Testimony of Mr. Martin Gerry, Deputy Commissioner for Disability and Income Security Policy,
before the House Committee on Ways and Means, Subcommittee on Social Security,
on the implementation of the Ticket to Work and Work Incentives Improvement Act
September 26, 2002
Mr. Chairmen and Members of the Subcommittees:
Thank you for inviting me today to discuss the Social Security Administration's (SSA) implementation of the Ticket to Work and Self-Sufficiency Program ("Ticket program"). As you know, Mr. Chairman, President Bush has a strong interest in disability issues. The President has said that he is committed to tearing down the remaining barriers to equality that face Americans with disabilities today. His "New Freedom Initiative" will help Americans with disabilities by increasing access to assistive technologies, expanding educational opportunities, and increasing the ability of Americans with disabilities to integrate into the workforce.
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 program a reality. Established as part of the Ticket to Work and Work Incentives Improvement Act of 1999 ("Ticket Act"), it was a crucial element of meeting that legislation's goal to remove barriers to employment that many Americans with disabilities face. Because of the Ticket Program, beneficiaries will have more choices in obtaining employment support services to help them reach their employment goals.
Today I would like to provide an update on the implementation of the Ticket program, and touch upon a few related issues.
Implementation of the Ticket to Work Program
First, let me briefly outline this program. A disabled beneficiary receives a Ticket if he or she is between the ages of 18 and 64 and his or her medical condition is not expected to improve in the near future. The beneficiary may take the Ticket to the State Vocational Rehabilitation Agency or any of the employment service providers who offer employment support services in the community. These providers are called Employment Networks (ENs). The beneficiary and the Employment Network will jointly develop a plan of services leading to employment. In addition, SSA will not schedule a periodic continuing disability review (CDR) for a beneficiary who is receiving services from an EN. I will discuss these provisions in more detail later.
We are implementing the Ticket program in three phases. By using a staggered approach to implementation we can further develop and refine the program before it is fully in place. About 2.4 million beneficiaries with disabilities are eligible to receive Tickets to Work in the 13 States selected for the first phase of the program. From February through June 2002, we mailed Tickets to most of these beneficiaries in a graduated release. (Because of the impact of last year's terrorist attacks, we developed a slightly delayed release schedule for Tickets in New York.) Using this method provided time to develop an infrastructure of ENs within these states to serve the beneficiaries and to ensure that they were aware of the program's availability. Currently we have more than 400 ENs in place.
We believe the program is off to a good start. Participation is voluntary, and I am happy to report that as of this month more than 7,000 beneficiaries out of the 2.4 million beneficiaries eligible to receive Tickets have assigned their Tickets to ENs or the State vocational rehabilitation agencies in the initial 13 States. We expect to see higher numbers of beneficiaries participating as we gain experience and the program matures, but we know we have much work to do to make those expectations a reality.
The second phase of the program will begin in November 2002. During this phase of the Program, approximately 2.6 million beneficiaries are eligible to receive Tickets in 20 additional States and the District of Columbia. Then in 2003, we will release Tickets to the approximately 3.3 million beneficiaries in the remaining 17 States and the U.S. Territories during the third and final implementation phase. By January 2004, we will have fully implemented the Ticket program.
I would now like to focus on the role of the EN in the Ticket program. Under the Ticket Act, the Commissioner enters into agreements with qualified State, local, or private organizations to serve as ENs. These ENs will then provide vocational rehabilitation, employment, and other support services to beneficiaries with disabilities to assist them to find and maintain employment.
Employment Networks operate under agreements with SSA, and can be any qualified State or local government agency, or a private entity, that assumes responsibility for the coordination and delivery of services under the Ticket program. An EN may be a one-stop delivery system established under the Workforce Investment Act of 1998; a State Vocational Rehabilitation Agency; a single provider of services; or a group of providers organized to combine their resources into a single entity. Employment Networks can provide services directly or by entering into agreements with other organizations or individuals to provide the appropriate services. ENs will only be paid based on their success in assisting beneficiaries to secure and maintain employment and move off the disability benefit rolls.
On April 13, 2001, the Agency published a Request for Proposals for organizations in the 13 States in the first phase of the Program wishing to serve as ENs. On April 25, 2002, SSA published an amended Request for Proposals from organizations wishing to serve as ENs, based on the final regulations published on December 28, 2001. Our Program Manager, MAXIMUS, is currently evaluating and making recommendations on the organizations responding to the Request for Proposals. MAXIMUS and the Agency are also marketing the Ticket program to other prospective ENs through mailings, EN recruitment fairs, and other contacts. As of September 2002, we have received over 500 applications from providers to be ENs, and have entered into agreements with more than 425 providers to serve as ENs. We are working hard to attract sufficient providers of employment services so that beneficiaries will enjoy the degree of choice when selecting an EN that members of Congress and people with disabilities envisioned when the Ticket Act was developed. ENs report that beneficiaries are apparently already comparing available ENs before deciding where to assign their Tickets. ENs are already setting up client interviews and are beginning to provide services to beneficiaries. We believe that these activities have increased demand for their services. For instance, as of early September 2002, over 60 percent of the tickets assigned were assigned by "new" participants (beneficiaries who had previously not received VR services and who first Ticket to Work program). I might note that, out of this group, about one-third assigned their Tickets to an EN. The remaining two-thirds signed plans for services with their State Vocational Rehabilitation Agency. We are and will continue to look carefully at the Ticket assignments to make sure that beneficiaries have a range of choice of providers envisioned by the legislation.A key element of the Ticket program is that the beneficiary bears none of the cost of employment, vocational, or other support services. It is the Agency that pays an EN for providing services to a beneficiary. An EN can 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 achieves 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. We have begun receiving and processing the first requests for milestone and outcome payments from the ENs. The first milestone payment was made during May 2002.
As I mentioned, the Ticket Act also calls for the Commissioner to enter into an agreement with a Program Manager to assist the Agency in administering the Ticket to Work Program, MAXIMUS, Inc. Among MAXIMUS' duties are recruiting, recommending, and monitoring the ENs selected by SSA to provide services; facilitating beneficiary access to the ENs; facilitating payment to the ENs; and resolving disputes between beneficiaries and ENs under the program. I am pleased to note that the ENs and beneficiaries appear to be satisfied with the level of service provided by MAXIMUS.
As an Agency, we appreciate the important role our employees play in successfully implementing any new policy. That is why we arranged for training sessions on Ticket to Work and employment support topics during all three phases of the Ticket implementation. We have already completed the training sessions for the first phase, and will hold the sessions for the second phase in October 2002. We are also developing specialized training for field employees on employment supports.
Other Supports for Return to Work
While the Ticket program is the central element of the Ticket to Work Act, that law includes several other provisions that seek to encourage disability beneficiaries to return to work. Importantly, these provisions benefit disabled individuals even if they are not using their Ticket. I will summarize the implementation status of these provisions.
Pursuant to Section 121 of the Ticket Act, we established Benefits Planning, Assistance and Outreach (BPAO) program to fund organizations to help disability beneficiaries understand the effect of work activities on their benefits and explain other existing programs which assist disability beneficiaries who wish to work. In fiscal years 2000 and 2001, we awarded cooperative agreements under the BPAO program to 116 organizations, which are located nationwide and all U.S. territories. So far, more than 28,000 beneficiaries have received help from BPAO organizations.
Section 122 of the legislation authorized SSA to make payments in each State to the protection and advocacy system established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act. The payments are made to the Protection and Advocacy (P&A) systems for the purpose of providing services to assist in protecting the rights of disability beneficiaries in their return to work efforts. The P&As are to provide information and advice about obtaining VR and employment services, as well as advocacy or other services that a beneficiary needs to secure or regain gainful employment. In FY 2001, we awarded 57 P&A grants nationwide, and in the U.S. territories. All P&A projects have completed implementation efforts and are providing the required information and advocacy services. By the end of 2001, they had provided services to over 10,000 beneficiaries.
The Ticket Act also reduced the need for disability beneficiaries to choose between returning to work and receiving health care coverage. It extended Medicare coverage for working individuals with disabilities by an additional four and a half years, and expanded the Medicaid program to give the states the option of providing coverage to more working people with disabilities. This extension of coverage became effective on October 1, 2000. Twenty-six states already have Centers for Medicare and Medicaid Services (CMS) approved plans for extending Medicaid coverage in place and an additional eight states have passed enabling legislation and are working with CMS to gain approval for their plans. Additionally, approximately 52,000 persons have benefited from the extension of Medicare coverage.
Also, the Ticket Act included two sections that sought to eliminate work disincentives for all disability beneficiaries, even those not using tickets. Under Section 112, an individual whose benefits terminated because of work activity can request that benefits start again without having to complete a new application. While the Agency determines the requestor's eligibility for reinstatement, he or she can receive provisional benefits for up to six months. This process is called expedited reinstatement. Since this provision became effective on January 1, 2001, we have adjudicated almost 12,000 expedited reinstatement claims that have been filed. We have completed SSA instructions and training for field employees, and expect to publish a Notice of Proposed Rulemaking on the provisions of expedited reinstatement in the winter. Under Section 111, a Social Security Disability Insurance beneficiary's work activity will not trigger a CDR if he or she has received benefits for at least 24 months. This provision became effective on January 1, 2002. We have completed instructions and training for field employees to familiarize them with the new provision, and we expect to publish a Notice of Proposed Rulemaking on the provisions of suspending CDRs also in the winter.
One of the systems enhancements we are developing to prevent triggering a CDR is called the Disability Claims File. This system will link the software that tracks work information and the end of the trial work period for beneficiaries to the system that controls medical diaries. Additionally, because one system will track all work information and control all continuing disability reviews, we expect to improve our ability to properly handle work reports, reducing both the number of incorrect payments and our processing time for these reviews. We have begun efforts to improve automation of these workloads and expect further enhancements.
Work Incentive Specialists
Section 121 of the Ticket Act requires SSA to establish a corps of specialists devoted to issues related to work incentives. From July 2000 to September 2001 we piloted an Employment Support Representative position as we look for ways to provide that service. We are considering how best to provide employment support-related information and services to beneficiaries with disabilities who want to work, within the context of our overall operations. We have not made any decisions yet.
Finally, I thank you, Mr. Chairman, Mr. Matsui, and all the members of the Subcommittee, for showing continued dedication to the Ticket program. Thanks to that commitment, we look forward to toward providing more beneficiaries with the additional opportunities and tools they need to enter or reenter the workforce.
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 shall implement the Ticket program with the goal of realizing this idea.
Again, thank you for inviting me to be here today. I look forward to working with you to successfully implement the Ticket program.