and state VR agencies. That collaboration
could result in increased choice, quality, and funding for SSI/DI
recipients interested in obtaining and retaining employment. However,
as others have stated in their testimony, the programs working to
assist individuals with disabilities to obtain real and meaningful work
are woefully under-funded. A Ticket Program designed to redistribute
rather than supplement existing funds is destined to fail. The work
that State VR agencies and community rehabilitation providers perform
is difficult, it is important, and it has real value to people with
disabilities. It can be improved upon but what is good must be
maintained. The threat of a new program diverting scarce funding from a
collaborative system of proven effectiveness causes apprehension and at
times conflict rather than promoting enthusiastic and creative
participation.
It is in the interest of the Social Security Administration, ENs,
State Vocational Rehabilitation Programs and most importantly people
with significant disabilities hoping to work, that this tension be
relieved. Congress and the SSA should make it clear that the Ticket
Program and the VR cost reimbursement program complement one another;
supplement one another, and together work to creatively address the
needs of individuals with disabilities seeking to maximize their
economic independence.
How the Ticket Program and VR Cost Reimbursement Program Could Together
Improve the Prospect of Long Term Employment for Individuals
With Disabilities
The State VR Program is mandated to provide an eligible individual
with any service described in an individualized plan of employment
necessary to assist them in preparing for, securing, retaining, or
regaining an employment outcome that is consistent with the strengths,
resources, priorities, concerns, abilities, capabilities, interests,
and informed choices of the individual. It is neither uncommon nor
unrealistic for many individuals with significant disabilities to seek
and obtain costly vehicle modifications or payments for the costs of
college degrees from the State VR Program. Yet, such expectations are
justifiably viewed as unrealistic or beyond the scope of the capacity
of ENs to address.
Many individuals with disabilities require long-term ongoing
supportive services to enable them to successfully obtain and retain
employment. Long-term supports to employment are often beyond the scope
of services available to consumers from the State VR agency. Community
rehabilitation providers, serving as ENs, have the expertise and staff
to provide this necessary and relatively low cost on the job service to
individuals with disabilities. All that is needed is a funding
mechanism. In Massachusetts, we have developed some means by which we
are able to support these activities. However, the need is only
partially met.
A Ticket payment mechanism that supports EN efforts to provide the
services necessary to ensure that individuals with disabilities are
able to retain employment, complimented by a VR reimbursement system
funding the up front costs associated with all aspects of individuals
preparing for and obtaining employment, will undoubtedly result in
increased, long-term, quality employment for SSI/DI recipients who
desire increased social and economic autonomy.
In Conclusion
The TWWIIA BPAO Program has been a tremendous success. There has
been positive cooperation among state and community based partners that
has resulted in an impressive number of consumer referrals with a very
high level of consumer satisfaction. The reauthorization of the BPOA
Program is a very positive development.
It is not the belief of the MRC that a lack of interested and
qualified Employment Networks is threatening the success of the Ticket
Program. 1,100 ENs is a sizeable network of service providers. It is
our belief that ENs make business decisions based upon their assessment
of what is in their and their consumers' best interests. A Ticket
Program that secures the funding base of ENs, through the preservation
of the VR cost reimbursement program, and provides ENs an opportunity
to expand existing services and resources, through a Ticket payment
system that funds the provision of long term support services, will go
a long way toward assuring the success of the Ticket Program.
Thank you again for providing the Massachusetts Rehabilitation
Commission with the opportunity to share with you some of its concerns
regarding the operation and improvement of the Ticket to Work Program.
Statement of Dan O'Brien, Oklahoma Department of Rehabilitation
Services, Oklahoma City, Oklahoma
Chairman Shaw, Ranking Member Matsui and Members of the
Subcommittee, thank you for holding this Hearing to evaluate the state
of Ticket to Work implementation. The Oklahoma Department of
Rehabilitation Services was one of the 13 initial rollout states for
the Ticket to Work in 2002.
The reality of the Ticket from the street level perspective is that
the system is broken and if not fixed will go the way of the failed
Alternate Participant (AP) Program. Most of the problems have been
predictable and the Adequacy of Incentives (AOI) Interim Report and the
Ticket Panel's Employment Network (EN) Summit report summarize both the
problems and make workable recommendations for solutions. We would
encourage Congress and SSA to adopt their recommendations forthwith
before any more potential energy is squandered. As they say in
Oklahoma, beneficiaries are beginning to wonder if they have been sold
a ``pig in a poke'', at this point the Ticket seems long on promise and
short on delivery.
It is our position that there is a substantial consensus among
experts and EN's alike that the Ticket can be salvaged if quick and
decisive action is taken soon. The market based competitive model
envisioned for the Ticket was undone by the lack of funding of the
Ticket payment structure. Baring a huge influx of new funding, a
blended funding approach, using existing resources to complement the
Ticket, is the only logical solution. The AOI Committee recommendations
(report link below), which operationalize this approach, should be
implemented rapidly and to the fullest extent possible.
http://www.dri.uiuc.edu/research/p03-08h/interim_report_03-08h.pdf
Oklahoma DRS has made every effort to ensure the Ticket's success
in Oklahoma. To that end we conducted the following activities:
Recrkuitment of EN's: When the Ticket legislation passed the DRS
agency assumed that it would be structured as complementary to the
traditional VR reimbursement program, much like the AOI study group has
recently recommended. We recruited our traditional partners in
delivering Supported Employment, a total of 26 Community Rehabilitation
Programs, to be Alternate Providers under the previous SSA return to
work program. It was our understanding that these organizations would
be grand fathered into the Ticket EN system, thus ensuring Oklahomans a
health EN network once the Ticket rolled out. However, SSA decided not
to grandfather in the AP providers and required them to resubmit an
application. The combination of this paperwork burden with the low
rates of payment resulted in few of our CRP recruits becoming EN's.
Those that did complete the paperwork have not been active. The primary
problem is the low payment rates, the Ticket milestone payments
represent a small fraction of what it costs for CRP/EN's to provide
Supported Employment services. Implementation of the AOI Interim Report
recommendations #1, to increase Milestone payments and allow payment
for partial self-sufficiency, and #3 known as the Partnership Plus,
would address the EN underfunding/undercapitalization problems that are
restricting the Ticket's EN provider systems growth.
Ticket Outreach Pilot: Under an SSA state partnership grant,
Oklahoma DRS piloted an assertive outreach/marketing effort combined
with Work Incentive education and choice of vendor using a vocational
voucher, similar to the Ticket but better funded. Beginning in 1999 and
ending in 2003 the ODRS developed systems for recruiting, educating on
work incentives and providing Job Coaching services to beneficiaries
with a Mental Health diagnosis. The techniques developed under this
grant were used to develop the procedures described in #3 through #7
below.
Required Benefits Planning: Supported Employment Contractors are
required to provide benefits planning assistance to all beneficiaries
who are placed in a job.
Active Recruitment of Ticket holders: Oklahoma DRS created a Ticket
Unit that works with the Workforce system to actively recruit Ticket
holders. Since February 2002 the Ticket staff have invited all callers
to the agency toll free Ticket hotline to Ticket Orientation meetings
held at the Workforce One Stop Centers. Thousands of Ticket holders
received basic work incentive training at a One Stop to enable them to
make use of their Ticket and plan their return to work.
Expected Eligibility Process: Oklahoma DRS developed an expedited
eligibility process for Ticket holders that resulted in determination
of eligibility and assignment to a VR/VS counselor within 3-5 days
after application. This is significantly faster than the normal
paperwork processing time prior to the Ticket rollout.
Training of DRS Staff: All DRS staff including front line staff
received training on the Ticket to Work and the agencies assertive
collaboration with Workforce on Ticket rollout.
Direct Marketing of the Ticket with the Disability Program
Navigators: The DRS and Workforce system have recently collaborated on
a pilot direct Marketing campaign designed to reinvigorate the Ticket.
Beginning in February and ending in April 2004 a pilot is being
conducted where every Ticket holder in a suburban county near Oklahoma
City is being invited to attend a Ticket Orientation meeting at the
Local Workforce One Stop conducted by the Disability Program Navigator.
In addition the SSA funded Benefits Planner, SSA's Area Work Incentive
Coordinator and local VR staff are present to answer questions about
available work incentives. This effort has received excellent feedback
from those involved and will be evaluated for it's expansion potential.
We share the CCD's concern, expressed in Paul Siefert's written
testimony, about SSA's rule on automatic assignment of the Ticket. As
one of our staff has said, ``We don't make the rules, we just abide by
them.'' SSA considers the signature on the IPE to be an indication that
an individual decided to use the ticket to obtain services from the
State VR Agency. SSA memos state ``. . . the Ticket is assigned when
the IPE (VR Individualized Plan for Employment) is signed.'' The
separation of the Ticket and Reimbursement systems, as recommended by
the AOI study group, would resolve this problem.
SSA reimbursement funds, over $100 million per year nationally,
provide services to thousands of additional beneficiaries each year.
Loss of reimbursement funds, as is happening this year across the
country, primarily due to the slow economy, reduces our ability to
serve beneficiaries. The VR system is the only part of the Ticket
system that is providing a significant level of services. SSA seems to
be in the process of dismantling the Reimbursement program without
having a working system to replace it. The logical step is to cross
breed the two systems, as the AOI group has recommended, which will
correct the deficiencies in both systems.
Our agency has collaboratively developed an EN agreement with our
EN/CRP partners, which both parties consider fair. Any funds recouped
under these agreements, strictly a theoretical case as to date there
are none, would allow the agency to serve additional SSA beneficiaries.
Our VR-EN agreement only requires EN's to pay VR 50% of payments
received from SSA under the Ticket up to the amount actually expended
by VR on direct client services. Theoretically, as no shared cases have
been developed, this is only necessary in the small minority of cases
where beneficiaries actually leave the SSA rolls. It is our
understanding that only one out of 14 beneficiaries who have work
activity ever leave the rolls, so most likely DRS will only receive any
reimbursement in less than 7% of the cases where we expend money. And
most beneficiaries do not work the entire 60 months of the outcome
period. Therefore DRS, hypothetically, would expend an average of
$10,000 per case and on 93% of the cases get nothing back from the EN
and on 7% of the cases would get back considerably less than the cost
of services. One would not be far wrong if you said this argument is
much ado about nothing.
Pennsylvania Office of Vocational Rehabilitation
Harrisburg, Pennsylvania 17102
November 24, 2004
Kim Hildred
Majority Staff Director
1025 Connecticut Avenue NW
Suite 205
Washington, DC 20036
Dear Kim:
The Pennsylvania Office of Vocational Rehabilitation (OVR) takes
exception to the testimony provided by Paul Seifert on March 18, 2004
to the House Social Security Subcommittee on Social Security's
Management of the Ticket to Work Program. OVR has invested a lot of
time, energy and resources into the Ticket to Work program in order to
maintain and continue the partnerships we have established over the
past years with other employment programs, schools, agencies and
facilities.
Employment Network Referral Agreements
A committee composed of representatives from the Pennsylvania
Association of Rehabilitation Facilities (PARF) and OVR staff spent
considerable time developing an agreement that met with the approval of
the committee. The federal guidelines established for Social Security
reimbursement were followed when determining reimbursement for services
provided. OVR's agreement does require repayment of services provided
whereby OVR receives fifty percent of each payment that the Employment
Network (EN) collects from Social Security until repaid. However, OVR
does not require repayment from the EN if the EN takes a loss on a
Ticket customer. OVR only receives payment from the EN if the EN
receives a payment.
Training and Outreach
OVR has invested significant resources to provide outreach and
training to the community and OVR staff about the Ticket to Work
Program. Individual training programs were designed and directed
specifically to OVR staff. In addition to training staff, the OVR
Ticket to Work Coordinator has presented to special interest groups,
advisory councils, schools, parents and Career Link staff. Many of
these presentations have been co-presented with members from the
Benefits Program Assistance and Outreach Programs, Social Security and
Employment Networks.
A letter has or will be sent to all OVR Pipeline cases as Tickets
are distributed informing them of the program. Included in the mailing
is a Fact Sheet that explains the Ticket program and the choices
available.
Transmittal #17
OVR does not involuntarily assign a beneficiary's Ticket without
his/her knowledge. OVR is following the guidelines established by
Social Security in Transmittal #17.
OVR counselors have been instructed to discuss the assignment of
the Ticket per Social Security regulations. In addition, a form has
been developed for counselors to give the beneficiary that specifically
addresses the assignment of the Ticket when the Individual Plan of
Employment is signed.
Employment Networks
OVR staff has reported that there are beneficiaries coming to OVR
with their Ticket, as other ENs have not accepted them for services.
Some of the reasons for refusal include:
Ticket holders only want to work part time
The EN doesn't have the resources to provide the services
needed
Lack of EN providers
EN can receive direct payment for services from OVR
faster than through Social Security
If customer isn't employment ready, they are referred to
OVR
OVR strives to facilitate and maintain viable working relationships
with agencies, schools, rehabilitation facilities, employers and all
other entities interested in providing services to people with
disabilities. Partnering with others is an intricate link in providing
quality services to those we serve.
Sincerely,
Stephen R. Nasuti
Executive Director
Statement of Larry C. Bryant, South Carolina Vocational Rehabilitation
Department, West Columbia, South Carolina
Based on the hearing that took place on March 18, 2004 regarding
the Social Security Administration's (SSA's) Management of the Ticket
to Work Program, it is evident that the concerns regarding the Ticket
to Work program continue to escalate. The South Carolina Vocational
Rehabilitation Department believes that the successful services that
the state vocational rehabilitation departments are providing to social
security beneficiaries are being over looked due to the unresolved
issued that have resulted from the 1999 Ticket to Work and Self-
sufficiency legislation. Therefore, we feel that it is necessary to
provide written documentation regarding the positive services to social
security beneficiaries that take place in South Carolina.
Since the program's inception in 1999, the South Carolina
Vocational Rehabilitation Department has actively supported the
program. Our agency has invested a significant number of resources to
train our staff regarding the ticket program and the impact that this
program has on social security beneficiaries who desire to obtain
independence through employment. Not only do we feel that our staff
members should be educated about the ticket program, we feel strongly
that our clients should have a full understanding of the program and
work incentives that go along with it. Therefore, we request that ALL
of our applicants and existing clients in the VR program who are
receiving SSI and/or SSDI meet with a Benefit Specialist to discuss
these issues. We encourage this regardless of ticket ``assignability.''
Our agency is especially proud of the relationship that we have
developed with our local Social Security offices. During the roll out
phase of the ticket program in our state, we invited Social Security
staff to attend and present at our ticket to work training sessions.
Currently, we are working closely with the Work Incentive Coordinator
in our state to provide additional ticket training in our 22 local
offices located through the state. We feel that this relationship with
SSA exemplifies the importance that South Carolina Vocational
Rehabilitation Department places on providing services to the social
security beneficiaries of South Carolina.
We are also in the process of fostering a positive working
relationship with the Employment Networks that serve South Carolina. We
feel that it is necessary to develop an Employment Network (EN)/
Vocational Rehabilitation (VR) agreement that caters to the needs of
the client not to the needs of ``reimbursement.'' It is our intention
to provide the best services to social security beneficiaries as
possible. Therefore, as we establish agreements with Employment
Networks, not only will they outline an agreed method of payment, but
most importantly shared service provisions. We do not agree with a
``take it our leave it, one size fits all'' attitude toward EN/VR
agreements. Service provision is our number one priority. The
reimbursement that we receive is to supplement our services to social
security beneficiary, not to supplant these services. Again, our
client's needs and employment objectives drive the services provided to
them. We encourage input from employment networks and other agencies
regarding service provision for our clients. I will say, however, that
the negative attitude displayed by other entities regarding Vocational
Rehabilitation and Ticket to Work activities has been discouraging.
As the Ticket to Work program continues to evolve, we feel that it
is imperative to continue obtaining input from all parties who have
been affected by this legislation. Resolutions to the issues
surrounding the ticket program need to occur quickly in order to
maintain the highest quality of service to social security
beneficiaries.
Tennessee Division of Rehabilitation Services
Nashville, Tennessee 37248
April 1, 2004
The Honorable E. Clay Shaw, Jr.
Chairman
Subcommittee on Social Security
U.S. House of Representatives
1102 Longworth House Office Building
Washington, DC 20515
Dear Chairman Shaw:
On March 18, 2004, the Subcommittee on Social Security held a
hearing on the Social Security Administration's Management of the
Ticket to Work Program. The Division of Rehabilitation Services (DRS),
with Tennessee Department of Human Services, would like to submit
written comments for the hearing record in rebuttal to testimony
presented by Mr. Paul J. Seifert, with the Social Security Task Force,
Consortium for Citizens with Disabilities.
Staff Training on the Ticket Program
Tennessee DRS State Office staff has traveled the state training
its field counselors on the Ticket to Work Program. The agency also
trains all new Vocational Rehabilitation (VR) Counselors on the Ticket
to Work Program as part of its New Counselor's Training. Additionally,
the agency often and regularly communicates to its staff updated and
important information on this subject.
Informing SSA Beneficiaries of the Ticket Program
A couple of months before the Ticket to Work Program was to be
implemented in Tennessee, the agency sent out thousands of letters to
its SSI/SSDI clients informing them of the forthcoming Ticket Program.
The letter explained the program and pointed out that this new program
was soon to start up in Tennessee. Clients were told that they may be
getting a ``ticket'' to use to help enable them to get employment.
Clients were told about the options they would have in choosing service
providers, as well about the CDR benefit in using the Ticket.
The Agreement with Employment Networks
The agency has a standard Employment Network agreement that is
applicable to all those ENs who wish to partner with the agency. There
are currently five such agreements in place in Tennessee. No EN has
voiced any concern to the State Office about the contents of this
Agreement.
According to the Ticket to Work regulations, if an EN holds a
ticket on an individual that they want to refer to a state VR agency,
they must first have an agreement in place with that agency. The
agency's agreement with ENs allows these referrals to be made under the
ticket rules.
As partners under the agreement, the Ticket Program lets the EN and
the state VR agencies decide how they wish to share the Ticket payments
from SSA.
Tennessee's agreement with their EN partners lets the state VR
agency recover monies it spends in serving the EN referrals. The money
comes through a percentage of the periodic payments the EN gets from
SSA via the EN payment system. This way, the EN always gets a portion
of the SSA payment and the state VR agency gets a portion up until the
state VR agency recovers its actual costs in serving the individual.
The state VR agency receives no monies above its actual costs.
A Possible Solution
Most state VR agencies across the nation would possibly welcome the
recommendation of the Adequacy of Incentives Work Group--i.e., that
cost reimbursement be made to state VR agencies separately from the
Ticket Program, with the Ticket money going to ENs serving the
beneficiary. In his testimony, Mr. Seifert seems to support this
recommendation. This solution lets state VR agencies recover their
costs and lets ENs receive money via the Ticket Program.
Sincerely,
Carl Brown
Assistant Commissioner
Statement of Terrell I. Murphy, Texas Department of Assistive and
Rehabilitative Services, Austin, Texas
I would like to take a moment to comment on the March 18,
2004 Hearing on the Social Security Administration's Management
of the Ticket to Work Program.
The Department of Assistive and Rehabilitative Services
(DARS) administers the public vocational rehabilitation program
in Texas. DARS has invested a significant amount of time and
other resources in order to train VR counselors about the
Ticket program. We have responded to numerous calls from
consumers inquiring about the program, and do our best to
explain not only the program but also the options available to
them. We routinely refer consumers to the Benefits Planning
Assistance and Outreach programs around the State, and
encourage consumers to contact other Employment Networks (EN)
in Texas so they can make informed decisions regarding the
service provider that can best meet their individual needs.
We originally developed a template for an EN agreement
based on models from other States. This template basically
required full repayment of VR's costs. For example, when VR
expends less than $10,000 on a beneficiary referred by an EN
that holds the beneficiary's ticket assignment, VR may ask for
50 percent of the EN's outcome payments until VR has received
full reimbursement for the services purchased for that
beneficiary. For cases where VR expends more than $10,000, VR
may seek a greater percentage of the EN's outcome payments. Our
rationale was that it was in the best interest of our consumers
for us to reclaim as much money as possible in order to be able
to serve additional consumers. Our experience has been that
Employment Networks have demonstrated little interest in
entering into this type of agreement. As a result, we have
initiated a process to meet with representatives from
Employment Networks to discuss creating an agreement that would
be more suitable.
Our goal is to work cooperatively with Employment Networks
and all other interested individuals and organizations in order
to best meet the employment needs of individuals with
disabilities.
Utah State Office of Rehabilitation
Salt Lake City, Utah 84114
April 1, 2004
Committee on Ways and Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington D.C. 20515
Dear Honorable Congressmen E. Clay Shaw Jr. and Members of the
Subcommittee,
In regard to the March 18th Hearing on the Social Security
Administrations management of the Ticket to Work program, we
respectfully provide the following input.
We applaud the efforts of Congress and Social Security to create
work incentives for individuals with disabilities. These new provisions
have created countless opportunities for individuals who otherwise
would not have engaged in work activity. We respect an individual's
right to choose how and whether rehabilitation services will be
provided. Furthermore, we support the efforts of Congress, the Social
Security Administration and the Ticket to Work Advisory Panel to make
improvements to the Ticket to Work program. It is due to our interest
in helping make this program a viable and affable program for
beneficiaries and Employment Networks (EN's) (including State
Vocational Rehabilitation Agencies), that we want to ensure Congress
have access to accurate information regarding states implementation of
the Ticket to Work program.
Many of the concerns regarding the Ticket to Work program have been
well documented over the past two years. Others have not. The Utah
State Office of Rehabilitation (USOR) agrees with the recommendations
made recently by the Ticket to Work Advisory Panel. The problems
associated with low EN participation have been attributed to the high
amount of risk involved in assigning tickets with little or no hope for
claiming any payment from Social Security. However USOR feels that EN
participation has not been affected in the manner espoused by Mr.
Seifert. In Paul Seifert's testimony, he asserts that ``State VR
agencies have developed stand alone, take it or leave it one size fits
all agreements for EN's in their states''. He further asserts that
these agreements ``require full and total repayment of all of VR's
costs''. In the state of Utah, we have conducted focus groups with our
EN's to explore the fairness of our draft agreement. The Employment
Networks were given a draft copy of the agreement and encouraged to
make comments. We have maintained the position that EN's in our state
are not obligated to sign any agreement, and we have encouraged them to
draft their own agreements for our consideration. Furthermore, we have
conducted countless focused training sessions in conjunction with our
Area Work Incentive Coordinator to ensure that EN's were up to date on
the provisions of the Ticket to Work legislation and to empower them to
draft their own agreements. We held our own ``EN recruitment''
symposium and dedicated almost \1/2\ day to discuss creative
partnerships. Despite our outreach efforts and openness to creative
partnerships, none of the EN's have submitted an EN agreement for our
consideration and have unanimously agreed to sign the agreement posed
by our agency.
The reasons cited by the EN's remain consistent with earlier and
well documented implementation issues with the Ticket to Work program.
The EN's in Utah are afraid of the financial risk involved in accepting
tickets, with or without VR as a partner. The EN's in Utah including
USOR meet periodically to discuss ticket issues and to provide general
support to each other. At all times, this has been done in a spirit of
cooperation and collaboration, not just between USOR, but also among
all seven of the Utah EN's. On one occasion, one of the EN's called the
Ticket to Work coordinator at USOR to ask her technical assistance in
assigning a ticket to his EN. She walked him through the process of how
he could assign a ticket to his company. In the end, the EN made the
decision not to accept the ticket, and referred the individual to VR
because he felt that the administrative work associated with the ticket
was burdensome. Our state has worked hard to create a healthy working
relationship with Employment Networks, and to emphasize the importance
of those relationships in our own staff training.
Frankly, we are offended by Mr. Seifert's testimony to the
contrary.
In further testimony, Paul Seifert criticizes the state VR agencies
who failed to register tickets in a timely fashion, with the
unfortunate circumstance of benefits being reduced (and later restored)
for a beneficiary. We would just like to assure Congress as well as Mr.
Seifert that our state database system allows us to track where all our
tickets are during the entire assignment process. We have created an
electronic system of completing the SSA1365 form and recording when the
ticket is actually assigned by Maximus thereby hoping to alleviate any
of the potential problems mentioned in testimony.
Finally, Mr. Seifert addresses transmittal 17. The Utah State
Office of Rehabilitation shares concern over this policy decision made
by the Social Security Administration. Informed Consent has been a
guiding force in our daily operations prior to Ticket to Work, and
remains integral to our Ticket policy and procedure today.
During the first two years of the Ticket Implementation process I
chaired the Council of State Administrations of Vocational
Rehabilitation (CSAVR) Committee on Social Security Relationships. The
committee had numerous meetings with SSA, RSA and others to identify
issues and seek solutions regarding implementation problems associated
with the Ticket to Work and Work Incentives Act. Quarterly
teleconferences were held between the states currently implementing the
ticket, CSAVR, RSA, and SSA to determine how the ticket was being
implemented and to provide technical assistance. In addition CSAVR, SSA
and RSA sponsored national training conferences prior to each group of
states that were implementing the Ticket program. Even before the
ticket program began, CSAVR was providing input to SSA and Congress
regarding these issues. In the last four years, upper management from
SSA and Maximus have participated in every CSAVR conference.
Contrary to Mr. Seifert's testimony, it has been my observation
that State VR agencies have bent over backwards to assist in the
development of the ticket program. Yes, a few states have made some
mistakes which have been corrected. In the final analysis the Ticket
program would be dead in the water without the State VR agencies.
The State of Utah is still in early implementation phase. There
have only been 11,698 tickets mailed thus far, with 72 tickets
assigned. Utah, like other states has made great preparations for this
program. We are hopeful that measures will be taken to ensure the
success of this program. We support the recommendations made by the
Adequacy of Incentives Advisory Committee and as well, the Ticket to
Work Advisory Panel recommendations. We urge Congress to seek input
from all states regarding Ticket to Work Implementation. The Ticket to
Work and Work Incentive Improvement Act holds much potential for job
seekers with disabilities, but to realize the potential of this program
we must work together to overcome the barriers rather than pointing
fingers. The Utah State Office of Rehabilitation is committed to
working with Congress and the Social Security Administration in
realizing the potential of this important program.
Respectfully,
Blaine Petersen
Executive Director
Statement of Michael O'Brien, Washington Department of Social and
Health Services, Division of Vocational Rehabilitation, Lacey,
Washington
Mr. Chairman, Mr. Matsui, and members of the House Social Security
Subcommittee, I am writing on behalf of Washington State Division of
Vocational Rehabilitation (DVR) in order to provide written testimony
in connection with the hearing on the Social Security Administration's
implementation of the Ticket to Work and Self-Sufficiency Program,
authorized under the Ticket to Work and Work Incentives Improvement Act
of 1999.
I am writing in response to the comments made in Mr. Seifert's
testimony under the heading ``State VR Agencies, Employment Networks
(ENs) and Beneficiaries.'' Mr. Seifert's written testimony states:
``State VR agencies have developed stand-alone, take-it-or-leave-it,
one-size-fits-all agreements for ENs in their states. These agreements
all contain one common provision--the full and total repayment of all
of VR's costs out of the EN's ticket payment by an EN who refers a
beneficiary to VR.''
This is not our practice in Washington State. The fact is, we want
and need ENs. Washington State has a capacity issue and we believe ENs
can assist in addressing this issue. Our agreements with ENs do not
require more than a forty percent reimbursement to DVR on a shared
Ticket. We have provided technical support to the local Workforce
Development Councils to assist them in becoming Employment Networks. We
are in the process of providing training on Ticket and work incentives
to One-Stop staff. We will be holding focus groups this spring with ENs
to figure out what else can be done to assist them.
Washington State DVR took an active role a year prior to the phase
three roll-out in order to ensure that Ticket was successful in our
State. We formed an interagency Ticket Advisory Group whose purpose was
to prepare the state for Ticket, to encourage and support the
development of Employment Networks, and to ensure that work incentives
were understood throughout the system so that customers would take
advantage of the incentives. Sixteen of DVR's staff have gone through
the SSA certification to become benefits planners. Washington State DVR
developed its own training modeled after the SSA training and has
trained one third of its staff in benefits planning.
The Ticket Advisory members also have coordinated numerous joint
and solo presentations on Ticket to Work, SSA work incentives, and the
Medicare Buy-In program. Washington State DVR sponsored and coordinated
two spring conferences on Ticket to Work to encourage EN development.
Those conferences were attended by over 400 people. Washington State
DVR paid for national experts on Ticket to speak.
Under the leadership of Washington State DVR, this committee
developed a Ticket brochure with basic information on Ticket that could
be used system wide, as well as a Ticket brochure for transition
students. We compiled a list of frequently asked questions which is
posted on all partners' websites. We currently are planning six one-day
conferences statewide that will enable customers to better understand
Ticket and the related work incentives.
Washington State DVR set up a toll-free line that anyone with a
Ticket question can call. What we are finding is that, as a state,
there is a serious problem of Ticket holders having nowhere to use
their Ticket. Few ENs in our state are accepting Tickets and many
Ticket holders are very frustrated. Unfortunately, DVR cannot be the
answer because we are in ``order of selection'' and have a long waiting
list.
Mr. Seifert, in his testimony, faults VR agencies for delaying or
failing to assign a beneficiary's Ticket, resulting in the beneficiary
being subjected to a Continuing Disability Review (CDR). I would like
to state that this does not occur in Washington State. We have made it
very clear to Ticket holders and DVR staff that a Ticket is assigned
only when the 1365 form and the Individualized Plan for Employment
(IPE) is signed. We have held four statewide trainings on the Ticket
program, and 31 additional trainings at every DVR office in the state
to insure our staff understands when and how a ticket is assigned.
However, there is a problem. Transmittal 17 states that a
beneficiary's signature on the IPE indicates that the beneficiary has
decided to use the ticket to obtain services from the State VR agency,
if the ticket is assignable. This effectively takes away any choice
from the individual. If ticket holders sign the IPE--which must occur
in order to receive services--then according to TM 17 they have
assigned their ticket.
Washington State has chosen to submit only Tickets that the
beneficiary has deliberately assigned to us. I would suggest that the
problem is with TM 17, not with public rehabilitation.
Thank you for the opportunity to share information about Ticket
implementation and issues in Washington State.
Statement of West Virginia Division of Rehabilitation Services,
Charleston, West Virginia
Reference Hearing on SSA Management of the Ticket to Work program held
on M arch 18, 2004
The West Virginia Division of Rehabilitation Services (WV DRS)
provides the following comments as it relates to the above referenced
hearing:
1. WV DRS has invested significant resources to train all VR
Counselors and administrative staff in the Ticket to Work program,
developed a brochure to educate beneficiaries about the program and
updated the Electronic Case Management system to collect additional
data needed for the program.
2. WV DRS has provided training to our Consumer Advisory
Committee, State Rehabilitation Council and Statewide Independent
Living Council on the ticket program, as well as, facilitated training
provided to the Community Rehabilitation Programs in our state.
3. WV DRS has worked with Social Security Administration and asked
for their input into developing our processes and procedures for
implementing the Ticket to Work program.
4. WV DRS refers all Social Security recipients to the Benefits
Planning Assistance and Outreach program specialist to discuss how
working will effect their benefits and any incentives they can take
advantage of when entering or re-entering the workforce.
5. Our interpretation of the SSA Transmittal 17--If an individual
applies for VR services, is determined eligible, meets our order of
selection of having a most significant disability and works with the
Rehabilitation Counselor to develop their Individual Plan of Employment
and would not agree to assign their ticket to the agency; then DRS
would send MAXIMUS the front and back page that includes signatures of
the IPE and the unsigned SSA 1365. This effectively establishes that
DRS is working with the individual and gives MAXIMUS the data it needs
to determine ticket assignment and/or sharing of reimbursements.
Since West Virginia is a third round state, we do not yet have any
agreements with Employment Networks in our state but we are not
experiencing negative relationships with other Employment Networks.