	Introduction

Title I of the Ticket to Work and Work Incentives Improvement Act of 1999 ( P.L. 106-170 ) established the Ticket to Work and Self-Sufficiency program (hereinafter referred to as the Ticket to Work or Ticket program), which is administered by the Social Security Administration (SSA). The purpose of this program is to enhance work incentives for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries . The goal of the Ticket program is to reduce dependence on disability benefits and help Social Security disability beneficiaries enter or reenter the workforce. This report provides an overview of how the Ticket to Work program operates and addresses several issues related to the Ticket program. 1180 into law on December 17, 1999, which became P.L. Specifically, the legislation authorized (1) "tickets" or vouchers to beneficiaries to give them increased choice of rehabilitation providers and access to services needed to obtain and retain employment, (2) payments to employment service providers based on ticket holder achieving certain employment "milestones" or outcomes, (3) SSA demonstrations to test different approaches to removing barriers to employment for Title II (SSDI) beneficiaries, and (4) options for states to adopt a Medicaid "buy-in" program to allow beneficiaries to maintain health coverage after returning to work and a continuation of Medicare coverage to certain beneficiaries who are working. ENs are responsible for assisting ticket recipients with entering or re-entering the workforce. The program is currently administered by two contracted program managers (PMs) who report to SSA administrators. The program was initially available for eligible beneficiaries in 13 states and was extended to all states by September 2004. ENs have been selected to conduct vocational rehabilitation and other services for ticket holders in all 50 states and the District of Columbia. The regulations indicate measures to assess beneficiaries' progress through SSA's performance of TPRs at
12 months in which the ticket holder is required to have worked 3 months above the TWP level or completed 60% of full-time college credits, 24 months in which the ticket holder is required to have worked 6 months above the TWP level or completed 75% of full-time college credits, 36 months in which the ticket holder is required to have worked 9 months at the SGA level or completed a 2-year program or an additional 1 year of full-time college credit, 48 months in which the ticket holder is required to have worked 9 months at the SGA level or completed an additional 1 year of full-time college credit, 60 months in which the ticket holder is required to have earnings for 6 months that are sufficient for a zero cash benefit or completed an additional 1 year of full-time college credit, 72 months in which the ticket holder is required to have earnings for 6 months that are sufficient for a zero cash benefit or completed a 4-year degree program, and successive 12-month periods in which the ticket holder is required to have earnings for 6 months that are sufficient for a zero cash benefit status. Other Provisions of Ticket to Work Legislation

P.L. The legislation also established two grant programs for the purpose of disseminating accurate information to beneficiaries with disabilities on work incentive programs. 106-170 also authorized SSA to award one or more cooperative agreements with qualified organizations to provide benefit planning, assistance, and outreach. These Work Incentives Planning and Assistance (WIPA) programs are community-based organizations that receive grants from SSA to provide services to Social Security disability beneficiaries with free access to long-term employment planning support. Awarded under the Protection and Advocacy for Beneficiaries of Social Security (PABSS) program, these grants are in addition to the current Developmental Disability program grants. The purpose of the grants is to provide information and advice about how to obtain vocational rehabilitation, employment, advocacy, or other services that SSDI or SSI beneficiaries may need to secure or regain gainful employment. Of the 13.6 million tickets issued, 319,972 (approximately 2.4%) have been activated (i.e., the ticket has been assigned to an EN or state VR agency). Low Participation Among Social Security Beneficiaries

The Ticket to Work program has come under increased scrutiny and criticism by policy makers for low participation rates among eligible SSDI and SSI recipients. Lack of Employment Network Oversight

GAO found that between FY2007 and July 2010, the number of ENs providing employment support services to ticket holders and SSA payments to ENs increased dramatically, likely a result of the July 2008 regulatory changes that offered additional financial incentives to ENs to participate in the Ticket program. This has possibly led to service approaches by ENs in which the Ticket to Work revenue sharing provisions have become out of line with the general goals of the Ticket program.
Title I of the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170) was signed into law on December 17, 1999, and created a Ticket to Work and Self-Sufficiency program, administered by the Social Security Administration (SSA). Through the Ticket to Work legislation, Congress sought to address several major work disincentives for individuals with disabilities. Ticket to Work provides a "ticket" or voucher to working-aged Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries to obtain employment and other support services. Services are furnished through the current system of state vocational rehabilitation (VR) agencies or a ticket holder's choice of an approved public or private sector, program-specific employment network (EN) to assist them in entering or re-entering the workforce. Additional provisions are briefly described below.
The Ticket to Work program was phased in nationally in three stages, which began in February 2002 and concluded in September 2004. By statute, SSA contracts with program managers (PMs) to administer program aspects related to ENs and ticket holders. As of December 31, 2013, SSA has 666 ENs certified to provide employment support services for ticket holders in all 50 states and the District of Columbia. Of the approximately 13.6 million "active" tickets that have been issued by SSA, 319,972 (approximately 2.4%) are "in-use," that is, a disability beneficiary has assigned his or her ticket to an EN or state VR agency.
P.L. 106-170 also directed SSA to establish supplementary work incentive programs designed to reduce dependence on disability benefits and encourage workforce participation. The Work Incentives Planning and Assistance (WIPA) program was created to disseminate accurate information to Social Security disability beneficiaries on work incentive projects. SSA established cooperative agreements with community-based organizations to provide benefits planning, assistance, and outreach services to beneficiaries. In addition, SSA established the Protection and Advocacy for Beneficiaries of Social Security (PABSS) program with the aim of providing information and advice about how to obtain vocational rehabilitation, employment, advocacy, or other services that SSDI or SSI beneficiaries may need to secure or regain gainful employment.
The Ticket to Work program underwent major regulatory changes in July 2008, which, among other adjustments, increased financial incentives for ENs and expanded the eligibility criteria for Social Security disability beneficiaries to participate. The program has come under increased scrutiny by policy makers due to low SSDI and SSI beneficiary participation and lower than expected return-to-work rates among ticket holders. In addition, a May 2011 Government Accountability Office (GAO) assessment reported a lack of oversight of the program that has led to service approaches among some ENs that are out of line with the general goal of the Ticket program, which is to reduce beneficiaries' dependence on benefits through earnings from work.
Ticket to Work legislation also created state options to eliminate the dilemma faced by many beneficiaries—choosing between work and health insurance coverage—through provisions that allow for additional Medicaid eligibility options and an extension of Medicare eligibility. This report only discusses the Ticket to Work program components administered by SSA and does not address issues related to the Medicaid or Medicare programs.