Ticket holders who assign their  tickets and demonstrate “timely progress” toward self- supporting employment, such as by fulfilling minimum earnings  or education requirements to be reviewed regularly, are  exempted from medical CDRs. When the ticket holder has sufficient earnings, the  EN becomes eligible for payments from SSA. Due to low participation rates by both ticket holders and ENs,  SSA revised the Ticket program regulations in 2008. According to EN  representatives, ticket holder participation remains low due, in  part, to a lack of understanding and awareness of the program. Although the number of ticket holders assigning their tickets has  increased since the 2008 changes, the extent to which more  ticket holders are returning to work and exiting the benefit rolls  is unknown. In our May report, we recommended that SSA prioritize and  carry through with a study of participating ticket holders’ exits  from the rolls and the agency noted it has plans to study the  effects of the 2008 changes on the Ticket program. Although an increasing number of ENs are participating in the  Ticket program since the 2008 changes in regulations, many  ENs are not actively participating and SSA ticket payments have  remained concentrated with only 20 ENs. Employment Networks Vary in Service Approaches, but Increasingly Focus on the Employed or Ready to Work

Those ENs receiving some of the largest payment amounts from  SSA provide a range of services, including assistance with job  search and retention. But since the 2008 changes in regulations,  an increasing number of ENs used service approaches targeting  ticket holders who are already working or do not need  assistance in obtaining employment. In our May report we recommended that SSA  adopt a strategy for compiling and using data on trends in EN  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. SSA Lacks Adequate Management Tools for Evaluating Employment Networks and Ticket Holders to Ensure Program Integrity and Effectiveness

SSA has not developed EN performance measures to assess  their success in helping assigned ticket holders obtain and retain  employment and reduce dependence on disability benefits. Without performance measures, SSA is unable to systematically  evaluate EN performance, and ultimately determine whether  ENs should be allowed to remain in the program. SSA’s EN handbook does state the ultimate goal  of the program is to reduce dependence and, whenever  possible, eliminate reliance on benefits. 1 for excerpts of calls our investigative staff made to ENs  posing as the brother of a ticket holder to learn about the Ticket  program and the services provided by the ENs). We recommended that SSA move  forward to develop EN performance measures consistent with  the requirements of the Ticket law. SSA also 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 CDRs—a key tool for assessing continuing  eligibility for benefits. However, SSA has acknowledged in the preamble to its program  regulations and in a 2005 internal memo the importance of  reviewing timely progress to ensure ticket holders who have  medically improved and no longer meet SSA’s disability  requirements do not receive benefits and its disability programs  do not incur unwarranted costs.
Why GAO Did This Study

This testimony discusses the Social Security Administration's (SSA) Ticket to Work and Self-Sufficiency Program (Ticket program). Created by law in 1999, the Ticket program was intended to assist disability beneficiaries in obtaining and retaining employment, and potentially bring about significant savings to the Disability Insurance Trust Fund by reducing or eliminating their benefits. Under the program, SSA provides each eligible beneficiary (ticket holder) with a ticket to obtain services from SSA-approved public or private providers, referred to as employment networks (EN), or from traditional state vocational rehabilitation agencies (VR). When the Ticket program was created, it was estimated that it had the potential to provide significant savings to the Social Security Trust Funds and Treasury. However, our prior work and the work of SSA's Office of the Inspector General and others has questioned the viability of the program due to low participation and costs that are not offset by beneficiaries returning to work and reducing dependency on benefits. In an effort to address these concerns, SSA revised its regulations in 2008 to attract more ticket holders and ENs. This testimony summarizes our report issued in May and focuses on (1) how participation of ticket holders and employment networks in the Ticket program has changed over time, (2) what is known about the range of service approaches used by employment networks, and (3) the policies and processes SSA has to evaluate employment networks and ticket holders to ensure program integrity and effectiveness.

What GAO Found

In summary, we found that more ticket holders and ENs are participating in the Ticket program since SSA revised its regulations in 2008, but the overall participation rate remains low. SSA has not yet studied whether the 2008 changes have enabled more ticket holders to obtain employment and exit the benefit rolls. The number of ENs approved to serve ticket holders has increased; however, many ENs are not actively participating, and ticket payments have remained concentrated with only 20 ENs. These ENs provide a range of services, including assistance with job search and retention. But since the 2008 changes in regulations, an increasing number have used service approaches targeting ticket holders who are already working or ready to work, including simply passing back a portion of the payment from SSA. Finally, we found SSA lacks adequate management tools for evaluating ENs and ticket holders to ensure program integrity and effectiveness. For instance, 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. Without such measures, we found multiple ENs communicating to ticket holders how to work part time and keep full disability benefits indefinitely, despite the fact that the ultimate goal of the program is to reduce dependence on benefits. In addition, ticket holders who show timely progress toward self-supporting employment are generally exempt from medical continuing disability reviews (CDRs) conducted to determine continued eligibility for benefits. However, SSA has not consistently monitored or enforced the requirements for timely progress and, therefore, ticket holders in the program have been exempt from CDRs for years regardless of whether they show progress in the program. 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. In our May report, we made four recommendations to address these issues and enhance program oversight. SSA has already implemented one of these recommendations, developing performance measures for ENs, and has reported it is moving forward to implement another to track EN service approaches and assess their consistency with program goals. We will continue to monitor the agency's implementation of the other recommendations.