1. Can the Ticket be Modified to Work for All Beneficiaries, or Should SSA Continue to Develop other Return-to-Work Programs ? Presented to participants of the Disability Research Institute Symposium Washington, DC Presented by David C. Stapleton Cornell University Institute for Policy Research March 16, 2004

2. The Ticket concept is a sound one Exploits an opportunity to make beneficiaries better off and save SSA money –Beneficiaries increase earnings, reduce reliance on benefits –SSA uses savings to help them Creates incentives to encourage return to work and program exit –Some beneficiaries will be able to improve their lives –Providers are paid for performance and must compete –Beneficiaries have more choices

3. Participation in Ticket to Work is low…

4. And predominately under the traditional VR payment system Participation by Payment Type, Phase I States, August 2003

5. .. But likely to increase Still increasing –New, voluntary programs often take years to catch on Some groups participate at higher rates: –Under 40: 2.0% –Hearing loss: 4.4% Significant challenges made for a slow start –“Simple” new program implemented on top of two complex programs, from scratch –SSA had very limited resources –Limited marketing to beneficiaries –Timing of business cycle could not have been worse SSA has made administrative improvements The economy is improving ENs and state VR agencies are just starting to figure out how they can take full advantage of this program Program changes could increase participation a lot, without departing from the basic concept

6. Ticket cannot serve the needs of the vast majority of beneficiaries …. Many beneficiaries want services and want to work But how many can and want to work enough to leave the programs? Project NetWork experience suggests 5% participation would be reason to celebrate

7. Unless other policies are changed Ticket to work is layered on top of an existing set of complex, flawed, and incompatible work incentive programs that limit Ticket’s effectiveness Substantial progress could be made through a complete overhaul of the SSDI/SSI work incentive rules to make them consistent with Ticket and each other

8. But even more fundamental changes are needed SSDI/SSI and their linked medical insurance benefits are rooted in an era when “disability” was equated with “inability to work” –They have “anti-work” features –“We’ll help you if you do not help yourselves” –The line between disability and ability to work is black and white –One-size-fits-all benefits for a heterogeneous population We’ve taken a patchwork approach to addressing this fundamental reality

9. What kinds of changes are needed? Change “disability” benefits to “ability-to-work” benefits Ability-to-work benefits would: –Be built on the principle that disability is a product of both medical conditions and the environment –Help people with disabilities support themselves –Include reasonable, but not punitive, work expectations –Provide access to an integrated array of supports –Tailor support to the needs of the individual

10. How could such a program be administered? The current program is simple by comparison –Challenges to administering that program are bad enough An ability-to-work program would –Require local offices to deliver a wide array of tailored supports for beneficiaries over a long period, efficiently and with integrity –Require that beneficiaries have substantial choice and control

11. Is Ticket is the ticket? SSA is developing a system of qualified public and private providers designed to –Offer providers and beneficiaries the flexibility to tailor supports that fit the individual’s needs –Offer beneficiaries substantial choice –Use a performance-based payment system and competition to ensure efficiency and integrity –Encourage long-term relationships between beneficiaries and providers The current Ticket program could be the precursor of a system that is up to the task of administering an ability-to-work program