Changes to Ticket Program Regulations

Due to low participation rates by both ticket holders and ENs—in 2005, we  reported less than 1 percent of 9.5 million ticket holders had assigned their  tickets to an EN or VR and 386 of 1,164 contracted ENs were accepting  tickets—SSA revised the Ticket program regulations in 2008 (see table 1). More Ticket Holders and Employment Networks Participating, but Participation Rate Remains Low

		More Ticket Holders Assigned Their Tickets Since 2008 Regulatory Changes, but They Remain a Small Share of Those Eligible

The number of eligible ticket holders assigning their tickets to ENs  increased from about 22,000 in fiscal year 2007, prior to the 2008 changes  in regulations, to more than 49,000 as of July 2010. During this time, ENs accepting at least  one ticket also increased from 752 to 1,086. Additionally, ENs receiving ticket payments from  SSA more than doubled, from 206 in fiscal year 2007 to 460 as of July 2010,  and total payments grew substantially, from $3.8 million in fiscal year 2007  to $13 million as of July 2010. In fiscal year 2009, 20 ENs representing 1.2  percent of all SSA-contracted ENs and 1.9 percent of those ENs accepting  tickets received 71 percent of total ticket payments. Employment Networks Vary in Service Approaches, but Increasingly Focus on the Employed or Ready to Work

ENs receiving among the largest payment amounts from SSA provide a  range of services, including assistance with job search and retention. The 2008  regulatory changes more explicitly allow ENs to pay ticket holders and we  found increasing numbers of ENs sharing SSA ticket payments with ticket  holders who have sufficient earnings to qualify the EN for payment. In addition to the shared payment approach which targets ticket holders  already working, two “employer-driven” service approaches which target  ticket holders who are ready to work have also accounted for a greater  share of SSA payments to ENs among those with the largest payment  amounts: the direct employment approach, in which the EN itself employs  ticket holders, and the staffing approach, in which the EN primarily works  with employers to develop and identify jobs for ticket holders, similar to a  staffing agency. SSA Lacks Adequate Management Tools for Evaluating Ticket Holders and Employment Networks to Ensure Program Integrity and Effectiveness

		SSA Has Not Consistently Monitored Ticket Holders’ Timely Progress Toward Self-Supporting Employment

Since 2005, SSA has not consistently monitored or enforced the timely  progress of ticket holders who assign their tickets to ENs and VRs in order  to assess whether they should continue to be exempt from medical  continuing disability reviews (CDR)—a key tool for assessing continuing  eligibility for benefits. SSA Has Not Developed Performance Measures for Employment Networks

SSA has not developed performance measures for contracted ENs to  assess their success in helping assigned ticket holders obtain and retain  employment and reduce dependence on disability benefits. SSA’s Approval Process for Employment Networks Lacks Systematic Mechanisms to Ensure Quality

SSA’s process for approving ENs to serve ticket holders lacks systematic  tools to ensure quality, such as requiring all applicants to submit a  comprehensive business plan for how their services will help ticket  holders obtain and retain employment and reduce dependency on benefits,  and providing clear and specific written criteria to SSA staff who review  qualifications of applicants. Recommendations for Executive Action

To inform assessments of the program’s cost and effectiveness and  enhance SSA’s oversight and monitoring of ENs and ticket holders, we  recommend that the Commissioner of Social Security take the following  four actions:    prioritize and carry through with a study of participating ticket holders’  exits from the rolls since revisions to the program’s regulations took effect  in 2008;   adopt a strategy for compiling and using data on trends in employment  network service provision to determine whether service approaches, such  as sharing SSA ticket payments with ticket holders, are consistent with  program goals of helping ticket holders find and retain employment and  reduce dependency on benefits; for example, SSA could revise existing  tools to compile information on service approaches used by all ENs;   develop a strategy to ensure on-time completion of timely progress  reviews of ticket holders and take steps to ensure the accuracy of  information used to make timely progress determinations; and   move forward to develop EN performance measures consistent with the  requirements of the Ticket law. SSA also offered alternative language  for the wording of two other recommendations. Appendix I: Scope and Methodology

Our review focused on (1) ticket holder and employment network (EN)  participation over time, (2) service approaches used by ENs, and (3) the  Social Security Administration’s (SSA) policies and processes for  evaluating ticket holders and ENs. We judgmentally selected ENs who  advertised paying a portion of the ticket payment to ticket holders or  providing financial incentives to employers, or whose services were  unclear. The full transcripts of these three  calls are provided below. What’s that? This is ? And still receive the benefits of both  Ticket to Work and—and—disability?
Why GAO Did This Study

The Social Security Administration (SSA) pays billions of dollars in Disability Insurance and Supplemental Security Income to people with disabilities. The Ticket to Work program, established in 1999, provides eligible beneficiaries (ticket holder) with a ticket they may assign to approved service providers, called employment networks (EN). ENs are to provide services to help ticket holders obtain and retain employment and reduce dependence on SSA benefits. ENs receive payments from SSA once a ticket holder has earnings exceeding a set threshold. Due to low participation, SSA changed program regulations in 2008 to provide ENs and ticket holders with more incentives to participate. GAO examined (1) changes in ticket holder and EN participation over time, (2) the range of service approaches used by ENs, and (3) SSA's efforts to evaluate ticket holders and ENs to ensure program integrity and effectiveness. GAO analyzed SSA data, policies, and procedures, and interviewed representatives of 25 ENs, disability advocacy organizations, and SSA.

What GAO Found

More ticket holders and ENs are participating in the Ticket to Work program since SSA revised regulations in 2008, but the overall participation rate remains low. Ticket holders assigning their tickets to ENs increased from about 22,000 in fiscal year 2007 to more than 49,000 as of July 2010. However, less than 1 percent of all ticket holders assigned their tickets to ENs and SSA has not yet studied whether regulatory changes enabled more ticket holders to obtain employment and exit the benefit rolls. During this time, ENs approved to serve ticket holders increased from 1,514 to 1,603, and SSA's ticket payments to ENs increased from $3.8 million to $13 million. However, 20 ENs, or less than 2 percent of those currently participating, have received the majority of total ticket payments from SSA. GAO found that ENs provide a range of services, including job search and retention assistance. Since the 2008 regulatory changes, which explicitly allowed ENs to pay ticket holders, an increasing number used service approaches such as sharing SSA's government-funded ticket payments with ticket holders. These ENs target ticket holders already working or ready to work, and accounted for a substantial and growing share of payments from SSA. Three ENs among those with the largest payment amounts reported providing limited or no direct services beyond passing back a portion of ticket payments to ticket holders who had sufficient earnings to qualify the ENs for payment. These ENs received a total of over $4 million in SSA payments-- nearly one-third of all SSA payments--in fiscal year 2009. Two of these ENs passed back 75 percent of SSA's ticket payments to ticket holders and kept the other 25 percent. The extent of these trends is unknown because SSA does not collect sufficient information on service approaches across all ENs. SSA lacks adequate management tools to systematically evaluate ticket holders and ENs. Since 2005, SSA has not consistently monitored or enforced ticket holders' progress toward self-supporting employment--a regulatory requirement. Ticket holders who show progress are generally exempt from medical reviews to determine their continued eligibility for benefits. Lack of systematic monitoring of timely progress has both program integrity and cost implications, such as the potential for ineligible beneficiaries to continue receiving benefits. During the course of GAO's review, SSA was beginning to resume the progress reviews, but it is too early to assess the effectiveness of these efforts. Moreover, SSA has not developed performance measures for approved ENs, as required by law, that can be used to assess their success in helping ticket holders obtain and retain employment and reduce dependency on disability benefits. Without such measures, multiple ENs communicate to ticket holders how to work and keep full disability benefits, despite the fact the ultimate goal of the Ticket program is to reduce dependence on benefits (to hear audio excerpts of GAO's calls with selected ENs, see http://www.gao.gov/products/GAO-11-324 ). Finally, SSA's EN approval process lacks systemic tools to ensure quality and clear and specific criteria for reviewing EN qualifications.

What GAO Recommends

GAO is recommending SSA take several steps, such as compiling service trend data and monitoring ticket holders' progress, to enhance program oversight. SSA agreed with two recommendations and offered alternative language for the other two to reflect actions it considers planned or under way.