Disability Topics

At a Glance

Funder:

Social Security Administration

Project Time Frame:

2003-2011

Ticket to Work: Helping People with Disabilities Find and Keep Jobs

Mathematica conducted a 10-year evaluation of the Ticket to Work (TTW) program, a major initiative of the Social Security Administration to increase disability beneficiaries' employment and reduce their dependence on benefits.

The TTW program increases beneficiaries' choice of employment-support providers by expanding the types of organizations that SSA will pay to assist beneficiaries' work efforts. Prior to TTW, SSA funded only state vocational rehabilitation agencies to help beneficiaries. Now, it pays a wide array of public and private providers, called employment networks (ENs). TTW also introduced a new financing system for the ENs. This system provides performance incentives for ENs because they receive full payment only when a beneficiary they served earns his or her way off the rolls and stays off for 36 months. The old system for state vocational rehabilitation agencies, which still exists, did not require beneficiaries to actually leave the rolls, only that they accrue earnings for nine months at a level consistent with SSA's definition of substantial gainful activity.

Service delivery in TTW is constrained, however, by providers' desire to limit expenditures to a level that fits within the payments they expect to receive. Service delivery is also constrained by providers' perceptions of whether the services they provide are likely to result in a beneficiary leaving the rolls. In fact, providers can refuse to serve beneficiaries they view as unlikely to leave the rolls for work. In July 2008, SSA implemented new regulations in the TTW program designed to increase participation by ENs and beneficiaries. The new regulations increased payments to ENs, reduced the time period beneficiaries must remain off the rolls for ENs to receive full payment, and allowed beneficiaries to receive services from ENs even after receiving services from a state vocational rehabilitation agency that were paid for by SSA.

Mathematica assessed program implementation and effects on employment, earnings, and benefit receipt. Special attention was paid to how well the program serves beneficiaries who may have difficulty finding a provider. The evaluation included a series of surveys: one focused on a nationally representative sample of all beneficiaries and another focused only on beneficiaries who have used their Ticket to Work. In total, we conducted more than 20,000 beneficiary interviews on a range of issues, including disability and work status, awareness of TTW and other work incentive programs, program experiences, employment services used, health and functional status, health insurance, income and other assistance, sociodemographic characteristics, and other issues.

Our 2008 evaluation report noted that TTW increased beneficiary use of employment services in 2002 and 2003, the first two rollout years. However, the increase did not appear to produce a corresponding increase in beneficiary earnings or a reduction in benefit payments. The authors noted that impacts for 2004 and later may be larger as participation rates continue to increase, and many nonparticipants say they plan to assign their TTW. Nevertheless, analysis of trends in TTW payment data suggests that the program would have to induce future shifts in beneficiary behavior that are much larger than what has been observed so far in order to generate the level of exits from the program envisioned by Congress. In particular, meeting the exit goal will require TTW participation to increase substantially and a larger share of participants to earn enough so that they no longer receive cash benefits.

From the studies conducted for the final evaluation report completed in 2013 it appears that TTW and related programs are having a limited but positive effect on the employment of Social Security disability beneficiaries and have motivated some beneficiaries to pursue employment. The 2008 revisions to the TTW regulations reinvigorated the program by modestly expanding the number of ENs and increasing their level of activity in the TTW program. The number of beneficiaries who assigned a Ticket under an EN payment system more than doubled between June 2008 and December 2009. The revised regulations also appear to have improved the viability of ENs, increasing both the timing and amounts of payments received for successfully serving TTW participants. Although relatively few beneficiaries continue to be enrolled in SSA-funded employment support programs through TTW, those who used such services had better employment outcomes and were more likely to leave benefits than those who did not. Beneficiary employment was adversely affected by the 2007–2009 recession and its aftermath, which confounded comparisons of TTW participant employment outcomes during the pre- and post-TTW regulation change periods. Although the employment and earnings of TTW participants were lower, on average, after the revised regulations took effect, beneficiary satisfaction with TTW services was greater. While we found evidence that TTW is targeting individuals interested in employment, rigorous impact analyses failed to provide strong evidence of its impact on employment.

Data Collection Highlights
For the National Beneficiary Surveys being conducted for the TTW evaluation, we used computer-assisted telephone interviewing (CATI) with computer-assisted personal interviewing to follow up with those who could not be reached through CATI and those who preferred, or needed, an in-person interview to accommodate their disabilities. Both modes were fully integrated to simplify reporting and data processing.

As part of our effort to innovate and develop best practices, we introduced design features into the questionnaire to overcome communication, stamina, and cognitive barriers. We also designed data collection procedures to maximize self-response while ensuring data quality. This process included conducting specialized interviewer trainings; using assistive technologies such as teletypewriters, Telecommunications Relay Service, amplifiers, and instant messaging to enable persons with hearing or speech impairments to participate for themselves; conducting in-person followups; and permitting assisted interviews to increase self-response rates. An innovative “mini-cognitive test” was used to identify when proxy respondents were needed to complete a survey for respondents who could not do so themselves (even with assistance). Several additional methodological experiments were built into round four to compare methods for determining the need for a proxy and evaluate potential mode effects.

In-house and in-the-field locating efforts resulted in more than 90 percent of the sample being located for each round. In 2004 7,604 interviews were completed for round one (a weighted response rate of 78 percent for the beneficiary sample and 81 percent for the TTW participant sample), 8,106 interviews were completed in 2005 for round two (a weighted response rate of 79 percent for the beneficiary sample and 81 percent for the TTW participant sample), 6,605 interviewers were completed for round three in 2006 (a weighted response rate of 81 percent for the beneficiary sample and 82 percent for the TTW participant sample), and 5,078 interviewers were completed for round four in 2010 (a weighted response rate of 73 percent for the beneficiary sample and 71 percent for the TTW participant sample). We also prepared analysis files, including public use files and documentation for each NBS round.