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+
+ - THE SOCIAL SECURITY ADMINISTRATION'S MANAGEMENT OF THE TICKET TO WORK PROGRAM
+
+[House Hearing, 108 Congress]
+[From the U.S. Government Publishing Office]
+
+
+
+
+
+ THE SOCIAL SECURITY ADMINISTRATION'S
+ MANAGEMENT OF THE
+ TICKET TO WORK PROGRAM
+
+=======================================================================
+
+ HEARING
+
+ before the
+
+ SUBCOMMITTEE ON SOCIAL SECURITY
+
+ of the
+
+ COMMITTEE ON WAYS AND MEANS
+ U.S. HOUSE OF REPRESENTATIVES
+
+ ONE HUNDRED EIGHTH CONGRESS
+
+ SECOND SESSION
+
+ __________
+
+ MARCH 18, 2004
+
+ __________
+
+ Serial No. 108-58
+
+ __________
+
+ Printed for the use of the Committee on Ways and Means
+
+
+
+ U.S. GOVERNMENT PRINTING OFFICE
+23-796 WASHINGTON : 2005
+_____________________________________________________________________________
+For Sale by the Superintendent of Documents, U.S. Government Printing Office
+Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
+Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001
+
+ COMMITTEE ON WAYS AND MEANS
+
+ BILL THOMAS, California, Chairman
+
+PHILIP M. CRANE, Illinois CHARLES B. RANGEL, New York
+E. CLAY SHAW, JR., Florida FORTNEY PETE STARK, California
+NANCY L. JOHNSON, Connecticut ROBERT T. MATSUI, California
+AMO HOUGHTON, New York SANDER M. LEVIN, Michigan
+WALLY HERGER, California BENJAMIN L. CARDIN, Maryland
+JIM MCCRERY, Louisiana JIM MCDERMOTT, Washington
+DAVE CAMP, Michigan GERALD D. KLECZKA, Wisconsin
+JIM RAMSTAD, Minnesota JOHN LEWIS, Georgia
+JIM NUSSLE, Iowa RICHARD E. NEAL, Massachusetts
+SAM JOHNSON, Texas MICHAEL R. MCNULTY, New York
+JENNIFER DUNN, Washington WILLIAM J. JEFFERSON, Louisiana
+MAC COLLINS, Georgia JOHN S. TANNER, Tennessee
+ROB PORTMAN, Ohio XAVIER BECERRA, California
+PHIL ENGLISH, Pennsylvania LLOYD DOGGETT, Texas
+J.D. HAYWORTH, Arizona EARL POMEROY, North Dakota
+JERRY WELLER, Illinois MAX SANDLIN, Texas
+KENNY C. HULSHOF, Missouri STEPHANIE TUBBS JONES, Ohio
+SCOTT MCINNIS, Colorado
+RON LEWIS, Kentucky
+MARK FOLEY, Florida
+KEVIN BRADY, Texas
+PAUL RYAN, Wisconsin
+ERIC CANTOR, Virginia
+
+ ______
+
+ SUBCOMMITTEE ON SOCIAL SECURITY
+
+ E. CLAY SHAW, JR., Florida, Chairman
+
+SAM JOHNSON, Texas ROBERT T. MATSUI, California
+MAC COLLINS, Georgia BENJAMIN L. CARDIN, Maryland
+J.D. HAYWORTH, Arizona EARL POMEROY, North Dakota
+KENNY C. HULSHOF, Missouri XAVIER BECERRA, California
+RON LEWIS, Kentucky STEPHANIE TUBBS JONES, Ohio
+KEVIN BRADY, Texas
+PAUL RYAN, Wisconsin
+
+ Allison H. Giles, Chief of Staff
+
+ Janice Mays, Minority Chief Counsel
+
+Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
+hearing records of the Committee on Ways and Means are also published
+in electronic form. The printed hearing record remains the official
+version. Because electronic submissions are used to prepare both
+printed and electronic versions of the hearing record, the process of
+converting between various electronic formats may introduce
+unintentional errors or omissions. Such occurrences are inherent in the
+current publication process and should diminish as the process is
+further refined.
+
+
+ C O N T E N T S
+
+ __________
+
+ Page
+
+Advisory of March 11, 2004, announcing the hearing............... 2
+
+ WITNESSES
+
+U.S. Department of Education, Troy R. Justesen, Acting Deputy
+ Assistant Secretary, Office of Special Education and
+ Rehabilitation Services........................................ 28
+Social Security Administration, Martin H. Gerry, Deputy
+ Commissioner, Disabiltiy and Income Security Programs.......... 21
+
+ ______
+
+Arizona Employment Network Association, Susan Webb............... 80
+Benjearlene Nelson, Ticket to Work Participant; accompanied by
+ Ron Rattay, Gulfstream Goodwill Industries, Inc................ 8
+Charmaine Teri Hancock, Ticket to Work Partcipant................ 10
+Consortium for Citizens with Disabilities, Paul J. Seifert....... 66
+Health and Disability Advocates, John Coburn..................... 84
+Integrated Disability Resources, Inc., Tom Foran................. 71
+Ticket to Work and Work Incentives Advisory Panel, Sarah Wiggins
+ Mitchell....................................................... 55
+Ticket to Work and Work Incentives Advisory Panel, Thomas P.
+ Golden......................................................... 55
+VR Services, Richmond Area Arc, Quintin M. Mitchell.............. 76
+
+ SUBMISSIONS FOR THE RECORD
+
+California Department of Rehabilitation, Sacramento, CA,
+ Catherine Campisi, letter...................................... 97
+Council of State Administrators of Vocational Rehabilitation,
+ Chicago, IL, Robert Kilbury and Louis Hamer, statement......... 98
+Indiana Vocational Rehabilitation Services, Indianapolis, IN,
+ Mike Hedden, statement......................................... 99
+Louisiana Rehabilitation Services, Department of Social Services,
+ Baton Rouge, LA, James Wallace, statement...................... 99
+Maryland Division of Rehabilitation Services, Baltimore, MD,
+ Robert A. Burns, letter........................................ 100
+Massachusetts Rehabilitation Commission, Boston, MA, Elmer C.
+ Bartels, statement............................................. 100
+Oklahoma Department of Rehabilitation Services, Oklahoma City,
+ OK, Dan O'Brien, statement..................................... 102
+Pennsylvania Office of Vocational Rehabilitation, Harrisburg, PA,
+ Stephen R. Natsui, letter...................................... 104
+South Carolina Vocational Rehabilitation Department, West
+ Columbia, SC, Larry C. Bryant, statement....................... 105
+Tennessee Division of Rehabilitation Services, Nashville, TN,
+ Carl Brown, letter............................................. 106
+Texas Department of Assistive and Rehabilitative Services,
+ Austin, TX, Terrell I. Murphy, statement....................... 107
+Utah State Office of Rehabilitation, Salt Lake City, UT, Blaine
+ Petersen, letter............................................... 107
+Washington Department of Social and Health Services, Division of
+ Vocational Rehabilitation, Lacey, WA, Michael O'Brien,
+ statement...................................................... 109
+West Virginia Division of Rehabilitation Services, Charleston,
+ WV, statement.................................................. 110
+
+
+ THE SOCIAL SECURITY ADMINISTRATION'S
+ MANAGEMENT OF THE
+ TICKET TO WORK PROGRAM
+
+ ----------
+
+
+ THURSDAY, MARCH 18, 2004
+
+ U.S. House of Representatives,
+ Committee on Ways and Means,
+ Subcommittee on Social Security
+ Washington, DC.
+
+ The Subcommittee met, pursuant to notice, at 10:08 a.m., in
+room B-318, Rayburn House Office Building, Hon. E. Clay Shaw,
+Jr. (Chairman of the Subcommittee) presiding.
+ [The advisory announcing the hearing follows:]
+
+ADVISORY FROM THE COMMITTEE ON WAYS AND MEANS
+
+ SUBCOMMITTEE ON SOCIAL SECURITY
+
+ CONTACT: (202) 225-9263
+FOR IMMEDIATE RELEASE
+March 11, 2004
+No. SS-8
+
+ Shaw Announces Hearing on
+
+ the Social Security Administration's
+
+ Management of the Ticket to Work Program
+
+ Congressman E. Clay Shaw, Jr. (R-FL), Chairman, Subcommittee on
+Social Security of the Committee on Ways and Means, today announced
+that the Subcommittee will hold a hearing on the Social Security
+Administration's (SSA's) management of the Ticket to Work Program. The
+hearing will take place on Thursday, March 18, 2004, in room B-318
+Rayburn House Office Building, beginning at 10:00 a.m.
+
+ In view of the limited time available to hear witnesses, oral
+testimony at this hearing will be limited to the SSA, the U.S.
+Department of Education, and other invited witnesses. However, any
+individual or organization not scheduled for an oral appearance may
+submit a written statement for consideration by the Subcommittee or for
+inclusion in the printed record of the hearing.
+
+BACKGROUND:
+
+ The Ticket to Work and Work Incentives Improvement Act of 1999
+(P.L. 106-170), signed into law on December 17, 1999, established the
+Ticket to Work and Self-Sufficiency Program, expanded the availability
+of health care coverage, and provided for demonstration projects and
+studies. The Ticket to Work Program, administered by the SSA, increases
+choice in obtaining rehabilitation and vocational services, and
+provides greater opportunities for Disability Insurance (DI) and
+Supplemental Security Income (SSI) recipients to receive assistance to
+help them return to work.
+
+ As part of the program, individuals receive a ``ticket'' from the
+SSA, which they may voluntarily assign to their State Vocational
+Rehabilitation Agency (SVRA) or to an Employment Network (EN) of their
+choice. An EN is a public agency or private organization that provides
+employment services, vocational rehabilitation services, or other
+support services necessary to achieve a vocational goal. The ENs are
+paid by the SSA for results, and choose between two payment systems--
+one based on the individual no longer receiving cash benefits because
+of work, the other based on attainment of certain vocational
+milestones. The program is being phased in over a 3-year period and
+will be in place nationwide in September 2004.
+
+ Most Social Security DI and SSI adult disability beneficiaries are
+automatically eligible to receive tickets, and to date, almost 7
+million tickets have been issued. Some 40,000 beneficiaries have chosen
+to assign their tickets to service providers. Of these, 10 percent have
+been assigned to one of more than 1,100 ENs and 90 percent have been
+assigned to a SVRA.
+
+ The bipartisan Ticket to Work and Work Incentives Advisory Panel,
+established in law to advise the President, the Congress, and the
+Commissioner of Social Security on issues related to work incentive
+programs, is monitoring the implementation of the ticket program. It
+has expressed growing concerns about the SSA's management of the
+program. In particular, the panel is deeply concerned that too few ENs
+are willing to accept tickets and assist beneficiaries to return to
+work. It's recently issued report to the Congress and the Commissioner
+entitled, ``The Crisis in EN Participation--A Blueprint for Action,''
+http://www.ssa.gov/work/panel/panel_documents/pdf_versions/
+CrisisEnParticipation.pdf made a number of recommendations, including:
+clarify the Ticket Program as a funding source that supplements, rather
+than displaces, other existing funding sources; improve the EN payment
+system and EN claims administration; expand EN and beneficiary
+marketing; and improve EN training and communication.
+
+ In addition, unresolved issues between ENs and many SVRAs may also
+be discouraging ENs from participating in the Ticket Program. These
+issues include: questions regarding automatic ticket assignments to
+SVRAs; pressure for ENs to contract with SVRAs rather than accepting
+tickets themselves; ineffective cooperative agreements between SVRAs
+and ENs; and lack of consumer information.
+
+ In announcing the hearing, Chairman Shaw stated, ``Work--essential
+for individuals with disabilities to achieve their goals and support
+their families--won't happen without an effectively run Ticket to Work
+Program. The Social Security Administration's management of this
+important program must fully meet the needs of those wanting to return
+to work as well as those assisting them in this effort.''
+
+FOCUS OF THE HEARING:
+
+ The Subcommittee will review the SSA's management of the Ticket to
+Work Program, including results achieved to date and challenges
+hampering program success.
+
+DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
+
+ Please Note: Any person or organization wishing to submit written
+comments for the record must send it electronically
+[email protected] along with a fax copy to
+(202) 225-2610, by close of business Thursday, April 1, 2004. In the
+immediate future, the Committee website will allow for electronic
+submissions to be included in the printed record. Before submitting
+your comments, check to see if this function is available. Finally, due
+to the change in House mail policy, the U.S. Capitol Police will refuse
+sealed-packaged deliveries to all House Office Buildings.
+
+FORMATTING REQUIREMENTS:
+
+ Each statement presented for printing to the Committee by a
+witness, any written statement or exhibit submitted for the printed
+record or any written comments in response to a request for written
+comments must conform to the guidelines listed below. Any statement or
+exhibit not in compliance with these guidelines will not be printed,
+but will be maintained in the Committee files for review and use by the
+Committee.
+
+ 1. All statements and any accompanying exhibits for printing must
+be submitted electronically to
+[email protected], along with a fax copy to
+(202) 225-2610, in WordPerfect or MS Word format and MUST NOT exceed a
+total of 10 pages including attachments. Witnesses are advised that the
+Committee will rely on electronic submissions for printing the official
+hearing record.
+
+ 2. Copies of whole documents submitted as exhibit material will not
+be accepted for printing. Instead, exhibit material should be
+referenced and quoted or paraphrased. All exhibit material not meeting
+these specifications will be maintained in the Committee files for
+review and use by the Committee.
+
+ 3. All statements must include a list of all clients, persons, or
+organizations on whose behalf the witness appears. A supplemental sheet
+must accompany each statement listing the name, company, address,
+telephone and fax numbers of each witness.
+
+ Note: All Committee advisories and news releases are available on
+the World Wide Web at http://waysandmeans.house.gov.
+
+ The Committee seeks to make its facilities accessible to persons
+with disabilities. If you are in need of special accommodations, please
+call 202-225-1721 or 202-226-3411 TTD/TTY in advance of the event (four
+business days notice is requested). Questions with regard to special
+accommodation needs in general (including availability of Committee
+materials in alternative formats) may be directed to the Committee as
+noted above.
+
+
+
+ Chairman SHAW. Good morning. Today our Subcommittee will
+examine the Social Security Administration's (SSA's) management
+of the Ticket to Work Program. The Ticket to Work and Work
+Incentives Improvement Act (P.L. 106-170) was signed into law
+in December 1999. The goal of this landmark legislation is to
+remove barriers and increase incentives for individuals with
+disabilities to seek work. These incentives empower
+beneficiaries with choices of job training and placement
+services.
+ Prior to enactment of the bill, less than 1 percent of the
+individuals with disabilities receiving Social Security
+Disability Insurance (SSDI) or Supplemental Security Income
+(SSI) left the rolls to return to work. Now the SSA is reaching
+the end of its three-phase implementation plan of this program.
+To date almost 7 million tickets to individuals with
+disabilities in all 50 States have been distributed and all
+program components are operational. This has been no small
+effort and I commend the agency for extraordinary efforts.
+ I have a sample of a ticket right here and you can see that
+it allows the ticket holder to obtain employment services by
+turning the ticket to a State Vocational Rehabilitation (VR)
+agency or Employment Network (EN). So far 40,000 tickets have
+been assigned yet 90 percent of these tickets have been
+assigned to State VR agencies and only 10 percent have been
+assigned to ENs. In the Ticket to Work Program choice is
+paramount. To continue to grow the success of the program we
+need to understand why a market of ENs has failed to
+materialize.
+ [The information follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T3796A.001
+
+ The bipartisan Ticket to Work and Work Incentives Advisory
+Panel has been examining issues relating to the service
+providers marketplace since it first convened. Today we will
+hear the panel's latest recommendation, along with the
+testimony from three ENs that are currently accepting tickets
+and helping the individuals return to work. Although the low
+number of ENs participating in the Ticket to Work Program is
+troubling, we must not lose sight that this program is having a
+positive impact on the lives of many individuals who do have
+disabilities.
+ Therefore, I think it is only fitting that our hearing
+begin with the testimony of two individuals who have changed
+their lives by taking advantage of the Ticket to Work Program.
+Following their testimony, we will hear from representatives of
+the SSA and the U.S. Department of Education, and then from
+other key stakeholders. Taking the first step to try to work is
+one of the most difficult decisions someone with a disability
+can make. Our challenge is to ensure that the Ticket to Work
+Program helps make this decision easier, not harder. I look
+forward to hearing the thoughtful counsel of each of our
+witnesses today and I thank you for joining us. Now I would
+yield to the gentleman from Maryland, Mr. Cardin.
+ [The opening statement of Chairman Shaw follows:]
+
+ Opening Statement of The Honorable E. Clay Shaw, Jr., Chairman, and a
+ Representative in Congress from the State of Florida
+
+ Good morning. Today, our Subcommittee will examine the Social
+Security Administration's management of the Ticket to Work Program.
+ The Ticket to Work and Work Incentives Improvement Act was signed
+into law in December of 1999. The goal of this landmark legislation is
+to remove barriers and increase incentives for individuals with
+disabilities to seek work. These incentives empower beneficiaries with
+choices for job training and placement services.
+ Prior to enactment of the bill, less than 1 percent of individuals
+with disabilities receiving Social Security Disability Insurance or
+Supplemental Security Income left the rolls to return to work. Now, the
+Social Security Administration is reaching the end of its three-phase
+implementation plan of this program.
+ To date, almost seven million tickets to individuals with
+disabilities in all 50 states have been distributed and all program
+components are operational. This has been no small effort, and I
+commend the Agency for its extraordinary efforts.
+ I have a sample of a ticket here and you can see that it allows the
+ticket holder to obtain employment services by turning in the ticket to
+a State Vocational Rehabilitation Agency or an Employment Network. So
+far 40,000 tickets have been assigned, yet ninety percent of these
+tickets have been assigned to State Vocational Rehabilitation Agencies
+and only 10 percent have been assigned to Employment Networks.
+ In the Ticket to Work Program, choice is paramount. To continue to
+grow the success of the program, we need to understand why a market of
+Employment Networks has failed to materialize.
+ The bipartisan Ticket to Work and Work Incentives Advisory Panel
+has been examining issues related to the service provider marketplace
+since it first convened. Today, we will hear the Panel's latest
+recommendations, along with testimony from three Employment Networks
+that are currently accepting tickets and helping individuals return to
+work.
+ Although the low number of Employment Networks participating in the
+Ticket to Work Program is troubling, we must not lose sight that this
+program is having a positive impact on the lives of many individuals
+with disabilities.
+ Therefore, I think it is only fitting that our hearing begin with
+testimony from two individuals who have changed their lives by taking
+advantage of the Ticket to Work program. Following their testimony will
+we hear from representatives from the Social Security Administration
+and the Department of Education and then from other key stakeholders.
+ Taking the first step to try work is one of the most difficult
+decisions someone with a disability can make. Our challenge is to
+ensure that the Ticket to Work Program helps make this decision easier,
+not harder. I look forward to hearing the thoughtful counsel of each of
+our witnesses today, and thank them for in advance for joining us.
+
+
+
+ Mr. CARDIN. Let me thank Chairman Shaw for calling this
+hearing. It is very important that this Committee follow-up on
+the Ticket to Work Program. I thank you for convening this
+hearing and for calling these panels so that we can hear from
+all of the different stakeholders, from people who are in the
+program, to the agencies that administer it at the Federal
+level, as well as other interested parties.
+ The Ticket to Work Program was one of the major
+accomplishments passed by Congress in 1999. It was an effort to
+reward individuals who were willing to take a risk to work.
+They had certain protections while on the disability rolls and
+they would have to give up to enter the employment market. We
+recognized that and passed the Ticket to Work Act to give them
+more opportunity for VR and to provide certain safety nets,
+particularly in regard to their health care benefits. We passed
+the law in 1999. It is now 2004. In my own State of Maryland,
+we just started receiving the tickets in November of 2003. So,
+Mr. Chairman, we do not yet have a lot of experience as far as
+people who are participating in the program. One of our
+objectives today is to determine how we can expedite the
+program and make it as effective as possible.
+ When we look at the individuals who are participating in
+the ENs, we find that the success rates are pretty much what we
+had predicted. Yet we think those rates can be even higher, if
+we improve the program's effectiveness.
+ So, there is more that we need to do. We have to encourage
+greater participation in the program. We have to provide
+necessary administrative support to the agencies. I am
+concerned that the agencies' budgets have not been realistic
+for carrying out this mission. It has been reported to us that,
+in some instances, the ticket may be replacing access to VR
+services rather than supplementing those programs. That
+certainly was not the intent of Congress.
+ No amount of outside assistance can convince beneficiaries
+to attempt to work if they believe that working will lead to a
+loss of vital health benefits and income support before they
+are financially ready. The Ticket Act recognized the importance
+of these incentives in helping beneficiaries work and the
+importance of SSA administering the work rules promptly and
+accurately. Although the SSA has taken some steps in the right
+direction, much remains to be done. Beneficiaries can not yet
+be confident that if they go to work, the SSA will adjust their
+checks in time to prevent a large overpayment of benefits.
+ Some of the obstacles can be addressed by the SSA and the
+Department of Education, which are charged with the
+administrative responsibilities. Others may require direction
+or clarification from Congress. This hearing will give us an
+opportunity to hear firsthand how the program is being
+implemented, so that the agencies can take the appropriate
+steps and we, in Congress, can carry out our oversight
+responsibilities.
+ Mr. Chairman, I want to raise one additional issue that was
+recently brought to my attention. It is my understanding that
+nearly a decade ago, officials at the SSA were made aware of a
+situation involving more than 500,000 SSI recipients who
+subsequently became eligible for Social Security disability
+benefits. Due to a computer error, these recipients were never
+identified. So, for over the last 10 years there have been
+literally thousands, hundreds of thousands of SSI recipients
+who were entitled to additional payments, but did not receive
+them.
+ The SSA is now trying to identify these individuals, but
+because of the lack of administrative support they have had to
+prioritize the group they are going after in trying to correct
+the situation. As a result, in some cases, these corrections
+will not take place for many, many years to come, obviously
+causing a major problem for the people who are entitled to
+additional benefits. I might point out it also affects our
+States, because if these beneficiaries were eligible for SSA
+disability they would have been covered by the Medicare Program
+rather than the Medicaid program. This means that our States
+are overpaying and are entitled to some adjustments.
+ Mr. Chairman, I would hope that in the future we would have
+an opportunity to review this issue and to try to expedite the
+process of correcting this error since it has been 10 years and
+we really need to clear up this record and do what is right for
+the beneficiaries and for our States. I look forward to hearing
+the testimony of all the witnesses today and working with the
+Chairman and the Members of this Committee to carry out our
+very important oversight responsibility and to see what we can
+do to make the Ticket to Work Program as effective as possible.
+Thank you, Mr. Chairman.
+ Chairman SHAW. Thank you, Ben. We now have our first panel.
+I will introduce Ms. Nelson, and Mr. Collins will introduce Ms.
+Hancock. Benjearlene Nelson is a Ticket to Work participant
+from my own area of West Palm Beach, Florida and she is
+accompanied by Ron Ratty, who is with Gulfstream Goodwill
+Industries (GGI), West Palm Beach, Florida. Ms. Nelson has had
+some pretty rough sledding. She has shown a tremendous amount
+of courage and I think her story should be an inspiration to
+all of us. Mr. Collins?
+ Mr. COLLINS. Thank you, Mr. Chairman. It is my pleasure to
+welcome Ms. Teri Hancock from Newnan, Georgia. I spoke with Ms.
+Hancock briefly before the hearing began and she has a very
+impressive resume that I have already read. Just listening to
+her, talking to her, the things that she has overcome based on
+a problem that she had several years ago and would not let it
+be something that would end her desire to be a career person
+again, because she has, as I say, a very impressive resume. She
+also is a very special strong advocate for this program, the
+Ticket to Work, and we appreciate that very much. I think you
+are going to find her testimony very interesting.
+ I regret to say, though, that she may be leaving Georgia in
+the very near future. She is formerly from the Washington area
+here and she may be moving back to the city rather than staying
+in some of the rural areas of Georgia. That will be our loss
+but it will be Washington's gain. Ms. Hancock, thank you very
+much for being here and for your testimony. It is very
+impressive, and your background is very impressive, and I know
+your future will be very impressive. Thank you.
+ Chairman SHAW. Mr. Rattay will be our first witness.
+
+STATEMENT OF RON RATTAY, GULFSTREAM GOODWILL INDUSTRIES, INC.,
+ WEST PALM BEACH, FLORIDA
+
+ Mr. RATTAY. Thank you. First, let me say that I am
+extremely privileged in having Benjearlene ask me to escort her
+here today. The GGI became an EN in November of 2001; it has
+been in the business of changing people's lives for
+approximately 105 years. We have many programs that are suited
+to individual's specific needs. Basically our mission is, and
+always will be, to help people with disabilities and other
+barriers to return to employment and become working members of
+our communities. So, becoming an EN was a natural transition
+for us. Approximately 7 months ago GGI engaged a fill team to
+implement and launch the Ticket to Work self-sufficiency
+program. We have researched, we have studied, and we learned
+the Ticket to Work self-sufficiency program in order to better
+it toward self-sufficiency.
+ With the support of our program manager, Maximus, national
+Industries for the Severely Handicapped (NISH), and,
+specifically, the local West Palm Beach Social Security office
+and the advisory panel, we have moved forward. Today we hold 26
+people, all of whom want to become self-sufficient. Ten of
+these people have succeeded far beyond Substantial Gainful
+Activity (SGA), either in the milestone or outcome status. The
+others are only a job away, and we have yet to scratch the
+surface. We recognize the concerns and issues of the Ticket to
+Work Program but for now GGI continues to be proactive and
+place the needs of our participants first. With this said,
+please allow me to introduce one of our heroes and
+participants, Ms. Benjearlene Nelson.
+ Chairman SHAW. Ms. Nelson?
+
+ STATEMENT OF BENJEARLENE NELSON, TICKET TO WORK PARTICIPANT,
+ WEST PALM BEACH, FLORIDA
+
+ Ms. NELSON. Thank you. I am very honored to be here today.
+My name is Benjearlene Nelson. I am 33 years old. I am a mother
+of two wonderful children, a loving mother--I have a loving
+mother, and I am also the loved one of a very supportive
+family. I am here today to testify for the Ticket to Work
+Program and to let you know how the Ticket to Work has worked
+for me. I am also a Social Security beneficiary. Because of my
+disability, I have had a lot of downfalls in life. It has
+affected me mentally, emotionally and physically
+ I am here to let you know that I have always been a striver
+to reach for the hills. Because of my disability, it has taken
+a lot from me, but with the Ticket to Work and GGI, I tell you
+they have given me an inner strength to continue to go on. Back
+in 2002 I was faced to pull out my Ticket to Work. I had
+received it 9 months ahead of time. I looked at it and put it
+away. At the time I was married, had a husband that was
+supporting the family. Because of my disability, I did not feel
+the need to work or to experience the outside world. I had kind
+of put myself in a closet and just felt that I did not need to
+be exposed to the world.
+ Back in 2002 my husband, who is an alcoholic, attempted to
+set the house on fire while my children and I were sleeping. By
+the grace of God I am here today. I want to say that at that
+time he was taken away I knew that I had to stand up and step
+out and stand on my own to support my family. I used my Ticket
+to Work. I went to GGI. I told them what my situation was and
+they were there with open arms. Goodwill has given me the
+strength that I needed to stand up. They have encouraged me.
+They have given me confidence and motivation to continue to go
+on and to lead my family as the head of the household.
+ I also want to say that I have come to some very low points
+in life where I did not feel that I could accomplish different
+things and in certain areas. I just did not feel that I was
+good enough. Being encouraged through the Ticket to Work and
+GGI, they have just inspired me. A lot of times I went in there
+feeling down and did not know what I can do. I know that I have
+a disability with my eyes, as well, and I had a long road ahead
+of me and I could not even see it. Goodwill has guided me in
+the direction that I needed to be in. Together, I know that
+they are a great team and I also want to say that through the
+Ticket to Work I have achieved a position at Crystal Marketing
+where I am working now, where I am the top seller. I enjoy
+working there. I look forward to moving on and going to better
+places.
+ I also want to let you know that without the Ticket to
+Work, I do not think that I would have stepped forward. I do
+not know where I would have been at this point in my life. The
+Ticket to Work gave me courage. They explained the Ticket to
+Work with me. It sounded like a great idea. They have backed me
+the whole way and I just want to say that the Ticket to Work is
+such a great program. It lets you know that they are standing
+behind you. You do not have to worry. I just think that more
+people should know about the Ticket to Work Program who are
+disabled so that they can get their life on the road and
+accomplish some of the things that I have in life.
+ [The prepared statement of Ms. Nelson follows:]
+
+Statement of Benjearlene Nelson, Ticket to Work Participant, West Palm
+ Beach, Florida; accompanied by Ron Rattay, Gulf Stream Goodwill
+ Industries Inc., West Palm Beach, Florida
+
+ Let me first say I'm privileged in having Benjearlene ask me to
+escort her and be with her on this very important day.
+ Gulfstream Goodwill become an Employment Network in November of
+2001, Goodwill Industries has been ``in the business of changing
+peoples lives'' for about 105 years. We have many programs that are
+geared to the individual's specific needs. Basically, our mission is to
+help people with disabilities and other barriers to employment to
+become self-sufficient, working members of our community. So becoming
+an Employment Network was a natural transition.
+ Approximately seven months ago GGI engaged a full time team to
+launch the TTW program. We have researched and studied the TTW program
+in order to make it geared toward self-sufficiency. With the support of
+Maximus, NISH, the local WPB SSA office, and the Advisory Panel we have
+moved forward. Today we hold 26 tickets for people who want to become
+self sufficient. Ten of these people have succeeded far beyond SGA and
+are in the ``milestone'' or ``out-come'' status; the others are only a
+job away.
+ We recognize that there are concerns and issues with the TTW
+Program, but for now GGI continues to be proactive and place the needs
+of our participants first.
+ With this said, please allow me to introduce to you one of our
+participants Benjearlene Nelson.
+How Gulfstream Goodwill Industries and Ticket to Work Helped Me
+ It was the night in 2002 that changed my life forever. My husband
+attempted to set our house on fire while my children and I were
+sleeping.
+ I am not a person that likes to talk a great deal about misfortune.
+I am not a negative person. It is because of this, and my loving
+Mother, that I have stayed strong.
+ I became disabled in 1991. It wasn't until I came down with
+pneumonia in 1995 that the reality of my condition hit me. I lay in the
+hospital and heard the shocking words from my doctor, ``Prepare a
+Living Will. You are not expected to live.'' Because I want to hang on
+long enough for my two children to be able to live without me, I
+fought. And I survived. But I was exhausted, both physically and
+emotionally. I hadn't worked a steady job in fifteen years. The burden
+of supporting Adrian (then 8 years old) and Greivondra (then 6 years
+old) in a fire-ravaged home was overwhelming. To add to this, my
+children and I were forced to jail ``Dad,'' which meant an additional
+fight and family upheaval.
+ I reached my lowest point after the arson and attempted murder by
+my husband. I had no energy, no direction, and no future. Looking about
+my room I saw a ``Ticket to Work'' certificate on my dresser that I had
+received about eight months before the fire. I don't believe it was a
+coincidence that I hadn't thrown it away. And it wasn't a coincidence
+that I knew about Goodwill either. I know Goodwill has a reputation for
+``doing good things,'' and I know they help people find jobs.
+ I took control again. Meeting with Elizabeth Jennings at Goodwill
+in May of 2003 was a good experience. She gave me encouragement and
+told me that I could get a job right away. I was in an emergency
+situation because I really needed to get a job and fast. There were
+bills to pay and no food to eat. It had to be a job with good pay, but
+one that would allow me to keep my Social Security benefits. To add to
+my worry, I don't have a high school diploma. It felt like I was
+walking another tight rope, and I was scared.
+ Goodwill was there for me. Judy Roy took over once Elizabeth
+completed the paper work. I told Judy about my work experience and how
+I always wanted a better education. (I have taken several courses from
+local universities.) Goodwill gave me benefits counseling, and Judy's
+job search produced three job opportunities for me within the first
+week. I decided that I wanted to go to the job interviews alone, even
+though Judy told me that she would go with me. I wanted to prove to
+myself that I COULD! I was offered all three jobs, and I took the one
+that paid the best: a telemarketing job at Kristel Marketing where I
+invite people to a vacation resort in the Poconos.
+ Today I look forward, not backward. I have a good job, and achieved
+``Best Sales'' within my company last year. I have two wonderful
+children who know the importance of a good education, and a fantastic
+mom, who has been supportive in the worst of times. And I have my
+Goodwill family.
+ It is important to have my Goodwill family because my fight isn't
+over. To keep my disability at bay I am forced to take medication that
+has attacked my joints and liver. I have been diagnosed with Avascular
+Necrosis of the hip and a chronic liver disease. Hip replacements are
+in my future, and I know Goodwill will be there for me again.
+ The ``Ticket to Work'' program has proved invaluable to me. Because
+I didn't believe in myself after all that happened to me, I really
+needed a helping hand. I think of Goodwill as offering me a much-needed
+hand up. The Ticket to Work program and Goodwill people gave me a lift
+so I could get up, work and support my children on my own.
+
+
+
+ Chairman SHAW. Thank you, Ms. Nelson. Ms. Hancock?
+
+ STATEMENT OF CHARMAINE TERI HANCOCK, TICKET TO WORK
+ PARTICIPANT, NEWNAN, GEORGIA
+
+ Ms. HANCOCK. Good morning, everyone. I am Teri Hancock and
+my story is a shade different. I, on the other hand, was at the
+height of my career when my injury happened, and because of
+that, I was in rehabilitation for about 4 years. I was in a
+wheelchair, couldn't walk, and I had to develop my muscles at
+the bottom of my body all over again. Having to learn how to
+walk is quite a task, believe me.
+ When you are young and you think you are invincible and you
+have everything to live for, your life goes from sugar to poop,
+and that is the thick of it. When you find yourself in a
+situation where everything is a gray area, you look around--I
+looked around because I wanted my old life back and I was
+willing to do anything to get that old life back. The problem
+was, society would not allow me to have that life back. There
+was no one there to listen, because I had a big white brace at
+the time. Mind you, I have had seven surgeries to correct my
+injury.
+ You would be surprised at how you are viewed when you have
+a handicap. Employers do not listen to you. People ignore you.
+You are ostracized. While working at the national Cancer
+Institute after my return to work after the initial injury, I
+was ridiculed, taunted, made fun of, poked fun at, the butt end
+of a joke. For someone that has come from my background, which
+is radio-television, behind the camera, in front of the camera
+mostly, talk show host, it was devastating. My self-esteem went
+to just about zero.
+ With my will and determination, I wasn't going to stay
+there long. I was looking for an out. I was looking for a
+helping hand. I was looking for an avenue to stroll that would
+bring me back to where I was. Actually, in the fifth year, I
+got a letter in the mail from Ticket to Work, Social Security.
+I said to myself, hmmm, a government agency. That means they
+are going to be around. I said to myself, an opportunity for
+the government to take a listen to what I have to say. Somebody
+is finally paying attention. I was very happy about that, very
+elated.
+ To find the right program--you get a list when you get your
+letter. When I got my list, I went through four--three agencies
+before I found the fourth one. Now, Integrated Disabilities
+Resources (IDR) in Connecticut--I live in Georgia--but not all
+Ticket to Work Program vendors are good, and I will have to
+tell you that. Not everybody does what they are supposed to do.
+There are some that do what they are supposed to do, and they
+are superior. For a win situation for myself, people like
+myself, we need the program to come back into life, to be
+reborn again.
+ Now, I worked with a woman by the name of Meg Moran, and
+Meg Moran understood where I was going, where I had come from,
+my level. Others may say to you, well, I want to teach you how
+to write a resume. I can teach you how to write a resume. You
+don't need to teach me that. I can set up an interview. I can
+set up my own interview. I didn't need that. I needed contacts.
+I needed somebody to listen. I needed a voice. They supplied
+the voice. Social Security backed it. The IDR was there to make
+the contacts. I went forward, got it done.
+ When you are called terrible names because of your handicap
+or made fun of, which I cannot even repeat the things I was
+called, the only thing you want to do is show them they are
+wrong. Well, I was able to show them that they were wrong with
+Ticket to Work. Not only do I counsel, not only do I counsel
+other people, not only have I written a book, not only do I
+tour with my book, but my self-esteem is back up to 100
+percent. No more big white brace. Ticket to Work listened. They
+heard my cry. There are thousands, probably millions of people
+like myself out there. They need Ticket to Work. They need a
+voice. They need an entry. I am here to say, thank God for
+them, and if you have a position for me at Ticket to Work,
+Social Security, you had better come get me because here I am.
+ [Laughter.]
+ I can say nothing except the program is a viable program.
+You have, as I said, a million intelligent people out here that
+want to go to work. Yes, we do have people that don't want to
+go to work, but we have so many that still want life. I am
+crying for life for these people, for myself, and I am saying,
+whatever you do, God bless Ticket to Work and that is where we
+want to be. Thank you.
+ [Applause.]
+ [The prepared statement of Ms. Hancock follows:]
+
+ Statement of Charmaine Teri Hancock, Ticket to Work Participant,
+ Newnan, Georgia
+
+ The challenge to move forward in life and live it as you once knew
+it after the affects of serious illness or injury, brings about idle
+yet common reflections of what could have been. Living and adjusting to
+life as it now presents itself, challenges the will to live, the
+necessity to thrive, the purpose of one's being and poses the age-old
+question of devastation--why? Or why me?
+ One never knows what may lie ahead in life, we live each day in
+health as if it will be there forever. We often times choose to close
+our eyes and minds to what does not directly effect us at that given
+moment but when the unexpected happens and life turns a sharp and
+warningless curve the cold hard vengeance of reality can hit you like a
+brick.
+ Which brings us to my own reality. After having had a massive
+cerebral hemorrhage totally out of the blue, while at the height of my
+success, life for me went from sugar to poop! On top of the world one
+day and flat on my back the next, helpless with no relief or hope in
+sight.
+ Once I was finally lucid enough to understand the condition I was
+left in immediate depression consumed me, leaving me breathless, lost
+and very alone. I really did not know who I was or what life held for
+me.
+ Well, after countless years of rehab, pain staking surgeries,
+endless therapies, never ending questions and people treating you like
+a mangled yarn, I ventured to pick myself up and get back I the race.
+ For over four years I tried to break back into the work force on my
+own. Between operations (seven to be exact) the healing process, the
+rehabilitation's, the weakness and the struggle to exist. But at many
+points because of how I was treated by others I viewed myself as less
+than whole, even a waste, and certainly not the person I use to be. I
+questioned who or what had I become anyway? Moreover why was this
+foreigner living in my body invading my wonderful life and when was it
+leaving?
+ I wanted to get back in the work force, but doors are often close
+to cripples, people seen as less than perfect, people who's presence
+one might find disturbing. During my period of healing I was indeed one
+of those people.
+ Although I held a wealth of knowledge, experience and information,
+it did not matter because my physical presentation was less than
+acceptable (hard on the eye) the public viewed me as less than whole,
+less than perfect.
+ I tried to get back into Telecommunications at MCI only to be
+taunted, laughed at and made fun of, always the butt end of a crippled
+joke.
+ My self-esteem totally destroyed, my sprit broken. Over and above
+all of this, I was still there inside of this broken body, no one would
+listen or give me the time of day.
+ TTW came in my life at a time when I had exhausted every avenue,
+literally. So for me this program was a ``God send'' my rescue from the
+hell of disablement. A real voice, a real person to join forces with.
+After receiving my ticket I view my options, spoke with four venders
+and settled on Integrated Disabilities Resources (IDR). Understand, not
+every ticket holding agency is equipped nor do they really understand
+their job. So IDR was the right choice for me.
+ This outfit seemed to understand my level and mindset really
+connecting with me. This is where I linked with an individual who
+seriously wanted to support me and understood my cry for help. This
+woman was Meg Moran of IDR, she saw me as a crop that simply needed to
+be harvested, a bountiful land full of nutrients and aid to bestow.
+ I started working Meg at IDR and soon people started listening
+because I now had a connected voice. Using IDR's connections,
+assistance and referral systems, new avenues of opportunity were made
+available.
+ In fact, working with one of their consultants (Dan T. Mcaneny)
+opened up a whole new world. Mr. McAneny helped me realize just how
+much I did have to offer; I was amazed with myself once we explored
+just what jewels I did posses. I realized that I had allowed society to
+beat me down like a bush in a rainstorm.
+ After working with IDR I took on new challenges and capitalized on
+what I had already had under my belt. As an air personality, I had
+lectured and counseled on radio and television before my injury and
+developed quite a following. While these people were still out there
+and hundreds more, people who needed my help as much as I needed to
+help them for my own esteem. With the help of Dan McAneny I turned my
+lectures into a book, did something constructive and came back into the
+forces of life. Thank goodness for the TTW program.
+ Much like myself there are thousands of people who have so much to
+give, so much to share, teach, produce, contribute, so much life to
+still live but with no practical means to display or showcase their
+abilities. Therefore they sit and waste, many are so beat down by the
+barriers of society until they have lost their fight or so terrified of
+rejection until they simply give up and concede.
+ So, Social Security developed an incentive program for the
+displaced, handicapped and physically challenged individuals to display
+their capabilities as to redeem their self worth. I think their
+original idea or mindset may have been to get able-bodied people back
+to work, off the system and help relieve the deficit. However the real
+gem of this program is that millions of Americans that lost who they
+use to be before that devastating injury or illness can once again
+become viable, productive, happy salary earning individuals!
+ Thus still helping with the world's deficits and financial crunch.
+Which leads into just what having a ticket has done for my life.
+ The Ticket to work Program provides an entry back to a productive
+life. It supplies one with direction, hope and guidance granting a
+solid home base to rise from. Because TTW is part of our Government its
+stability speaks for itself, the injured can trust and take refuge in a
+program such as this. Therefore, We really do need TTW and agencies
+with caring hard working advocates for the disabled such as IDR. TTW/
+IDR helped save my sanity and got me on track because I certainly could
+not do it alone.
+ Please, help me help others get their life back and be productive,
+whole individuals who contribute to the face of this universe.
+ Save TTW, help Social Security help its contributors and please
+save the agencies that give human beings back their dignity and self
+worth.
+
+
+
+ Chairman SHAW. I can tell you that applause applies to both
+of you ladies. I can't recall a single time in my 24 years of
+Congress where a panel has been applauded.
+ [Laughter.]
+ Social Security, if you need somebody to sell your stuff, I
+think you have found her.
+ [Laughter.]
+ Mr. Collins?
+ Mr. COLLINS. I told you, Mr. Chairman, she was going to be
+very impressive. I really have no questions other than just to
+thank each of you for being here. You have very humbling
+stories to tell and we appreciate the fact that you had the
+will not to take these roadblocks and let them stand before
+you, but knock them down and get things done, and I would
+appreciate your support for the program and we wish you the
+best in the future, which I know it will be. Thank you.
+ Chairman SHAW. Mr. Cardin?
+ Mr. CARDIN. Let me join the Chairman in thanking you for
+coming before our Committee. The SSA tells us there are 40,000
+people who have taken advantage of the Ticket to Work. That is
+a small fraction of the number of people who could benefit from
+the Ticket to Work. A lot of times in Congress, we debate
+numbers. We debate dollars. Your testimony has really put a
+face on the issue to us, that we are dealing with real people
+and their lives and affecting their lives. So, we very much
+appreciate your testimony and what it means to us when we work
+for programs that we think can make a difference in people's
+lives. The two of you come from different backgrounds, but it
+was the same program that benefited both of you. You were able
+to take advantage of this program, and I very much appreciate
+the manner in which you expressed that.
+ Ms. Nelson, it was very courageous of you to get into this
+program because you knew there were certain risks involved. You
+gave up certain safety nets that were available to you, but the
+importance of work, the importance of being the head of your
+household and taking care of your family, the Ticket to Work
+gave you a chance to use that and to use those talents and we
+thank you for having the courage to move forward. Ms. Hancock,
+as you said, your case was different. You needed the bridge to
+bring you back to be able to use your talents, and the Ticket
+to Work worked for both. So, I think that is really a testament
+to the flexibility of this program, and exactly what we
+intended in Congress. We intended this program to be a ticket
+to be used outside the conventional rehabilitation services
+that were available through the States, that you could use it
+to get the help that you needed to be able to reenter the
+employment marketplace.
+ We wanted to be flexible. We wanted to have a variety of
+vendors out there that were available, and I think you have
+raised a very good point, one that I want to make sure we
+follow up on, and that is there are different types of ENs that
+are out there. Some are better than others for your particular
+needs. One of the things we have to make sure that we have
+adequate information so that the ticket is used by the
+recipient in the most effective way in order to accomplish the
+results, and I think your testimony has helped us to focus in
+on that. So, to both of you, we thank you for being here. We
+thank you for your testimony. I can tell you it has a major
+impact on our work.
+ Ms. NELSON. Thank you.
+ Ms. HANCOCK. Thank you.
+ Chairman SHAW. Thank you, Ben. Mr. Hayworth?
+ Mr. HAYWORTH. Thank you, Mr. Chairman. Again, let me thank
+the witnesses. Just a couple of questions, and we appreciate
+the testimony. Ms. Nelson, do you have any piece of advice for
+others who are receiving benefits who are just now thinking
+about getting back to work? Is there anything that is just
+really important for people to remember as they take a look at
+this Ticket to Work Program?
+ Ms. NELSON. I think that it is very important that they
+look at the Ticket to Work Program, also that it will also
+protect their benefits, their medical. The Ticket to Work is
+there so that you don't have to worry about your benefits or
+your medical. So, that is one thing that is very important if
+they decide to use the Ticket to Work. They don't have to worry
+that their medical will be taken away from them.
+ Mr. HAYWORTH. So, the real thing is to emphasize the
+message and expand, and that leads me to Ms. Hancock, a fellow
+broadcaster. I worked in television and many a television news
+director said I had a face for radio. Maybe that is how I ended
+up in the Congress.
+ [Laughter.]
+ I think we get into the real challenge we are confronting
+today with these hearings, because as our colleague from
+Maryland pointed out, we passed this program in 1999. Now, Mr.
+Chairman and my colleagues, witnesses and others gathered here,
+this is a critical time because we have the irony of some
+really gratifying success stories and we appreciate the
+presence of television cameras here today, and yet the ability
+of folks to take advantage of this seems to be the real
+challenge, to make sure the word gets out.
+ Ms. Hancock, I could not help but notice in your testimony
+your willingness, your invitation to the SSA and others to take
+advantage of your background in broadcasting and of your story
+to get the message out. It is a bit unfair, but we have both
+been in the broadcasting business, and sometimes in Washington,
+we get involved in--I am not here to castigate, it is just
+sometimes in the order of doing things. We introduce pilot
+projects to get the word out, and sometimes things are very
+laudable on the surface, but the results are projected a year
+or two down the road, and there may be a lag time that is not
+at all satisfactory. As a fellow broadcaster, what is the best
+way to get the message to the people who are qualified for the
+Ticket to Work? What do you think would be the most effective
+means of communication?
+ Ms. HANCOCK. I am so glad you asked that, because I do have
+an answer, and that answer is when people go to apply for their
+disability and you see your counselor there, the Ticket to Work
+needs to be introduced at that juncture because they need to
+know--for example, if you are on short-term disability, we have
+got a program called Ticket to Work. You don't lose anything.
+You don't lose your benefits. You get to work. You have got a
+trial work period. If you can't succeed, you lose nothing. You
+start over. Disability benefits stay. If you go past the 9
+months, then we take the Social Security away. You get back
+into the mainstream of life. It is a win-win situation for all.
+You are helping to stop the deficit in terms of all the moneys
+going out to people that don't really need to be on Social
+Security.
+ Let us face it. We have got people, excuse me, that don't
+need to be on Social Security. They are there because they are
+afraid to come back into the workforce, or it is just plain
+easier not to go back to work because you are getting that
+money. You have some people that will stay at that safe house
+because they are lazy. You have got other people, such as the
+two people you have here. We want to get back into society. We
+want to do the right thing.
+ If it was simply introduced when you had your review or
+when you had your initial interview, it is an option that is
+open without passing any type of legislative law. It is already
+there. The counselors can simply do it at that point, and let
+you know what your options are. Many people do not read the
+mail. I read the mail. She reads the mail. Many people don't
+open the mail, so the ticket goes in the drawer. The Ticket
+goes in the trash. So, to get it out, you have got to have a
+one-on-one communication with a human being, so the person will
+understand what the ticket is.
+ Mr. HAYWORTH. So, job one of the counselor is to bring up
+Ticket to Work?
+ Ms. HANCOCK. Absolutely, and the benefits of Ticket to
+Work.
+ Mr. HAYWORTH. Ms. Nelson, you want to make a comment on
+that?
+ Ms. NELSON. I just want to make a comment as to what she
+said. She is telling the truth, because when I received the
+Ticket to Work, the first place I put it was in the filing
+cabinet. At the time, my husband was there. I didn't read it
+over. I didn't think that I needed it. Nine months later is
+when I pulled it out, and at the time, I wasn't even sure if it
+had expired, or if I was still able to use it. So, I agree with
+her.
+ Mr. HAYWORTH. Thank you both very much. Thank you, Mr.
+Chairman.
+ Chairman SHAW. Thank you. Just to follow up on that, in
+looking at the Ticket to Work, I don't know whether the Members
+have it in their back-up material, but it is a pretty cold
+document. I think we can do a better job of making it more
+consumer-friendly. When you read it, you don't know if you are
+getting in trouble or what.
+ [Laughter.]
+ Whether to put it in the filling cabinet or in the round
+filing cabinet.
+ [Laughter.]
+ I think it is a little intimidating, and I think maybe we
+can do something to help that out. Ms. Tubbs Jones?
+ Ms. TUBBS JONES. Thank you, Mr. Chairman. Ms. Nelson, Ms.
+Hancock, on behalf of all of the folks who are receiving SSI
+across this country, I want to thank you for your wonderful
+commentaries and reports. I am interested, even though you are
+not here for this purpose, how, when you made an application
+for disability, how long that took for you. Was it a long
+process? Was there delay? What happened for you? I hate to go
+to another part, and maybe it is not as glorious as your
+commentary, but I need to know that if you could help me out.
+ Ms. HANCOCK. Yes. For me, it was short. This is a true
+story. My mother was visiting me in Atlanta, Georgia. We were
+at a CHU facility and a woman saw me, and I was limping. She
+said to me, ``Excuse me, are you receiving Social Security,''
+and I really ignored her, because I was trying to ignore the
+condition. In fact, I was a little hurt, and I said, ``No, I am
+not receiving,'' because it was one of those things where you
+don't want to be bothered. The injury was too new. So, to make
+a long story short, my mother says, ``Listen to what this woman
+has to say,'' and I did.
+ Ms. TUBBS JONES. Mothers always say that, don't they?
+ [Laughter.]
+ Ms. HANCOCK. So, the woman worked at Social Security and
+she said, ``You need to see me at my office.'' It was almost
+like a Godsend, like a little blessing. I went in and mine
+actually didn't take long at all. When people say they are
+denied, I just went through the process fairly quickly. Within
+3 months, I was getting Social Security. So, I didn't have a
+bad time at all.
+ Ms. TUBBS JONES. Where are you from, again?
+ Ms. HANCOCK. Washington, D.C.
+ Ms. TUBBS JONES. Okay. Thank you. I thought they had some
+other State on there.
+ Ms. HANCOCK. I live in Newnan, Georgia.
+ Ms. TUBBS JONES. That is what I am saying. Okay. I am not
+totally confused. Great. What about you, Ms. Nelson?
+ Ms. NELSON. For me, it didn't take long at all. I was in
+the hospital for about a month and they weren't expecting me to
+live. When I did start to recover, to get better, they did it
+in the hospital so when I returned home, I was eligible for
+Social Security.
+ Ms. TUBBS JONES. So, tell me what you are doing right now,
+Ms. Nelson. What type of work are you doing?
+ Ms. NELSON. Right now, I work for a marketing company. I
+invite people to a vacation resort in the Poconos, the
+Pennsylvania and New Jersey area.
+ Ms. TUBBS JONES. What about you, Ms. Hancock?
+ Ms. HANCOCK. Right now, I am mediating, mostly divorce
+cases. Daily, I teach, and I am a master's candidate for
+counseling.
+ Ms. TUBBS JONES. If there was one thing, and I am almost
+done, Mr. Chairman, if there was one thing that you would
+improve in addition to how people are noticed of Ticket to
+Work, what would that proposal be for either one of you?
+ Ms. NELSON. I would say a lot of people watch television.
+Put it on television.
+ Ms. HANCOCK. Yes, they do. That is good.
+ Ms. TUBBS JONES. Ms. Hancock?
+ Ms. HANCOCK. For me, again, I would build a campaign, an
+actual campaign, because when we campaign and we get things
+done through campaigns, we stir up, again, from the
+broadcasting, we stir up interest.
+ Ms. TUBBS JONES. If there was an opportunity for either of
+you to serve on an advisory Committee to the Ticket to Work
+Program, would you consider that?
+ Ms. HANCOCK. I would be your girl.
+ Ms. NELSON. Yes.
+ Ms. TUBBS JONES. Okay.
+ [Laughter.]
+ Thank you very much, Mr. Chairman.
+ Chairman SHAW. Thank you. Mr. Hulshof?
+ Mr. HULSHOF. Thanks, Mr. Chairman. I promised Mr.
+Hayworth--he had to step out just for a moment, and I promised
+that we would not ask for a recorded roll call vote on whether
+we believe he has a face for radio.
+ [Laughter.]
+ Chairman SHAW. We are still wondering if he has a face for
+politics.
+ [Laughter.]
+ That will teach him to leave the hearing.
+ [Laughter.]
+ Mr. HULSHOF. I am sure he will be back any minute now. I
+certainly don't have the breadth of experience as the Chairman
+as far as the number of hearings, but I do look around the
+room, and I think of the number of hearings that this
+Subcommittee has had regarding this issue, and I see some
+familiar faces here in the hearing room who have been with us
+working on this issue, actually even back to 1997. I think is
+when we began under a former Chairman, and now Senator, Jim
+Bunning of Kentucky, when he chaired this Subcommittee.
+ We have a very active disability community in Central
+Missouri. I will confess that before they brought this issue to
+my attention about things like the income cliff, and things
+like losing health insurance, and things like the barriers and
+obstacles in place to keep people who want to return to the
+workforce and be productive, and the self-esteem and all those
+things, they are the ones who brought it to my attention. So,
+it is great that we can come and talk about a successful
+program, but also then to see what we need to do to make sure
+that this program continues, that we go and recruit others and
+tell others about this very successful program.
+ This was an interesting political lesson for me because
+this was the first time I actually got to be on a Conference
+Committee, that is, to work with Senator Kennedy and Rick Lazio
+of New York, again, a former Member, and we were trying to work
+the details of this out. I know that when the bill, the final
+version, there were folks that were concerned about the final
+version, but I think we had a good product. There is my friend
+back.
+ [Laughter.]
+ So, again, whatever suggestions that you have, and I
+applaud each of you and I know, Ms. Hancock, just as a final
+question, I know you are not here for self-promotion, but where
+can I get your book?
+ Ms. HANCOCK. I will send you a copy.
+ Mr. HULSHOF. Okay. Thank you, Mr. Chairman.
+ Chairman SHAW. Thank you. Mr. Becerra?
+ Mr. BECERRA. Thank you, Mr. Chairman, and thank you very
+much for what was compelling testimony. I think you bring real
+life to what we try to do sometimes, so it is nice to see that
+oftentimes policy is put in practice, and it is great to see
+that. I know we are going to have an opportunity to talk to the
+folks from the agencies that are equipped and empowered to
+administer these programs, and hopefully what we can do is try
+to perfect them, because we know that there have been some
+difficulties, whether it is not the best providers being out
+there or just not having the access and to beneficiaries not
+knowing about them. So, we thank you for the testimony and
+appreciate that you shared your stories. Just so you know, my
+understanding is that there is an opening right now with the
+Ticket to Work Program for the Director, so if any of you are
+interested in applying, you might want to consider submitting
+your resume.
+ [Laughter.]
+ I think Congresswoman Tubbs Jones asked a question that I
+wanted to ask, which was give us your on-the-ground impressions
+of what we should do, and you mentioned two very good ones, the
+publicity campaign, doing something on television, maybe
+through public service announcements. Any other thoughts about
+what we should know about making the program more user
+friendly? The simplest things, just so we know how you all need
+to access the program.
+ Ms. NELSON. I think one thing to make the program more user
+friendly is to emphasize on the medical part of it protecting
+medical benefits. That was one of my biggest issues of even
+beginning to work and to continuing to work. We are always
+going to need medical help, and me personally, I know that I am
+going to have hip replacements soon. I never know when I am
+going to need another eye surgery. So, that is always a major
+concern as far as me working at this time.
+ I am in training to become supervisor on my job, but at the
+same token, I am afraid to take the position because I know
+with a certain amount of money, the medical benefits are taken
+away and that is one of my biggest concerns. Even with the
+medications I take, it is really a big concern of mine. So, if
+there is some way that you can assure Social Security
+beneficiaries that they will be protected in that aspect, I am
+sure that a lot of people will take advantage of the Ticket to
+Work.
+ Mr. BECERRA. Ms. Nelson, have you had or do you have a good
+experience that you can tell us about with regard to VR
+services? Has that continued? Now that you have used the Ticket
+to Work Program, are you still accessing the VR services?
+ Ms. NELSON. Yes. Goodwill has helped me. Everything that I
+need, I went to GGI, any encouragement, counseling. Regardless
+as to what it was, I have been to GGI. I consult GGI. I always
+consult Ron Rattay, who has answered all of my questions. If he
+didn't know the answer, he found the answer, and this made me
+feel confident.
+ Mr. BECERRA. So, you had a pretty good experience working
+with the agencies involved?
+ Ms. NELSON. Yes.
+ Mr. BECERRA. Good. Ms. Hancock, I don't know if you have
+anything you would like to add.
+ Ms. HANCOCK. I think I have probably said enough. I do want
+to say that she is absolutely right. If we could just alleviate
+the fear of, ``Are we going to lose this?'' People just don't
+understand that you can benefit in a win-win situation, and
+that everything is not taken away from you at once. They think
+if they are working 4 or 5 months, that is 4 or 5 months into
+their ticket period, not understanding that if you start over,
+the whole process starts over, so you are losing nothing. I
+think that should be made more clear. Other than that, I am
+done.
+ [Laughter.]
+ Mr. BECERRA. Thank you for coming. Mr. Chairman, thank you.
+ Chairman SHAW. Thank you. I am going to just read something
+into the record off of an actual Ticket to Work ticket. It has
+been a successful program, I am not knocking it, but I think
+there are many people out there like you two who would avail
+themselves of this instead of being too quick just to throw it
+away or being intimidated by it.
+ I am reading right from the ticket. It says, ``This ticket
+is issued to you by the SSA under the Ticket to Work and Self-
+Sufficiency Program.'' Now, that has got to mean a lot to
+people who are on disability. ``If you want help in returning
+to work or going to work for the first time, you may offer this
+ticket to an EN of your choosing or take it to your State VR
+agency for services. If you choose an EN and it agrees to take
+your ticket, or if you choose your State agency and you qualify
+for services, these providers can offer you services to help
+you go to work. An EN provides the services at no cost to you.
+The SSA will pay the EN if you assign your ticket to it, and
+the EN helps you go to work and complies with the other
+requirements of the program. An EN serving under the program
+has agreed to abide by the rules and regulations of the program
+under the terms of its agreement with the SSA for providing
+services under the program. Your State agency can tell you
+about its rules for getting services.''
+ Now, if you are going to be informed about the program
+after reading this, you have got a sense that I think is rather
+remarkable. I do understand there is a letter accompanying
+this, but I don't have a copy of it. I am sure it gives us a
+lot more information, but, all of us here on this panel have
+been involved in advertising ourselves in political campaigns
+and we would never send out something like this, because it
+would never be read. I think that we must become a little more
+imaginative if we are going to get more people into the
+program. You people have demonstrated, Ms. Nelson and Ms.
+Hancock, you have demonstrated what you can do for yourself.
+ This Subcommittee and the entire Committee on Ways and
+Means has, I think, done some wonderful things, and Ticket to
+Work, I think, is another program in which we show that we have
+faith in the human spirit if we just let it fly. You have
+certainly proven that to us. Ms. Nelson, I am really very proud
+to have you. I think you just live outside of my congressional
+district. I checked you out. I don't think you live in my
+district.
+ [Laughter.]
+ You do live in the West Palm Beach area, which I do
+represent a portion of, and I am very proud to--I will claim
+you as a constituent, even if you live out of the district.
+ Mr. BECERRA. So do we.
+ [Laughter.]
+ Chairman SHAW. California is a stretch.
+ [Laughter.]
+ I have heard of gerrymandering----
+ Mr. BECERRA. We stretch a lot of things in Congress.
+ Chairman SHAW. I have heard of gerrymandering, but it
+doesn't go from Palm Beach to Los Angeles.
+ [Laughter.]
+ Ron, do you have a question?
+ Mr. LEWIS. No.
+ Chairman SHAW. I want to thank you for being here and
+sharing your story. Hopefully, it will be an inspiration to
+many, and Mr. Rattay, just keep up what you are doing. You are
+obviously doing the right thing and we very much appreciate
+your being here with us this morning.
+ Ms. HANCOCK. Thank you for having us.
+ Ms. NELSON. Thank you.
+ Mr. RATTAY. Thank you.
+ Chairman SHAW. Our next panel is made up of Martin Gerry,
+who is Deputy Commissioner, disability and Income Security
+Programs, SSA, and Troy Justesen, who is the Acting Deputy
+Assistant Secretary, Office of Special Education and
+Rehabilitation Services at the Department of Education. We
+welcome both of you back to this panel and we look forward to
+your testimony. As both of you know, we have your full
+testimony and it will be made a part of the record. You may
+proceed as you see fit. Mr. Gerry?
+
+ STATEMENT OF MARTIN H. GERRY, DEPUTY COMMISSIONER, DISABILITY
+ AND INCOME SECURITY PROGRAMS, SOCIAL SECURITY ADMINISTRATION
+
+ Mr. GERRY. Thank you, Mr. Chairman. Mr. Chairman and
+Members of the Subcommittee, as you know, Mr. Chairman, the SSA
+administers both the SSDI, and the SSI programs. These programs
+provide benefits to about 10.5 million Americans with
+disabilities. The Ticket to Work Program allows these
+beneficiaries greater flexibility and expanded choice in
+obtaining the rehabilitation, employment, and other support
+services that they need in order to go to work and to attain
+their employment goals.
+ Mr. Chairman, I would like to express my thanks to you, Mr.
+Matsui, and to the other Members of this Subcommittee for all
+of the hard work and support that you have provided in making
+the Ticket to Work Program a reality. I look forward to
+continuing to work together closely with the Subcommittee to
+strengthen the program in a way that builds on our early
+experience and significantly expands participation in the
+program by both our beneficiaries and by ENs.
+ In his New Freedom Initiative, President Bush pledged that
+his Administration will work tirelessly to help Americans with
+disabilities become fully integrated into the American work
+force so that they may realize their dreams for meaningful and
+successful careers. The Ticket to Work Program will help us
+tear down many of the barriers that currently prevent Americans
+with disabilities from full participation in the economic
+mainstream of American society.
+ With the Ticket to Work Program, beneficiaries have more
+opportunities to obtain employment support services to help
+them reach their employment goals. In addition, the program
+will help us fulfill the promise of the Americans with
+Disabilities Act. Commissioner Barnhart and I are deeply
+committed to achieving the goals of this very important
+program.
+ Mr. Chairman, I would like to begin by briefly describing
+how the Ticket to Work Program operates and making some
+comments on where we are in implementation of the program. The
+SSA currently provides benefits under the SSDI and SSI
+Programs, as I said, to approximately 10.5 million Americans
+with disabilities. Under current agency regulations, an SSDI or
+SSI beneficiary with a disability receives a Ticket to Work if
+he or she is between the ages of 18 and 64 and has a medical
+condition that is not expected to improve in the near future.
+Approximately 9.2 million, or a little over 85 percent of the
+10.5 million of all our current beneficiaries with disabilities
+meet this standard.
+ Under the act, the SSA enters into agreements with ENs, and
+State VRs. The ENs are qualified State, local, or private
+organizations that offer employment support services. A
+beneficiary who receives a Ticket to Work can choose to assign
+it to the State VR agency or to any EN that provides services
+within his or her community. Together, these agencies serve as
+ticket providers under the program. The act does require that a
+ticket provider accept a measure of risk whenever it agrees to
+provide services to a beneficiary. The ENs and State VR
+agencies may only be paid under the program based on success in
+assisting beneficiaries to secure and maintain employment and
+to move off the disability benefit rolls. An EN might never be
+paid if a beneficiary's cash benefits do not stop as a result
+of work. An EN may decide whether or not to accept the
+assignment of a ticket. State VR agencies incur less risks than
+ENs do because those agencies are already funded and fully
+capitalized through the Rehabilitation Act (P.L. 93-112).
+ Once a ticket is assigned by a beneficiary to a ticket
+provider, the beneficiary and the provider jointly develop and
+implement a plan of employment, vocational, or other support
+services designed to lead to and maintain employment. Providers
+may offer these services directly or by entering into
+agreements with other organizations or individuals to provide
+the appropriate services at no cost to the beneficiary. The
+Ticket to Work Act provides three additional incentives to
+encourage work activity by beneficiaries. First, the SSA will
+not schedule a periodic continuing disability review (CDR), for
+a beneficiary who is receiving services from a ticket provider.
+Second, work activity by a beneficiary will not trigger a CDR
+if the beneficiary has received benefits for at least 24 months
+under the Disability Insurance program. Finally, an individual
+whose benefits terminated because of work activity can request
+that benefits start again without having to complete a new
+application for benefits.
+ Mr. Chairman, as you know, we have implemented the Ticket
+to Work in three phases and it is currently available in all
+States and U.S. territories. Through February 2004, tickets
+have been mailed to over 6.9 million disabled beneficiaries,
+and by September of this year, the remaining 2.2 million
+eligible beneficiaries will have received a Ticket to Work. As
+of the beginning of this month, 40,441 beneficiaries who had
+received Tickets to Work had assigned them to ticket providers.
+Of this total, 36,525, or approximately 90 percent, have been
+assigned to a State VR agency, and 3,916, or 10 percent, have
+been assigned to an EN. It is interesting, however, to note
+that 30 percent of the ticket assignments have been made in the
+last 5 months. This suggests to me, Mr. Chairman, that there is
+a significant acceleration going on in the use of tickets and
+the assignment of tickets.
+ The first milestone payment was made by Maximus in May of
+2002, and the first outcome payment was paid in July of 2002.
+We now have more than 1,600 payments based on the work of 450
+beneficiaries going to 116 ENs and totaling over $530,000. Over
+the last few months, we have received valuable information from
+several sources regarding the initial implementation of the
+Ticket to Work Program. The Ticket to Work Act requires the
+Commissioner to submit periodic evaluation reports of the
+Ticket to Work Program to the Congress. The SSA has contracted
+with Mathematica Policy Research to evaluate the impact of the
+Ticket to Work Program.
+ Mathematica has provided a draft of the first in a series
+of evaluation reports, and while Mathematica notes in its draft
+report that, overall, the SSA has made great progress in
+developing a system to assist individuals with disabilities to
+find work and to remain in the work force, it points out that
+most beneficiaries who use the Ticket to Work have assigned
+them to traditional State VR agencies and the ticket
+assignments to ENs have been concentrated among a few. It
+reports that ENs as a group feel that the SSA needs to move
+quickly to make the process friendlier to providers, and I will
+be happy, both to provide the Subcommittee with a copy of the
+final version of this report, which we expect to be available
+shortly, and to brief Members and staff as to its findings.
+ The Ticket to Work Act also identifies four groups of
+beneficiaries with disabilities as potentially at risk and
+requires the Commissioner to study the adequacy of incentives
+for ENs to serve people in these populations. To this end, the
+SSA formed an Adequacy of Incentives Advisory Group that has
+been meeting quarterly and will complete its work this spring.
+I think I have attended all but one half-day of their meetings.
+ Last fall, the Advisory Group issued an interim report
+recommending regulatory and administrative changes. The
+Advisory Group will also issue a final report, we believe by
+the end of next month, that proposes projects to evaluate the
+effectiveness of adjusted incentives and provides
+recommendations regarding the most promising of these
+incentives. The Ticket to Work Advisory Panel has been a
+valuable partner in studying the Ticket to Work Program and
+making recommendations for improvements. The panel has been
+concerned about the balance between State VR agencies and other
+ENs and about ways in which we can encourage more beneficiaries
+to assign their tickets to ENs. It has also advised us on ways
+to improve our marketing of the program to both beneficiaries
+and potential ENs, provided specific recommendations with
+respect to establishing a core of work-incentive specialists,
+and offered suggestions on a way to reduce the incidence of
+overpayments caused by work.
+ Commissioner Barnhart and I believe that it is our mission
+to see that the ticket program lives up to its potential, and I
+think it has great potential to return people to work. Based on
+all of the information that we have received, we have already
+taken a series of actions to improve our return to work
+service. These include steps to simplify the payment process
+for ENs, to increase the pool of ENs, and to improve our wage
+reporting process. We have jointly funded with the U.S.
+Department of Labor new positions in the One-Stop Career
+Centers to help people with disabilities increase their
+employment opportunities and have expanded the pool of SSA
+field employees who are available to answer questions relating
+to return to work, including the employment of 58 full-time
+employees who serve as Area Work Incentive Coordinators.
+ I want to thank the Subcommittee for its advice and
+guidance as we work closely with you to develop this approach.
+In summary, Mr. Chairman, our early experience and the
+preliminary evaluation, analyses, and recommendations that I
+summarized earlier have shown us both that the Ticket to Work
+Program can provide beneficiaries with more opportunities to
+obtain employment support services to help them reach their
+employment goals, and also that we need to do more to increase
+program participation and build on program success.
+ Finally, I want to thank you, Mr. Chairman, Mr. Matsui, and
+all the other Members of the Subcommittee for showing continued
+dedication to the program. Thanks to that commitment, we look
+forward to providing more beneficiaries with additional
+opportunities and the tools that they need to enter or reenter
+the workforce.
+ In addition, I would also like to thank the Subcommittee
+for its work to pass H.R. 743, the ``Social Security Protection
+Act'' (P.L. 108-203). With the provisions in that bill
+regarding SSA demonstration projects, we can move forward with
+our agenda of projects designed to provide alternative return
+to work services. We look forward to working with the
+Subcommittee as we continue our efforts to make the Ticket to
+Work Program a success. I would be happy to answer any
+questions.
+ [The prepared statement of Mr. Gerry follows:]
+
+ Statement of Martin H. Gerry, Deputy Commissioner, Disability and
+ Income Security Programs, Social Security Administration
+
+Mr. Chairman and Members of the Subcommittee:
+
+ Thank you for inviting me today to discuss implementation by the
+Social Security Administration (SSA) of the Ticket to Work and Self-
+Sufficiency Program (the ``Ticket to Work program'') authorized by The
+Ticket to Work and Work Incentives Improvement Act of 1999 (the
+``Act''), PL 106-170.
+ As you know, Mr. Chairman, SSA administers both the Social Security
+Disability Insurance (SSDI) and Supplemental Security Income (SSI)
+programs. These programs provide benefits to about 10.5 million
+Americans with disabilities. The Ticket to Work program allows these
+beneficiaries greater flexibility and expanded choice in obtaining the
+rehabilitation, employment and other support services that they need to
+go to work and attain their employment goals.
+ 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 to Work program a reality. I know we will continue to
+work together closely to strengthen the program in a way which will
+build on our early successful experience and expand the participation
+we have already seen in the program.
+ Commissioner Barnhart and I have been fortunate to participate in
+Ticket to Work program activities throughout the nation. I know that
+she has especially fond memories of kicking off the Ticket to Work
+program in February 2002 alongside the late Senator William Roth. Among
+the other Ticket events she attended that year was one in
+Representative Hayworth's district. In addition, senior agency staff
+have traveled throughout the country to help introduce this program to
+the American people. Today I would like to provide an update on the
+implementation of the Ticket to Work program, and touch on a few
+related issues.
+
+An Overview of the Ticket to Work Program
+
+ First, let me briefly describe how the program works. SSA currently
+provides benefits under the SSDI and SSI programs to approximately 10.5
+million Americans with disabilities. Under current agency regulations,
+an SSDI or SSI beneficiary with a disability receives a Ticket to Work
+if he or she is between the ages of 18 and 64 and has a medical
+condition that is not expected to improve in the near future.
+Approximately 9.1 million, or over 85 percent, of all beneficiaries
+with disabilities meet this standard.
+ Under the Act, SSA enters into agreements with Employment Networks
+(ENs) and with State Vocational Rehabilitation Agencies (``State VR
+Agencies''). ENs are qualified State, local, or private organizations
+that offer employment support services. These organizations include
+One-Stop Career Centers established under the Workforce Investment Act
+of 1998; single providers of services; or groups of providers organized
+to combine their resources into a single entity.
+ A beneficiary who receives a Ticket to Work can choose to assign it
+to any EN that provides services within the community or to the State
+VR Agency. Together, these organizations are referred to as ``Ticket
+Providers.'' An EN may decide whether or not to accept the assignment
+of a Ticket. The Act requires that an EN accept a measure of risk
+whenever it agrees to provide services to a beneficiary. ENs may only
+be paid based on their success in assisting beneficiaries to secure and
+maintain employment and move off the disability benefit rolls. An EN
+might never be paid if a beneficiary's cash benefits do not stop as a
+result of work. State VR Agencies are receiving approximately $2.6
+billion from the Department of Education for the primary purpose of
+providing employment services to individuals with significant
+disabilities. VR agencies are therefore better capitalized than small
+or new ENs and incur less financial and actuarial risk than ENs serving
+smaller numbers of individuals.
+ Once a Ticket is assigned by a beneficiary to a Ticket Provider,
+the beneficiary and the Provider jointly develop and implement a plan
+of employment, vocational, or other support services designed to lead
+to and maintain employment. Providers may provide these services
+directly or by entering into agreements with other organizations or
+individuals to provide the appropriate services at no cost to the
+beneficiary.
+ Ticket Providers may be paid based only on their success in
+assisting beneficiaries to secure and maintain employment and move off
+the disability benefit rolls. Where this occurs, an EN may 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 reaches 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.
+ The Ticket to Work Act provides three additional incentives to
+encourage work activity by beneficiaries. First, SSA will not schedule
+a periodic continuing disability review (CDR) for a beneficiary who is
+receiving services from a Ticket Provider. Second, work activity by an
+SSDI beneficiary will not trigger a CDR if the beneficiary has received
+benefits for at least 24 months. Finally, an individual whose benefits
+terminated because of work activity can request that benefits start
+again without having to complete a new application for benefits.
+
+Implementation of the Ticket to Work Program
+
+ SSA is implementing the Ticket to Work program in three phases.
+During the first phase of the program, from February through October
+2002, about 2.4 million beneficiaries with disabilities in 13 states
+received Tickets to Work. During the second phase, which ran from
+November 2002 through September 2003, we mailed Tickets to
+approximately 2.6 million beneficiaries in 20 additional States and the
+District of Columbia. Then beginning in November 2003, we started
+releasing Tickets to the approximately 4.1 million beneficiaries in the
+remaining 17 States and the U.S. Territories during the third and final
+implementation phase.
+ Through February 2004, Tickets have been mailed to over 6.9 million
+disabled beneficiaries. By September 2004, the remaining 2.2 million
+eligible beneficiaries will have been mailed a Ticket to Work, and any
+eligible beneficiary who has yet to receive a Ticket to Work in the
+mail can obtain one by asking for it. To date, we have certified almost
+1,100 ENs to participate in the Ticket program.
+ The Act calls for the Commissioner to enter into agreements with
+Program Managers to assist the Agency in administering the Ticket to
+Work program. Among the duties of our Program Manager, Maximus, Inc.,
+are recruiting, recommending, and monitoring the ENs selected by SSA to
+provide services; facilitating beneficiary access to the ENs;
+facilitating payment to Ticket Providers; and resolving disputes
+between beneficiaries and Ticket Providers under the program.
+
+Ongoing Operation of the Ticket to Work Program
+
+ As of the beginning of this month, 40,441 SSDI and SSI
+beneficiaries who had received Tickets to Work (``Ticket Holders'') had
+assigned them to Ticket Providers. Of this total, 36,525 (90%) were
+assigned to a State VR Agencies and 3,916 (10%) were assigned to other
+ENs. Approximately 30 percent of ticket assignments have been made in
+the last 5 months.
+ The first milestone payment was made by Maximus during May 2002.
+The first outcome payment was paid in July 2002. Through February 2004
+we have made more than 1,600 payments to nearly 120 ENs totaling over
+$530,000 based on the work of 450 beneficiaries.
+ Our early experience shows us that the Ticket is already proving it
+can provide beneficiaries with more opportunities to obtain employment
+support services to help them reach their employment goals. It is our
+mission to see that the ticket lives up to its potential to return
+people to work
+
+Evaluation of the Ticket to Work Program
+
+ Section 101(d) of the Ticket to Work Actrequires the Commissioner
+to submit periodic evaluation reports of the Ticket to Work program to
+Congress. SSA has contracted with Mathematica Policy Research, Inc.
+(``Mathematica ``) to evaluate the impact of the Ticket to Work
+program. Mathematica has provided a draft of its first in a series of
+evaluation reports. I will be happy to provide the Subcommittee with a
+copy of the final version of this report which we expect to be
+available shortly, and will also be happy to brief you on its findings.
+ Mathematica's preliminary findings are generally consistent with
+our experience with the program. Most beneficiaries who use Tickets to
+Work have assigned them to traditional State VR agencies. Ticket
+assignments to ENs have been concentrated among a few ENs, and the ENs
+as a group feel that SSA needs to move quickly to make the process
+friendlier to providers.
+ As Mathematica notes in the draft report, overall, it is clear that
+SSA has made great progress in developing such a system to assist
+individuals with disabilities to find work and remain in the workforce.
+This undertaking, which required SSA to develop new capabilities to
+integrate information
+ from the SSI and DI programs, so that beneficiaries work could be
+appropriately considered in determining theirs and their service
+providers eligibility to benefits.
+
+The Work of the Adequacy of Incentives Advisory Group
+
+ The Ticket to Work and Work Incentives Improvement Act of 1999
+identified four groups of people with disabilities as potentially ``at
+risk.'' These groups are: 1) individuals with a need for ongoing
+support and services; 2) individuals with a need for high-cost
+accommodations; 3) individuals who earn a sub-minimum wage; and 4)
+individuals who work and receive partial cash benefits.
+ The Act requires the Commissioner to study the adequacy of
+incentives to Employment Networks in the Ticket to Work program for
+serving these four groups of beneficiaries. SSA formed an Adequacy of
+Incentives Advisory Group to help determine the best approach for
+conducting a targeted, in-depth analysis of the ``at risk'' groups. The
+Advisory Group has been meeting quarterly, and will complete its work
+this spring 2004. Last fall, the group issued an interim report,
+``Recommendations for Improving Implementation of the Ticket to Work
+and Self-Sufficiency Program (Regulatory and Administrative Changes).''
+The group will also issue a final report, which will propose projects
+to evaluate the effectiveness of adjusted incentives and
+recommendations regarding the most promising adjusted incentives.
+
+Recommendations of the Ticket to Work Advisory Panel
+
+ The Ticket to Work Advisory Panel has been a valuable partner in
+studying the program and making recommendations for improvements. They
+too have been concerned about the balance between State VR agencies and
+other ENs, and about ways in which we can encourage more beneficiaries
+to assign their Tickets to ENs. They also advise us on ways to improve
+our public education of the program and how to market the program to
+both beneficiaries and potential ENs.
+ We have carefully considered the recommendations of the Panel with
+respect to establishing a corps of work incentive specialists, who will
+be available to advise beneficiaries on the effects of work on benefit
+payments, and on ways to reduce the incidence of overpayments caused
+ by work. They recognize, as do we at SSA, that the fear of creating
+overpayments is a powerful disincentive to returning to work that our
+beneficiaries face.
+
+The $1 for $2 Benefit Offset Demonstration
+
+ The Ticket to Work legislation required SSA to test a DI benefit
+offset similar to what is provided in the SSI program. Generally, SSI
+benefits are reduced $1 for every $2 earned over the $65 earned income
+monthly exclusion. Because there is no parallel provision for the DI
+program, DI beneficiaries are often reluctant to attempt work because
+of the abrupt loss of all cash benefits faced if they engage in
+substantial gainful activity.
+ Therefore, we plan to conduct a national demonstration project to
+test a $1 reduction in benefits for every $2 in earnings over a certain
+level in the DI program in combination with interventions that offer a
+range of ongoing employment supports, which may include some
+combination of employment services, health care services,
+transportation assistance, training, and other similar supports.
+ In addition, we plan to conduct a small-scale process demonstration
+of the benefit offset in four sites. We expect this project to begin
+enrolling participants this fall.
+
+Program Improvements
+
+ I would now like to discuss a number of initiatives we have already
+put in place on a number of fronts to improve our return to work
+services based on all the information that we have received. They
+include simplifying the payment process for ENs, increasing the pool of
+ENs, improving our wage reporting process, and jointly funding with the
+Department of Labor a new position to help people with disabilities
+increase their employment opportunities. I will discuss these in more
+detail.
+
+Work Incentive Specialists
+ Section 1149 of the Social Security Act, as enacted by Section 121
+of the Ticket Act requires SSA to establish a corps of specialists
+devoted to issues related to work incentives. We have worked closely
+with Subcommittee staff to develop and implement this concept.
+ Commissioner Barnhart has expanded the pool of field employees who
+would be available to answer questions relating to return to work,
+while establishing a dedicated number of employees in each area of the
+region who will serve full time as Area Work Incentive Coordinators
+(AWICs), for a total of 58 employees nationwide. I want to thank the
+Subcommittee for its advice and guidance as we worked closely with you
+to develop this approach.
+ AWICs are the focal point of contact for advocates area-wide, and
+serve as ombudsmen. They monitor the area employment support workloads
+and work with the Area Directors to ensure that we effectively manage
+work incentive workloads. In addition, we have trained all of our
+public service employees, including staff in all local Social Security
+offices, on SSA employment support programs. AWICs work with other
+staff to develop any area training needs to maintain the level of
+expertise on work incentives for all direct contact employees and they
+are a ready resource for providing accurate information to those
+employees when questions arise.
+
+An Improved EN Payment Process
+ Because many ENs found the payment process too cumbersome, we have
+developed a new, simpler process for paying them. Under the new
+process, SSA will pay ENs upon receiving a certification from the EN
+that a Ticket Holder is still working, provided that the EN initially
+submits return to work evidence. Prior to this change, ENs were
+required to send in evidence of the work, such as pay stubs, monthly.
+Now ENs have several options for requesting payments on either a
+monthly or quarterly basis without needing to submit pay stubs.
+
+Expanded Choice of Employment Networks
+ In order to attract sufficient providers of employment services and
+in concert with Maximus, we have conducted 90 Employment Network
+Opportunity Conferences across the country. We did this so
+beneficiaries will enjoy the degree of choice when selecting an EN that
+the Congress envisioned when the Act was passed. These events were
+attended by more than 8,000 individuals, representing 6,100
+organizations. To date, 483 conference attendees have applied to become
+employment networks. In addition, Maximus has made presentations about
+the Ticket to Work program at nearly 300 events nationwide and
+delivered the message to 20,000 different organizations and 50,000
+individuals through 250,000 distinct contacts. We will continue to seek
+out EN recruitment opportunities and process improvements so we may
+offer more choices for our beneficiaries who want to work.
+ Because we learned that the lack of upfront funding was a barrier
+to EN participation, SSA has developed an EN capitalization initiative
+that helps ENs locate and apply for additional funding to support their
+efforts.
+
+Eliminating Barriers and Disincentives
+ Overpayments to beneficiaries with disabilities attempting to work
+are a major barrier to participation in the Ticket to Work program.
+Disability recipients who try to return to work deserve to know that
+their work information will be processed right away to prevent large
+overpayments that are a burden to the recipient as well as an important
+program integrity issue. Accurate and prompt wage report processing is
+critically important.
+ The Social Security Protection Act of 2004 (P.L. 108-203) imposes a
+requirement for a work report receipt, and we expect that our current
+software, known as the Modernized Return to Work, or MRTW, and our PC-
+CDR processes that field offices have been using, should be able to
+fulfill that requirement. The issue of handling work reports is a major
+priority of Commissioner Barnhart, and we expect several new processes
+to have a positive impact on the problem, reducing both overpayments
+and the work disincentives caused by the threat of such overpayments.
+ In January 2004, we began a phased rollout of our eWork application
+for controlling and processing disability work activity and work CDR
+workloads. It replaces the stand-alone MRTW and PC-CDR that I have just
+mentioned. The eWork system automates and simplifies the processing of
+work issues in Title II disability cases; its key functional areas are
+workload management and control, case development, adjudication and
+decision-making, notices and forms, and automated mainframe systems
+inputs. In summary, eWork connects all of the separate pieces to the
+whole through an electronic interface usable by authorized personnel
+nationwide and work to minimize the occurrence of overpayments due to
+work..
+
+Expansion of Work Opportunities
+ Over the last 18 months, SSA has worked closely with the Department
+of Labor's Employment and Training Administration and its State and
+local partners to jointly fund the establishment of a new position, the
+Disability Program Navigator. Approximately 110 Navigators have been
+hired to work in DOL One-Stop Career Centers in 14 states. A key role
+for Navigators is to help people with disabilities to increase their
+employment opportunities. Locating of the Navigator in the One-Stop
+Career Centers provides an important link to local employers in
+fulfilling this role. Navigators will also facilitate access to
+programs and services that impact successful entry or reentry into the workforce. This includes access to housing, transportation, health care,
+and assistive technologies as needed to effectively participate in training services or for successful placement in employment.
+ SSA is also continuing to use the Employer Assistance Referral
+Network (EARN) managed by the Department of Labor's Office of
+Disability Employment Policy and the Ticket to Hire, a specialized
+subunit of EARN that matches employers with job ready candidates from
+the Ticket to Work program.
+
+Conclusion
+
+ Finally, I thank you, Mr. Chairman, Mr. Matsui, and all the members
+of the Subcommittee, for showing continued dedication to the Ticket to
+Work program. Thanks to that commitment, we look forward to providing
+more beneficiaries with the additional opportunities and tools they
+need to enter or reenter the workforce.
+ In addition, I would like to thank you for your work to pass H.R.
+743, the Social Security Protection Act of 2004(P.L. 108-203). Because
+of the provisions in the bill regarding SSA demonstration projects,
+including ensuring that projects can continue to move beyond this
+December, we can move forward with our agenda of projects designed to
+provide alternative return to work services.
+ 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 look forward to working with you as we continue our efforts to make
+the Ticket to Work program a success.
+
+
+
+ Chairman SHAW. Thank you. Mr. Justesen?
+
+ STATEMENT OF TROY R. JUSTESEN, ACTING DEPUTY ASSISTANT
+ SECRETARY, OFFICE OF SPECIAL EDUCATION AND REHABILITATION
+ SERVICES, U.S. DEPARTMENT OF EDUCATION
+
+ Mr. JUSTESEN. Thank you, Mr. Chairman and the Committee for
+having me here today and for having me join my colleague,
+Martin Gerry from SSA, of which we are developing a very strong
+relationship between the SSA and the Department of Education to
+implement the success of the ticket program with the VR
+Services Program.
+ The State VR Program is the Nation's longest-running public
+employment program serving people with disabilities. In its 80-
+plus-year history of the program, over 10 million individuals
+with disabilities have achieved employment through the VR
+Program. Each year, approximately 220,000 individuals go to
+work with the help of the VR Program. Based on a recent study
+of this program, approximately 85 percent of individuals with
+disabilities who get jobs maintain employment at least 3 years
+after they have been employed and their hourly wage increase
+over this same 3-year period is over 78 percent.
+ Social Security recipients and beneficiaries presently
+account for about one-fourth of the total VR caseload
+nationwide, but each State agency's caseload varies depending
+on the unique characteristics of the State, the flexibility of
+the VR Program, and referral sources within the State. For
+example, in California 43 percent of its individuals with
+disabilities served through the VR Program, there are also SSDI
+and SSI beneficiaries, whereas in Wisconsin, only 8.6 percent
+of individuals whose cases were closed received SSI or SSDI
+benefits.
+ Other factors, such as VR's requirements to serve
+individuals with the most significant disabilities when there
+are insufficient funds to serve all eligible individuals may
+also have an impact on the number of SSI and SSDI beneficiaries
+served by the VR Program. Further, the 1998 amendments to the
+Rehabilitation Act requires VR agencies to presume eligibility
+for individuals who have already been determined eligible for
+SSI and SSDI services. State VR agencies are a significant
+partner in implementing the options available in the Ticket to
+Work Program for many individuals with disabilities. As of this
+March, and you know this, Mr. Chairman, you said this earlier,
+40,950 tickets have been assigned by SSI and SSDI recipients.
+Over 90 percent of those issued tickets are assigned to VR
+agencies.
+ Since the passage of the Ticket to Work legislation, the
+Office of Special Education and Rehabilitative Services
+(OSERS), the office within the Department of Education charged
+with working with VR State agencies, has held training programs
+for State VR agency staff during SSA's roll-out phase of the
+ticket program in order to facilitate success of the program.
+In addition to providing ongoing training to State VR agencies,
+OSERS is committed to continuing its work with the SSA to help
+evaluate the ticket program and the role State VR agencies play
+in this overall program.
+ To this end, we at the Department of Education have been
+working very closely with the SSA to complete a Memorandum of
+Understanding which will be allow for both agencies to share
+and link valuable data concerning individuals with disabilities
+who are served by both of these programs. We are doing this
+because we can better determine the long-term benefits of the
+VR Program and its relationship to the overall ticket program.
+We know there are several issues that have arisen regarding the
+program interactions between VR Programs and private and public
+ENs. One complication is that the Rehabilitation Act requires
+VR agencies to seek comparable services and benefits from other
+providers, which may include ENs. The issue of comparable
+services is discussed in greater length in my written
+testimony, but let me just say that we recognize the importance
+of collaboration on this issue and we will work with all of our
+partners to provide guidance on this issue and to resolve the
+concerns.
+ Second, many of our private ENs have expressed concern
+regarding agreements that are required when private ENs refer
+ticket holders to a State VR agency for services. It is our
+understanding at the Department of Education that in the
+majority of cases, these agreements are regarded by both
+parties as fair and inclusive of the principle of shared risk
+and reward. However, we recognize that some agreements may not
+reflect the principles of true partnerships and fairness. We
+are committed to continuing our work with the SSA to provide
+guidance to the State agencies and other ENs on this issue and
+are hopeful that we can continue to work together to be able to
+resolve issues regarding these agreements.
+ Third, we, and particularly I, Mr. Chairman, want you to
+know that we have heard of many concerns about ENs competing
+with State VR agencies for ticket assignments. It is important
+to recognize that State VR agencies have a long history that
+predates the ticket program with most ENs operating today.
+Without the assistance of Community Rehabilitation Programs
+that are now ENs, the success of the program I mentioned
+earlier would not have been possible. I would like to highlight
+a couple of beneficial aspects of our continuing dialog between
+the advocacy community regarding the ticket program. Since its
+inception, the Ticket Advisory Panel continues to be a main
+conduit of information for us at the Department of Education.
+From the panel, we have learned what is working and what needs
+to be improved.
+ For example, as a result of our work with the panel, we
+have seen a need to more closely monitor the cooperative
+agreements between the State agencies and private ENs and we
+are working with the initial 13 States in the program to
+examine their agreements and provide feedback to Social
+Security and with Social Security and with the Members of your
+Committee. As we are learning more about the implementation of
+the ticket program, we understand that there is more that needs
+to be done to improve the participation of both beneficiaries
+in the program and private and public ENs. This is a vital
+effort. It is an area particularly important to the Department
+of Education and we hope this information that we have provided
+you today in my extended written comments and our continuing
+work with Social Security will improve the ticket program, and
+more importantly, improve the lives of people with
+disabilities. I am happy to be here, and I am also happy to
+take any questions you have. Thank you, Mr. Chairman.
+ [The prepared statement of Mr. Justesen follows:]
+
+ Statement of Troy R. Justesen, Ed.D., Acting Deputy Assistant
+ Secretary, Office of Special Education and Rehabilitation Services,
+ U.S. Department of Education
+
+ Mr. Chairman, members of the Committee, thank you for the
+opportunity to appear before you today to discuss the Ticket-to-Work
+program. I am pleased to join you and my colleague, Martin Gerry, to
+discuss the Ticket-to-Work program and its relationship to the State
+Vocational Rehabilitation (VR) Services Program administered by the
+Department of Education. The Office of Special Education and
+Rehabilitative Services (OSERS) is committed to working with the Social
+Security Administration (SSA) to ensure the effective implementation
+and success of the Ticket-to-Work program.
+ The State VR Services Program is the nation's longest-running
+public employment program serving individuals with disabilities. In our
+80-plus year history, over ten million individuals served by VR have
+achieved employment. Each year, approximately 220,000 individuals go to
+work with the help of VR. Based on a recent longitudinal study of the
+State VR Services Program, approximately 85 percent of the individuals
+who obtain jobs maintain employment for at least three years after
+leaving the program. The longitudinal study also found that these
+individuals increased their average hourly wage from $7.56 to $13.48
+per hour, a 78 percent increase in earnings over the same three-year
+period.
+ As you may know, Social Security beneficiaries account for
+approximately one-fourth of the total VR caseload. It should be noted,
+however, that the Rehabilitation Act of 1973, which authorizes the
+State VR program, provides substantial flexibility to States. Because
+of this flexibility, the referral sources and the characteristics of
+each State agency's caseload vary. For example, in California, 43
+percent of individuals whose cases were closed in Fiscal Year 2002
+after receiving VR services were Supplemental Security Income
+recipients and/or Social Security Disability Insurance (SSI/DI)
+beneficiaries, while in Wisconsin, only 8.6 percent of individuals
+whose cases were closed in Fiscal Year 2002 after receiving VR services
+received SSI and/or SSDI. Other factors, such as the Rehabilitation
+Act's requirement that States give priority to individuals with the
+most significant disabilities when there are insufficient funds to
+serve all eligible individuals, may have an impact on the number of SSI
+recipients and SSDI beneficiaries served.
+ The 1998 Amendments to the Rehabilitation Act reflected Congress'
+desire to provide seamless access to VR services for SSI recipients and
+SSDI beneficiaries. The Amendments required State VR agencies to
+presume VR eligibility for individuals who receive SSI and/or SSDI.
+Presumed eligibility allows individuals who have already gone through
+the arduous Social Security benefit-eligibility process to avoid
+providing similar information to State VR agencies in order to be
+determined eligible for VR services.
+ Since the start of the Ticket program, State VR agencies have been
+a significant partner in implementing options under the Ticket program
+for individuals with disabilities. As of March 8, 2004, a total of
+40,950 tickets have been assigned by SSI recipients and SSDI
+beneficiaries. Just over 90% of those Tickets (36,972) were assigned to
+VR agencies. It is clear how important the State VR Services Program is
+to the success of the Ticket-to-Work program.
+ Since the passage of the Ticket-to-Work and Work Incentives
+Improvement Act (TWWIIA), we have held training programs for State VR
+agency staff as Social Security conducted its three-phase ``roll-out''
+of the Ticket program. At each training session, we brought together
+SSA staff, SSA's Ticket Program Manager (Maximus), and State VR agency
+staff to discuss emerging issues and to build long-term relationships
+designed to facilitate the return to work of individuals with
+disabilities. We have recognized throughout the early implementation
+phases of the Ticket-to-Work program that there is a critical need for
+on-going discussions across Federal programs and we are committed to
+keeping the dialogue open. We monitor and provide updates via several
+listservs that are dedicated to the interaction between State VR
+agencies and the Ticket program. We are hopeful that, in the future,
+joint training opportunities for State VR agency staff and private
+Employment Networks (ENs) will be possible.
+ In addition to providing ongoing training to State VR agencies,
+OSERS is committed to working with SSA to conduct research and
+evaluation of the Ticket program and the involvement of State VR
+agencies in the program, as well as other issues affecting the ability
+of individuals with disabilities to achieve employment outcomes. To
+this end, we are completing a Memorandum of Understanding, or MOU, with
+SSA, which will allow both agencies to share and link data concerning
+individuals with disabilities served by both the VR program and SSA. By
+linking this data, SSA and OSERS can better determine the long-term
+outcomes for SSI and SSDI beneficiaries who receive services through
+the VR and Ticket programs.
+ The Ticket program unquestionably presents new challenges to OSERS
+and the State VR Services Program, and we have a great deal more work
+to do as we attempt to redefine our role and those of our State
+partners. Several issues have arisen regarding program interactions
+between the VR programs and the private Employment Networks (ENs) and
+we are working with SSA to address these issues.
+ First, many private ENs are concerned about the impact of the
+``comparable services and benefits'' requirement under the
+Rehabilitation Act when they and the State VR agency are jointly
+serving the same individual. With only a few exceptions, section
+101(a)(8)(A)(i) of the Act requires the State VR agency to determine
+whether a comparable service or benefit is available from any other
+program to an eligible individual with a disability prior to providing
+a VR service. The VR Regulations (34 CFR 361.5(b)(10)) define a
+``comparable service or benefit'' as a service available from another
+public source, health insurance or employee benefit that is (1)
+available when the individual needs it, and (2) is commensurate with
+the service that the individual otherwise would receive from the VR
+agency. Therefore, if an individual is served by both the State VR
+agency and a public-funded EN, then VR can consider services provided
+by the EN that are available and commensurate with the services that
+would be provided by the VR agency to be a ``comparable benefit or
+service.'' Let me give you an example. An EN that receives public
+funding may provide general job-placement services. However, if that EN
+does not have experience in providing job-placement services to
+individuals with severe and persistent mental illnesses, then the EN's
+job-placement services may not meet the specific needs of such an
+individual. In that circumstance, the State VR agency may not consider
+the EN's job-placement services to be ``commensurate'' and, therefore,
+not a comparable benefit or service. So, VR could then provide the job-
+placement service to the individual. We will continue to work with SSA
+to provide guidance to State VR agencies on this issue.
+ A second issue is that many private ENs have expressed concern
+regarding agreements that are required when a private EN refers a
+Ticket holder to a State VR agency for services. These agreements are
+called for by TWWIIA. It is our understanding that, in a majority of
+States, these agreements are regarded by both parties as fair and
+inclusive of the principle of shared risk and reward. However, we also
+recognize that some agreements may not reflect the principles of true
+partnership and fairness. We are committed to working with SSA to
+provide State agencies and other ENs with guidance on this issue.
+Office of Management and Budget Circular A-87 may affect these
+agreements in regard to proportionality of effort by various parties.
+However, we are hopeful that together SSA and OSERS will be able to
+resolve issues that arise in this regard.
+ Third, some private ENs have made statements that they do not wish
+to ``compete'' with State VR agencies for Ticket assignments. It is
+important to recognize that, typically, State VR agencies have long
+histories that pre-date the Ticket program with most ENs operating
+today. Without the assistance of community rehabilitation programs that
+are now ENs, the successes of the VR program that I mentioned earlier
+would not have been possible. We value our EN partners and recognize
+the need for their participation, not only for the services they
+provide, but also for the choice of service provision that their
+participation ensures Ticket holders.
+ Now that I have enumerated some of the challenges we face in moving
+forward with the implementation of the Ticket program, I would like to
+take a moment to highlight what I consider to be a truly beneficial
+byproduct of continued dialogue with the advocacy community regarding
+this new program. Since its inception, the TWWIIA Advisory Panel has
+been a main conduit of information for us. From the Panel, we at OSERS
+have learned about what in the VR/EN relationship is working and what
+needs to be improved. Without the meaningful exchange that occurs
+regularly between OSERS and the Panel, we would be at a distinct
+disadvantage in determining areas of concern as well as aspects of the
+VR/Ticket interface that are working well.
+ As a result of our interaction with the Panel, we have seen a need
+to more closely monitor the cooperative agreements between State VR
+agencies and private ENs. We have just started that effort. We are
+working closely with the 13 State VR agencies that were involved in the
+first-phase roll-out of the Ticket-to-Work Program and we are examining
+their agreements with ENs and providing feedback on those agreements.
+We hope to provide our findings to both SSA and the TWWIIA Advisory
+Panel.
+ What we are all learning as we implement the new Ticket program is
+that more needs to be done to improve the participation of both
+beneficiaries and private ENs in this vital effort. I hope that the
+information I have provided today will assist you in your work with the
+Ticket program. Again, I thank you for the opportunity to share our
+experiences to date. OSERS and our partners in the State VR Services
+Program stand ready to do our part to facilitate the successful
+employment of Ticket holders.
+ I will be happy to answer any questions that you may have.
+
+
+
+ Chairman SHAW. Thank you very much. Mr. Gerry, you heard
+Ms. Nelson, her testimony, and one of the things that she was
+emphasizing was making these programs known to other people and
+she mentioned that it would be good to put some of this stuff
+on television. Now, I don't know what extent you can. People
+are griping about us talking about Medicare and the drug bill
+on television. Has any thought been given to, in some way,
+getting more of this information out through the media?
+ Mr. GERRY. Yes, Mr. Chairman. Perhaps what I might do is
+explain. We have entered into a contract with Fleischman-
+Hillard, which is a large public relations consulting firm, to
+design--and they are in the process of creating, a strategic
+plan for this very question of how we effectively communicate,
+not only with beneficiaries, but also potential ENs.
+ Over a 2-year period they are conducting telephone
+interviews with beneficiaries and with other stakeholders. They
+are trying to figure out the most effective way, and it goes to
+your comments earlier about the design of the ticket and the
+kind of language that is used. They are really trying to figure
+out how to get the message across in the most effective way.
+Now, part of that would obviously be what medium you would use
+and part of it would be what you would say in terms of the
+content. They are developing a national marketing strategy and
+materials that we would use.
+ We really believe that given the importance of this task
+and the ticket itself, it was important to get people who are
+really experts to help us do this design. So, that is the
+process that we are involved in. That task order was met on
+September 30 of last year, so we are about 6 months into the
+process now. My sense of what is going on is it has been very
+positive. I think we are getting some insights, and we are
+continuing to have dialogs with other organizations, which we
+do believe is very important. On the other hand, as you
+mentioned, without getting people with that kind of expertise
+to give us advice, television advertising is very expensive and
+it has, at least recently, become somewhat controversial. So,
+we thought it important to do it as quickly as we could, but to
+do it prudently, as well, and so we are trying to balance these
+two tasks.
+ Chairman SHAW. I would say one of the things you have to do
+is to try to make a determination of people with disabilities
+that are not in the work force, how do they spend their day. I
+would say that you will probably find out that a large part of
+that day is sitting in front of the television set. Then, what
+are they watching? That would be something. So, you can be very
+selective as to where you put it. Of course, cable is always an
+inexpensive option. I think, too, I think one of the most
+effective ways you can do it is to get people like Ms. Nelson
+and Ms. Hancock to get on the television and say, ``If I can do
+it, you can do it.'' It just gets people thinking.
+ Mr. GERRY. Like everyone else in the room, I was very much
+moved by what they had to say and I certainly would agree with
+that point. We are not going to sit and wait for this period to
+go by. We expect to get feedback throughout the process from
+Fleischman-Hillard and I would certainly be happy to take up
+that specific topic with them.
+ Chairman SHAW. I think the ticket--I have been very
+critical of this, and in all fairness, I don't know what else
+is in the envelope, but just looking at this, it is a document
+that I think is not very understandable in the verbiage and I
+think it can be jazzed up considerably with some kind of
+illustration on it, such as somebody gainfully employed while
+sitting in a wheelchair or with crutches or showing obvious
+signs of blindness or another type of disability.
+ Mr. GERRY. I have to say, Mr. Chairman.
+ Chairman SHAW. I applaud you for getting the advertising
+agency or public relations agency involved in it because these
+programs have to be sold to people and they are getting
+courage. I can tell you, if you are on disability, probably
+every time you get something from the Social Security office
+that you know is not a check, you probably hold your breath
+when you open the envelope. It is kind of like getting
+something from the IRS that is unexpected. I think we all have
+experienced having to open that envelope to see what is in
+there. I just think that we can go a long way toward helping
+them. Mr. Collins?
+ Mr. COLLINS. Thank you, Mr. Chairman. I just wonder what
+the postage is to mail those. Mr. Gerry, what did you think
+about Ms. Hancock's idea that when an individual files, that
+they be given the information at that point of contact with
+Social Security?
+ Mr. GERRY. Well, I thought it was an interesting idea. The
+Ticket to Work Program, of course, applies to beneficiaries so
+that we could explain when someone filed an application, what
+their options would be if they were to become a beneficiary.
+Under the statutory language, I think we can only actually make
+the program available to beneficiaries.
+ Now, we do have an early intervention demonstration which
+we have been in the process of designing and will actually
+start in the next 3 or 4 months that really focuses on
+applicants and is designed to try to help people who might not
+wish to continue even to pursue their application because they
+might be able to go to work through a somewhat parallel
+structure. I think the only problem right now would be,
+although we could explain the Ticket to Work, there is no way
+that we could offer the ticket itself until someone actually
+became a beneficiary. Although we heard good stories about how
+long it took from the panelists, sometimes, obviously, it takes
+a much longer period of time.
+ I think everything we know about the psychology of people
+in the population that we serve would strongly argue that the
+earlier we can make an offer of assistance in returning to
+work, probably the better in terms of what will happen, but we
+would be somewhat constrained right now by the statutory
+requirement that only beneficiaries can be served.
+ Mr. COLLINS. You don't have to be a beneficiary to be given
+the information.
+ Mr. GERRY. Absolutely not.
+ Mr. COLLINS. All right. That is probably too simple. Ms.
+Hancock also mentioned that she went through three ENs before
+finally finding one in Connecticut, I believe it was, that
+would actually listen to her. What kind of feedback have you
+had from others in this same area?
+ Mr. GERRY. We certainly have had all kinds of feedback. We
+have had people who are very happy with the EN, and that was
+true of obviously one of the panelists who preceded us, and
+others who were dissatisfied and changed. I think it is
+inherent in the choice model. I think what the Congress wanted
+us to do is to maximize the opportunity for people to choose,
+and as a result of that, although we do through Maximus review
+the applications from people who are ENs, there is likely to be
+a pretty significant variation out there in terms of not just
+the ability of people to relate to particular beneficiaries but
+the kinds of services and strategies that they offer. That
+seems to me to be kind of inherent in the way the program was
+designed, in that the idea was to get as much competition and
+choice as possible.
+ Mr. COLLINS. Do we have any method, are we putting in place
+any method to keep some statistics on these ENs?
+ Mr. GERRY. Yes. We do collect information about the ENs and
+we are developing strategies for tracking payments. What we
+haven't attempted to do, and again, it would be a question of
+how consistent it is with the overall goal of the statute, is
+to try to do any kind of qualitative assessment of ENs. Now,
+these are risk-bearing activities, so when the ENs accept
+tickets, they do put money out to provide services, which, if
+they are not successful, they wouldn't receive payment.
+ Of course, we also have in our regulations rules that say
+that not only do ticket holders have a choice of ENs, but they
+can discharge them, and as the witness testified, can change.
+So, we have really been, frankly, looking at the market as the
+primary way in which ENs who would better serve our
+beneficiaries would be the ENs people choose and keep. We have
+also assumed that if they are not successful in providing those
+services, they won't be paid, so that their incentive should be
+for ENs to be as responsive as they can. I am not arguing that
+is always true.
+ Mr. COLLINS. You mentioned Ticket Tracker. I was just
+looking at the Georgia statistics here earlier. There have been
+285,000-plus tickets issued in Georgia. Assigned to State VR
+agencies, 780; assigned to ENs, 181, for a total of 961, or
+0.34 of 1 percent.
+ Mr. GERRY. I am looking at the same numbers, Mr. Chairman.
+ Mr. COLLINS. The number I don't see is how much success
+have we had with the 961?
+ Mr. GERRY. I don't have that information--I would be happy
+to provide it for the record--broken down by State. I can talk
+about.
+ Mr. COLLINS. This is broken down by State.
+ Mr. GERRY. That is, and I don't know specifically.
+ Mr. COLLINS. Would that be an important statistic, to keep
+track of that?
+ Mr. GERRY. I think it sounds to me like it would be an
+important statistic----
+ Mr. COLLINS. It would be some good information. Is Ms.
+Hancock the only one in Georgia?
+ Mr. GERRY. As I indicated, Mr. Collins, I don't know.
+ Mr. COLLINS. You don't know, do you?
+ Mr. GERRY. No, I don't.
+ Mr. COLLINS. Well.
+ Mr. GERRY. I will find out and make it available.
+ [The information follows:]
+
+ The following information is through March 29, 2004:
+
+
+----------------------------------------------------------------------------------------------------------------
+ SVRA Payments
+ for Work EN Payment
+ Tickets Tickets Activity Tickets for Work
+ State Issued Assigned to *(Cost Assigned to Activity/#
+ SVRA Reimb.)/# ENs Beneficiaries
+ Beneficiaries
+----------------------------------------------------------------------------------------------------------------
+Alabama 89,065 160 2 22 0
+----------------------------------------------------------------------------------------------------------------
+ Alaska 14,770 70 0 2 0
+----------------------------------------------------------------------------------------------------------------
+Arizona 167,662 463 4 272 81
+----------------------------------------------------------------------------------------------------------------
+Arkansas 136,370 97 5 100 0
+----------------------------------------------------------------------------------------------------------------
+California 369,343 968 13 156 1
+----------------------------------------------------------------------------------------------------------------
+Colorado 102,854 385 1 36 5
+----------------------------------------------------------------------------------------------------------------
+Connecticut 94,787 530 2 28 3
+----------------------------------------------------------------------------------------------------------------
+Delaware 26,990 493 5 14 5
+----------------------------------------------------------------------------------------------------------------
+District of Columbia 20,729 61 1 25 0
+----------------------------------------------------------------------------------------------------------------
+Florida 581,072 2,836 58 463 45
+----------------------------------------------------------------------------------------------------------------
+Georgia 287,627 911 22 184 11
+----------------------------------------------------------------------------------------------------------------
+Hawaii 11,016 8 0 4 1
+----------------------------------------------------------------------------------------------------------------
+Idaho 14,851 126 0 7 0
+----------------------------------------------------------------------------------------------------------------
+Illinois 389,456 4,850 65 256 45
+----------------------------------------------------------------------------------------------------------------
+Indiana 191,759 365 0 53 1
+----------------------------------------------------------------------------------------------------------------
+Iowa 86,467 755 13 59 11
+----------------------------------------------------------------------------------------------------------------
+Kansas 71,129 251 1 63 3
+----------------------------------------------------------------------------------------------------------------
+Kentucky 252,598 353 6 45 5
+----------------------------------------------------------------------------------------------------------------
+Louisiana 200,537 1,246 2 67 4
+----------------------------------------------------------------------------------------------------------------
+Maine 24,086 92 0 6 0
+----------------------------------------------------------------------------------------------------------------
+Maryland 51,688 60 8 32 0
+----------------------------------------------------------------------------------------------------------------
+Massachusetts 240,821 694 29 125 16
+----------------------------------------------------------------------------------------------------------------
+Michigan 358,958 3,061 8 154 16
+----------------------------------------------------------------------------------------------------------------
+Minnesota 47,910 102 1 29 0
+----------------------------------------------------------------------------------------------------------------
+Mississippi 160,833 233 0 138 9
+----------------------------------------------------------------------------------------------------------------
+Missouri 213,754 485 1 154 11
+----------------------------------------------------------------------------------------------------------------
+Montana 28,265 156 1 2 0
+----------------------------------------------------------------------------------------------------------------
+Nebraska 17,052 103 0 2 0
+----------------------------------------------------------------------------------------------------------------
+Nevada 57,053 251 0 115 419
+----------------------------------------------------------------------------------------------------------------
+New Hampshire 37,339 33 1 11 1
+----------------------------------------------------------------------------------------------------------------
+New Jersey 219,116 398 1 87 7
+----------------------------------------------------------------------------------------------------------------
+New Mexico 64,345 67 1 19 2
+----------------------------------------------------------------------------------------------------------------
+New York 721,629 7,844 24 426 59
+----------------------------------------------------------------------------------------------------------------
+North Carolina 125,719 244 0 19 0
+----------------------------------------------------------------------------------------------------------------
+North Dakota 15,289 16 0 7 0
+----------------------------------------------------------------------------------------------------------------
+Ohio 148,667 1,594 1 20 0
+----------------------------------------------------------------------------------------------------------------
+Oklahoma 132,799 1,597 7 20 48
+----------------------------------------------------------------------------------------------------------------
+Oregon 108,967 282 0 75 8
+----------------------------------------------------------------------------------------------------------------
+Pennsylvania 173,216 432 0 32 0
+----------------------------------------------------------------------------------------------------------------
+Rhode Island 16,290 12 0 4 0
+----------------------------------------------------------------------------------------------------------------
+South Carolina 185,861 1,461 21 95 8
+----------------------------------------------------------------------------------------------------------------
+South Dakota 20,327 347 0 1 0
+----------------------------------------------------------------------------------------------------------------
+Tennessee 256,261 1,041 6 330 13
+----------------------------------------------------------------------------------------------------------------
+Texas 209,248 186 6 99 0
+----------------------------------------------------------------------------------------------------------------
+Utah 15,321 105 0 0 0
+----------------------------------------------------------------------------------------------------------------
+Vermont 22,643 500 1 4 2
+----------------------------------------------------------------------------------------------------------------
+Virginia 222,186 621 3 154 12
+----------------------------------------------------------------------------------------------------------------
+Washington 68,673 76 0 45 125
+----------------------------------------------------------------------------------------------------------------
+West Virginia 48,671 48 0 5 0
+----------------------------------------------------------------------------------------------------------------
+Wisconsin 162,498 2,044 1 150 33
+----------------------------------------------------------------------------------------------------------------
+Wyoming 4,979 4 0 0 0
+----------------------------------------------------------------------------------------------------------------
+*data for the period 1/01/2002 through 2/29/2004
+
+
+
+
+ Mr. COLLINS. Well, one-third of 1 percent assigned to
+either one the EN or the State VR agency, but that leaves 99
+and two-thirds percent tickets issued and never followed up on.
+ Mr. GERRY. Well, they haven't been assigned. Let me just
+suggest that----
+ Mr. COLLINS. They have been issued.
+ Mr. GERRY. They have been issued. It is accurate, they
+haven't been assigned. They may still be assigned. We do note,
+and one of the findings that Mathematica had in its preliminary
+report is that for a variety of reasons, people do wait, and
+actually, we heard that from one of the witnesses, often many
+months, I think an average of 10 or 11 months, before they
+actually use the ticket. So, it isn't necessarily true that
+that is going to be all of the tickets that are assigned.
+ Mr. COLLINS. The whole goal of the whole program is to get
+people back to be active in the workplace if that is their
+desire to do so, but the follow-up oftentimes to something that
+is in the mail, follow-up like I believe it was Ms. Nelson put
+hers on the dresser and found it after the fire.
+ Mr. GERRY. We are planning.
+ Mr. COLLINS. I think there are a lot of loose ends that you
+learn as you go. You are learning. I appreciate your time.
+ Mr. GERRY. Thank you.
+ Chairman SHAW. Mr. Gerry, I got a little bit of
+clarification from Kim Hildred while you were answering Mr.
+Collins's questions. Obviously, you can't offer someone a
+Ticket to Work if they are not a beneficiary, because by
+definition, you have got to be a beneficiary before you can get
+a ticket, and that is certainly a reasonable part of the
+legislation. However, when somebody is advised that they have
+been approved for disability, are they advised--now, I assume
+they are advised through the mail?
+ Mr. GERRY. Yes, they receive a notice.
+ Chairman SHAW. At that point, do they receive any
+information on the Ticket to Work?
+ Mr. GERRY. I don't believe so.
+ Chairman SHAW. This would be a good time to let them know
+that this doesn't have to be a permanent part of their life and
+that we do have ways for them to escape the dependency of SSI
+if they feel able to go into the workplace.
+ Mr. GERRY. I would like to check on that, Mr. Chairman. I
+am not sure of the answer to that, that is, whether we----
+ Chairman SHAW. I would say when somebody is advised that
+they have been approved, you have got their attention, and they
+are probably going to read very carefully anything you send to
+them and I think that is important. Ms. Tubbs Jones?
+ Ms. TUBBS JONES. Mr. Chairman, thank you very much. Mr.
+Gerry, Mr. Justesen, good morning. I wasn't here at the early
+part of your testimony because I took a few moments to call the
+Vocational Guidance and Rehabilitation Services Center in
+Cleveland, Ohio, to kind of get a feel for what is going on
+with them and their ability to provide Ticket to Work. They
+said they were referred 25 Ticket to Work folks but were only
+able to take 1 because of the situation of the other 24 people
+that were referred, but a young woman by the name of Nora Owens
+gave me about 7,000 things she wanted to tell you, but I told
+her I didn't have that much time.
+ [Laughter.]
+ Before I get to what Nora talked about, I understand how
+difficult it is sometimes to administer large programs like
+this particular program. What I might suggest to you, that you
+find the media agency that the Administration used to do
+prescription drug benefits and have them do the work that you
+need to do to do media for the people on disability, because
+they were able to turn it out real quick. I believe that this
+issue is as important as the prescription drug benefit, and the
+people who are receiving disability across this country would
+love to hear about Ticket to Work as quickly as the others did.
+I say that tongue-in-cheek, but I really am sincere about it. I
+am confident that the people who are representatives in this
+audience kind of agree with me, as well.
+ From the Cleveland Vocational Guidance and Rehabilitation
+Services, one of the issues raised is that, for example, if
+they receive a person referred for a particular service, they
+get a fee-for-service for whatever the referral is. Very seldom
+will they get a referral like a State agency referral where
+they have the opportunity to get a longer term payment and that
+the reason that a number of the smaller agencies are not ENs is
+because the payment is so long in coming, you deliver a service
+and it is 9 months, 2 years down the line, that they are not
+able to get the service. I am going to just put on two or three
+of these points and then you can use the rest of my 5 minutes
+to respond.
+ The other problem that they seemed to say, for example, the
+need for someone who is ultimately given a Ticket to Work to be
+able to do a Medicaid buy-in. They gave me, for example, a
+young man who was an excellent computer person, but his medical
+service needs far exceeded anything that he would be able to
+pay or receive in their health care program and that he ought
+to be able to work as many hours as he would like to work and
+they ought to be able to employ him as many hours as they can
+without him being put in the position to be removed from the
+program because there are a limited number of hours he can work
+and a limited amount of money that he could pay. They said that
+if he, in fact, could work full-time, he could make $40,000 or
+$50,000 a year, but he still would need the supplemental
+benefit of a Medicaid buy-in.
+ I talked about the small agencies. I talked about the
+Medicaid. The first point they made was that the way it is
+operated or the payment for the services through Ticket to Work
+makes it exceptionally costly to provide some of the services
+and that a review of how services are provided and how they are
+paid might make a better use of dollars.
+ Finally, she said to me that if, in fact, you got, for
+example, 10 Ticket to Works, that the referral to a Ticket to
+Work EN really reduces the number of dollars that a State
+agency actually gets to provide VR services so that, in
+essence, instead of providing additional services for those
+with disability, we are supplanting some of those services with
+these services instead of extending the service. I asked a lot
+of questions, put a lot out there, but you are free to use the
+rest of the time to do what you can do to respond to my
+questions.
+ Mr. JUSTESEN. Thank you.
+ Ms. TUBBS JONES. I used all my time, Mr. Chairman? Doggone
+it.
+ [Laughter.]
+ Maybe you can write back to me.
+ Chairman SHAW. Go ahead.
+ Mr. JUSTESEN. First of all, Congresswoman, I counted 15
+questions.
+ [Laughter.]
+ Ms. TUBBS JONES. I am a trial lawyer.
+ [Laughter.]
+ Mr. JUSTESEN. Well, first of all, the State of Ohio is
+under an order of selection with regard to the VR Services
+Programs which, in a nutshell, means that when the State
+agency's funds are not sufficient enough to serve all
+potentially eligible consumers of the VR system, the State must
+prioritize a service to those individuals with the most
+significant disability. In addition, I want to say that.
+ Ms. TUBBS JONES. Are any other States like that?
+ Mr. JUSTESEN. I think there are--it is in the early
+twenties. We can supply you with those exact facts.
+ [The information follows:]
+
+ ORDER OF SELECTION STATUS FOR STATE VR AGENCIES
+ 2004--FINAL
+------------------------------------------------------------------------
+ TOTAL 80
+ agencies ORDER OF SELECTION 42 agencies NO ORDER 38 agencies
+------------------------------------------------------------------------
+Region I Connecticut G; Maine G & B; Connecticut B;
+ Massachusetts G; Rhode Island; Massachusetts B;
+ Vermont G New Hampshire;
+ Vermont B
+------------------------------------------------------------------------
+Region II New Jersey G; Virgin Islands New Jersey B; New
+ York G & B; Puerto
+ Rico
+------------------------------------------------------------------------
+Region III Delaware B; Maryland; Delaware G; District
+ Pennsylvania; Virginia G & B; of Columbia
+ West Virginia
+------------------------------------------------------------------------
+Region IV Georgia; Kentucky G & B; Alabama; Florida G &
+ Mississippi; North Carolina G; B; North Carolina
+ Tennessee B; South Carolina G
+ & B
+------------------------------------------------------------------------
+Region V Indiana; Illinois; Minnesota G; Michigan G & B;
+ Ohio; Wisconsin Minnesota B
+------------------------------------------------------------------------
+Region VI Arkansas G & B; Louisiana; New New Mexico G; Texas
+ Mexico B; Oklahoma G & B
+------------------------------------------------------------------------
+Region VII Iowa G; Kansas; Missouri G; Iowa B; Missouri B;
+ Nebraska G Nebraska B
+------------------------------------------------------------------------
+Region VIII Colorado; North Dakota; Wyoming Montana; South
+ Dakota G & B; Utah
+------------------------------------------------------------------------
+Region IX Arizona; California; Hawaii American Samoa;
+ CNMI; Guam; Nevada
+------------------------------------------------------------------------
+Region X Oregon B; Washington G Alaska; Idaho G & B;
+ Oregon G;
+ Washington B
+------------------------------------------------------------------------
+Changes from previous year: Indiana, Virginia G, and Virginia B moved to
+ an order.
+ Of the 24 general VR agencies: 14 (58 percent) were on an order
+ Of the 24 agencies serving blind individuals: 7 (31 percent) were on
+ an order
+ Of the 32 combined VR agencies: 21 (66 percent) were on an order
+ Revised Dec 2004
+
+
+
+
+ Ms. TUBBS JONES. Thank you.
+ Mr. JUSTESEN. John Connelly is the State VR Director for
+the State of Ohio and is a very good resource with us at the
+Federal level and with Social Security in working through some
+of these challenges that are unique to the State of Ohio. Let
+me also say before Martin answers more of the technical
+questions, since I am 2 months on the job from moving over from
+the White House that individuals with disabilities who receive
+SSI--who are recipients of SSI or SSDI beneficiaries are
+presumed eligible for VR services. That is regardless of their
+choosing to use their ticket for other public or private EN
+providers. In other words, individuals in Ohio with significant
+disabilities, or the most significant disabilities, are
+entitled to the services that the State ER agencies provide and
+make available regardless of their use or choice to use the
+ticket options that they have available to them. I will turn it
+over to Martin to be more specific on your questions.
+ Mr. GERRY. Thanks, Troy. The first point that I wrote down
+was that agencies don't become ENs because it takes too long to
+get paid, and that is a serious problem. That is to say that
+there is risk involved in this program and there is a need, of
+course, for agencies that are providing services who accept a
+ticket to finance the initial provision of those services in
+hopes that they will be paid later when an individual achieves
+SGA, then goes off benefits and then for a period of time
+payments are made. So, it is, in fact, fairly common to hear
+from smaller agencies that might be interested in becoming ENs
+that the period of time and the way in which payments are set,
+the amount of those payments, is a disincentive.
+ The issue of capitalization, obviously, what the VR
+agencies have is an advantage in that they have money. They
+have a flow of money under the Rehabilitation Act that allows
+them to, in effect, front the cost of some of these services in
+the hopes that they will collect under the program. So, I think
+one of the things that we have been looking at and one of the
+things we have been getting advice on from several of the
+organizations that I mentioned, the Advisory Panel and others,
+is the need to really look carefully at the payments, the way
+we have set the payments, the amounts of the payments, things
+that we could do that would make it at least more attractive
+for ENs, where they could be paid at least earlier.
+ The capitalization problem is a much tougher one for us in
+that we want to help, we want to see if we can provide as many
+inducements to others to provide initial capital, but it is not
+something that we are really able to do under the statute as it
+is drafted. I do think it is a significant problem, and I think
+that what you heard on the telephone, which was probably
+something we could have heard in several other States----
+ Ms. TUBBS JONES. Mr. Chairman, Mr. Gerry, thank you very
+much. In deference to my colleagues, you have been very
+generous with time. I would be willing to accept my answers in
+writing at a subsequent time, Mr. Chairman. Thank you, Mr.
+Gerry.
+ [The information follows:]
+
+ Ms. Tubbs Jones: And that the reason that a number of the smaller
+agencies are not ENs is because the payment is so long in coming. You
+deliver a service, and it's 9 months, 2 years down the line, that
+they're not able to get the service.
+ The SSA has taken aggressive steps to address the need to get
+timely payments to ENs by establishing a Certification Payment Request
+Process. The Certification Payment Request Process allows ENs to submit
+a signed written statement that the ticket holder's work and earnings
+are sufficient to warrant outcome payments, in lieu of having to
+provide proof of the ticket holder's earnings, ENs can request payments
+under the Certification Payment Request Process after a ticket holder
+meets specific work requirements and has achieved a level of earnings
+from employment to qualify an EN for outcome payments. This new process
+can be used either on a monthly or quarterly basis. The SSA will pay
+outcome payments based on the EN's certification, unless our records
+indicate that the Ticket holder is receiving cash disability benefits.
+ In addition, the SSA launched the Employment Network Capitalization
+Initiative in September 2002. Through this initiative, our Program
+Manager, MAXIMUS, has been training ENs on how to identify and secure
+alternative funding sources. Such funding can be used by ENs to cover
+the costs of services to beneficiaries under the ticket program until
+such time as the EN receives payments based on the employment outcomes
+achieved. In addition to offering training online, MAXIMUS has
+conducted a series of regional seminars (with five completed, and 3
+more planed for 2004) and distributed an Employment Network
+Capitalization Resource Directory to all ENs.
+ Ms. Tubbs Jones: The other problems that they seem to say--for
+example, the need for someone who is ultimately given a Ticket to Work
+to be able to do a Medicaid buy-in.
+ An SSI beneficiary may keep Medicaid benefits while he/she is
+working if his/her earnings e insufficient to replace SSI cash
+benefits, Medicaid benefits, and publicly funded healthcare that would
+be lost due to those earnings. We use a formula that includes the SSI
+Federal benefit rate (FBR) plus the average per capita Medicaid
+expenditures for each state to calculate the amount of earnings that is
+considered sufficient to replace all benefits that could be lost, The
+resultant figure is called the threshold amount and is different for
+each State. As long as a person earns under their state's threshold
+amount, he/she will keep Medicaid eligibility. In some states, a person
+could earn $40,000 and still be under the threshold amount.
+ If a person's earnings are higher than the threshold amount for
+his/her State, we can calculate individualized threshold amount if he/
+she has medical expenses that are higher than the State's average per
+capita Medicaid expenditures. In calculating an individualized
+threshold, we use the person's actual medical expenses instead of the
+state's per capita Medical expenditures to determine the amount of
+earnings that are sufficient to replace all benefits. If that person's
+earnings are below his/her individualized threshold amount, he/she will
+keep Medicaid benefits.
+ States have the option of providing Medicaid coverage to people
+with disabilities whose earnings are too high to qualify under other
+rules (such as under the SSI threshold amount). A state may extend
+Medicaid coverage to working people with disabilities between ages 16
+and 65 who have income limits to allow a working person with a
+disability to buy into Medicaid. At least 27 states have a Medicaid
+buy-in program.
+ Ms. Tubbs Jones: the way it's operated, or the payment for the
+services through Ticket to Work, makes it exceptionally costly to
+provide some of the services and that a review of how services are
+provided and how they're paid might make it better--a better use of
+dollars.
+ Section 1148(h) of the Social Security Act provides that ENs will
+be paid under the Ticket to Work Program on the basis of outcomes and/
+or milestones achieved by beneficiaries using their tickets in going to
+work and achieving self-sufficiency. The total payment available to an
+EN is limited to the amount of outcome payments available over 60
+months, in addition tomilestone payments (and reduced outcome payments)
+if the EN elects the outcome-milestone payment system.
+ Section 1148(c) of the Act provides a State VR agency witha choice
+of receiving payment for serving beneficiaries using their tickets
+either on the same basis as an EN, or on the basis of reimbursement for
+the cost of services provided to beneficiaries by the State VR agency.
+e total reimbursement payable to a State VR agency under the cost
+reimbursement system is limited to the estimated savings to the trust
+funds and general revenues which will result in the rehabilitated
+beneficiary leaving the beneficiary rolls. This choice is not available
+under the Act to ENs.
+ Ms. Tubbs Jones: the referral to a Ticket to Work EN really reduces
+the number of dollars that a State agency actually gets to provide VR
+services. So that, in essence, instead of providing additional services
+or those with disability, we're supplanting some of those services with
+these services instead of extending the service.
+ The Ticket to Work and Work Incentives Advisory Panel and other
+observers of the Ticket to Work Program have noted that services and
+supports provided by other programs should. be combined with, rather
+than offset by, services and supports provided by the Ticket to Work
+Program.
+ We are working with the Office of Special Education and
+Rehabilitation Services in the Department of Education, as well as
+other agencies including the Center for Medicare and Medicaid Services,
+to ensure that the Ticket to Work, State VR programs, and other
+programs work together to ensure that our beneficiaries are provided
+with the services and supports they need to return to work and attain
+self-sufficiency.
+
+
+
+ Chairman SHAW. Thank you. Mr. Hayworth?
+ Mr. HAYWORTH. Thank you, Mr. Chairman. Deputy Commissioner
+Gerry, Mr. Justesen, thank you both for being here. Deputy
+Commissioner Gerry, please extend my good wishes to
+Commissioner Barnhart. It was great, because she came to
+Arizona. We had the first Tickets to Work in Arizona. If could
+just say, and we all lived happily ever after, that would be
+delightful, but we are in, as we documented earlier, really the
+challenging phase, from the notion of drafting a bill, seeing
+the good work of folks, and on conference Committees, having it
+voted out of both Houses, having it signed into law, and now
+implementation.
+ We heard from the previous panel the challenges of letting
+people know the word and emphasizing what has happened here.
+You touched on in answering the question, Deputy Commissioner
+Gerry, about the marketing firm or the firm that is developing
+a marketing strategy, but I have heard from representatives of
+ENs on our next panel, there is a real concern that even with
+this contract, it will take at least 2 years for the SSA to
+implement a full-blown marketing campaign.
+ Now, here is the problem we have in Arizona. We have
+already seen the number of ENs accepting tickets drop from 27
+to just a handful, in part because there seems to be no demand.
+The ENs need help now. I appreciate the professionalism that a
+marketing firm can bring, but is there not an interim step that
+could be taken? What can be done now to get the word out to the
+folks about Ticket to Work?
+ Mr. GERRY. Thank you, Mr. Hayworth. There are things that
+we are doing now. I think it is a combination of both you
+mentioned the ENs that are dropping out and it is a concern
+that we have. Part of it is the whole question of what
+beneficiaries now--the whole question of providing information
+and prompting beneficiaries.
+ I think we also have to look at the other problem I was
+just talking about with Ms. Tubbs Jones, which is that one of
+the things we have envisioned, of course, was ENs coming in who
+had contacts with beneficiaries because they were organizations
+that routinely served those beneficiaries. So, the more we
+could bring ENs that had those kinds of contacts, the more
+likely we would be able to get beneficiaries. So, I think it is
+both of those issues together.
+ The other thing I would have to say, having worked with the
+populations of people for many years who are being served by
+the program, is that there is a trust factor that we have to
+overcome. The history of the relationship between the SSA and
+some of our beneficiary groups has not necessarily engendered
+trust in the likelihood of what is going to happen and we have
+to sell the reality of the ticket, as we know it really is to
+people who have had reasons to be concerned about what will
+happen. So, we have to overcome that.
+ I think word of mouth is probably something that is going
+to have to go a long way in doing that. I think what really
+happens when you have those kinds of problems often is you need
+successes and then you need people talking to other people
+about the successes. So, I think it is all three of those
+things. I didn't mean to suggest that we were going to wait 2
+years to do anything about it. What I really wanted to suggest
+is that we are 6 months into a 2-year activity to really come
+up with a national marketing plan. Now, we have been doing a
+lot of conferences around the country. We have been doing a lot
+of talking to organizations. I won't read the numbers. I would
+be happy to provide them for the record.
+ [The information follows:]
+
+ The SSA has been working on outreach and marketing
+activities to raise the public's awareness about the Ticket to Work
+Program through;
+ Partnering with the Department of Labor's Office of
+Disability Employment Policy to use their Employer Assistance Referral
+Network (EARN) and a specialized subunit of EARN, named Ticket to Hire,
+which specializes in matching employers with job ready candidates from
+the Ticket to Work Program. Ticket to Hire links employers to
+Employment Networks in their community that have job-ready candidates.
+ Partnering with other agencies to expand awareness and
+understanding of the Ticket legislation, Ticket to Hire, and other
+employment supports, including the Office of Personnel Management, the
+U.S. Chamber of Commerce, and the Department of Education.
+ Publishing Ticket to Work success stories in newsletters,
+electronic publications and on websites such as the Office of
+Employment Support Program's ``Work Site'' and MAXIMUS' Web site. We
+also share success stories with numerous disability organizations for
+use in their publications and websites.
+ Participating in conferences, meetings and forums that
+promote the hiring of people with disabilities.
+ Maintaining the Internet ``Work Site'', http://
+www.socialsecuritv.aov/work, that educates and provides resources to
+people interested in the Ticket to Work and other employment supports
+for people with disabilities. The ``Work Site'' has an entire section
+dedicated to Ticket to Work information for beneficiaries, advocates
+and service providers. This includes Frequently Asked Questions,
+statistics on Ticket assignments and directories of ENs, Benefits
+Planning, Assistance, and Outreach organizations and Protection and
+Advocacy organizations.
+ Contracting with The Arc of the United States to provide
+an analysis and evaluation of beneficiary data to determine how to
+segment markets and target beneficiaries with marketing efforts to
+maximize participation in the Ticket to Work Program.
+
+ In addition, MAXIMUS, the SSA's Program Manager for the Ticket to
+Work Program, is Marketing the ticket program to prospective employment
+networks. Their primary marketing vehicle has been the Employment
+Network Recruitment Fair. Through December 00.3, MAXIMUS had held 90 of
+these events, at least one in every State and Puerto Rico, employment
+Network Recruitment Fairs allowed MAXIMUS to reach more than 8,000
+individuals representing nearly 6,400 different organizations. In
+addition, by invitation
+ MAXIMUS made presentations at more than 200 other events. The
+combination of onsite marketing with direct mail and telephone outreach
+has resulted in MAXIMUS delivering the ticket program message to about
+50,000 individuals, representing approximately 20,000 different
+organizations. In total, MAXIMUS has made over 250,000 distinct
+contacts. This presents a ratio of about 200 direct outreach contacts
+to each Employment Network proposal received.
+
+
+
+ Maximus has made a lot of presentations, and we are
+significantly working on our field offices. That is a place
+where we can have right now some significant impact--it has
+come up two or three times already. As we talk to our
+beneficiaries, we could be saying more about the ticket. We
+could be giving out more information.
+ I mentioned in both my written and oral testimony that we
+have hired 58 Area Work Incentive Coordinators. Those are in
+our areas within the 10 regions that we have, and one of their
+major tasks is to train our staff in the field offices who come
+into daily contact with our beneficiaries to talk about the
+ticket and to answer questions about the program. That is
+pretty important, and probably ultimately one of the crucial
+things we need to do, which is to change the culture of our
+field offices so that these capabilities are there. Is it going
+to happen overnight? I wish I could say yes. I think where we
+have these people in place, we see significant differences. I
+think that is an important strategy, as well. I would be very
+interested in any other specific things that we can do as we
+get this marketing plan. It is not that we don't have an
+interest in it or that we aren't willing to devote resources to
+it, but it is not clear to me precisely how we should do it.
+ Mr. HAYWORTH. I thank you for that, and as I was listening
+to you talk, I thought about a marketing slogan for a certain
+sports attire firm that is three words that I think is really
+important here. ``Just do it.''
+ [Laughter.]
+ Just do it. The most basic things are here, and I have to
+admit we understand Congress is a deliberative body. You talked
+about the trust factor. One of the problems we have is if
+Congress is a deliberative body, I don't know how we describe
+the pace of the bureaucracy. It is glacial. Despite the best of
+intentions, we have a glacial pace here. So, to the extent that
+we bring, I like to think, light and maybe a little heat from
+Arizona, we appreciate the efforts, but my friend Susan Webb
+will be on the following panel. For purposes of full
+disclosure, she is my friend from Arizona and obviously part of
+ENs and part of the EN Association in the State of Arizona, but
+she made this point to me earlier this morning.
+ If Binder and Binder and other Social Security attorneys
+can advertise on television day in, day out, over and over
+about getting people onto benefits, why can't the SSA advertise
+at least as often to get people off benefits and back into the
+world of work? A comment, a thought on that from either of you
+gentlemen?
+ Mr. GERRY. I tried to address earlier the question of
+television advertising, which is not without controversy and
+also not without expense. I don't mean that in some penny-
+pinching sense, but as a practical matter. One of the things I
+hope that we will get is a recommendation on how to do that. It
+would not be difficult to spend $50 or $100 million to do
+ineffective television advertising.
+ Mr. HAYWORTH. Maybe I will just talk to the Arizona
+Association of Broadcasters saying, hey, if you are receiving
+Social Security disability and need to go back to work, why not
+find out about the Ticket to Work Program? You can keep your
+medical benefits and go back to work. Contact your counselor
+for more information. Ta-dah. There it is, and it didn't take
+me 2 years to explain that, and I can get that right to the
+Arizona Broadcasters Association. I appreciate the good
+efforts, and I am not here to beat you up. I really do. I just
+believe we have got to get moving to get the word to folks, and
+I thank you.
+ Chairman SHAW. We are going to have to move on to Mr.
+Becerra.
+ Mr. BECERRA. Thank you, Mr. Chairman. Commissioner Gerry,
+Mr. Justesen, thank you very much for your testimony. Let me
+ask a quick question. How much did the Fleischman and Hilliard
+contract cost the SSA and the taxpayers?
+ Mr. GERRY. It is about $900,000 for 2 years.
+ Mr. BECERRA. You might want to explore paying Fleischman
+and Hilliard the way you pay the ENs. Maybe they will act a
+little faster and give us more outcome if they know that they
+don't get paid until they have some outcome.
+ Mr. GERRY. If we can get it consistent with the statute, I
+am sure we will do that.
+ Mr. BECERRA. It might be tough. I know that you receive no
+resources to administer this Ticket to Work Program. First, I
+want to mention something that I mentioned to the Commissioner
+when she was last here. You all do yeoman's work. You have what
+is a large agency, but you deal with tens of millions of people
+and beneficiaries, so first and foremost, to all the people who
+work very hard at the SSA, we want to say thank you very much.
+ In that hearing that we had last week with the
+Commissioner, she mentioned that her budget request was half-a-
+billion dollars higher than what the Bush Administration
+allocated in its budget. Obviously, tough times. We are in
+deficit so everyone is having to tighten the belt, but given
+that the SSA is receiving less money than it asked for from the
+Administration and given that you never received any new
+resources to try to administer the Ticket to Work Program, how
+can you tell us that you will be able to deal with some of the
+bureaucratic delays that have been raised by my colleagues and
+others and that you have identified with fewer resources?
+ Mr. GERRY. First, let me just say for the record, although
+I wasn't present during the Commissioner's testimony, actually,
+had the agency received what the President requested from the
+Congress, this budget problem that you are talking about
+wouldn't have existed. The problem was not what we received
+from the Administration or from the Office of Management and
+Budget but, frankly, what we received from the Congress.
+ Mr. BECERRA. So, we need to do.
+ Mr. GERRY. The President's budget request for 2004 was
+significantly higher than that approved by Congress.
+ Mr. BECERRA. So, a clear message, then. I hope all of us
+then in Congress will hear that.
+ Mr. GERRY. I just wanted to clarify where the shortfall
+came from.
+ Mr. BECERRA. Clarion call. Make sure we are clear.
+ Mr. GERRY. We appreciate very much the efforts of this
+Subcommittee.
+ Mr. BECERRA. I want to make sure there is no doubt. Let the
+buck stop where it should. If you are not getting the resources
+that you should have, then Congress has to do more to allocate
+resources so you can have the personnel to administer the
+programs properly.
+ Mr. GERRY. Well, I certainly would agree with that. I think
+the Commissioner has also testified that she is very pleased
+with the 2005 budget as proposed by the President, which is a
+substantial increase, 6.5 percent----
+ Mr. BECERRA. Well, remember, she also said that she is
+going to have to put off implementing some of her programs to
+try to reduce the backlog in disability determinations because
+she is not getting what she asked for. So, while she may be
+pleased, I suspect if we had a chance to give her a couple of
+drinks in private times, she would probably tell us something a
+little differently, as well.
+ [Laughter.]
+ Mr. GERRY. I think if she is displeased, it may be with the
+outcome of the appropriations process in the Congress, not with
+the President's request.
+ Mr. BECERRA. The whip has to be used both ways.
+ Mr. GERRY. As far as your question about our ability to do
+the work, I think we have the resources. I would not want to
+leave the impression with the Subcommittee that the problems
+that we are encountering in the ticket program that we need to
+overcome are resource-driven. I don't think that is the
+situation.
+ Mr. BECERRA. I want to make sure, then. You are not going
+to come back to us later on and say, we just didn't have the
+personnel. So, let me get to another question. Is it correct to
+say that for the last 7 months, the Ticket to Work Program has
+been without a Director?
+ Mr. GERRY. No. It would be incorrect to say that. There has
+been an acting Associate Commissioner throughout that entire
+period.
+ Mr. BECERRA. Not a permanent Director.
+ Mr. GERRY. That is right, and we are.
+ Mr. BECERRA. How long have we had an Acting Director?
+ Mr. GERRY. We have had an Acting Director since, I believe,
+September.
+ Mr. BECERRA. When do you think we will have someone?
+ Mr. GERRY. Actually, it is an acting Associate
+Commissioner, to be accurate.
+ Mr. BECERRA. When do you think, Commissioner, that we will
+have a permanent individual in that position?
+ Mr. GERRY. We have permanent people there, Mr. Becerra, but
+the position will be filled, I think as a result of the posting
+we have right now. The position is being posted. I think it was
+alluded to earlier in the hearing. I am not sure whether it
+closes tomorrow or a week from tomorrow, but that is roughly
+the timeframe.
+ Mr. BECERRA. Okay. Do you think?
+ Mr. GERRY. I would anticipate we would have an Associate
+Commissioner who would be selected within the next month.
+ Mr. BECERRA. That is good to know. The ENs, a question for
+you. Of the 1,100 that have participated, how many of them are
+nonprofits?
+ Mr. GERRY. I don't know that. I would have to provide that
+for the record.
+ [The information follows:]
+
+ Approximately 75% of the 1,137 Employment Networks currently
+available to assist beneficiaries are not-for-profit.
+
+
+
+ Mr. BECERRA. Could you get that for me, because it seems
+that one of the difficulties that we are having, and I am not
+sure if there is an easy way to resolve it, is that the ENs
+don't get paid until after they have a positive outcome, and
+for a lot of folks, it is tough to go that long before you get
+some dollars in for the services you have been providing.
+ Now, I don't want to put a further burden on a nonprofit,
+but nonprofits tend to run under very tight budgets and often
+they get their funding from various sources in lump sums, so
+they sometimes have to go periods without a regular source of
+income flowing in. Since they are nonprofits, their status
+depends on their abiding by Federal laws.
+ I am wondering with a nonprofit as opposed to a for-profit,
+which has to generate the moneys to continue to pay employees
+and stay in business, that maybe there is an opportunity to
+work with nonprofits where you can come up with a creative
+system of payment where you might not be able to do it with a
+for-profit, because if a for-profit ultimately goes under, we
+all lose because they can claim bankruptcy and we will never
+get the money, but a nonprofit, if it goes under, chances are
+it is going to have a tough time ever reenergizing itself and
+asking for nonprofit status from the Federal Government again.
+ So, I am wondering if there may be some work that we can
+do. Obviously, Goodwill Industries does tremendous work in so
+many different areas, and I bet you they could use 10 times the
+budget they do all the work on. Again, not to impose something
+on Goodwill or any of these other noble nonprofits, but maybe
+there is a way to address the payment problems you have with
+the EN by working with the nonprofits that aren't trying to
+make the buck to make a living but are doing this because of
+the charitable and noble purpose behind it and work out a
+creative way to find a way to fund these ENs in a way that
+keeps them going and adds more of these ENs to the system,
+because it seems like if you are only going to live with 1,100
+of them, it is always going to be tough nationwide to let the
+beneficiaries have that full sense of who is out there, who can
+help them. I put that out there. Maybe if you can let us know
+later on how many of these nonprofits are out there, that would
+be very helpful.
+ Mr. GERRY. If I can just make one comment.
+ Mr. BECERRA. Yes, sir.
+ Mr. GERRY. You mentioned in passing about living with the
+1,100, and I am not satisfied that we have adequately recruited
+ENs. I think that the number is perhaps less crucial than the
+reality of what is actually available to our beneficiaries.
+There are still significant areas of this country where there
+isn't a good competitive market available. The 1,100 are not
+evenly distributed around the country and they don't serve all
+of the beneficiary groups.
+ So, I just didn't want to pass by the idea that that is
+enough or that I would imply that it is enough. I think we have
+to really do a better job of reaching out to ENs. The other
+observation I make is that I don't believe anywhere in the
+statute Congress differentiated within the category of ENs, and
+that could create some difficulty in trying to come up with
+separate payment schemes, but I am perfectly willing to look at
+the options.
+ Mr. BECERRA. Just to look at it. I don't know, either, but
+I am just wondering if because they operate under different
+scenarios, that maybe we can do that. Mr. Chairman, if I can
+ask one last question, I will make it very quick. The notice to
+beneficiaries, I thought Ms. Hancock made a great suggestion of
+providing the information upon first point of contact, which is
+when the then-applicant for benefits first reaches the SSA, no
+telling whether the person will actually qualify for the
+benefits. It seems to make perfect sense to just give the
+notice up front and say, by the way, should you end up
+qualifying for these benefits, we hope that you will consider
+the possibility of returning to work at some point soon and
+here is your Ticket to Work. Maybe you don't have the authority
+right now, but is there any reason why the SSA would not want
+to consider that?
+ Mr. GERRY. I don't think it is a question of authority. I
+think it is an interesting idea and I would be happy to look
+into it. I think we have the legal authority to do it. I would
+be happy to pursue it and give you a more complete answer.
+ [The information follows:]
+
+ While we cannot issue a ticket to an individual who is not yet a
+beneficiary, we believe that providing information about the program as
+early as possible to applicants who might later become eligible for the
+Ticket program is an excellent idea and are considering various ways to
+ensure that accurate information is offered to individuals so that they
+can make sound decisions about work activity.
+
+
+
+ Mr. BECERRA. Mr. Chairman, thank you very much.
+ Mr. HULSHOF [presiding]. Let me announce there are votes
+upcoming and there are some Members on the next panel that
+actually have flights to catch, so, if Members could try to
+confine their remarks to the time allotted, I would appreciate
+it. I am going to make a quick comment and a question, taking
+my time. I appreciate, Mr. Justesen, in your testimony you
+recognize--you are absolutely correct that State VR agencies do
+have long histories that predate the ticket program and most of
+the ENs today, but I also appreciate that you in that same
+paragraph on page 6 of your testimony state unequivocally that
+you value the EN partners and recognize the need for their
+participation, not only for the services that they provide, but
+for the choice of service provisions that they offer.
+ If you mention in Columbia, Missouri, the name Advent
+Enterprises, everybody immediately understands that this is a
+private VR service that has a good relationship with the State
+VR, and so I appreciate that. Mr. Gerry, I know that we have
+beaten you up a bit about the fact that 90 percent of the
+tickets are being assigned to the State VR agencies, only 10
+percent to the ENs. The only comment I would have, and you set
+out a number of reasons why that is the case, what I wanted to
+just reiterate in anticipation of the next panel, there are
+those that are expressing the burdens of the payment process.
+One referred to it as, I think, quote, ``administrative drag,''
+and I enlisted that term from the next panel, which forces
+these ENs to spend time and their resources dealing with
+Maximus, and/or the agency rather than helping the
+beneficiaries, and a couple of examples that seemed to be a bit
+egregious, let me ask if you agree.
+ Twenty-thousand dollars due from the agency 3 to 12 months
+or longer. I recognize what you said earlier about
+capitalization and some of the smaller networks, and yet
+waiting for that amount of funds for any private agency seems
+to be a pretty substantial burden, or some citing the fact that
+they spend more money and staff time to collect the payment
+than the payment amount. I know, again, you have talked about
+Maximus briefly. What can you do or the SSA do to address their
+concerns on administrative drag?
+ Mr. GERRY. We actually have been doing several things, and
+in my written testimony, I provide a little more detail about
+this. On the payment collection issue, I think we have done
+some things that make it much easier, much less time consuming,
+and, frankly, less expensive for ENs. We have changed our
+administrative procedures. We used to require a much more
+rigorous verification of ongoing employment. In other words, we
+had the issue of pay stubs. We had expectations that
+beneficiaries would continue to provide evidence on a monthly
+or quarterly basis that they were continuing to be employed.
+Now, many beneficiaries, once they are employed, don't
+particularly want to go back and forth to the EN and that makes
+perfectly good sense. So, we have actually changed our
+administrative procedures to allow some of the good faith
+verification that the EN is not aware of any change in the
+employment status rather than requiring the collection of pay
+stubs.
+ Now, that is a big change in terms of the amount of work
+that has to go on. So, the first time that a payment is
+claimed, we want some proof that the individual went to work,
+but we are not requiring that kind of documentation for all of
+the payments, and we have also created three or four different
+ways in which payments can be made, either quarterly or
+monthly, and we have given choices to the ENs of how to
+basically manage the payment process.
+ So, those are efforts to try to make it easier, and I think
+on the pay stub collection of information front, we have done a
+pretty good job of eliminating a lot of the problems. The
+staggering and the timing of payments, the amounts of the
+payments, those are problems that we are actively reviewing. I
+think Congress intended in the legislation that the
+Commissioner look at that, and we are doing that right now.
+ Mr. HULSHOF. A last comment and then I will yield briefly
+to Mr. Pomeroy, then Mr. Brady. Even before the ticket program
+was signed into law, this Subcommittee has actually been
+concerned about overpayments. We have had hearings on this
+issue. Each time, overpayments has been one of the serious
+concerns, and so I also wanted to, at least on the record,
+express that matter. Mr. Pomeroy?
+ Mr. GERRY. If I can just comment, and I will do it briefly.
+ Mr. HULSHOF. Okay.
+ Mr. GERRY. I have a lot of detail about what we are doing
+right now in terms of some of the systems changes, but I want
+to say for the record that this is a matter of the highest
+priority to the Commissioner and to me personally. I think we
+have to move and we have to move extremely quickly on the
+overpayment problem. I think it is one of the most serious
+barriers to getting people to work and I think that even though
+it has been accelerated, it is something that we cannot just
+leave to the routine changes of our systems, and wait for that.
+I think we are looking at as many different ways as we can
+right now to make that problem disappear because I think it is
+a serious problem.
+ Mr. HULSHOF. There are those in the audience nodding their
+heads in assent to that statement. Mr. Pomeroy?
+ Mr. POMEROY. Thank you, Mr. Chairman. Years ago, I spoke to
+the North Dakota Mental Health Association and a young woman
+followed me out and explained to me her situation. She was a
+nurse who no longer could work because of a bipolar disorder
+and she desperately needed an SSA disability determination for
+the medicine that she required, but when she didn't work, her
+condition got worse and she was just desperate to get to work.
+So, when we passed this Ticket to Work, I thought of her and I
+thought of that situation and I was thrilled about the
+potential.
+ I look at the chart. North Dakota has got 22 people that
+have actually been able to access this, and needless to say,
+that is so far short of what my hope and expectation was for
+this program. I don't recall a program where I have been as
+excited about the launch of it and disappointed about the mid-
+term implementation of it.
+ So, from both sides of the dais here, we have given one
+message, and that is we can do a better job of getting this
+program available to people whose lives will turn around if
+they have access to it and can fully implement it. I couldn't
+have been more impressed by the initial panel this morning as
+an indication of what can happen to people when they can get
+back to work. I am looking at the Advisory Committee's
+recommendations to you and among their recommendations, they
+call for congressional action to make it clear that Congress
+did not intend to make beneficiaries ineligible for the full
+range of services from VR, Medicaid, or other Federal and State
+programs. To me, that ought not take an additional act of
+Congress. Isn't it pretty clear from Ticket to Work legislation
+that this is to be additive, not a zero-sum game in terms of
+these benefits?
+ Mr. GERRY. I am a recovering lawyer, Mr. Pomeroy, and I
+don't want to give you a legal opinion about it, particularly
+because I think it applies probably partly to the
+Rehabilitation Act. In other words, I think when Troy was
+talking earlier about provisions of the Rehabilitation Act,
+which we don't administer, the Department of Education
+administers, there are provisions there about comparable
+benefits that have been interpreted in different ways. It is up
+to the Department of Education, of course, to interpret that
+statute, but it is, of course, up to the Congress what the
+content of that statute is and what that means.
+ So, the question which you are raising involves partly the
+SSA and Ticket to Work, but it also involves the question of
+what acceptable practice under the Rehabilitation Act would be,
+and that is really a question that I am not prepared to answer.
+I think it is an important question, and Troy, I don't know if
+you want to try to respond, or----
+ Mr. JUSTESEN. You asked a complex question, Congressman,
+and one which is very important to the Rehabilitation Services
+Administration that is under my office and its interaction
+between that statute, the Rehabilitation Act, and the Ticket to
+Work and Work Incentives Improvement Act, and that is one in
+which we would be happy to supply for the record a more----
+ Mr. POMEROY. I actually will want from both agencies a
+clear explanation of where Congress needs to clarify, if
+clarification is needed. Just specifically on this one, Mr.
+Justesen, to follow up, if I can get this straight. If a
+beneficiary assigns a ticket to an EN, is he or she still
+entitled to VR services under the Rehabilitation Act if the
+EN's services are not comparable to what was being provided by
+VR?
+ Mr. JUSTESEN. As I understand your question, the answer is
+yes.
+ Mr. POMEROY. They are still entitled to compensation,
+because the education.
+ Mr. JUSTESEN. They are entitled to services and benefits
+under VR.
+ Mr. POMEROY. Services, right. I am sorry, wrong word.
+Services and benefits. Are you monitoring States to make
+certain that they are implementing the VR Act (P.L. 105-220) in
+that fashion?
+ Mr. JUSTESEN. Yes, and it is important for us, as I said in
+my comments earlier, that we are valuing the input from the
+Advisory Board, the Ticket Advisory Board, and our
+collaboration with Social Security. Anecdotally, we have
+received in the Department of Education communications,
+concerns expressed by advocates and others throughout the
+country that this is an issue in which we in the Rehabilitation
+Services Administration under the Department of Education need
+to pay particular attention to. We are doing that.
+ Mr. POMEROY. Great.
+ Mr. JUSTESEN. It is important for us to make sure that each
+of the three phases, and we are beginning with the first 13, of
+review of the agreements between the State VR agencies and
+other public and private ENs, to make sure that individuals
+with disabilities are protected under the Rehabilitation Act as
+well as the opportunity for them to benefit under the ticket
+program.
+ Mr. POMEROY. That is terrific, because what this is about
+is an additional level of support to get people back to work,
+not just another source of funding to then have other funding
+withdrawn.
+ Mr. JUSTESEN. As I said, I will be happy to submit for the
+record a clear explanation of this issue. Individuals with
+disabilities, regardless of their option of exercising the
+ticket, if they are individuals who receive SSI benefits or
+SSDI benefits, those individuals are presumed eligible for VR
+services without the need in the past to have completed a great
+deal of extra paperwork to be eligible for both programs.
+ Mr. POMEROY. As you do supply that information, I would
+like you to reference the Advisory Committee's recommendation.
+I am not trying to at all point fingers at anybody. If Congress
+has more clarification to do, let us go ahead and do it. I am
+not, frankly, at all certain that we do. I believe that it is
+relatively clear on what has been enacted already.
+ Mr. JUSTESEN. Perhaps. I would be happy to submit it for
+the record.
+ Mr. POMEROY. All right.
+ [The information was not received at the time of printing.]
+ Mr. JUSTESEN. Let me tell you, I don't think, and we don't
+take in any way your questions to be those of criticism. These
+are areas of partnership building for us at all of the Federal
+agency levels and one of the efforts we need to do at the
+Federal agency levels is model interaction and interagency
+implementation of the ticket program even better than we have
+done in the past, and I think we are making efforts to do that.
+ Mr. POMEROY. The only final question--I asked a lot of
+questions, comments--this business of getting this marketed in
+an effective way so that people that might avail themselves of
+these services know that they can is just terribly important. I
+right now extend an invitation to SSA to have a meeting with me
+in North Dakota. Hopefully, with media coverage, we will be
+able to get the word out on it. We have about the lowest rate
+of participation in the entire country, and I know that does
+not reflect the work ethic of North Dakotans on disability
+payments. They want to get off. We have got a program to get
+them off. I will personally work with you to do that.
+ Mr. JUSTESEN. I would be happy to accept your invitation
+right now. I have actually worked in North Dakota on the
+Special Education Program and know a little bit about the
+population. I certainly would be happy to do that. I am sure
+Commissioner Barnhart would.
+ Mr. POMEROY. Terrific. We look forward to it, and we are
+coming into springtime, so it is not even that bad of a draw.
+ [Laughter.]
+ Thank you very much. I yield back.
+ Mr. BRADY [presiding]. Thank you, Congressman.
+Commissioner, Secretary, the Ticket to Work Program is a great
+concept. It is real important that it succeed and it is
+appropriate at this hearing that we focused a lot because of
+the roll-out on process, but let us conclude the panel with
+this question. We are at different phases in different areas.
+For our customers, for our clients, for the ones we really want
+to serve, what are the results so far for those especially
+choosing ENs? Are the disabled getting services more tailored
+to their individual needs? Are they getting them better or
+faster or in a way that helps them get to the workplace sooner?
+For those, we are really concerned. They happen to be our
+employers, as well. What are the results for them so far?
+ Mr. GERRY. Let me see if I can set the stage to answer that
+question by going back to where we were before the ticket and
+where we had consistently two-tenths of 1 percent of our
+beneficiaries leave our rolls for reasons other than death. I
+can't testify they all went to work, but some significant
+number of the two-tenths of 1 percent. That is where we were.
+That is where we have been for 20 years. That was the status
+quo that the ticket changed.
+ I think it is important to remember that that is where we
+were because the ticket has, I think, had significant effects
+on that as demonstrated. Specifically, we have about 670 people
+that we are paying, that have generated EN payments. So, it is
+people who are working, that have been working for some time,
+that are off cash benefits. While that doesn't sound like a
+huge number of people, even out of the 40,000, we have to
+remember where we are in the process, because in order to be
+paid, you have to have worked for a significant period of
+time--in the case of VR, it is 9 months, and in the case of the
+ENs, it is an even longer period of time. So, I expect that
+number to expand fairly significantly over the next year or
+two.
+ Now, I think that is impressive compared to where we
+started. Is it what Congress looked for as the outcome or the
+final effect? No. I think we have to work on a lot more things
+in order to make this program work. I think in reading the
+statute, as I read it anyway, and looking at the legislative
+history, I think Congress knew that we were going to learn a
+lot as we implemented the statute, and what the Commissioner is
+dedicated to, and I am, too, is to make changes as soon as we
+learn, not to wait, not to hesitate, but to do it and to do it
+with this Subcommittee. There may be things that ultimately
+have to come back to the Subcommittee and say, these are
+statutory issues.
+ We are, at this point, trying to do everything we can
+within the Commissioner's regulatory authority, and in some
+cases, I mentioned even changing administrative procedures. So,
+I think, yes, there are real people who are getting real
+benefits and I think that there is real promise and that the
+vision that this Subcommittee had when it passed the ticket is
+the right vision and one that we can reach. I just think we
+are, as you say, we are at a critical point in time and I think
+that we have to do--and I can pledge to you on the behalf of
+the agency what we are doing is trying to think about all the
+changes we can make or recommend to the Congress that would
+really make this program work more successfully.
+ I think the one concern I have is that we have to keep
+going back to who the program is supposed to work for, and that
+is the beneficiaries. The fundamental issue is the choice of
+beneficiaries of different kinds of services that will allow
+them to achieve their employment goals, and that is what I keep
+reminding myself of, because we can get drawn off on other
+interests.
+ Now, to have a vibrant and an active set of ENs and to have
+VR agencies become competitive. What we really want is not to
+repeat the two-tenths of 1 percent experience that we had
+before, but through competition to see good things happening.
+So, instead of seeing VR agencies as associated with a program
+that hasn't produced much in the past, they would become part
+of a new program where they actively compete and cooperate. I
+think that is what we want and what we want to achieve, but I
+am very optimistic that we are going to get there. I just don't
+want to over-promise or over-commit. At the same time, we
+couldn't be more dedicated to getting there.
+ Mr. BRADY. Thank you, Commissioner. I appreciate it. Mr.
+Secretary?
+ Mr. JUSTESEN. It is important for the Committee to
+understand, and I know that you do, but I want to reemphasize
+this, that the success of the Ticket to Work Program is not
+solely on the shoulders of the SSA. They are the lead. We at
+the Department of Education look to the SSA to provide us with
+guidance on how to best implement the Ticket to Work Program.
+The VR Services Program administered at the Department of
+Education is a very important partner, together with the
+Department of Labor's efforts, that are new in terms of our
+understanding how this evolution has evolved for us to all
+begin to work together at the Federal level.
+ The VR Program has an important component and access in the
+advocacy community that may well be the primary access for
+entry into the world of employment. The Social Security may not
+always be in all cases. We have a large Independent Living
+Advocacy Program in which we partner that with the VR Services
+Program that is a vital first entry point for many individuals
+who may later become recipients of SSI or SSDI in which we are
+looking to build on that partnership and, frankly, we haven't
+done as well as we could, but the Secretary of Education,
+Secretary Paige, is very interested in our efforts to increase
+the employment opportunities for people with disabilities and
+we look forward to doing that.
+ Mr. BRADY. Thank you. I think this is important because my
+experience is everything looks perfect on paper in Washington,
+D.C. How it works in life is usually a whole different matter.
+Staying on top of it to make it work the right way is our job,
+so, thank you, panelists. We appreciate it.
+ Mr. BRADY. The next panel, I would like to invite up at
+this point. Thank you for being here today. We have with us
+Sarah Wiggins Mitchell, who is Chair of the Ticket to Work and
+Work Incentives Advisory Panel; Tom Golden, who is a member of
+the same panel; Paul Seifert, Social Security Task Force,
+Consortium for Citizens with Disabilities (CCD); Tom Foran,
+Vice President of Integrated Disability Resources (IDR);
+Quintin Mitchell, who is Director of VR Services in Richmond;
+Susan Webb with the Arizona Employment Network Association; and
+John Coburn, Staff Attorney for Health and Disability Advocates
+in Chicago, Illinois. In that order, why don't we begin with
+Sarah Wiggins Mitchell for her 5-minute statement.
+
+STATEMENT OF SARAH WIGGINS MITCHELL, CHAIR, TICKET TO WORK AND
+ WORK INCENTIVES ADVISORY PANEL; AND THOMAS P. GOLDEN, MEMBER,
+ TICKET TO WORK AND WORK INCENTIVES ADVISORY PANEL
+
+ Ms. WIGGINS MITCHELL. Thank you, Mr. Chairman, and good
+afternoon. On behalf of the Advisory Panel, we would like to
+thank you for this opportunity to speak to you today. The panel
+appreciates the support this Committee demonstrates for people
+with disabilities and the SSA disability programs. We have
+submitted written testimony for the record and now will simply
+be highlighting some of the points we made in that testimony.
+ The panel believes that the ticket program has much
+unrealized potential. Beneficiaries are showing interest in the
+program in two ways. Forty thousand people have assigned their
+tickets to receive VR and employment support services. In
+addition, the program manager, Maximus, received over 23,000
+calls about the ticket in the month of February alone and over
+10 million hits were made to their Ticket to Work website in
+the calendar year 2003.
+ The support programs established by the Ticket Act are also
+proving to be very successful. Almost 100,000 beneficiaries
+have sought information and assistance from the Benefits
+Planning and Assistance and Outreach Program (BPA&O). The SSA's
+customer satisfaction survey supports what the panel has been
+hearing from beneficiaries across the country. The BPA&O
+services are excellent and essential to people with
+disabilities who want to work. The panel was pleased that the
+BPA&O and PABS Programs were reauthorized in H.R. 743 and
+thanks this Committee for their hard work in passing that
+legislation.
+ The establishment of the Area Work Incentive Coordinator
+(AWIC) position within the SSA is a very positive development.
+The panel was very pleased that SSA decided to create a
+position that is permanent and devoted full-time to work
+incentive duties as part of their internal core of work
+incentive specialists. The panel has heard positive testimony
+and comments regarding the AWIC positions and hopes that SSA
+will expand the number of AWIC positions to meet the enormous
+demand for their services.
+ Mr. GOLDEN. While the SSA is making some progress in a
+number of areas, the panel has serious concerns in three key
+areas which threaten the success of the ticket program. Of most
+concern to the panel is the current low participation of ENs.
+As you are aware, the panel issued a report last month
+entitled, ``The Crisis in EN Participation: A Blueprint for
+Change.'' Central to this report is the assumption that
+recruiting and retaining a large number of ENs is crucial to
+accomplishing the primary Stated goal of the ticket program,
+giving people with disabilities a real choice in rehabilitation
+and employment.
+ Our report identified a number of issues that are causing
+providers not to participate or to drop out of the program
+altogether. These are the need for Congress to clarify that the
+ticket program should be used as a supplemental, rather than a
+substitute, funding source; the design of the EN payment
+system; the inadequacy of provider incentives, the
+administration of claims for payment; marketing; EN training;
+and the treatment of American Indian VR Programs. While all of
+these issues are important, I will briefly discuss only two.
+ The design of the payment system for the ticket program and
+the administration of claims for payment by ENs pose immediate
+threats to the success of the program, placing too much
+financial risk on ENs, who must make large investments up front
+and wait a long time for payments. The panel has recommended
+moving more of the payment into the first 12 months of
+employment, increasing the payment to greater than 40 percent
+of the average benefit amount, reducing the difference between
+milestone and outcome payments, and increasing the sum of
+payments for SSI to equal that of the payments for SSDI.
+ Second, the requirements SSA places on ENs to make a claim
+for and receive payment are burdensome and costly. SSA not only
+does not make payments to ENs in a timely manner, sometimes
+taking up to 120 days, but also has established a quarterly
+payment schedule. Finally, the panel is concerned that SSA has
+yet to undertake a demonstration project addressing any of
+these issues. These administrative problems must be addressed
+without delay.
+ The second major area hindering the success of the program
+is the lack of marketing and public education about the program
+itself. Over the past 3 years, the panel has repeatedly
+recommended that SSA undertake a national coordinated marketing
+and public education campaign to increase awareness of and
+interest in the program. While the panel is pleased that SSA
+has awarded a contract for the design of a strategic marketing
+plan, no actual marketing plan will have been implemented until
+the plan is completed. The panel urges SSA to move forward
+quickly with other interim marketing activities such as
+possibly sending a reminder letter to beneficiaries who have
+received a ticket in the past and not used them, or other
+suggestions that were made by our esteemed panel earlier today.
+ Finally, the panel is concerned about the insufficient
+training SSA field staff receive about SSA work incentives and
+the ticket program. The panel continues to hear stories of
+beneficiaries who received inaccurate information about work
+incentives from SSA field staff. Receiving bad information can
+cause a person not to make a job attempt, to receive an
+overpayment, or to be forced to stop working altogether. It
+also increases mistrust and fear. This situation is
+unacceptable to the panel and Americans with disabilities.
+ The Ticket Act requires the SSA to have staff available and
+accessible that possess a thorough understanding of the work
+incentives and are able to provide this information to
+beneficiaries who want to work. As Stated earlier, AWICs
+represent the best type of customer service. However, the
+training received by AWICs does not seem to filter down to the
+Work Incentive Liasons and other field staff. We urge SSA to
+expand the training available to all SSA field staff and put in
+place quality assurance measures.
+ Ms. WIGGINS MITCHELL. In conclusion, the panel believes the
+ticket program has great potential to help many people with
+disabilities improve their lives by going to work. While it is
+still early in the implementation process, the failure of SSA
+to take steps to immediately address the concerns outlined in
+this statement could have a dire effect on the success of the
+program. Thank you again for your opportunity to speak with you
+today. Normally, I would say we would be happy to stay and
+answer questions, but my colleague and I need to be in other
+areas of the country and are going to have to leave.
+ Mr. BRADY. That is fine.
+ Ms. WIGGINS MITCHELL. We would be glad to answer in writing
+any questions that you would have for the panel.
+ Mr. BRADY. Thank you. Have a safe trip.
+ Ms. WIGGINS MITCHELL. Thank you.
+ Mr. BRADY. I noticed that I don't think either of you took
+a breath during your----
+ [Laughter.]
+ I thought, man, things are speeding up in this room now.
+ [Laughter.]
+ So, anyway, we appreciate you being here. Thank you.
+ Ms. WIGGINS MITCHELL. Thank you very much again.
+ [The prepared statement of Ms. Wiggins Mitchell follows:]
+ [The prepared statement of Mr. Golden follows:]
+
+ Statement of Sarah Wiggins Mitchell, Chair, Ticket to Work and Work
+ Incentives Advisory Panel
+
+Introduction
+ The Ticket to Work and Work Incentives Advisory Panel (the Panel)
+would like to thank Chairman Shaw for holding this hearing. The Panel
+appreciates the Committee's high level of interest in ongoing oversight
+regarding the Ticket Program and the other important programs and
+policies of the Ticket to Work and Work Incentives Improvement Act. The
+Panel would also like to take the time to recognize the support this
+committee demonstrates for people with disabilities and the Social
+Security Administration Disability programs.
+
+Good News
+ The Panel believes that the Ticket Program is a very popular
+program with still much unrealized potential. Advocates for people with
+disabilities at the national and grassroots levels are very supportive
+of this program and are working with their Federal partners to make the
+program succeed.
+
+Positive Sign: Consumer Interest
+ Consumers are also showing great interest in the program. Forty
+thousand people have assigned their tickets to receive vocational
+rehabilitation and employment support services. While only about 4000
+of those are with Employment Network providers, or what we call ENs,
+that is a big number for the short time that the Ticket Program has
+been around. This is especially true given the fact that the roll out
+of the Ticket program was delayed and is not yet completed. The rest of
+the Tickets have been assigned to State Vocational Rehabilitation
+agencies.
+ Even beneficiaries who have not assigned a Ticket are very
+interested in finding out about the program. The Program Manager,
+Maximus, received over 23,000 calls in the month of February alone.
+Almost 20,000 of those were inquiries made by or on behalf on
+beneficiaries with interest in the Ticket program. In addition, MAXIMUS
+reports that during calendar year 2003, over 10 million hits were made
+to the Ticket to Work website.
+
+TWWIIA Support Programs are Excellent
+ The support programs established by the Ticket to Work and Work
+Incentives Improvement Act are also proving to be very successful.
+Almost 100,000 beneficiaries have sought information and assistance
+from the benefits planning assistance and outreach program, or BPAO.
+The results of the customer satisfaction survey that were just released
+by the Social Security Administration supports what the Panel has been
+hearing from beneficiaries across the country: BPAO services are
+excellent and essential to people with disabilities who want to work.
+Eighty nine percent of those surveyed rated the service they received
+as excellent, very good, or good. And, the percent of the people who
+reported they were working jumped by 19 % subsequent to their contact
+with the BPAO. The Panel is pleased that the BPAO program was
+reauthorized in HR743 and thanks this Committee for their hard work in
+passing that legislation.
+Positive Implementation Step: Area Work Incentive Coordinator
+ The establishment of the Area Work Incentive Coordinator, or AWIC,
+position within SSA is a very positive development in implementation of
+the Ticket program, as well as in the overall administration of work
+incentives. The Panel is very pleased that SSA decided to create a
+position that is permanent and devoted full time to work incentive
+duties as part of their internal corps of work incentives specialists.
+The Panel has repeatedly heard very positive testimony and comments
+regarding the dedicated and skilled SSA employees that fill the AWIC
+positions. As we all know, the provision of accurate and timely
+information on work incentives is a critical factor in making people
+feel secure in their attempt to go to work. AWICs help to make that
+happen for SSA beneficiaries. The Panel hopes that SSA will expand the
+number of AWIC positions to meet the enormous demand for their
+services.
+
+Three Areas of Concern
+ While the Agency is making good progress, the Panel has serious
+concerns in three key implementation areas that threaten the success of
+the Ticket Program. Of most concern to the Panel is the current low
+participation of ENs. Second, we are concerned about the lack of public
+education and marketing of the Ticket Program to beneficiaries, their
+families, and ENs. A third major area of concern is the inadequate
+training provided to SSA field staff about work incentives in general,
+and the Ticket Program specifically.
+
+Concern One: EN Participation
+ As you probably know, the Panel issued a report last month on the
+crisis in EN participation and its potential impact on the Ticket
+Program. The Executive Summary of that report is included at the end of
+this statement (beginning on page 8).
+ Central to this report is the assumption that recruiting and
+retaining a large number of active ENs is a critical factor in
+accomplishing the primary stated goal of Ticket Program--giving people
+with disabilities a real choice in rehabilitation and employment
+services. Our report identified a number of issues related to the
+structure of the Ticket Program that are causing providers not to
+participate as ENs or to drop out altogether. These are: the need for
+Congress to clarify that the Ticket Program should be used as a
+supplemental, rather than a substitute, funding source; the design of
+the EN payment system; the inadequacy of provider incentives; the
+administration of claims for payment; marketing; EN training; and the
+treatment of American Indian VR programs.
+ Finally, the Panel is concerned and puzzled that in the fourth year
+of the Ticket Program, SSA has yet to undertake a demonstration or
+pilot project addressing some of these issues especially the payment
+issue. The problems outlined below in the Executive Summary must be
+addressed without delay to make the Ticket Program more attractive to
+current and potential ENs and to ensure that current ENs to remain in
+the program.
+
+Concern Two: Marketing and Public Education
+ The second major area the Panel believes maybe hindering the
+success of the program is the lack of marketing and public education
+being conducted by SSA in support of the program. The Panel has
+repeatedly recommended that SSA undertake a national coordinated
+marketing and public education campaign in order to increase awareness
+of and interest in the Ticket program. Currently, beneficiaries are
+informed only once about the Ticket Program and they may not be
+informed at all about other TWWIIA provisions and work incentives. The
+only marketing material most beneficiaries receive on the Ticket
+Program is a letter describing the program when the Ticket is being
+rolled out, or when they first become eligible for benefits.
+ The Panel is pleased that SSA has awarded a contract for the design
+of a strategic marketing plan for the program that will be completed
+this year. However, in the meantime, many ENs report having trouble
+finding people willing to assign their Tickets and many beneficiaries
+and local advocates remain completely in the dark about the Ticket
+program and the other work incentives. Although these SSA contracting
+efforts are very positive steps, the Panel is concerned that the next
+year or two will be devoted to planning marketing efforts rather than
+actual marketing of the Ticket Program. Extensive planning activities
+may delay implementation of a national marketing plan even further. The
+Panel believes it is reasonable to expect that marketing would occur
+prior to, or during, the rollout of a new program, not after.
+ The Panel urges SSA to move forward quickly with other marketing
+activities, such as sending reminder letters to all people who have
+received but not yet used their ticket.
+
+Concern Three: Training
+ The final area that is of most concern to the Panel is the
+insufficient training SSA field staff receive about work incentives and
+the Ticket Program. The Panel has heard in public testimony across the
+country, stories of beneficiaries who have received inaccurate
+information about work incentives from SSA staff in the field office.
+Receiving bad information can cause a person not to make a job attempt,
+to receive an overpayment, or to be forced to stop working. It also
+increases mistrust and fear. This situation is unacceptable to the
+Panel and Americans with disabilities. Every SSA field office should
+have accessible and available staff that possess a thorough
+understanding of the work incentives and be able to provide accurate
+basic information to SSA beneficiaries with disabilities who want to
+work.
+ On that note, the Panel wants to again recognize the very positive
+step the Agency took in the creation of the AWIC position as part of
+their internal corps of work incentive experts. This represents the
+best type of customer service. The AWICs received good basic training
+(two full weeks) and many of them were former Employment Support
+Representatives (with six weeks of training). AWICS are reported to be
+very knowledgeable and highly regarded in the field and by
+beneficiaries.
+ There are not nearly enough AWICs to be available to answer every
+question beneficiaries have but the training that AWICs have received
+on SSA work incentives and the Ticket Program is exemplary. SSA cannot,
+however, rely on AWICs to provide all information and advice to
+beneficiaries on work incentives and the Ticket Program. SSA created a
+filter down, train the trainer approach to build their corps of
+internal work incentive specialists. AWIC's train Work Incentives
+Liaisons (or WILs), the people who provide information on work
+incentives on top of their regular duties in the field office. WILs
+receive their limited training from the AWICs and then are expected to
+train the remainder of the field office staff. SSA work incentives and
+their interaction with the Ticket Program are very complicated and
+technical topics. The problem with SSA's current strategy is that the
+necessary knowledge does not seem to filter down to the claims
+representatives and service representatives who are answering
+beneficiary questions about work incentives on a day-to-day basis. We
+trust that SSA will make more intensive training, along the lines of
+what AWICs receive, available to all SSA field staff.
+
+Conclusion
+ The Panel believes the Ticket Program has great potential to help
+many people with disabilities improve their lives by going to work.
+This statement outlines a number of concerns the Panel has about SSA's
+administration of the Ticket Program. While it is still early in the
+implementation process of this new program, the failure of SSA to take
+steps immediately to address these concerns may have a dire effect on
+the success of the program.
+
+The Crisis in EN Participation: A Blueprint for Action (February 2004)
+Executive Summary
+ Thousands of people with disabilities and their advocates shared a
+dream that the Ticket to Work and Work Incentives Improvement Act of
+1999 (the Act) would greatly expand employment opportunities for people
+on the Social Security Administration (SSA) disability rolls. Three
+years after enactment of the law, it is clear that their dream is
+faltering. The Ticket to Work and Self-Sufficiency Program (Ticket
+Program) is failing to recruit the anticipated numbers of new
+employment service providers, called Employment Networks (ENs). In
+addition, those enrolled as ENs are serving only a fraction of the
+beneficiaries thought to be interested in participating in the Ticket
+Program. Nearly 1,000 providers have enrolled in the program, but only
+about one-third of those operating have accepted any tickets. The Panel
+believes that without immediate attention to the very real problems
+affecting EN participation, the Ticket Program will fail. The Panel
+urges Congress and the Commissioner to act quickly on the following
+recommendations.
+
+Issues and Recommendations
+
+ Ticket Program as a Supplemental Funding Source_ENs are uncertain
+about whether and how they can use funds from other public sources to
+serve ticket holders and have chosen not to actively participate in the
+Ticket Program because of fear of losing other stable funding sources.
+
+Recommendations
+
+ Congress should develop statutory language that clearly
+articulates its original intent that the Ticket Program's outcome and
+milestone payments should provide additional resources to assist
+beneficiaries in attaining and retaining employment. In general, the
+Panel believes that Congress did not intend to make beneficiaries
+ineligible for the full range of services from vocational
+rehabilitation (VR) programs, Medicaid, or other Federal and State
+programs by making them eligible for the Ticket Program.
+ Congress should direct the Commissioner to implement the
+Ticket Program as a complement to the traditional SSA VR Reimbursement
+Program, paying State VR agencies for up-front services and paying ENs
+for long-term employment outcomes.
+ As part of the mandated evaluation of the Ticket Program,
+the Commissioner should conduct an assessment of the Ticket Program and
+the SSA VR Reimbursement Program, running in combination, to determine
+whether that approach produces better long-term, cost-effective
+outcomes than the historical VR Reimbursement Program alone, and to
+ensure the financial viability of running the two programs in
+combination.
+
+ The EN Payment System_Two problems in the EN payment system
+discourage the active participation of many providers: (1) the payment
+system places too much financial risk on ENs and (2) the payment system
+provides significantly lower reimbursements to ENs for serving
+Supplemental Security Income (SSI) recipients than for serving Social
+Security Disability Income (SSDI) beneficiaries.
+
+Recommendations
+
+ The Commissioner should immediately modify the EN payment
+system to move more of the payment into the first 12 months of
+employment and reduce the difference between the milestone and outcome
+payments.
+ The Commissioner should test two or three creative
+approaches that place more up-front financial risk on SSA but, if
+successful, could significantly increase Ticket Program participation
+by both ENs and beneficiaries, thereby increasing long-term savings to
+SSA.
+ Congress should amend the statute to permit payments to
+ENs to be set at a level greater than 40 percent of average benefits
+for both SSDI and SSI beneficiaries and after the statutory change the
+Commissioner should implement an increase in EN payments for
+beneficiaries of both programs.
+ Congress should amend the statute to permit the Ticket
+Program to increase the sum of payments available for serving SSI
+recipients to a level equal to the sum of payments available for
+serving SSDI beneficiaries.
+ The changes to the EN payment system should be
+implemented as quickly as possible.
+
+ Adequacy of Provider Incentives_Because little is known about
+outcome payments for providers, the Act authorizes the Commissioner to
+review, refine, and alter the payment system to ensure that it provides
+adequate incentives for ENs to serve beneficiaries and produce savings
+to the program. Despite major problems with the payment model, no
+alterations have been made to the original program payment system. The
+Commissioner has established an advisory group on Adequacy of
+Incentives (AOI) to assist SSA with the design of a workable payment
+system, including financial incentives to serve four groups of
+beneficiaries with special needs that were referenced in the Act.
+
+Recommendations
+
+ The Commissioner should implement a modified EN payment
+system that generally incorporates the principles outlined in the AOI
+Advisory Group's interim report. (The Panel supports the principles in
+the report but has not endorsed a specific model.)
+ For any new payment system to be successful, the
+Commissioner must first implement the Panel's recommendations relating
+to the EN payment system and EN claims administration.
+ The Commissioner and Congress should make clear in
+statute and in program regulations that payments to ENs must supplement
+funding from other public programs (such as State VR, Mental Health,
+Medicaid, Housing and Urban Development, Department of Labor) and
+should not pay for services for which beneficiaries are already
+eligible.
+
+EN Payment Claims Administration_Two factors compound the financial
+ risk and working capital problems of Employment Networks: (1)
+ long-term tracking of beneficiary earnings is labor intensive
+ and administratively burdensome for ENs and (2) there are often
+ long delays in processing EN claims for payment.
+
+Recommendations
+
+ Once a beneficiary has been certified as employed above
+the substantial gainful activity (SGA) level or leaves cash benefit
+status, the Commissioner should continue to pay the EN on a monthly
+basis as long as the beneficiary remains in zero benefit status and the
+EN has not yet received 60 months of outcome payments, or until the
+beneficiary requests a new EN.
+ The Commissioner should refine the EN payment claims
+processing system to ensure timely payments to ENs within businesslike
+timeframes. A widely accepted business standard for turnaround time on
+receivables is 30 days.
+
+ Marketing to ENs and to Beneficiaries_To date, there is no national
+marketing plan for the Ticket Program and the Program is not well
+understood by the vast majority of beneficiaries or by those who
+influence a beneficiary's decision to attempt work. Further, ENs spend
+considerable time explaining the Program and dispelling misconceptions.
+Also, the lack of marketing contributes to the insufficient demand for
+EN services. However, SSA has recently awarded contracts to support
+development of a strategic marketing plan and EN marketing and
+recruitment efforts. The Panel has made numerous recommendations to the
+Commissioner on this issue in past reports.
+
+Recommendation
+ The Commissioner should create opportunities for the Panel to (1)
+review the work plans and proposed activities under the strategic
+marketing plan contract and the project designed to improve EN
+participation and (2) engage in a dialogue with the contractors and
+relevant SSA staff so that the Panel can provide timely and substantive
+input on these marketing activities.
+
+ EN Training and Communication_There is inadequate training,
+technical assistance (TA), and timely information available to ENs.
+Existing TA and training resources are inadequate, nonuniform,
+piecemeal, uncoordinated, and of varying quality, with no coordinated
+means for ENs to identify and share best practices.
+
+Recommendations
+
+ The Panel, in partnership with the Commissioner, should
+convene a meeting of key stakeholders to develop a national training
+and communications conference for all ENs.
+ The Commissioner should appoint a working committee to
+develop the plan for this training conference and to develop the
+overall strategy for bringing together a broad-based coalition of
+stakeholders to oversee and sponsor the event. Panel members should be
+active participants.
+
+ American Indian VR Program Eligibility for the SSA VR Reimbursement
+Program_Despite having to meet the same service standards as State VR
+agencies, American Indian Vocational Rehabilitation (AIVR) programs
+operated by Tribal Nations programs are not exempt from the Ticket
+Program EN application process and are excluded from the traditional
+SSA Reimbursement Program for State VR agencies.
+
+Recommendation
+ Congress should amend the statute to permit AIVR programs operating
+under section 121 of the Rehabilitation Act to participate in Ticket to
+Work in a manner equivalent to State VR agencies; that is, they should
+be exempt from the EN application process and be subject to the same
+reimbursement rules.
+
+
+
+ Statement of Thomas P. Golden, Member, Ticket to Work and Work
+ Incentives Advisory Panel
+
+Introduction
+ The Ticket to Work and Work Incentives Advisory Panel (the Panel)
+would like to thank Chairman Shaw for holding this hearing. The Panel
+appreciates the Committee's high level of interest in ongoing oversight
+regarding the Ticket Program and the other important programs and
+policies of the Ticket to Work and Work Incentives Improvement Act. The
+Panel would also like to take the time to recognize the support this
+committee demonstrates for people with disabilities and the Social
+Security Administration Disability programs.
+
+Good News
+ The Panel believes that the Ticket Program is a very popular
+program with still much unrealized potential. Advocates for people with
+disabilities at the national and grassroots levels are very supportive
+of this program and are working with their Federal partners to make the
+program succeed.
+
+Positive Sign: Consumer Interest
+ Consumers are also showing great interest in the program. Forty
+thousand people have assigned their tickets to receive vocational
+rehabilitation and employment support services. While only about 4000
+of those are with Employment Network providers, or what we call ENs,
+that is a big number for the short time that the Ticket Program has
+been around. This is especially true given the fact that the roll out
+of the Ticket program was delayed and is not yet completed. The rest of
+the Tickets have been assigned to State Vocational Rehabilitation
+agencies.
+ Even beneficiaries who have not assigned a Ticket are very
+interested in finding out about the program. The Program Manager,
+Maximus, received over 23,000 calls in the month of February alone.
+Almost 20,000 of those were inquiries made by or on behalf on
+beneficiaries with interest in the Ticket program. In addition, MAXIMUS
+reports that during calendar year 2003, over 10 million hits were made
+to the Ticket to Work website.
+
+TWWIIA Support Programs are Excellent
+ The support programs established by the Ticket to Work and Work
+Incentives Improvement Act are also proving to be very successful.
+Almost 100,000 beneficiaries have sought information and assistance
+from the benefits planning assistance and outreach program, or BPAO.
+The results of the customer satisfaction survey that were just released
+by the Social Security Administration supports what the Panel has been
+hearing from beneficiaries across the country: BPAO services are
+excellent and essential to people with disabilities who want to work.
+Eighty nine percent of those surveyed rated the service they received
+as excellent, very good, or good. And, the percent of the people who
+reported they were working jumped by 19% subsequent to their contact
+with the BPAO. The Panel is pleased that the BPAO program was
+reauthorized in HR743 and thanks this Committee for their hard work in
+passing that legislation.
+
+Positive Implementation Step: Area Work Incentive Coordinator
+ The establishment of the Area Work Incentive Coordinator, or AWIC,
+position within SSA is a very positive development in implementation of
+the Ticket program, as well as in the overall administration of work
+incentives. The Panel is very pleased that SSA decided to create a
+position that is permanent and devoted full time to work incentive
+duties as part of their internal corps of work incentives specialists.
+The Panel has repeatedly heard very positive testimony and comments
+regarding the dedicated and skilled SSA employees that fill the AWIC
+positions. As we all know, the provision of accurate and timely
+information on work incentives is a critical factor in making people
+feel secure in their attempt to go to work. AWICs help to make that
+happen for SSA beneficiaries. The Panel hopes that SSA will expand the
+number of AWIC positions to meet the enormous demand for their
+services.
+
+Three Areas of Concern
+ While the Agency is making good progress, the Panel has serious
+concerns in three key implementation areas that threaten the success of
+the Ticket Program. Of most concern to the Panel is the current low
+participation of ENs. Second, we are concerned about the lack of public
+education and marketing of the Ticket Program to beneficiaries, their
+families, and ENs. A third major area of concern is the inadequate
+training provided to SSA field staff about work incentives in general,
+and the Ticket Program specifically.
+
+Concern One: EN Participation
+ As you probably know, the Panel issued a report last month on the
+crisis in EN participation and its potential impact on the Ticket
+Program. The Executive Summary of that report is included at the end of
+this statement (beginning on page 8).
+ Central to this report is the assumption that recruiting and
+retaining a large number of active ENs is a critical factor in
+accomplishing the primary stated goal of Ticket Program--giving people
+with disabilities a real choice in rehabilitation and employment
+services. Our report identified a number of issues related to the
+structure of the Ticket Program that are causing providers not to
+participate as ENs or to drop out altogether. These are: the need for
+Congress to clarify that the Ticket Program should be used as a
+supplemental, rather than a substitute, funding source; the design of
+the EN payment system; the inadequacy of provider incentives; the
+administration of claims for payment; marketing; EN training; and the
+treatment of American Indian VR programs.
+ Finally, the Panel is concerned and puzzled that in the fourth year
+of the Ticket Program, SSA has yet to undertake a demonstration or
+pilot project addressing some of these issues especially the payment
+issue. The problems outlined below in the Executive Summary must be
+addressed without delay to make the Ticket Program more attractive to
+current and potential ENs and to ensure that current ENs to remain in
+the program.
+
+Concern Two: Marketing and Public Education
+ The second major area the Panel believes maybe hindering the
+success of the program is the lack of marketing and public education
+being conducted by SSA in support of the program. The Panel has
+repeatedly recommended that SSA undertake a national coordinated
+marketing and public education campaign in order to increase awareness
+of and interest in the Ticket program. Currently, beneficiaries are
+informed only once about the Ticket Program and they may not be
+informed at all about other TWWIIA provisions and work incentives. The
+only marketing material most beneficiaries receive on the Ticket
+Program is a letter describing the program when the Ticket is being
+rolled out, or when they first become eligible for benefits.
+ The Panel is pleased that SSA has awarded a contract for the design
+of a strategic marketing plan for the program that will be completed
+this year. However, in the meantime, many ENs report having trouble
+finding people willing to assign their Tickets and many beneficiaries
+and local advocates remain completely in the dark about the Ticket
+program and the other work incentives. Although these SSA contracting
+efforts are very positive steps, the Panel is concerned that the next
+year or two will be devoted to planning marketing efforts rather than
+actual marketing of the Ticket Program. Extensive planning activities
+may delay implementation of a national marketing plan even further. The
+Panel believes it is reasonable to expect that marketing would occur
+prior to, or during, the rollout of a new program, not after.
+ The Panel urges SSA to move forward quickly with other marketing
+activities, such as sending reminder letters to all people who have
+received but not yet used their ticket.
+
+Concern Three: Training
+ The final area that is of most concern to the Panel is the
+insufficient training SSA field staff receive about work incentives and
+the Ticket Program. The Panel has heard in public testimony across the
+country, stories of beneficiaries who have received inaccurate
+information about work incentives from SSA staff in the field office.
+Receiving bad information can cause a person not to make a job attempt,
+to receive an overpayment, or to be forced to stop working. It also
+increases mistrust and fear. This situation is unacceptable to the
+Panel and Americans with disabilities. Every SSA field office should
+have accessible and available staff that possess a thorough
+understanding of the work incentives and be able to provide accurate
+basic information to SSA beneficiaries with disabilities who want to
+work.
+ On that note, the Panel wants to again recognize the very positive
+step the Agency took in the creation of the AWIC position as part of
+their internal corps of work incentive experts. This represents the
+best type of customer service. The AWICs received good basic training
+(two full weeks) and many of them were former Employment Support
+Representatives (with six weeks of training). AWICS are reported to be
+very knowledgeable and highly regarded in the field and by
+beneficiaries.
+ There are not nearly enough AWICs to be available to answer every
+question beneficiaries have but the training that AWICs have received
+on SSA work incentives and the Ticket Program is exemplary. SSA cannot,
+however, rely on AWICs to provide all information and advice to
+beneficiaries on work incentives and the Ticket Program. SSA created a
+filter down, train the trainer approach to build their corps of
+internal work incentive specialists. AWIC's train Work Incentives
+Liaisons (or WILs), the people who provide information on work
+incentives on top of their regular duties in the field office. WILs
+receive their limited training from the AWICs and then are expected to
+train the remainder of the field office staff. SSA work incentives and
+their interaction with the Ticket Program are very complicated and
+technical topics. The problem with SSA's current strategy is that the
+necessary knowledge does not seem to filter down to the claims
+representatives and service representatives who are answering
+beneficiary questions about work incentives on a day-to-day basis. We
+trust that SSA will make more intensive training, along the lines of
+what AWICs receive, available to all SSA field staff.
+
+Conclusion
+ The Panel believes the Ticket Program has great potential to help
+many people with disabilities improve their lives by going to work.
+This statement outlines a number of concerns the Panel has about SSA's
+administration of the Ticket Program. While it is still early in the
+implementation process of this new program, the failure of SSA to take
+steps immediately to address these concerns may have a dire effect on
+the success of the program.
+
+The Crisis in EN Participation: A Blueprint for Action (February 2004)
+Executive Summary
+ Thousands of people with disabilities and their advocates shared a
+dream that the Ticket to Work and Work Incentives Improvement Act of
+1999 (the Act) would greatly expand employment opportunities for people
+on the Social Security Administration (SSA) disability rolls. Three
+years after enactment of the law, it is clear that their dream is
+faltering. The Ticket to Work and Self-Sufficiency Program (Ticket
+Program) is failing to recruit the anticipated numbers of new
+employment service providers, called Employment Networks (ENs). In
+addition, those enrolled as ENs are serving only a fraction of the
+beneficiaries thought to be interested in participating in the Ticket
+Program. Nearly 1,000 providers have enrolled in the program, but only
+about one-third of those operating have accepted any tickets. The Panel
+believes that without immediate attention to the very real problems
+affecting EN participation, the Ticket Program will fail. The Panel
+urges Congress and the Commissioner to act quickly on the following
+recommendations.
+
+Issues and Recommendations
+
+Ticket Program as a Supplemental Funding Source_ENs are uncertain about
+ whether and how they can use funds from other public sources to
+ serve ticket holders and have chosen not to actively
+ participate in the Ticket Program because of fear of losing
+ other stable funding sources.
+
+Recommendations
+
+ Congress should develop statutory language that clearly
+articulates its original intent that the Ticket Program's outcome and
+milestone payments should provide additional resources to assist
+beneficiaries in attaining and retaining employment. In general, the
+Panel believes that Congress did not intend to make beneficiaries
+ineligible for the full range of services from vocational
+rehabilitation (VR) programs, Medicaid, or other Federal and State
+programs by making them eligible for the Ticket Program.
+ Congress should direct the Commissioner to implement the
+Ticket Program as a complement to the traditional SSA VR Reimbursement
+Program, paying State VR agencies for up-front services and paying ENs
+for long-term employment outcomes.
+ As part of the mandated evaluation of the Ticket Program,
+the Commissioner should conduct an assessment of the Ticket Program and
+the SSA VR Reimbursement Program, running in combination, to determine
+whether that approach produces better long-term, cost-effective
+outcomes than the historical VR Reimbursement Program alone, and to
+ensure the financial viability of running the two programs in
+combination.
+
+The EN Payment System_Two problems in the EN payment system discourage
+ the active participation of many providers: (1) the payment
+ system places too much financial risk on ENs and (2) the
+ payment system provides significantly lower reimbursements to
+ ENs for serving Supplemental Security Income (SSI) recipients
+ than for serving Social Security Disability Income (SSDI)
+ beneficiaries.
+
+Recommendations
+ The Commissioner should immediately modify the EN payment
+system to move more of the payment into the first 12 months of
+employment and reduce the difference between the milestone and outcome
+payments.
+ The Commissioner should test two or three creative
+approaches that place more up-front financial risk on SSA but, if
+successful, could significantly increase Ticket Program participation
+by both ENs and beneficiaries, thereby increasing long-term savings to
+SSA.
+ Congress should amend the statute to permit payments to
+ENs to be set at a level greater than 40 percent of average benefits
+for both SSDI and SSI beneficiaries and after the statutory change the
+Commissioner should implement an increase in EN payments for
+beneficiaries of both programs.
+ Congress should amend the statute to permit the Ticket
+Program to increase the sum of payments available for serving SSI
+recipients to a level equal to the sum of payments available for
+serving SSDI beneficiaries.
+ The changes to the EN payment system should be
+implemented as quickly as possible.
+
+Adequacy of Provider Incentives_Because little is known about outcome
+ payments for providers, the Act authorizes the Commissioner to
+ review, refine, and alter the payment system to ensure that it
+ provides adequate incentives for ENs to serve beneficiaries and
+ produce savings to the program. Despite major problems with the
+ payment model, no alterations have been made to the original
+ program payment system. The Commissioner has established an
+ advisory group on Adequacy of Incentives (AOI) to assist SSA
+ with the design of a workable payment system, including
+ financial incentives to serve four groups of beneficiaries with
+ special needs that were referenced in the Act.
+
+Recommendations
+
+ The Commissioner should implement a modified EN payment
+system that generally incorporates the principles outlined in the AOI
+Advisory Group's interim report. (The Panel supports the principles in
+the report but has not endorsed a specific model.)
+ For any new payment system to be successful, the
+Commissioner must first implement the Panel's recommendations relating
+to the EN payment system and EN claims administration.
+ The Commissioner and Congress should make clear in
+statute and in program regulations that payments to ENs must supplement
+funding from other public programs (such as State VR, Mental Health,
+Medicaid, Housing and Urban Development, Department of Labor) and
+should not pay for services for which beneficiaries are already
+eligible.
+
+EN Payment Claims Administration_Two factors compound the financial
+ risk and working capital problems of Employment Networks: (1)
+ long-term tracking of beneficiary earnings is labor intensive
+ and administratively burdensome for ENs and (2) there are often
+ long delays in processing EN claims for payment.
+
+Recommendations
+
+ Once a beneficiary has been certified as employed above
+the substantial gainful activity (SGA) level or leaves cash benefit
+status, the Commissioner should continue to pay the EN on a monthly
+basis as long as the beneficiary remains in zero benefit status and the
+EN has not yet received 60 months of outcome payments, or until the
+beneficiary requests a new EN.
+ The Commissioner should refine the EN payment claims
+processing system to ensure timely payments to ENs within businesslike
+timeframes. A widely accepted business standard for turnaround time on
+receivables is 30 days.
+
+Marketing to ENs and to Beneficiaries_To date, there is no national
+ marketing plan for the Ticket Program and the Program is not
+ well understood by the vast majority of beneficiaries or by
+ those who influence a beneficiary's decision to attempt work.
+ Further, ENs spend considerable time explaining the Program and
+ dispelling misconceptions. Also, the lack of marketing
+ contributes to the insufficient demand for EN services.
+ However, SSA has recently awarded contracts to support
+ development of a strategic marketing plan and EN marketing and
+ recruitment efforts. The Panel has made numerous
+ recommendations to the Commissioner on this issue in past
+ reports.
+
+Recommendation
+ The Commissioner should create opportunities for the Panel to (1)
+review the work plans and proposed activities under the strategic
+marketing plan contract and the project designed to improve EN
+participation and (2) engage in a dialogue with the contractors and
+relevant SSA staff so that the Panel can provide timely and substantive
+input on these marketing activities.
+
+EN Training and Communication_There is inadequate training, technical
+ assistance (TA), and timely information available to ENs.
+ Existing TA and training resources are inadequate, nonuniform,
+ piecemeal, uncoordinated, and of varying quality, with no
+ coordinated means for ENs to identify and share best practices.
+
+Recommendations
+
+ The Panel, in partnership with the Commissioner, should
+convene a meeting of key stakeholders to develop a national training
+and communications conference for all ENs.
+ The Commissioner should appoint a working committee to
+develop the plan for this training conference and to develop the
+overall strategy for bringing together a broad-based coalition of
+stakeholders to oversee and sponsor the event. Panel members should be
+active participants.
+
+American Indian VR Program Eligibility for the SSA VR Reimbursement
+ Program_Despite having to meet the same service standards as
+ State VR agencies, American Indian Vocational Rehabilitation
+ (AIVR) programs operated by Tribal Nations programs are not
+ exempt from the Ticket Program EN application process and are
+ excluded from the traditional SSA Reimbursement Program for
+ State VR agencies.
+
+Recommendation
+ Congress should amend the statute to permit AIVR programs operating
+under section 121 of the Rehabilitation Act to participate in Ticket to
+Work in a manner equivalent to State VR agencies; that is, they should
+be exempt from the EN application process and be subject to the same
+reimbursement rules.
+
+
+
+ Mr. BRADY. Mr. Seifert?
+
+ STATEMENT OF PAUL J. SEIFERT, SOCIAL SECURITY TASK FORCE,
+ CONSORTIUM FOR CITIZENS WITH DISABILITIES
+
+ Mr. SEIFERT. Thank you, Mr. Chairman. I am testifying today
+on behalf of the CCD and Work Incentives Task Forces. The CCD
+is a national organization representing over 100 disability
+organizations, membership organizations of people with
+disabilities, provider organizations, a good many people who
+are participating in the ticket program and a good many
+organizations providing those services as ENs. It was with a
+great deal of support from the disability community and, of
+course, bipartisan support from Congress that the ticket
+legislation passed in 1999. However, an array of factors, we
+believe, have kept the ticket program from meeting its full
+potential and we have four areas of concern that we would like
+to mention today.
+ As previously mentioned, the reimbursement schedule for ENs
+is wholly inadequate, and is creating a major barrier to ENs
+who want to participate in the program. There are issues
+between State VR agencies, ENs, and beneficiaries that have
+resulted in many potential ENs not participating in the program
+and beneficiaries unknowingly assigning their tickets to VR,
+overly burdensome reporting requirements on EN and State VR
+agencies in order to receive reimbursement, and as I think has
+been gone over in great detail, poor marketing to ENs in terms
+of recruitment and a lack of awareness about the ticket among
+SSA beneficiaries, not to mention the other work incentives.
+ I want to talk about the reimbursement scheme, and just
+skip right to our proposals. First of all, we think Congress
+should eliminate the statutory requirement that the milestone
+outcome payment system pay less than the outcome payment only
+system. Congress should clarify that a partial reduction of
+benefits under the SSI Program for working SSI beneficiaries
+is, in fact, an outcome, deserving a payment to an EN, maybe
+not the full amount, but certainly that is something we want to
+reward and not penalize.
+ Congress should shorten the period in which outcome
+payments are made and should raise the percentage of the
+average monthly benefit used to determine payments to ENs.
+Waiting 60 months for the full repayment is just too long for
+most small nonprofits to capitalize expenses over that period
+of time. Fourth, the SSA should increase the value of the
+milestone payments and allow the partial payment for some work
+that is under the SGA level. Again, we endorse the
+recommendations of the Employment Network Work Group that the
+panel put together and also the Adequacy of Incentives Work
+Group report which will be coming out shortly.
+ The interplay between State VR agencies and beneficiaries
+and ENs is another area of concern to us and has been a concern
+ever since this legislation was developed. Quite frankly, we
+believe Congress needs to repeal the language that requires
+agreements between ENs and VR agencies. Second, we think that
+the legislative language should be enacted that prohibits VR
+agencies from collecting ticket payments from ENs who refer
+beneficiaries to State VR agencies. We think that Social
+Security ought to pay VR its cost reimbursement under its
+current situation, and keep the ticket intact so ENs can regain
+or at least get reimbursed for the payments and services that
+they provide over the 60-month period for which a beneficiary
+has deposited that ticket.
+ The marketing issue is one that we discussed with Social
+Security in the early rollout of the ticket, and one that we
+had several concerns with. First of all, we were worried that
+the tickets would roll out before enough ENs were signed up,
+and part of the reason why so few tickets are being deposited
+or so many are being deposited with VR agencies is we rolled it
+out so fast that there aren't enough ENs to potentially provide
+enough services to all the people who may want them.
+ Number two, mailing the ticket to beneficiaries was
+probably not the best marketing device. Beneficiaries get
+essentially two things from Social Security, a check and bad
+news, and probably since this was not a check, at best it was
+probably kept in a drawer or on top of a dresser somewhere
+where it might be gotten later or forgotten. So, that was
+probably not the best technique. In addition, the cost of
+mailing out millions of these tickets was probably prohibitive
+and not the best use of the agency's resources. We believe that
+use of the advocacy community to advertise the ticket as well
+as the other work incentives, the use of television and radio
+public service announcements would do a lot to promote the use
+of the ticket among beneficiaries, and a more aggressive
+strategy for signing up ENs plus a modification of the payment
+and reimbursement schedule will convince more smaller
+nonprofits to get involved in the program.
+ It was touched on briefly by Mr. Hulshof, but the issue of
+overpayments is a staggeringly frightening phenomena for anyone
+who has ever experienced it and it has got to be dealt with. It
+not only affects ENs in the sense that when an overpayment is
+made, a payment to an EN is not being made when it should be,
+but perhaps most significantly, beneficiaries are stuck having
+to repay at times tens of thousands of dollars of benefits they
+were not supposed to get even when they have reported their
+earnings to Social Security in accordance with the statute.
+Worse than that, beneficiaries have to pay taxes on the
+overpayment that they get and they can't pay it out of the
+benefits they get. So, we have imposed an additional tax burden
+on a working beneficiary for getting an overpayment they are
+not supposed to get. Now, they can always file for
+reimbursement in a later tax year, but do we really have to do
+this to people who are trying to work?
+ In conclusion, we believe the ticket has a great deal of
+potential. We think these modifications will go a long way to
+help the ticket realize that potential. We applaud the agency
+for its rapid and extraordinary rollout and we hope that some
+adjustments are forthcoming. Thank you.
+ [The prepared statement of Mr. Seifert follows:]
+
+ Statement of Paul J. Seifert, Social Security Task Force, Consortium
+ for Citizens with Disabilities
+
+ Mr. Chairman, Mr. Matsui, members of the Subcommittee, my name is
+Paul J. Seifert. I am the Director of Government Affairs for the
+International Association of Psychosocial Rehabilitation Services
+(IAPSRS) and today I am testifying on behalf of the Consortium for
+Citizens With Disabilities (CCD) Work Incentives and Social Security
+Task Forces. CCD is a coalition of nearly 100 national organizations
+advocating on behalf of people with physical, mental, and sensory
+disabilities. On behalf of CCD I thank you for this hearing to examine
+the Social Security Administration's management of the Ticket to Work
+program.
+ With a great deal of support from the disability community and near
+unanimous, bi-partisan support in both the House and Senate, Congress
+enacted and President Clinton signed into law the Ticket to Work & Work
+Incentives Improvement Act (TWWIIA) in December 1999. This legislation
+was designed to expand the rehabilitation services and health care
+coverage for Social Security beneficiaries who want to go back to work.
+A key component of the TWWIIA legislation is the Ticket-to-Work
+Program.
+ There are high expectations in both the disability community and
+among members of Congress for the Ticket to Work program. And though
+those expectations have not been fully realized, a couple of key
+positive points should be mentioned. First, SSA should be recognized
+for their rapid regulatory development and rollout of the Ticket
+program. The first tickets were issued to beneficiaries a little over
+two years after passage of the legislation, and today just four years
+after the final regulations were approved, beneficiaries in every
+state, the District of Columbia and the territories are able get a
+Ticket to Work. This is an extraordinary accomplishment given that the
+Ticket to Work is a brand new program that required the creation of a
+new Office of Employment Support Programs within SSA and the hiring or
+reassignment of many SSA staff.
+ Second, while much criticism has been leveled at the Ticket Program
+for its real or perceived failures the fact is, when compared to the
+old SSA Alternate Provider (AP) Program, more people are using the
+Ticket and SSA is making payments to more Employment Networks for
+serving more beneficiaries than they did under the old AP program. The
+numbers speak for themselves. Under the AP Program only 428 private
+agencies participated. Today 1,100 Employment Networks are
+participating in the Ticket. Under the old AP program only about 15
+successful outcomes were achieved resulting less than $50,000 in
+payments to providers. As of March 17, 2004, the Ticket has paid
+$583,000 in payments have been made to 160 ENs for serving 473
+beneficiaries.
+ However, the standard for success was not merely to do better than
+the AP program, but rather to significantly expand the array of
+employment services for people with disabilities and increase the
+resources available to provide those services. Unfortunately, an array
+of factors has kept the Ticket from reaching its full potential. Those
+factors are 1) a wholly inadequate EN reimbursement schedule that is
+keeping potential ENs from participating and keeping most of those who
+do participate from taking Tickets, 2) issues between State Vocational
+Rehabilitation Agencies and ENs and beneficiaries have resulted in many
+potential ENs deciding to not participate and has beneficiaries
+unknowingly assigning their Tickets to State VR, 3) overly burdensome
+reporting requirements on ENs seeking reimbursement, and 4) poor
+marketing to ENs and a lack of awareness about the Ticket among SSA
+beneficiaries.
+
+REIMBURSEMENT IS INADEQUATE
+
+ Reimbursement under the Ticket to an EN occurs when a beneficiary
+who has assigned their Ticket goes to work and no longer receives cash
+benefits. Small milestone payments are available to the EN and paid
+when the beneficiary's work effort reaches Substantial Gainful Activity
+for a certain period of months. The outcome payments are spread out
+over 60 months, payable for a month whenever the beneficiary is not
+receiving cash benefits. The payments are calculated as forty percent
+of the average monthly SSI and SSDI benefit.
+ SSA's payment methodology has several flaws. ENs who choose to
+receive milestone payments (all but a couple have chosen milestones)
+have their total payment cut by fifteen percent compared to the
+outcome-only payment scheme. No upfront funding means ENs must
+capitalize all the costs until the person is working above SGA and then
+completely off cash benefits and the milestone payments are too small
+to be attractive to ENs. The policy of requiring SSI beneficiaries to
+go completely off cash benefits ignores that many SSI beneficiaries who
+offset much of their SSI benefit through work generate much savings
+that ENs get no credit for under the current payment scheme developed
+by SSA.
+ Participation by ENs will continue to be weak unless they can
+foresee a more reasonable level of payment made in a more timely
+fashion.
+ We propose several improvements: 1) Congress should eliminate the
+statutory requirement that the milestone-outcome payment system pay
+less than the outcome-only payment system, 2) Congress should clarify
+that a partial reduction of benefits under the SSI program is an
+``outcome'' deserving of some reward to ENs, 3) Congress should shorten
+the period in which outcome payments are made and raise the percent of
+average monthly benefit used to determine payments to ENs, and 4) SSA
+should increase the value of the milestone payments and allow partial
+payment for some work that is under the SGA level.
+
+STATE VR AGENCIES, ENs and BENEFICIARIES
+
+ The interplay between State VR agencies, ENs and beneficiaries was
+a concern from the day the first Ticket legislation was developed.
+State VR agencies have developed stand alone, take it or leave it, one
+size fits all agreements for ENs in their states. These agreements all
+contain one common provision--the full and total repayment of all of
+VR's costs out of the ENs ticket payment by an EN who refers a
+beneficiary to VR. In two states we found the VR agency demanded a
+percentage of the ENs ticket reimbursement ABOVE the state VR agencies
+actual costs. In two other states the VR agency has required ENs to
+join the state VR agency's ``Employment Network.'' It was hoped by
+advocates that the Ticket would supplement existing VR funds for
+employment services, not supplant those funds.
+ In addition, in one state we found examples of state VR counselors
+who had failed to file the beneficiaries Ticket when the beneficiaries
+went to VR for services. As a result, the beneficiary was not eligible
+the Continuing Disability Review (CDR) protections Congress
+incorporated into the Ticket and the person was denied that protection.
+Fortunately the action taken by local Protection and Advocacy program
+was able to stop the CDR and restore the protection afforded under the
+Ticket.
+ Finally, in an SSA document known as ``Transmittal 17,'' SSA has
+essentially allowed state VR agencies to involuntarily assign a
+beneficiary's ticket apparently without their knowledge or signed
+consent. Furthermore, we just discovered that the Florida state VR
+agency is going back through their case files and retroactively
+assigning the Tickets of every person who had received VR's services
+after February 2002 without notice to the beneficiary and regardless of
+whether the beneficiary had intended to assign that Ticket to VR or
+not.
+ It is abundantly clear that, after more than two years of Ticket
+roll out, no resolution of the issues between state VR agencies and ENs
+and beneficiaries is in sight. Further, the Rehabilitation Services
+Administration (RSA) and SSA have been unable to resolve matters at the
+federal level. However, we want to also be clear that it would be
+unfair to vilify VR agencies. The Federal-State VR Program remains
+woefully under funded given its broad mission and the number of people
+who seek VR services. One example of the strain on the system is the
+number of cases VR counselors must handle. It is not uncommon for a
+state VR counselor to be assigned 150 to 200 cases. This strain is
+unlikely to ease as state budgets tighten. Consequently, we hope the
+recommendations below will both make the Ticket more successful and
+help State VR agencies play a more significant part.
+ We urge Congress to amend the Ticket program by eliminating the
+requirement that there be agreements between ENs and state VR agencies
+when the EN refers a beneficiary to VR. Congress should adopt language
+prohibiting state VR agencies from requiring ENs who refer clients to
+state VR from demanding repayment from the EN. Most significantly, a
+recommendation of the Adequacy of Incentives Work Group that was
+created under the TWWIIA law would allow cost reimbursement for state
+VR agencies separately from the Ticket program, and would thus keep
+intact the Ticket for the beneficiary's use.
+
+EN REPORTING REQUIREMENTS and OVERPAYMENTS
+
+ Payment under the Ticket program occurs when the beneficiary is no
+longer receiving benefits. Because SSA is unable to verify in a timely
+way the wages and income of working beneficiaries or former
+beneficiaries, SSA is requiring ENs to produce the beneficiary's wage
+verification for each month the EN is requesting a payment. The EN
+payment request system leaves major difficulties for the vast majority
+of ENs. Those ENs who are using the Milestone/Outcomes payment system
+still must turn in copies of pay stubs until the beneficiaries reach
+zero cash benefit. This means that they may be faced with one to two
+years or more of collecting pay stubs. Current ENs and potential ENs
+need to know that a reliable system exists to provide payments for
+their successful efforts.
+ In addition, because SSA does not stop checks to working
+beneficiaries in a timely fashion, many beneficiaries continue to
+receive benefits that SSA should have stopped, even when the
+beneficiary has reported their income to SSA. The few people who figure
+out this problem just put the money in the bank and wait for SSA to ask
+for it back, a request that may come years later. The vast majority of
+beneficiaries simply believe the money is theirs and spend it, then
+don't have it when SSA demands repayment. Often times calls to SSA
+offices are of little help or the wrong information is given. These
+overpayments often go one for months and sometimes years and total tens
+of thousands of dollars. More astounding is the fact that beneficiaries
+must pay taxes on the overpayments they receive. An adjustment can be
+made in later tax years, but must we really put beneficiaries though
+this?
+ Public Law 108-203, which President Bush recently signed on March
+2nd, calls on SSA to issue ``receipts'' whenever a beneficiary reports
+earnings to SSA. This receipt may well help a beneficiary waive an
+overpayment, but it does not solve the tax problems facing
+beneficiaries or the payment issues facing ENs. Worse, overpayments
+reinforce the fears that many beneficiaries have about returning to
+work.
+ We call on Congress to allocate resources to SSA to put an end to
+their inability to process earnings reports. With overpayments causing
+massive problems for beneficiaries and ENs, it is time to act
+decisively on this issue.
+
+PROMOTING THE TICKET and RECRUITING ENs
+
+ SSA's plan to mail Tickets to beneficiaries was viewed skeptically
+by advocates. The cost was high and we know that beneficiaries would be
+apt to ignore the mailings without knowing more about the work
+incentives, vocational services and employment options. Also, to date
+while the TWWIIA legislation has provided over seventy-five million to
+states to start their Medicaid Buy-in programs, all ENs received was a
+burdensome application form, a fight with their state VR agency, and a
+stingy reimbursement scheme. The wonder isn't that too few ENs have
+signed up or that they are taking too few Tickets, the real wonder is
+that any signed up at all and that they take any Tickets.
+ To do better SSA must make real changes in the program. SSA should
+make use of the networks of advocacy groups and PSAs on radio and TV to
+advertise the Ticket to beneficiaries and non-traditional potential
+ENs. Most of all, more must be done to explain the Ticket and the work
+incentives to beneficiaries. Early results show that the Benefits
+Planning Outreach and Assistance program, as well as the Protection and
+Advocacy program, are a success. It is time for Congress to
+dramatically increase funding for these effective programs. Finally,
+Congress unintentionally excluded Vocational Rehabilitation Programs
+for American Indians from participating in the Ticket program.
+
+Disabled Adult Child Benefits
+
+ KWe want to thank this Subcommittee and Congress for resolving a
+problem in the way the Title II work incentives, including the Ticket
+program, affect people who receive Disabled Adult Child (DAC) benefits.
+P.L. 108-203, has a provision to extend indefinitely the time-frame for
+a DAC beneficiary to re-enter the Title II program with DAC benefits if
+the individual is still disabled and the termination was due to work
+over the SGA level. When this provision becomes effective in October
+2004, people receiving DAC benefits will no longer be faced with the
+potential permanent loss of DAC benefits if they are at first
+successful in leaving the rolls due to work but later need to return to
+the Title II program.
+ We urge the Subcommittee to consider addressing the situation of
+people who are on the SSI program who are likely to receive DAC
+benefits in the future when their parents retire, die, or become
+disabled. If the individual with disabilities earns income above the
+SGA level before applying for DAC benefits, access to DAC benefits may
+be permanently barred. This is a substantial work disincentive for
+people who are severely disabled during childhood and who may need the
+benefits earned for them by their parents. But for the fact that their
+parents have not yet retired, died, or become disabled, they stand in
+the same position as those for whom the provision was included in P.L.
+108-203. We would be happy to work with the Subcommittee to explore
+possible solutions to this problem.
+ There is one remaining work disincentive for people who qualify for
+DAC benefits that could be resolved through regulatory change. We
+understand that SSA's interpretation regarding the value to be placed
+on a worker's work effort (regarding whether it exceeds SGA or not) is
+different for people in supported employment depending upon whether the
+individual is supported directly by an employer or whether the
+individual is supported by services from an outside source, such as a
+state-funded supported employment agency. As a result, an individual's
+work effort could be found to exceed SGA when the support is from a
+third party while that same work effort could be found not to exceed
+SGA when the support is from the employer. From the perspective of the
+individual, this is an arbitrary distinction. Further, there may be
+additional complications in that the nature and scope of the support
+provided to the individual may be misunderstood when making the
+valuation of work effort. For instance, while the individual may be
+performing the actual task (bagging groceries, assembling a package,
+etc.), it may be that the individual would be unable to perform the
+task without the help of the job coach in ensuring that the individual
+arrives at work on time properly attired, that he/she interacts
+appropriately with customers and co-workers, and that he/she remains
+focused on the assigned job tasks, among other things. We believe that
+this is an area that needs further examination if work incentives are
+to work as intended by TTWWIIA. We urge the Subcommittee to collaborate
+with SSA to ensure resolution of this problem.
+ In conclusion, the Ticket program is full of potential, but that
+potential can only be realized with action by Congress and SSA to make
+the necessary changes. We knew that it would take time to shape this
+program into a successful effort and that changes large and small would
+be needed. We are on the right track but it is time make those changes
+as mentioned earlier.
+ Again thank you Mr. Chairman, and members of the Committee, for the
+opportunity to testify on this important issue.
+
+
+
+ Mr. BRADY. Thanks for racing through that and giving us a
+lot of good information. Tom?
+
+ STATEMENT OF TOM FORAN, VICE PRESIDENT, INTEGRATED DISABILITY
+ RESOURCES, INC., BLOOMFIELD, CONNECTICUT
+
+ Mr. FORAN. Thank you. I represent IDR. We are the EN that
+Ms. Hancock worked with. I would like to share with you some of
+our experiences with the ticket program to date which is a bit
+of a good news/bad news scenario. Currently, we have about 162
+active tickets from 30 different States. We are negotiating
+ticket assignments with an additional 400 beneficiaries. We
+have 65 people currently employed, 35 of them over SGA. We are
+on target to return an additional 120 beneficiaries back to
+work by the end of 2004. We have received over 5,000 inquiries
+from beneficiaries interested in returning to work and we have
+invested over $1.3 million into the ticket to Work Program
+structure to allow us to handle a large number of
+beneficiaries.
+ On the bad news side, we have earned about $50,000 in
+payments to date. We have only been paid about $22,000. We have
+several outstanding payments due from November of 2002. We
+spend in many instances as much in time and energy to collect
+our first payment as the first payment amount. Administrative
+drag can be mind-numbing at times. Due to the negative cash
+flow and the administrative burden that we experience on a day-
+to-day basis, we have had to turn away over 4,000 beneficiaries
+who wanted to return to work that we just could not afford to
+provide services to.
+ Without some change in the payment structure and the
+administration of the program, we may be forced to shut down in
+the near future, at least for beneficiaries who our only source
+of revenue is from the Ticket to Work Program. However, given
+all that, we do think this program has tremendous potential.
+You heard this morning from individuals who have been served
+already. We are regularly serving folks. This is an exciting
+program. It really hurts my staff personally to have to turn
+people away. They get very, very upset with me when I tell them
+we can't work with certain folks.
+ We fully support the recommendations that were laid out in
+the Ticket to Work and Work Incentives Advisory Panel report,
+``The Crisis in EN Participation: A Blueprint for Action.'' We
+would actually suggest taking the recommendations a step
+further by implementing the payment structure that was outlined
+from the Adequacy of Incentives Group in the interim report
+from September of 2003, basically moving about 25 percent of
+the payments into the first year of service, which is when the
+majority of expenses are incurred.
+ We feel the key to success of this program is really
+basically a demand and supply issue. The first piece,
+obviously, is creating demand amongst beneficiaries for return
+to work services, and Susan Webb will be talking a bit more
+about that. So, I am not going to touch on that right now. On
+the supply side, we currently have over 1,000 ENs. However,
+only about a third of them are actively taking tickets and I
+would like to know what the definition of actively taking
+tickets is. If it is one or two tickets, I would not call that
+being an active EN.
+ Two critical issues that we have already heard today are,
+one, the amount and the duration of the negative cash flow that
+is created. As I said before, we have invested over $1.3
+million and we have only earned about $50,000. If we shut down
+today and only served the people that we would be working with
+and they were successful in returning to work or remaining at
+work for the full 60 months, we probably would be almost close
+to break even, but trying to convince an investor to wait 60
+months is a pretty hard thing to do. They get very impatient.
+ The other issue is the lack of access to capital for ENs.
+Typically, an EN has no collateral to take to a bank and get a
+loan. Additionally, the risk is too great, the negative cash
+flow too high, and there is no history to the program to show
+demonstrated success to attract venture capital. Our suggestion
+would be, one, to adopt the changes in the payment structure.
+Two, create some type of loan guarantee program or tax credit
+program whereby investors who take the risk in this program are
+rewarded down the road with tax credits.
+ There are many other improvements that can be made to this
+program. However, without addressing these two critical issues
+for ENs, which is really the supply side of the whole equation,
+addressing those issues is tantamount to fixing or setting an
+individual's broken leg after an accident when they are
+actually in cardiac arrest. The ENs will not be here 6 months
+from now. I know I won't be. I don't think Susan Webb will be
+if some changes aren't made soon. I think this would be a
+tremendous loss to the program, to have the experienced ENs who
+have already gone through the process drop out of the programs
+because they can no longer fund it.
+ Some of the other suggestions we have are, again,
+increasing the administrative efficiency. Help Maximus change
+their focus from purely recruiting new ENs, that ultimately
+don't become active, into the system, to making the existing
+ENs successful. I think that is a critical thing. Reducing the
+administrative drag, increasing the efficiencies, increasing
+the supports to them. Educating beneficiaries on the quality
+active status of ENs. Right now, a beneficiary gets a list of
+about 20 to 30 ENs that are serving their area with no idea
+whether those ENs are actually taking tickets or what their
+track record is. I don't look at that as choice. I look at that
+as a bunch of phone calls that a beneficiary has to make and
+just get disappointed over and over again.
+ So, in conclusion, if we can provide more information to
+the beneficiaries about what is out there and provide them with
+successful ENs, I think you will start seeing a significant
+amount of momentum being generated, and again, success always
+breeds success. Thank you very much.
+ [The prepared statement of Mr. Foran follows:]
+
+ Statement of Tom Foran, Vice President, Integrated Disability
+ Resources, Inc., Bloomfield, Connecticut
+
+ Thank you for the opportunity to provide testimony today.
+Integrated Disability Resources (IDR) is one of the largest national
+Employment Networks (EN). IDR's experience with the Ticket to Work
+program to date is a good news/bad news story.
+ The good news is, we:
+
+ Have 161 active tickets assigned from beneficiaries in 30
+different states
+ Are negotiating ticket assignment with over 400
+additional beneficiaries
+ Have returned 65 beneficiaries (40% of active tickets) to
+work with 35 of them already over SGA
+ Are on target to return an additional 120 beneficiaries
+to work by 12/31/2004
+ Have invested over $1,300,000 in the TTW program to date
+ Have received over 5,000 inquiries from beneficiaries
+interested in returning to work
+
+ On the surface, this appears to be a very successful program.
+However, without some significant changes in the program's design and
+administration we will be forced to stop accepting tickets resulting
+from new inquiries, which of course is the bad news side of our story.
+Given our success rate in helping individuals return to work, this
+would also be bad news for the SSA. To date, we:
+
+ Have earned only $50,000 compared to the $1,300,000
+investment mentioned above. Of this $50,000
+ $7,000 is on beneficiaries who will not provide us
+with their pay stubs
+ $21,000 has been received from Social Security
+ $20,000 is due from Social Security much of this has
+been outstanding for three to twelve months or longer (as of our last
+EN payment report from Maximus we have 2 open requests for payment that
+are with the SSA field office from November of 2002)
+ .Often have had to spend more money in staff wages to
+physically collect the first payment than the amount of the payment
+itself.
+ Have spent an enormous amount of time managing
+unrealistic beneficiary expectations (e.g. ``buy me a $100,000 tractor
+trailer'' or ``pay for my college education'')
+ Have experienced an incredible amount of ``administrative
+drag'' that requires us to spend valuable resources dealing with
+Maximus and or the SSA, instead of helping beneficiaries execute their
+individual work plans. We suggest implementing:
+ On-line access to information from Maximus for:
+ Status of a ticket regarding its ability to be
+assigned
+ Past history of a beneficiary's ticket to
+determine if multiple ENs will need to share payments
+ Status of payment requests
+ Automated reimbursement processes
+ Currently, each EN must create its own billing
+and ticket tracking system instead of having Maximus maintain one
+online system.
+ Follow-ups with SSA field offices are sporadic
+and not automated
+ The milestone portion of the payment process
+still requires pay stubs as documentation.
+ Have had to ``screen out'' over 4,000 interested
+beneficiaries. Initially, we were willing to work with a much higher
+percentage of interested beneficiaries but have determined that due to
+capital restraints caused by the reimbursement structure and process,
+we need to limit the scope of our program.
+ Will soon have to stop working with beneficiaries for
+whom our only source of revenue is the Ticket to Work program. This
+represents about 90% of our active tickets.
+
+ While our situation and current level of participation is tenuous,
+it is important to note that we feel with some relatively moderate
+changes, the TTW program can be a tremendous success for both the SSA
+and its beneficiaries.
+ We strongly support the changes suggested in the Ticket to Work and
+Work Incentives Advisory Panel's February, 2004, Advice Report to
+Congress and the Commissioner of the Social Security Administration The
+Crisis in EN Participation--A Blueprint for Action. In fact we
+recommend taking it one step further, and suggest adopting the payment
+system outlined in the Adequacy of Incentives (AOI) Advisory Group's
+September, 2003 Interim Report.
+ The AOI Advisory Group suggested moving a significantly greater
+portion of the TTW payments into the first 12 months and decreasing the
+threshold of success for milestone payments to a $600 earnings level.
+ Modeling the AOI suggested payment structure revealed that our
+earned revenue to date would have been closer to $80,000. While this is
+still nowhere near our overall investment in the program, it
+dramatically reduces our negative cash flow on any one beneficiary
+allowing us to reinvest in serving more beneficiaries sooner.
+ What follows is IDR's perception of the issues diminishing the
+success of the program and our suggestions for change. It is our belief
+that the success of the Ticket to Work program comes down to its
+ability to create both demand and supply.
+ Demand for return to work services must be created within the
+beneficiary population. Once created, there needs to be an adequate
+supply of return to work services from quality employment networks.
+
+Demand
+ Experience has shown us that the mailing of tickets to
+beneficiaries creates a significant amount of interest and demand for
+return to work services. We regularly see a dramatic spike in inquiries
+for services from beneficiaries seven to fourteen days after each batch
+of ticket mailings.
+ For states in which the mailings are completed (phase one and two
+states) we see a drop in the volume of inquiries that correlates
+closely with the amount of time since the last mailing.
+ Given the success of the mailings to date, we suggest regular re-
+mailings to beneficiaries encouraging them to consider returning to
+work. These mailings could be as simple as a postcard including success
+stories and reminding them of the incentives in place to help them in
+the return to work process.
+ For EN's that are limited to serving phase one and two states, the
+time to execute these re-mailings is now. Without them, the few
+successful ``local'' EN's may go out of business.
+
+Supply
+ While the demand for return to work services appears to be
+relatively easy to create, the supply is critically low. In general,
+beneficiaries tend to identify the list of EN's serving their area and
+begin contacting EN's at the top of the list (typically an alphabetical
+listing) to see what is available.
+ IDR is typically mid-way through an alphabetical listing of 30 to
+50 EN's serving a beneficiary's area. By the time they get to us, 75%
+of the beneficiaries are completely frustrated by the process. With 2/3
+of EN's listed not actively taking tickets, a beneficiary has typically
+received no response from 12 to 30 EN's before reaching IDR!
+
+Supply Issues
+ The overwhelming issues driving EN's to either stop or never begin
+serving beneficiaries are:
+
+ The negative cash flow created by the current program
+design; and
+ The lack of access to working capital.
+
+ Most EN's do not have the collateral to qualify for a loan and the
+payback time, lack of historical results and overall risks are too
+great to attack venture capital.
+
+The Solution
+ To ensure an adequate and effective supply of return to work
+services for motivated beneficiaries the negative cash flow and overall
+risk to EN's needs to be dramatically reduced, while increasing access
+to working capital. Implementing the AOI Advisory Group's suggested
+payment structure, or something similar, will go along way in reducing
+the negative cash flow issue.
+ Access to capital can be accomplished through the use of loan
+guarantees and or tax credits for qualified investments in the TTW
+program. For example, the State of Connecticut has a program in place
+that provides a dollar for dollar tax credit to investors that invest
+in new businesses that create insurance jobs within the state.
+
+Other Suggested Improvements
+
+ Providing more information and/or education to
+beneficiaries would facilitate greater participation in the program and
+help improve its overall effectiveness. Areas of concern are:
+ Each EN's status in regard to its ability to accept
+new tickets and its track record in serving beneficiaries
+ What a beneficiary can expect from an EN
+ Clarity regarding the types of return to work
+services to expect from and EN. We have found that many individuals
+request unrealistic programs, such as funding a four-year college
+education or the purchase of a $100,000 tractor-trailer, and feel that
+managing expectations would improve the success of the program and save
+time on the part of the EN.
+ Change Maximus' focus from recruiting more EN's to making
+the existing EN's more successful, which will in turn make recruiting
+EN's easier. Areas to consider are:
+ Improve the administrative efficiency of the program
+with more on-line reports and processes
+ Provide training by successful EN's to inactive EN's
+improving their likelihood of success
+ Establish and support regional EN associations to
+foster communication and the sharing of best practices
+ Congress should set a clearly defined target for reducing
+the Social Security roles and identify the entities that are
+accountable for attaining this goal. We suggest setting the goal for
+job placements at a minimum range of 5 to 10% of the current
+beneficiary population with incentives in place for success above this
+level.
+
+ Thank you again for the opportunity to testify today.
+
+
+
+ Mr. BRADY. Thank you, sir. Quintin, welcome. The microphone
+is yours, sir.
+
+ STATEMENT OF QUINTIN M. MITCHELL, DIRECTOR, VR SERVICES,
+ RICHMOND AREA ARC, RICHMOND, VIRGINIA
+
+ Mr. MITCHELL. Thank you. I am Quintin Mitchell. Thank you
+for the opportunity, Mr. Chairman. I am Director of
+Rehabilitation Services for Richmond Area ARC in Richmond,
+Virginia. Our agency became a--upon reviewing the Ticket to
+Work incentive, one of the motivating factors of ARC to become
+an EN was having the opportunity to provide employment services
+to individuals who want to work and become self-sufficient,
+additionally, provide a non-traditional referral base to ticket
+holders or individuals who have the appropriate skill set to
+filing the positions we have open and other jobs in the
+community.
+ Our agency has traditionally serviced the Mentally Retarded
+population. However, other areas of service provision includes
+individuals with diagnoses of mental illness, autism,
+developmental delay, brain trauma, and individuals with
+physical disability. Our agency's NISH contracts have provided
+the opportunity to service a vast array of individuals.
+Individuals' backgrounds include undergraduate and graduate
+degrees as well as persons who are Ph.D. candidates. When
+positions become available within our organization, individual
+ticket holders are encouraged to apply when their skill set
+matches the advertised position.
+ Since ticket participants don't have to use their tickets,
+we have found that those who elected to do so really have the
+incentive to work because they aren't forced to. There are many
+participants who want to get off the benefit rolls and this
+desire benefits not only participants, but also other sources,
+as well. Employees who are in need of skilled, reliable
+employees, ENs who have the resources to provide employment and
+other related services, and the reduction of benefits being
+paid out by SSA are all win-win situations.
+ Richmond ARC's initial experience with the Ticket to Work
+Program was that of being bombarded by ticket holders wanting
+employment services. We began providing services in March of
+2003. To date, we have screened over 340 calls from individuals
+who wanted us to provide employment services. While this may
+not be an astronomical number by comparison with other ENs,
+however, in Virginia, we have billed for the most milestones,
+which is 15, which Tina Chang, Financial Director for Maximus,
+provided me with the information the day before yesterday.
+ We have accepted and have been assigned so far, 90 ticket
+holders. Holding orientation twice per month at two locations
+has resulted in meeting the needs of individuals who don't have
+the means to come to our facility. As of this date, the need to
+conduct intakes more frequently has resulted in weekly one-on-
+one consultations as well as screenings. In order to meet the
+various needs of the ticket holders, we have elected to
+implement features in the orientation to expedite the process.
+Initially, as tickets began to roll out in Virginia, calls
+jammed the switchboard. Now all inquiries are routed either to
+the employment specialist or me with an extension just for
+ticket holders. ARC makes it a policy to return calls promptly.
+ Additionally, recruitment is not limited to just call ins.
+We also are viewing the monthly disk of ticket holders that
+Maximus supplies and send letters of introduction to a random
+sampling of the unassigned ticket holders, specifying what
+services we provide and inviting them to an orientation.
+Employment specialists also post flyers at the local SSA office
+or to the Metro Richmond networking meeting, participates in
+focus groups and job fairs, and have been fortunate enough to
+be the recipient of marketing expertise by the leadership of
+Metro Richmond organization. Additionally, an advertisement is
+placed in the Employment Guide publication by our agency at our
+expense.
+ It should also be noted that no additional staff was hired
+in order to meet the undertaking. Even though no additional
+staff was hired, the ARC still meets the presenting needs of
+all inquiries and works toward effectively and efficiently
+addressing areas of concern that most have about their benefits
+and how they may be affected. Maximus has provided much support
+and endless help in maneuvering through the maze of red tape we
+have encountered in many instances.
+ While there are many positives in the Ticket to Work and
+Self-Sufficiency Program, there are also obstacles that impede
+and deter ticket holders from participating in this program.
+Unfortunately, some ticket holders have elected, after having
+gone through the screening, the interviewing, counseling,
+placement on the job, to leave their jobs in some cases, decide
+against being employed at all because of the lack of critical
+information having been provided to them by SSA.
+ It has been our experience that most ticket holders are
+unaware of the most basic information concerning their benefits
+and how they can be affected and/or knowledge of work
+incentives. This information now has become part of our
+orientation process when we meet with the ticket holder.
+ Some of the problems that impede and interrupt the
+provisions of services for our agency to the ticket holders
+revolve around the lack of information provided to them by the
+SSA. A few examples that we have encountered and continue to
+encounter are SSA has provided inaccurate and sometimes
+inconsistent information to the ticket holders. An example is a
+ticket holder was told that there was an application for the
+1619(b) by an SSA individual but they couldn't find it, while
+another person told the ticket holder there was no such
+application.
+ Inconsistency of providing EN payment processing report so
+as not to know the status of receiving payment for services
+already rendered. ticket holders who have been working before
+contracting services with our agency have not been informed
+that they were required to turn in their pay stubs. This lack
+of information causes the individual to be in overpayment and
+the EN doesn't receive payment. Not notifying beneficiaries
+that they are not eligible for benefits, but a check is still
+mailed and/or deposited in the beneficiary in overpayment. The
+lack of advertising or marketing in the SSA office about the
+Ticket to Work Program. Our agency has taken initiatives to go
+down to the SSA buildings and place flyers and posters at our
+own expense.
+ The Ticket to Work Self-Sufficiency Program is a viable
+entity to beneficiaries who want to work. However, identifying
+and rectifying the problems that impede a successful placement
+of individuals in jobs has to be addressed. The potential for
+other agencies becoming an EN is sometimes thwarted by the lack
+of manpower, resources, and investment coupled with the slow
+turnaround time and being paid for the services that they
+provide. Having had the opportunity to provide services to wide
+range of individuals who have the desire and initiative to be
+gainfully employed and the continuation of inquiries regarding
+our employment services are all indicators that the ticket
+program can be a success. In order to facilitate this success,
+it is absolutely essential that all stakeholders work
+collaboratively and consistently.
+ In closing, I thank you for this opportunity to share our
+agency's experiences with the Ticket to Work Self-Sufficiency
+Program. It is my hope that after identifying these areas of
+concerns that impact the ticket holder in an adverse manner, we
+can move forward toward a resolution.
+ [The statement of Mr. Mitchell follows:]
+
+ Statement of Quintin M. Mitchell, Director, Vocational Rehabilitation
+ Services, Richmond Area Arc, Richmond, Virginia
+
+ Mr. Chairman, Members of the Committee, my name is Quintin M.
+Mitchell and I am Director of Rehabilitative Services for the Richmond
+Area Arc in Richmond, Virginia. Thank you for the invitation for me to
+comment on Social Security Administration's management of the Ticket to
+Work and Self-Sufficiency Program.
+ I would like to take a brief moment to provide some background
+information on how our agency elected to become a participating
+Employment Network (EN).
+ Upon reviewing the Ticket to Work initiative, one of the motivating
+factors of Richmond Area Arc to become an EN was having an opportunity
+to provide Employment Services to individuals who want to work and
+become self-sufficient. Additionally, it provides a non-traditional
+referral base and the Ticket-holders are individuals who have the
+appropriate skill set for filling positions that we have open, and
+other jobs in the community. Our agency has traditionally serviced the
+M.R. population. However, other areas of service provision includes
+individuals with diagnosis of M.I., autism, developmentally delayed,
+brain trauma and individuals with physical disabilities.
+ Our agency's NISH contracts have provided the opportunity to
+service a vast array of individuals. Individual's backgrounds include
+undergraduate and graduate degreed persons as well as Phd. Graduates.
+ When positions become available within our organization individual
+Ticket-holders are encouraged to apply when their skill set matches the
+advertised position.
+ Since Ticket participants don't have to use their Ticket we have
+found that those who have elected to do so really have the incentive to
+work because they aren't forced to. There are many participants who
+want to get off the benefit rolls and this desire benefits not only the
+participants but other sources as well. Employers who are in need of
+skilled, reliable employees, ENs who have the resources to provide
+Employment and other related services and the reduction of benefits
+being paid out by the Social Security Administration (SSA) are all win-
+win situations.
+ Richmond Area Arc's initial experience with the Ticket to Work
+Program was that of being bombarded by Ticket-holders wanting
+Employment Services. We began providing services in March of 2003. To
+date we have screened over three (340) hundred forty calls from
+individuals wanting us to provide Employment Services. While this may
+not be seen as an astronomical number by comparison with other ENs,
+however, in Virginia, we have billed for the most Milestones, fifteen
+(15). (Tina Chang, Financial Director for Maximus). We have accepted
+and have been assigned, so far, ninety (90) Ticket-holders. Holding
+Orientation twice per month at two (2) locations has resulted in
+meeting the needs of individuals who do not have the means to come to
+our facility. As of this date the need to conduct Intakes more
+frequently has resulted in weekly one-on-one consultations/screenings.
+ In order to meet the various needs of the Ticket-holders we have
+elected to implement features in the orientation to expedite the
+process. Initially, as Tickets began to rollout in Virginia, calls
+jammed the switchboards. Now all inquiries are routed either to the
+Employment Specialist or me with an extension just for Ticket-holders.
+ARC makes it a policy to return all calls promptly. Additionally,
+recruitment is not limited to call-ins of inquiries. We also, after
+viewing of the monthly disk of Ticket-holders, that Maximus supplies,
+sends letters of introduction to a random sampling of the unassigned
+Ticket-holders, specifying what services we provide and inviting them
+to an orientation. Employment Specialists also post flyers at the local
+SSA office, attend the Metro Richmond networking meetings, participates
+in focus groups and job fairs and have been the fortunate recipient of
+marketing expertise by the Leadership Metro Richmond organization.
+Additionally, an advertisement is placed in the Employment Guide
+publication.
+ It should also be noted that no additional staff was hired in order
+to meet this undertaking. Even though no additional staff was hired,
+the ARC still meets the presenting needs of all inquiries and works
+towards effectively and efficiently addressing areas of concerns that
+most have about their benefits and how they will be affected.
+ Maximus has provided much support and endless help in maneuvering
+through the maze of red tape we have encountered in many instances.
+ While there are many positives in the Ticket to Work and Self
+Sufficiency Program there are also obstacles that impede and deter
+Ticket-holders from participating in the program. Unfortunately, some
+Ticket-holders have elected, after having gone through screening,
+interviewing, counseling and placement on the job, to leave their jobs
+and in some cases, decide against being employed at all because of the
+lack of critical information having been provided to them by S.S.A.
+ It has been our experience that most Ticket holders are unaware of
+the most basic information concerning their benefits and how they can
+be affected and/or knowledge of Work Incentives. This information, now,
+has become a part of the orientation process when we meet with the
+Ticket-holder.
+ Some of the problems that impede and interrupt the provision of
+services, for our agency, to Ticket-holders, revolve around the lack of
+information provided to them by the Social Security Administration. A
+few examples that we have encountered, and continue to encounter are:
+
+ 1. S.S.A. has provided inaccurate and sometimes inconsistent
+information to Ticket-holders. Ex.: Ticket-holder was told there was an
+application for 1619b by S.S.A. but they couldn't find it while another
+person told the Ticket-holder there was no application.
+ 2. Inconsistency of providing EN Payment Processing Report so as
+not to know the status of receiving payment for services rendered.
+ 3. Ticket-holders, who have been working before contracting
+services with our agency, have not been informed that they were
+required to turn in their pay stubs. This lack of information causes
+the individual to be in overpayment and the EN doesn't receive payment.
+ 4. Not notifying beneficiary that they are not eligible for
+benefits, but check is mailed/deposited and beneficiary is in
+overpayment.
+ 5. The lack of advertisement/marketing in the S.S.A. office
+building about the Ticket to Work Program.
+
+ The Ticket to Work Self Sufficiency Program is a viable entity to
+beneficiaries who want to work. However, identifying and rectifying the
+problems that impede the successful placement of individuals in jobs
+has to be addressed.
+ The potential for other agencies becoming an E.N. is sometimes
+thwarted by the lack of manpower, resources, and investment coupled
+with the slow turnaround time of being paid for the services they
+provided.
+ Having had the opportunity to provide services to a wide range of
+individuals, who have the desire and initiative to be gainfully
+employed, and the continuation of inquiries regarding our Employment
+Services are all indicators that the Ticket Program can be a success.
+In order to facilitate this success it is absolutely essential that all
+stakeholders work collaboratively and consistently.
+ In closing, I thank you for this opportunity to share our agency's
+experiences with the Ticket to Work Self Sufficiency Program. It is my
+hope that after identifying
+
+areas of concerns, that impact the Ticket-holder in an adverse manner,
+we can move towards resolution.
+ Ticket to Work can be a beneficiary's best option.
+
+
+
+ Mr. HAYWORTH [presiding]. Thank you, Mr. Mitchell, for your
+testimony from someone from Virginia. I turn to a fellow
+Arizonan, Susan Webb. Welcome.
+
+ STATEMENT OF SUSAN WEBB, ARIZONA EMPLOYMENT NETWORK
+ ASSOCIATION, PHOENIX, ARIZONA
+
+ Ms. WEBB. Mr. Chairman from the great State of Arizona, it
+is always good to see you. My name is Susan Webb and I am the
+Director of Arizona Bridge to Independent Living (ABIL)
+Employment Services in Phoenix, Arizona, and I am here today on
+behalf of the Arizona EN Association. I want to thank you for
+the opportunity to testify today on behalf of the association.
+In general, our association agrees with the outcomes and
+recommendations of the EN Summit that was sponsored last May by
+the Ticket to Work Advisory Panel. We believe that several
+issues that were identified during that summit contribute to
+the current lack of participation among ENs nationwide.
+ Those issues are, first, high capitalization costs and
+risks; second, inadequate payment structure and pay stub
+processing burdens; third, the need for comprehensive training
+and technical assistance for EN staff; and fourth, the need for
+a national marketing campaign conducted by SSA to motivate
+beneficiaries to contact ENs about the program. We believe that
+all of these issues are equally important and their solutions
+must be implemented concurrently for the ticket program to
+sustain itself and achieve the goals that you, Mr. Chairman,
+were very, very adamant about when this legislation first
+passed. However, my testimony today is designed to focus solely
+on the marketing issues.
+ I, however, would remind you, as some of my colleagues have
+been testifying, I feel the need to say that some of the
+information that has come forward, for example, there has been
+$523,000 paid out in payments to ENs nationally, there are
+1,100 existing ENs. We understand about a third are accepting
+tickets in some form. I want to make the point that our little
+agency, 1 EN out of 1,100, has received $71,000 of that
+$523,000 and we have about another $20,000 pending. For one EN
+to be representing that much of the outcome is very disturbing.
+There is something wrong. Even though I feel very fortunate to
+be here to give my opinion, I think that somehow we are in the
+trenches here and I think we need to be heard in terms of what
+we are saying about these four major areas, and they need to be
+solved concurrently and right now. So, I just wanted to make
+that point very strongly.
+ Arizona is one of the first 13 States to implement the
+Ticket to Work Program. It is now more than 2 years since the
+tickets were first distributed in our State. I would disagree
+with some of the comments made about--I think Martin Gerry may
+have made this comment, actually. During the initial phases of
+the ticket rollout, there were approximately 27 ENs signed up
+in our State. Today, there are only a handful left that are
+accepting tickets. I talked to one of my colleagues in Tucson
+just before coming here and he told me he accepted one ticket
+last month. Is that an active EN out of the handful? That is
+certainly not going to get those 150,000 ticket holders in
+Arizona off the rolls and back to work.
+ We believe the reasons for this statewide rescission are
+several. However, many have simply stopped taking tickets due
+to the lack of sufficient demand by beneficiaries to justify
+maintaining the qualified staff they need to do this work.
+Since the initial ticket mailing, beneficiary inquiries to ENs
+have dropped to just a trickle. They are just not even on the
+radar screen with this anymore.
+ I guess this is where I probably want to take issue with
+Martin Gerry, and that is that we are seeing in the trenches,
+honest-to-goodness ENs out there doing this work. As a Center
+for Independent Living, our center since 1981 has served
+primarily people with significant disabilities. Those are not
+the people coming forward in the ticket program. It is the
+people that have job skills and experience and much to offer an
+employer. They are coming forward. They are not the ones that
+go to organizations like ours. They don't go to disability-
+related stuff. They don't hang out at the field offices, as I
+believe one of the--in fact, I believe it was Clay Shaw who
+said that, in fact, these people are sitting in their living
+rooms and that is where we need to get to them, hence the
+reason for my testimony today.
+ The members of our EN association recognized this problem
+more than a year ago and we decided to pool our resources to
+market the program. We began by making cold calls from the
+compact disk we receive monthly from Maximus. Unfortunately,
+this yielded very, very little return on our investment.
+Beneficiaries refused to talk to us because they thought we
+were telemarketers and they wanted us to take them off our call
+list. Then, those who did talk to us were totally unfamiliar
+with the program and required an average of 15 minutes per
+call, which is very, very expensive for any EN to be able to
+undertake that kind of activity. Even though there is benefit
+to that, it is not a solid return on investment because very
+few of those people end up being actual ticket users.
+ We then decided to approach the SSA about a piggyback
+approach. We knew that the SSA was going to be doing something
+and we were very, very pleased that they were very willing to
+work with us and to talk with us, and we have been doing that
+systematically. As a result of those teleconferences we have
+had, we conducted some focus groups and I would have to again
+disagree with my colleague, Paul Seifert, that, in fact, from
+the focus group what came out loudly and clearly was that if
+they get a letter from the SSA, they do read it, even if it is
+only because they fear bad news.
+ So, our association recommends the following: that the SSA
+be allocated the resources to send reminder letters or
+postcards about the Ticket to Work Program at least once
+annually and to stagger those in one-twelfths, so, that it
+doesn't create this up front demand and then nothing toward the
+end of the year.
+ Second, we believe the notices should direct ticket holders
+to contact their local BPA&O Program and should be specific
+about that BPA&O Program in their area. The reason for that is
+because our local BPA&Os contact which ENs are currently
+accepting tickets and so that beneficiaries are not forced to
+call from a long list of ENs just to be told, ``I am sorry, we
+are not participating anymore.'' Thirdly, we believe that the
+SSA should begin distributing the interim reminders to
+beneficiaries in the year one rollout States no later than June
+this year. Year two States could begin in June of next year,
+and year three States in 2006 if SSA hasn't begun a national
+campaign by that time.
+ I want to make one final comment, and that is that we have
+read the statement of work for the 2-year marketing contract to
+Fleischman-Hillard. We believe it is excellent. The problem is,
+2 years will mean 3 and a half years into this program and we
+will only have a pilot done by then. We will be dead in the
+water. We will not be an EN by that time without something done
+in the interim.
+ Although I applaud the response from the SSA, I applaud the
+statement of work in that contract, we are a rollout State in
+year one; and last month, I received 24 inquiries from 150,000
+tickets, and we are the number one EN in the country. Something
+has got to be done, and I encourage SSA and this body to work
+together to find the money to do that. Thank you, Mr. Chairman.
+ [The prepared statement of Ms. Webb follows:]
+
+ Statement of Susan Webb, Arizona Employment Network Association,
+ Phoenix, Arizona
+
+ Thank you for the opportunity to provide testimony on behalf of the
+Arizona Employment Network (EN) Association. In general, our
+association agrees with the outcomes and recommendations of the
+Employment Network Summit sponsored last May by the TWWIIA Advisory
+Panel. We believe that several issues identified during that Summit
+contribute to the current lack of participation by ENs nationwide.
+Those issues are 1) high capitalization costs and risks; 2) inadequate
+payment structure and pay stub processing burdens; 3) the need for
+comprehensive training and technical assistance for EN staff; 4) the
+need for a national marketing campaign conducted by SSA to motivate
+beneficiaries to contact ENs about the Ticket to Work Program.
+ We believe all of these issues are equally important and their
+solutions must be implemented concurrently for the TTW Program to
+sustain itself and achieve the goals Congress intended when it
+overwhelmingly passed the TWWIIA legislation. However, my testimony
+today will focus solely on the marketing issues.
+ Arizona is one of the first 13 states to implement the TTW Program.
+It is now more than two years since tickets were first distributed in
+our state. During the initial phases of ticket rollout there were
+approximately 27 ENs on the approved list. Today there are only a
+handful left who are accepting tickets. There is only one ENs in the
+Tucson metropolitan area accepting only a small number of tickets any
+longer. Tucson is the second largest metro area in our state with more
+than 850,000 residents and 16% of our state's population. We believe
+the reasons for this statewide rescission are several; however, many
+have stopped taking tickets due to the lack of sufficient demand by
+beneficiaries to justify maintaining the necessary qualified staff to
+do so. Since the initial ticket mailing beneficiary inquiries to ENs
+have dwindled to a trickle.
+ The members of our EN Association recognized this problem more than
+a year ago. We decided to pool our resources to market the program. We
+began by making cold calls from the CD we receive monthly from MAXIMUS.
+Unfortunately, this yielded very little return on our investment.
+Beneficiaries refused to talk to us and asked us to take them off our
+``call lists'' as they thought we were telemarketers. Those who did
+talk with us were not familiar with the ticket program and required an
+average of 15 minutes per call. While there is value in such calling as
+it certainly gives beneficiaries good information, it does not result
+in solid return on investment for the EN in terms of signed-on,
+qualified ticket users.
+ We then decided to approach SSA about a ``piggyback'' approach;
+that is, if SSA did some sort of marketing, our ENs could follow up
+with the necessary contacts. That approach would strengthen SSA's
+marketing efforts and be less resource-intensive for ENs. We are
+pleased that SSA staff has been very responsive to us in this regard
+and we have participated in several teleconferences with them to pursue
+the idea. From those teleconferences our association's marketing
+committee agreed to conduct focus groups among our existing ticket
+users to determine what marketing activities caused or would cause them
+to respond to the program. We completed those focus groups, and our
+final report of the outcomes is attached to this testimony.
+ Last September SSA awarded a two-year contract to a marketing firm
+to design a marketing plan. We have reviewed the statement of work and
+believe the end result will be a good one. However, at the end of the
+two-years of that contract, only a pilot program will have been
+completed. There is no time frame stipulated as to when an actual full-
+blown national campaign will be implemented. Arizona and the other
+first-year rollout states will have been implementing the ticket
+program for 3\1/2\ years when the pilot is completed. Without an
+effective, interim marketing campaign we fear the TTW program will be
+dead by then.
+ Our Association recommends the following:
+
+ 1. SSA should be allocated the resources to send reminder letters
+or post cards about the TTW Program at least once annually to all
+current ticket holders. \1/12\ of the notices should be distributed
+monthly to even out the demand upon MAXIMUS, ENs, BPAOs, PABBS and SSA
+Field Offices. This will ensure better service to beneficiaries.
+ 2. The notices should direct ticket holders to contact their local
+BPAO program and should include the specific BPAO contact information
+for their area/state. The BPAOs will track which ENs in their
+communities are currently accepting tickets and will give contact
+information to beneficiaries only for those ENs who have indicated that
+they are currently accepting tickets. The BPAOs should be allocated
+appropriate resources to accommodate this additional demand.
+ 3. SSA should begin distributing the interim reminders to
+beneficiaries in the year-one rollout states no later than June of this
+year. Year two states could begin in June of next year and year three
+states in June of 2006 if there is no comprehensive, national marketing
+campaign developed and implemented by that time.
+
+ We believe an interim plan as outlined above will have the
+following benefits:
+
+ 1. Rekindle beneficiary demand and interest in the Program. The
+initial mailing generated significant inquiries from beneficiaries. We
+believe periodic reminders will generate at least as much response and
+will capture potential participants who might not have been ready to
+work during the initial rollout.
+ 2. Increased beneficiary demand could create interest by ENs to
+accept tickets again, thus improving the choice among providers as
+originally envisioned by Congress.
+ 3. Periodic reminders will help beneficiaries accept the ``new''
+SSA culture that Social Security Disability programs are not early
+retirement, but are in fact offering ways for individuals and their
+families to become self-supporting.
+ 4. Provide TTW Program information in beneficiaries' living rooms
+rather than requiring them to go to disability-related or public
+service-related locations to get the information. Our focus group
+respondents stressed the fact that they always read mail they get from
+SSA, even if it is only because they fear bad news.
+ 5. Having local BPAOs be the initial point of contact will relieve
+that burden from MAXIMUS and will take advantage of the excellent
+training and skills that have been demonstrated by the BPAOs across the
+country.
+
+ In conclusion, I am posing a question to the Social Security
+Subcommittee that I have asked many times and have yet to receive an
+answer:
+ If Binder and Binder and other social security attorneys can
+advertise on TV day in, day out, over and over about getting people
+ONTO benefits, why can't SSA advertise at least as often to get people
+OFF benefits? This is especially puzzling since the money that pays for
+those attorneys' ads comes directly from the SSA Trust Fund.
+ Once again, on behalf of the Arizona Employment Network Association
+we thank you for the opportunity to comment.
+
+
+
+ Mr. HAYWORTH. I thank you very much for your testimony,
+Susan. Now we turn to Mr. Coburn.
+
+ STATEMENT OF JOHN V. COBURN, STAFF ATTORNEY, HEALTH AND
+ DISABILITY ADVOCATES, CHICAGO, ILLINOIS
+
+ Mr. COBURN. Thank you, Mr. Chairman. Thank you for the
+opportunity to share our organization's recommendations on how
+to improve the Ticket to Work Program. I actually as I got up
+here realized going last, I get to tie up some of the loose
+ends and get us going so that we can continue on.
+ The Health and Disability Advocates is my employer and they
+are the convener of the Midwest Employment and Training
+Partnership. The Partnership currently has roughly 80 active
+members and is comprised of employment and training service
+providers participating in the Ticket to Work Program in Region
+V, which includes Illinois, Indiana, Michigan, Minnesota, Ohio,
+and Wisconsin. Also participating in the Partnership are the
+SSA-funded BPA&O projects and the Protection and Advocacy for
+Beneficiaries of Social Security projects.
+ As you might suspect, our first policy recommendation is to
+enhance the payment system for ENs. This is key to the
+viability of this program, and you heard on the panel today
+that recommendation. The Partnership fully endorses the
+recommendations of the Adequacy of Incentives Advisory Group
+and the EN Summit which is mentioned in the panel report you
+received. Second, the Partnership strongly recommends that SSA
+abandon its sub-regulatory Transmittal 17 and completely
+disconnect cost reimbursement to State VR agencies from ticket
+assignment. This is a clear point that I want to make today. We
+believe that this policy is directly contrary to the intent of
+Congress and the authorizing statute. State VR agencies rely on
+a projected amount of SSA reimbursement as a base for their
+annual budgets. As a result of Transmittal 17 and SSA policy,
+many State VR agencies have been put into the position of
+having to aggressively seek tickets from beneficiaries just to
+meet their annual budget.
+ I think this explains the enormous differential, with 90
+percent VR ticket assignment and 10 percent private EN, along
+with the payment system. I think it also, I suspect, may
+account for the increase recently in ticket participation. I
+think that the State VR agencies have been assigning more
+tickets and I would submit that we need to look into that to
+see, is it that there are more ticket participants coming
+forward to participate in this program, or has the State VR
+agency under Transmittal 17 submitted the tickets for
+assignment, and that is accounting for the increase.
+ The problem with not separating cost reimbursement from the
+ticket assignment is that you have a system right now as it
+stands with these statistics that 10 percent of the
+beneficiaries are participating in, which is the system
+Congress intended to create, a system that is designed to
+assist beneficiaries in leaving the Social Security rolls. The
+other 90 percent are potentially--we don't know--participating
+in the pre-Ticket Act cost reimbursement system, which does not
+have as its ultimate goal the leaving of the beneficiary rolls.
+Cost reimbursement has a different standard for payment. If
+this continues, the Ticket Act will never come close to
+reaching its goal of doubling the number of beneficiaries
+leaving the Social Security rolls because of employment.
+ Another recommendation from our Partnership which was
+mentioned today is that SSA has to immediately address this
+problem with overpayments. We heard testimony today about how
+long it is taking on claims administration. I think that
+Maximus and SSA have been doing a good job on their part in
+claims administration by passing some new policies that deal
+with quarterly reporting. However, in order to get paid, that
+still has to go through the SSA reporting system at the local
+offices, which still is not modernized and still is not up to
+date in all circumstances.
+ The Partnership recognizes that SSA is working toward
+modernizing the current worker reporting system and that this
+will take time. In the interim, SSA can make minor operation
+changes to speed up this process. We heard mention today about
+the recently retooled Work Incentive Liaison in the local SSA
+offices. The Partnership believes that it should become a
+specific job duty of each of these Work Incentive Liaisons to
+take the ticket participant work histories and work on those
+cases. The Partnership also recommends that SSA set up a system
+for itself where claims with proper documentation have a 30-day
+turnaround in order to keep them viable.
+ Since launching the Midwest Employment and Training
+Partnership in June of 2003, Health and Disability Advocates
+has received an overwhelming number of requests for training or
+technical support from employment service providers on topics
+ranging from what is the ticket program, what are these
+regulations, how does this work, to requests for assistance in
+building a service model that ensures successful and
+financially feasible participation in the Ticket to Work
+Program. Fortunately, we do have some private foundation
+funding to do some of this, but our limited funding will not
+meet this need. Based on this experience, the Partnership
+recommends that a technical assistance and training system
+built off of the current existing SSA-funded technical
+assistance and training systems be created.
+ Finally, I want to briefly mention the Chicago Ticket to
+Work Pilot Program that we are going to be starting here in a
+few months. We created this pilot and secured funding for it
+from the City of Chicago and the Illinois Division of
+Rehabilitation Services. The pilot is designed to demonstrate
+to you as a committee, SSA, and others how an adequate payment
+system with up front funding can result in the positive
+outcomes that the Ticket to Work legislation intended. The
+project's payment system is based upon and resembles the up
+front payment system recommended by the AOI Advisory Group and
+the EN Summit. We have created this project to put into action
+what everybody has been saying about the payment system, and we
+hope that SSA will follow our lead. Thank you.
+ [The prepared statement of Mr. Coburn follows:]
+
+ Statement of John Coburn, Staff Attorney, Health and Disability
+ Advocates, Chicago, Illinois
+
+ Chairman Shaw and Members of the Committee--
+ I thank you for the opportunity to share our organization's
+recommendations on how to improve the Ticket to Work program. I work
+for the Health & Disability Advocates, a national policy and advocacy
+group headquartered in Chicago, Illinois. The Health & Disability
+Advocates (HDA) is the convener of the Midwest Employment and Training
+Partnership (Partnership). The Partnership currently has roughly 80
+active members and is comprised of employment and training providers
+and state Vocational Rehabilitation agencies (VR) that are
+participating as Employment Networks (ENs) in the Social Security
+Administration's (SSA) Region V, which includes Illinois, Indiana,
+Michigan, Minnesota, Ohio and Wisconsin. Also participating in the
+Partnership are the SSA-funded Benefits Planning Assistance & Outreach
+(BPAO) and Protection & Advocacy for Beneficiaries of Social Security
+(PABSS).
+ Today I am going to share with you policy recommendations developed
+by the Partnership. I will also talk to you about the Chicago Ticket to
+Work Pilot, a project that our organization has developed to
+demonstrate a more integrated and responsive payment model for
+Employment Networks.
+ As you might suspect, our first policy recommendation is to enhance
+the payment system for Employment Networks. You will hear from many
+today about the need to change the payment structure, so I will not
+dwell on this in my testimony. The Partnership fully endorses the
+recommendations of the Adequacy of Incentives Advisory Group for
+structuring the payment system on gross wages, with some payment upon
+job placement, and allowing payment for partial self-sufficiency. It is
+our belief that you will never get adequate participation from
+employment and training providers outside of the traditional state
+vocational rehabilitation model without changing the current payment
+system. The current payment structure provides no financial incentives
+for providers to become active ENs. Until the Ticket Work Program
+payment structure is on par with how state vocational rehabilitation
+services are funded and how services under the Workforce Investment Act
+are funded, the Ticket to Work Program will always be subpar.
+ As our second policy recommendation, the Partnership strongly
+recommends that SSA change how it compensates state VR under the Ticket
+to Work Program. The current SSA policy--explained in SSA Transmittal
+17--often only allows cost reimbursement to state VR agencies on those
+cases in which individuals have assigned their Ticket to that state VR
+agency. We believe that this policy is directly contrary to the intent
+of Congress and the authorizing statute.
+ State VR agencies rely on a projected amount of SSA reimbursements
+as a base for their annual budgets. As a result of Transmittal 17, many
+state VR agencies have been put into the position of having to
+aggressively seek Tickets from beneficiaries just to meet their annual
+budget. This creates an employment and training services environment
+where state VR is given little or no encouragement, nor reward, for
+creating innovative partnerships with other employment training service
+providers or the private sector.
+ The numbers bear this out--there are 3,978 (10%) beneficiaries
+participating in a system that Congress intended to create, a system
+that is designed to assist beneficiaries in leaving the Social Security
+roles. The other 36,972 (90%) beneficiaries are potentially (and most
+likely) participating in the pre-TTWWIIA cost reimbursement system, a
+system that does not base payment upon assisting a beneficiary in
+leaving the roles. If this continues, TWWIIA will never come close to
+reaching its goal of doubling the number of beneficiaries leaving the
+Social Security roles because of employment.
+ Our next policy recommendation is that the SSA immediately address
+the inadequacy of its work reporting system to eliminate problems with
+overpayments. The work reporting system must be drastically improved to
+assure the maintenance of up-to-date records on work history. If it
+does not improve, Employment Networks can face significant payment
+delays. It only takes a few experiences with payment delays and
+complications for a service provider to decide continued participation
+in the Ticket to Work Program is not worth it. In addition, problems
+with this work reporting system continue to discourage beneficiaries
+from seeking employment, which diminishes interest in seeking services
+from the Ticket to Work Program.
+ The Partnership recognizes that SSA is working toward modernizing
+the current work reporting system and that this will take time. Prior
+to achieving full modernization, the Partnership believes SSA can make
+minor operation changes to improve EN claims administration. We suggest
+that SSA give the recently re-tooled Work Incentives Liaisons in the
+local SSA offices the specific job duty of maintaining ticket
+participant's work activity. Upon assignment of a ticket, the EN should
+be notified of the name and contact information of the local Work
+Incentive Liaison assigned to that ticket holder's case. With this
+information, the EN could follow up with the local Work Incentive
+Liaison if payment is not made in a timely manner. The Partnership also
+recommends that SSA provide payment on EN claims with proper
+documentation within 30 days of submission.
+ The last recommendation I will share with you today deals with the
+lack of technical assistance and support available to those Employment
+Networks currently trying to make a success of the Ticket to Work
+program. Since launching the Midwest Employment and Training
+Partnership in June of 2003, HDA has received an overwhelming number of
+requests for training or technical support from employment service
+providers on topics ranging from the Ticket to Work Program regulations
+to building a service model that ensures successful and financially
+feasible participation in the Ticket to Work Program. Fortunately, we
+have private foundation funding to do some of this, but our limited
+funding will not meet the need. Based on this experience, the
+Partnership recommends that a technical assistance and training system
+built off of the existing SSA-funded technical assistance and training
+system be created. The system must be built on a regional and local
+level so that employment service providers can receive services without
+extensive travel costs and lost staff time. Such a model will also
+foster information sharing and replication of promising practices among
+ENs.
+
+Chicago Ticket to Work Pilot
+ I will use the balance of my time to talk the Chicago Ticket to
+Work Pilot Project designed to demonstrate to you, SSA, and others how
+an adequate payment system can result in the positive outcomes that the
+TWWIIA legislation intended. Health & Disability Advocates and other
+members of the Partnership have successfully engaged the Chicago
+Mayor's Office for People with Disabilities, Chicago Mayor's Office of
+Workforce Development, and the Illinois Department of Human Services--
+Division of Rehabilitation Services to pilot an up-front payment system
+for ENs in the city of Chicago.
+ The Chicago Ticket to Work pilot is slated to begin in April or May
+of 2004, and will be the only project of its kind in the country that
+combines municipal and state dollars. The purpose of this pilot is to
+demonstrate a payment system that provides ENs with guaranteed payment
+within the first year of placement, encourages active participation by
+ENs and, more importantly, results in successful transitions to self-
+sufficiency. The Pilot Project will be implemented as follows. Through
+a neutral application process, three ENs serving residents of Chicago
+will be chosen to participate in the Project. These three ENs will be
+eligible to receive payment on 8 to 10 of their assigned tickets. Upon
+placing one of these ticket holders in competitive employment, the EN
+will receive $2000. After 6 months of successful placement, the EN will
+receive another $2000. Upon completion of one year of successful
+employment, the EN will receive $1000. After this, the Employment
+Network will continue to be paid by the Social Security Administration
+through the current payment system.
+ Each EN will be assigned to work closely with one of the Department
+of Labor/Social Security Administration-funded Disability Program
+Navigators (DPN) and/or the Department of Labor-funded Work Information
+Navigator (WIN). The DPN and/or WIN will provide recruitment and
+referral services to the EN. The EN will only be paid under the Pilot
+Project for tickets assigned as a result of a referral from the DPN
+and/or WIN. Through this requirement, the Project hopes to build new
+and lasting relationships between the Employment Network and the One-
+Stop Center system.
+ Many stakeholders and experts have stated that the payment
+structure needs to change for TWWIIA to meet its goals. We have created
+this Project to put into action what so many have said and hope that
+SSA will follow our lead.
+ Mr. Chairman, and members of the committee, I thank you for your
+time and welcome any questions you may have.
+
+
+
+ Mr. HAYWORTH. Thank you, Mr. Coburn. I appreciate that you
+appreciate the importance of going last and the advantage of
+tying everything up. All of you on this third panel should
+know, and I think you do after listening to the discussion
+today, your testimony, all of your testimony, is very important
+to us and was used to inform us as we brought your issues to
+Mr. Gerry and Mr. Justesen. As we continue to move through this
+process to the implementation and to ensure the effectiveness
+of Ticket to Work, we will be continuing to monitor and be
+calling on you again in the future, because we are at a
+critical juncture in this program. Your testimony today is very
+much appreciated and we thank you for it. With that, this
+hearing of the Subcommittee on Social Security is adjourned.
+ [Whereupon, at 12:52 p.m., the hearing was adjourned.]
+ [Questions submitted from Chairman Shaw to Mr. Gerry, Mr.
+Justesen, Mr. Foran, Mr. Mitchell, and Mr. Coburn, and their
+responses follow:]
+
+ Questions from Chairman E. Clay Shaw, Jr. to Mr. Martin H. Gerry
+
+ Question: Why are 90 percent of tickets being assigned to State VR
+(VR) agencies and only 10 percent to Employment Networks (ENs)? The
+Subcommittee has heard concerns about the payment system for ENs since
+the SSA first proposed it over 2 years ago. When will the SSA address
+this and how?
+ Answer: Section 1148(h)(5) of the Social Security Act requires the
+Commissioner to review the EN payment systems and alter them to better
+provide incentives for ENs to assist beneficiaries to enter the
+workforce, while providing for appropriate economies. Based on this
+authority, we are considering changes in the payment system.
+ The SSA also h as taken aggressive steps to address the need to get
+timely payments to ENs by establishing a Certification Payment Request
+Process. The Certification Payment Request Process allows ENs to submit
+a signed written statement that the ticket holder's work and earnings
+are sufficient to warrant outcome payments, in lieu of having to
+provide proof of the ticket holder's earnings. ENs can request payments
+under the Certification Payment Request Process after a ticket holder
+meets specific work requirements and has achieved a level of earnings
+from employment to qualify an EN for outcome payments. This new process
+can be used either on a monthly or quarterly basis. SSA will pay
+outcome payments based on the EN's certification, unless our records
+indicate that the ticket holder is receiving cash disability benefits.
+ Question: A procedural directive, known as ``Transmittal 17'' from
+the SSA requires VR agencies to be assigned a ticket before they can
+receive any reimbursement for costs from the SSA. Many argue that this
+requirement denies ticket holders the right to make an informed choice.
+Also, since the budgets of VR agencies often rely on income from the
+SSA, many believe that VRs are aggressively seeking ticket assignments,
+rather than creating partnerships with ENs so that beneficiaries can
+receive services from both a State VR provider and an EN. What is the
+SSA doing to resolve this issue?
+ Answer: The operating guidelines issued to the State VR agencies in
+Transmittal Number 17 are based on the policies in the Social Security
+Regulations. The Social Security Regulations require that each State VR
+agency must participate in the Ticket to Work Program by accepting
+ticket assignments if it wishes to receive payments from SSA for
+serving beneficiaries who are issued tickets. (A State VR agency can
+receive payment under the cost reimbursement system for the cost of
+reasonable and necessary services provided to a beneficiary who has not
+been issued a ticket.) This ensures that all beneficiaries with tickets
+receiving services from State VR agencies will receive the same
+protection from continuing disability reviews based on their employment
+that are provided to beneficiaries receiving services from ENs.
+ The pamphlet that we provide to beneficiaries with their tickets
+allows them to make an informed choice by explaining that they will be
+assigning their tickets when they sign a plan. Beneficiaries also
+receive a letter after they assign their ticket. This letter tells them
+their ticket has been assigned and includes a fact sheet with
+information about continuing disability review protection. In addition,
+a beneficiary whose ticket has been assigned to a State VR agency
+retains the opportunity under the Social Security Regulations to choose
+to unassign the ticket and reassign it to receive services from an EN.
+ We are working with the Rehabilitation Services Administration to
+foster better partnerships between the State VR agencies and ENs when
+they provide services to beneficiaries with tickets.
+ Question: Given that less than 1 percent of disabled beneficiaries
+return to work, it is easy to understand why field office staff in
+1,800 offices across the country, buried in other work, can't stay
+current with their understanding of how work and work incentives affect
+benefits. Given advances in technology, why doesn't the agency
+centralize expertise in a cadre of experts to ensure beneficiaries get
+the right answer the first time? Couldn't these individuals also help
+address work reports to avoid overpayments?
+ Answer: Since the Ticket to Work and Work Incentives Improvement
+Act was implemented, SSA has worked to establish a corps of trained,
+accessible, and responsive specialists within the agency who specialize
+in disability work incentives. At the Regional level, the Plan for
+Achieving Self Support (PASS) cadre members have been participating in
+this effort, along with Public Affairs Specialists and other field
+personnel.
+ In May 2003, the Area Work Incentives Coordinator (AWIC) position
+was established. The AWIC position is a full-time permanent position
+and is part of SSA's approach to assist beneficiaries with disabilities
+to obtain accurate and timely information regarding work, and to
+expeditiously process work reports and other disability work-issue
+workloads.
+ Work Incentives Liaison (WIL), located directly in local offices,
+train all direct-service personnel on SSA's disability employment
+support programs. WILs have the technical background to provide
+improved service and information related to SSA's employment support
+programs to SSA beneficiaries, applicants, advocates and service
+providers.
+ The SSA has ongoing automation enhancements directed to improving
+work incentive workloads. SSA is currently in the process of
+implementing an application called eWork, which will enable SSA to
+provide better, more timely service by consolidating work reporting and
+documentation on one, universally available system. eWork will also
+generate a work report receipt and provide improved management
+information, workload controls and processing tools for work incentive.
+Our automation enhancements c ombined with our establishment of a
+network of experts will help ensure work reports will be addressed
+timely, thereby avoiding overpayments.
+ Question: The Ticket Advisory Panel recommends that Congress
+clarify in law that the ticket program should be used as a
+supplemental, rather than a substitute-funding source. In other words,
+that Congress did not intend to make beneficiaries ineligible for the
+full range of services from VR programs, Medicaid, or other Federal and
+State programs by making them eligible for the ticket program. Can you
+provide more details about the genesis of this recommendation and your
+reactions to it?
+ Answer: The Ticket to Work and Work Incentives Advisory Panel has
+noted that services and supports provided under other programs should
+be combined with, rather than offset by, services and supports provided
+by the Ticket to Work Program. They also reported that some ENs have
+chosen not to participate in the Ticket to Work Program because they
+are uncertain about whether and how they can use funds from these other
+sources to service ticket holders. We are working with other agencies,
+including the Rehabilitation Services Administration and the Centers
+for Medicare and Medicaid Services, to ensure that the guidance they
+provide is clear and does not unnecessarily restrict the use of their
+program funds when the Ticket to Work Program offers additional
+assistance to a beneficiary.
+
+ Questions from Chairman E. Clay Shaw, Jr. to Dr. Troy R. Justesen
+
+ Question: A procedural directive, known as ``Transmittal 17'' from
+the SSA requires State VR (VR) agencies to be assigned a ticket before
+they can receive any reimbursement for costs from the SSA. Many argue
+that this requirement denies ticket holders the right to make an
+informed choice. Also, since the budgets of State VR agencies often
+rely on income from the SSA, many believe that State VR agencies are
+aggressively seeking ticket assignments, rather than creating
+partnerships with employment networks (ENs) that allow a beneficiary to
+receive services from both a State VR provider and an EN. What is the
+Department of Education doing to resolve this issue and encourage
+partnerships between State VRs and private ENs?
+ Answer: For purposes of this question, SSA's ``Transmittal 17''
+requires two things: 1) VR can assign an individual's ``ticket'' to
+itself if the individual has been determined eligible for the VR
+program, has signed an agreed-upon Individualized Plan for Employment
+(IPE) with the VR agency, and has not yet assigned the ticket to
+another Employment Network (EN); and 2) VR (or any EN) must have an
+assigned ``ticket'' before VR can receive payment, including the
+traditional cost-reimbursement payment method, for VR services rendered
+under the Ticket-to-Work program. My answer to your question is lengthy
+and technical because the issues you have raised involve complicated
+interrelationships between two complex programs. I would like to assure
+you that ``Transmittal 17'' and its various implications and effects as
+they are now understood are under close joint review by the Department
+and SSA. Above all, we must remain focused on the larger purpose of
+enabling and assisting consumers with disabilities to achieve the
+dignity, sense of self-worth and capacity for social and economic
+contributions to society. Good policies will lead to good jobs.
+ The Ticket to Work and Work Incentives Improvement Act (TWWIIA) is
+designed to give consumers more options when seeking employment-related
+services. To this end, TWWIIA gives consumers the right to assign the
+ticket to the EN of their choice. This means that the individual can
+assign the ticket to the VR agency or to an EN that will accept it.
+However, Transmittal 17 removes this choice in certain circumstances,
+namely when the individual has a ticket that he/she has not yet
+assigned and seeks services from the VR agency. Transmittal 17 advises
+the VR agencies that individual consent is not required to make the
+assignment in this scenario. To accomplish the assignment of the ticket
+in this case, Transmittal 17 advises VR agencies to submit the
+signature page of the IPE to Maximus, the contractual program manager
+for the Ticket-to-Work program. Maximus then treats the assignment as
+voluntary on the basis of the signed IPE. This situation has caused
+some advocates to argue that individuals are being denied the ability
+to choose an EN as required by TWWIIA.
+ The principle of informed choice is a central theme throughout the
+State VR services program. section 102(d)(4) of the Rehabilitation Act
+1973, as amended (Rehabilitation Act), requires that a State VR
+agency's written policies and procedures must ``provide or assist
+eligible individuals in acquiring information that enables those
+individuals to exercise informed choice under this title in the
+selection of--(A) the employment outcome; (B) the specific VR services
+needed to achieve the employment outcome; (C) the entity that will
+provide the services; (D) the employment setting and the settings in
+which the services will be provided; and (E) the methods available for
+procuring the services.'' Because of these requirements of the
+Rehabilitation Act and an individual's right to choose an EN under
+TWWIIA, we have advised State VR agencies to discuss openly the options
+available to the individual with regard to choosing an EN. We have
+advised State VR agencies to inform SSI recipients and SSDI
+beneficiaries holding unassigned tickets that the IPE signature can be
+interpreted as the individual's willingness to assign his or her ticket
+to the State VR agency. In doing this, we believe the State VR agencies
+are operating within the requirements of both the Rehabilitation Act
+and TWWIIA in ensuring that the individual has the opportunity to
+exercise informed choice.
+ The issue of payment is interrelated to the issue of ticket
+assignment because TWWIIA authorizes payment for services rendered to
+the EN holding the assigned ticket. The payments are incentives for ENs
+and VR agencies to assist SSI recipients and SSDI beneficiaries to
+become employed. ENs can choose to receive payments under the Outcome
+system or the Milestone/Outcome system. VR agencies have a third
+payment option; that of receiving payment pursuant to the traditional
+cost-reimbursement method authorized by the Social Security Act.
+However, Transmittal 17 appears not to distinguish among these three
+payment methods. It requires that the EN or VR agency have the assigned
+ticket before being able to seek any payment (including cost-
+reimbursement) from SSA. For this reason, ENs and VR agencies are
+anxious to get a ticket assigned as soon as possible.
+ Certainly some State VR agencies have come to rely on income from
+the traditional cost reimbursement payment system, as you mention. VR
+agencies use this income to supplement the formula grant funds received
+from the Department of Education. The amount of SSA cost
+reimbursements, as a percentage of the overall VR agency budget is
+relatively small, however, the level of such reimbursements varies
+widely among VR agencies as a percentage of the total agency budget. A
+few agencies, particularly active and successful in SSA
+rehabilitations, receive higher levels of reimbursement. Because
+Transmittal 17 seems to have subsumed the traditional cost
+reimbursement option under the Ticket-to-Work program, VR agencies are
+on an equal footing with the other ENs with regard to needing an
+assigned ticket in order to be eligible for payment at a later date.
+Thus, VR agencies and other ENs need to make concerted efforts to
+inform individuals about the ticket assignment process.
+ Question: The Ticket to Work Advisory Panel has found that some
+State VR agencies have determined that the ``comparable services and
+benefits'' requirement under the Rehabilitation Act prevents them from
+providing services to Social Security Disability Insurance and
+Supplemental Security Income recipients who assign their ticket to a
+private EN. Can you explain how the Department of Education will work
+with State VR agencies to provide the maximum amount of services
+available under the law? Do you believe that any legislative changes
+are needed to the Rehabilitation Act to allow for ENs and State VR
+agencies to coexist and complement each other as envisioned under the
+Ticket to Work Act, or can needed change be accomplished through
+regulation?
+ Answer: We are not aware of any State VR agency that has refused as
+a general practice to provide services to an SSI recipient or SSDI
+beneficiary who has assigned his/her ticket to a private EN. However,
+we are aware that State VR agencies in certain circumstances are asking
+that the private ENs holding the ticket provide some of the necessary
+services as a ``comparable service and benefit.''
+ Section 101(a)(8)(A)(i) of the Rehabilitation Act requires the VR
+agency, except in very limited circumstances, to determine whether
+comparable services and benefits exist prior to providing services to
+an eligible individual. The VR regulations define ``comparable services
+and benefits,'' in pertinent part, as those services and benefits
+``that are--(A) provided or paid for, in whole or in part, by other
+Federal, State, or local public agencies. . . .; (B) available to the
+individual at the time needed to ensure the progress of the individual
+toward achieving the employment outcome. . . .; and (C) commensurate to
+the services that the individual would otherwise receive'' from the
+State VR agency (34 CFR 361.5(b)(10)). This means that VR must
+determine whether another appropriate source can provide the services
+that VR otherwise would provide in accordance with the individual's IPE
+in a timely manner. As you know, the intent behind this requirement was
+to ensure that VR funds could be maximized in order to meet the needs
+of more eligible individuals, especially those with the most
+significant disabilities.
+ We do not view a ticket by itself as representing a comparable
+service and benefit. Nor do we consider the fact that an individual has
+assigned his/her ticket to a private EN by itself as constituting a
+comparable service and benefit under the Rehabilitation Act. However,
+we do consider the ticket as being a comparable service and benefit
+under the Rehabilitation Act when: 1) the individual has assigned the
+ticket to an EN; 2) the EN has listed the service in its own
+individualized work plan (developed between the EN and the individual)
+pursuant to TWWIIA requirements; 3) the EN is capable of providing a
+service that is listed on the individual's IPE; 4) the service offered
+by the EN is commensurate to the service that otherwise would be
+provided by the State VR agency; and 5) the EN is capable of providing
+the service when it is needed by the individual. If any of the above
+factors are not met, the ticket does not constitute a comparable
+service and benefit for purposes of the VR program. In that instance,
+assuming comparable services and benefits do not exist from another
+source, the State VR agency should provide the services pursuant to the
+IPE.
+ Our interpretation encourages a cooperative effort between both the
+VR agencies and the ENs to serve individuals as effectively as possible
+while maximizing funds from each program. We will continue to provide
+technical assistance to the State VR agencies to ensure that the search
+for comparable services and benefits does not result in a delay in
+services to individuals. We also will continue to remind State VR
+agencies that the requirement for seeking comparable services and
+benefits should be done in such a manner to ensure cooperation among
+programs serving individuals with disabilities.
+ As a policy matter we recognize that the intent of the Ticket
+program is to establish a cadre of rehabilitation service providers, in
+addition to the traditional VR services program present in every State
+that can provide multiple opportunities and pathways for SSI recipients
+and SSDI beneficiaries to obtain the services necessary for gainful
+employment. For decades, the VR program has been essentially the sole
+public program assisting individuals with disabilities to achieve
+gainful employment. The current situation in which the potential for
+competition between VR agencies and ENs for both clients and payments
+from SSA is new and the implications are not fully understood.
+ The Department has not taken a position on the need for a
+legislative change. However, we are aware the current Senate Bill (S.
+1627) reauthorizing the Work force Investment Act 1998 (which includes
+the Rehabilitation Act in Title IV) proposes clarifying language on
+comparable benefits.
+ We must defer to SSA concerning regulatory changes governing the
+Ticket program, but we will of course work with SSA if changes are
+proposed.
+ Question: It has been reported that private providers perceive that
+if they sign up to be an EN, their current relationship with their
+State VR agency may be jeopardized. It has also been reported that some
+current VR clients were threatened with termination from VR if they did
+not assign their ticket to the VR agency, or worse, weren't informed
+that they could be better served by taking their ticket to elsewhere
+versus staying on a waiting list at the VR agency. This is deeply
+disappointing and completely opposed to the goals of the ticket
+program. Have you heard similar allegations? Are they true? If so, what
+are you doing to address the situation?
+ Answer: I am not aware of any individual threats concerning
+termination of clients or willful ``noninformation'' about ticket
+options being provided to VR clients. However, if complaints are
+brought to our attention we will certainly respond to them.
+ State VR agencies have typically had longstanding cooperative or
+purchaser-vendor relationships with many, if not most ENs. Thus, it is
+understandable that some providers could be concerned about the
+potential for jeopardizing their relationship with the VR agency.
+However, perceptions that a relationship ``may be jeopardized'' provide
+little basis for investigation in the absence of specific complaints. I
+have heard anecdotal references similar to the allegations you have
+mentioned. However, no documented and specific examples have been
+brought to my attention. However, we will work with our colleagues at
+SSA to address any specific complaints that may be presented.
+ Question: As you mention in your testimony, many EN perceive that
+negotiated agreements they have entered into with the State VR agencies
+do not reflect the principles of true partnership and fairness. This is
+especially a concern given the low percentage of tickets assigned to
+ENs. When do you plan to complete your review of all agreements between
+the State VR agencies and ENs?
+ Answer: TWWIIA authorizes ENs and VR agencies, when serving mutual
+consumers, to share payments received from SSA when the two entities
+have developed an agreement that outlines how services will be provided
+and income shared. ENs and VR agencies may, of course, enter into a
+wide range of agreements for various purposes for their mutual benefit.
+ We are aware that some ENs, including some VR agencies, believe the
+agreements they have developed do not reflect the principles of true
+partnership and fairness. This has prompted OSERS to begin reviewing
+these agreements. Although there is no legal requirement for us to
+conduct this review or for the VR agencies to submit these agreements
+to us, we believed such a review would be helpful in order to get a
+better understanding of the actual working relationships between State
+VR agencies and ENs.
+ We are currently reviewing agreements that were developed by ENs
+and VR agencies in the 13 first-phase States. We hope to review all
+available agreements within the next 6 months. We will provide the
+Subcommittee with a report of our findings once our review and analysis
+are completed.
+
+ Questions from Chairman E. Clay Shaw, Jr. to Mr. Tom Foran
+
+ Question: Can you share with me on average, what are the costs of
+returning an individual to employment? Even with adjustments to the
+milestone payments, can employment networks cover their costs and still
+make a reasonable profit, given the potential total payment of $16,740
+for Social Security beneficiaries and $10,620 for Supplemental Security
+Income beneficiaries?
+ Answer: Because of the tremendous variation in costs, at the
+individual level, giving an average cost may be less meaningful than
+focusing on the second part of this question. We've seen beneficiaries
+that are able to return to work with an outlay of only several hundred
+dollars. We've also seen others that would require more than $50,000
+and even at that level the success is not guaranteed.
+ When looking at the second part of your question it is important to
+understand the effects of:
+
+ The time value of money on payments,
+ The cost of Maximus and SSA imposed administrative costs
+(drag),
+ Success rate in returning beneficiaries to work,
+ Once at work the effect of beneficiaries dropping out of
+the work force due to death, economy related work force reductions,
+choice and worsening of their physical state.
+
+ Additionally, we need to define ``reasonable profit'' which is
+directly tied to the source and cost of capital.
+ Once all of these parameters are determined a present value of
+future cash flows can be created to determine the amount of resources
+that can be provided to any one individual in the return to work
+process. An employment networkthen looks for beneficiaries that can be
+returned to work with that level of resources.
+ Taking into account the above items, IDR has estimated the present
+value of future payments per successful ticket as follows:
+
+ SSDI current milestone structure = $2,800
+ SSI current milestone structure = $1,420
+ SSDI with AOI workgroup suggested changes $3,800
+ SSI with AOI suggestions (diff. Reflects lower success
+rate) $3,000
+
+ With the current dramatically lower payments for SSI beneficiaries,
+we feel the risk/reward is too great and therefore do not work with SSI
+only beneficiaries. Under the current milestone structure only 1 in 25
+beneficiaries that contact us meet our screen of being a SSDI
+beneficiary with a 75% likelihood of successful full-time return to
+work for $2,800 in time and services.
+ We believe it is dangerous to use a cost figure that represents an
+average per individual placement, however. We fear that policy makers
+will use such a number to reduce payouts for the program without
+realizing the actual costs to operate the program include far more than
+just the cost of an individual placement. The aggregate program costs
+for screening all the people who never actually deposit their ticket as
+well as the people we are never actually able to place represents the
+majority of the costs incurred to operate a successful employment
+network.
+ Additionally, for the reasons mentioned above, a significant
+percentage of those who are placed for whom we are eligible for a
+milestone/outcome payment will never actually achieve 60-72 months of
+employment. It is also impossible to compute the total cost of any
+placement at this time since the ticket program is so new. For example,
+we do not know the cost or amount of future services that will be
+required to help those ticket users who are working now stay at work.
+Consequently, the total possible payout for any one beneficiary (i.e.
+$16,750 for SSDI and $10,620 for SSI) not only has to cover our costs
+and generate a reasonable profit for those we actually place but also
+must cover the aggregate costs incurred for all the people we do not
+place.
+ We believe placement rates could be increased by restructuring the
+payment system. By changing to the AOI workgroup recommended payment
+structure we estimate we would be able to work with 1 in 10 to 1 in 15
+beneficiaries. By removing much of the administrative drag we would
+likely be in 1 in 8 to 1 in 12 ranges. Improving access to capital
+(reducing cost) would also allow us to work with more beneficiaries.
+ So, yes it is possible for an employment network to earn a fair
+profit at the $16,740 (or current $17,170) total payment for SSDI
+beneficiaries. The question is how many beneficiaries is an employment
+network able to serve?
+ When IDR decided to become an employment network, we planned to do
+so on a significant scale. Our initial plans were to serve 2,000 plus
+beneficiaries per year. Our infrastructure was built to handle at least
+that amount.
+ Unfortunately, given the level of screening we have to do to deal
+with unexpected issues like administrative drag and lack of appropriate
+education given to beneficiaries on the Ticket to Work Program it is
+unlikely we will come anywhere near our goal without improvements in
+the program.
+ Question: What has been your experience in working with the State
+VR agencies? What suggestions do you have for improvements?
+ Answer: Our main office is in Connecticut and we have had a very
+positive experience in dealing with Connecticut's Bureau of
+Rehabilitation Services. The problem we face in dealing with other
+State VR agencies is that each state takes a different approach with
+different agreements in dealing with EN's. To be honest, we made the
+decision early on that it was not worth the time and expense to enter
+into negotiations with each state and simply refer beneficiaries to
+their State VR agency if we can't help them.
+ We would be much more likely to work on a collaborative basis with
+other State VR agencies if there was a uniform agreement applicable to
+all states.
+ It is important to note the comments we get from beneficiaries
+about their experiences with State VR agencies. In general, they
+revolve around frustrations the beneficiaries have with not being
+served by State VR for the following reasons:
+
+ Lack of funding
+ The beneficiary not having a disability ``severe'' enough
+to be assisted
+ The waiting list for services is ``years'' long
+ Rehab Counselors don't get back to the beneficiary for
+months on end
+
+ Another suggestion would be to more strongly encourage State VR to
+focus their limited resources on providing services designed to get
+beneficiaries ``job ready'' under the existing cost reimbursement
+program and to rely on EN's to provide the placement services under the
+ticket program.
+ Although some more traditional ENs have recommended operating the
+ticket program payment system similarly to the cost-reimbursement
+scheme currently in use with State VR, we believe that such a plan
+would create more administrative burden ``proving'' to SSA that the
+costs for which we are requesting reimbursement are legitimate.
+Further, it would designate a bureaucratic approach to the types of
+services provided rather than the ``whatever it takes'' approach we are
+free to use under the current Ticket structure. This has been
+demonstrated clearly by the Projects with Industry programs that exist
+today. Originally, they were intended to be more community and
+employer-focused. However, because of the manner in which PWIs are
+funded and monitored their programs today are so restricted that they,
+too, are not able to place as many people as they could if their
+program contained more flexibility.
+ Question: What can be done to assist recipients who want to use
+their Ticket in selecting one employment network from the often long
+list of employment networks available to recipients?
+ Answer: Provide adequate and timely information on each employment
+network servicing their area. Examples of information/services to
+provide include items currently tracked by Maximus such as:
+
+ Tickets assigned to date
+ Tickets unassigned by ENs
+ Tickets unassigned by beneficiary
+ Number of successful placements to date
+
+ Regularly updated (at least monthly) list of what EN's are still
+active
+ Offer workshops via the BPAOs on how to choose an EN and what an EN
+and a consumer can offer each other.
+ I want to emphasis that the information provided needs to be
+readily available information that Maxims is ALREADY collecting. Asking
+EN's report and track additional statistics will only add to the
+administrative drag and reduce resources available to provide services
+to beneficiaries.
+
+ Questions from Chairman E. Clay Shaw, Jr. to Mr. Quintin M. Mitchell
+
+ Question: Can you share with me on average, what are the costs of
+returning an individual to employment? Even with adjustments to the
+milestone payments, can employment networks cover their costs and still
+make a reasonable profit, given the potential total payment of $16,740
+for Social Security beneficiaries and $10,620 for Supplemental Security
+Income beneficiaries?
+ Answer: On average the costs of returning an individual to
+employment, for our agency, is $15,819.00. This figure is at the low
+end. Even with adjustments to the milestone payments, it is a very slim
+margin for our agency to cover cost and still make a profit.The profit
+is really not a reasonable one.
+ Question: What has been your experience in working with the State
+VR agencies?What suggestions do you have for improvements?
+ Answer: Our agency has opted not to work with the State VR agencies
+in our area. From the start of this initiative we decided that working
+with the State Voc Rehab would not be in our best interest,
+economically or providing the Ticket participants with expedient
+service delivery.
+ Question: What can be done to assist recipients who want to use
+their Ticket in selecting one employment network from the often long
+list of employment networks available to recipients?
+ Answer: One approach to assist recipients who want to use their
+Ticket in selecting one employment network from the often long list of
+EN.s available is to narrow the list to their service area within 30
+miles. We are finding that more and more Ticket holders are contacting
+our agency, which is outside of our service delivery area. To
+accommodate these individuals we have set up satellite meeting space in
+that area and travel to meet them on an as needed basis. Because of
+fewer E.N. participation and more Ticket participants, slim margin of
+profit and already stretched staff it is becoming increasingly more
+challenging to ensure that the program is successful.
+
+ Questions from Chairman E. Clay Shaw, Jr. to Mr. John V. Coburn
+
+ Question: Can you share with me on average, what are the costs of
+returning an individual to employment? Even with adjustments to the
+milestone payments, can employment networks cover their costs and still
+make a reasonable profit, given the potential total payment of $16,740
+for Social Security beneficiaries and $10,620 for Supplemental Security
+Income beneficiaries?
+ Answer: The cost of returning an individual to employment can vary
+greatly depending on many factors, including but not limited to, the
+nature of the individual's disability, the individual's employment
+history, and the individual's education and experience. In addition to
+the costs expended to assist a particular individual in returning to
+work, there are general overhead costs associated with actively
+participating as a provider in the Ticket to Work Program. These costs
+may include staff costs associated with performing intake, staff costs
+associated with assessing an individual's service needs prior to
+accepting their ticket, marketing of the Ticket to Work Program, and so
+forth. These costs are incurred on all individuals who contact the
+agency, including individuals who the agency may ultimately decide not
+to serve under the Ticket to Work Program.
+ In order to develop response to your questions, I polled members of
+the Midwest Employment and Training Partnership (Partnership). I have
+received several different responses with a range of costs for
+employment and training services One Employment Network, which serves
+exclusively blind individuals, stated that the average cost per
+individual to train, educate, and place the individual in competitive
+employment ranged from $35,000 to $40,000. This was the highest amount
+reported. On the lower end, another agency that works with a cross-
+disability population reported that it was currently costing about
+$2000 per individual to place a person in competitive employment
+through the Ticket to Work Program. This figure does not include what
+it may or may not cost to keep the person in competitive employment
+throughout the Ticket to Work payment timeline, nor does it include
+some of the overhead costs mentioned previously. A third agency that
+works with younger adults reported an average cost of between $5000 and
+$6000 to obtain employment, with follow-up services costing
+approximately $3000 per year. Finally, another agency, which works with
+a cross-disability population, reported a range of $5200 to $12,000 to
+assist an individual in returning to work with 3 months of intensive
+follow-up services.
+ So, our experience has been that there is a great variance in
+expenditures needed to assist a person in securing and maintaining
+employment. However, in almost all cases, the greatest percentage of
+these expenditures are incurred by agencies prior to and upon placement
+in competitive employment. Therefore, adjustments in the milestone
+payments to further increase the funds available during the beginning
+of the employment services process will increase the ability of
+Employment Networks to accept more Tickets.
+ The current total payment system under the Ticket to Work Program
+will not make it possible to serve all beneficiaries. For some
+beneficiaries, payments of $16,740 or $10, 620 will never cover the
+expenditures required in order to return them to employment. However,
+these amounts, if paid out in a greater percentage during the first
+year, would make it financially feasible for Employment Networks to
+accept more Tickets and increase their participation over time.
+ Question: What are the one or two most significant benefits of the
+upcoming City of Chicago Pilot that represent an improvement over the
+current Ticket to Work payment systems for employment networks?
+ Answer: In the Midwest, we have learned that Employment Networks
+have been hesitant to meaningfully participate in the Ticket to Work
+Program because the agency must bear all the costs associated with the
+placement of the individual in employment. And, even after incurring
+these costs, the Employment Network may never receive payment if it is
+not successful, or the EN receives payments over a significant period
+of time at very low rates. Quite simply, the current system of payment
+requires agencies to incur costs that it cannot carry for the period of
+time it must wait in order to be reimbursed. To be frank, the current
+Ticket to Work milestone and outcome payment model is not a strong
+business model that will bring new players into the system much less
+attract many of the experienced employment and training providers to
+this new program.
+ First and foremost, the City of Chicago Pilot (CCP) provides the
+Employment Networks with a significant income to cover their cost of
+service within the first year of a ticket participant's employment. The
+Employment Networks can be assured of reimbursement of at least some of
+their costs at placement ($2000), when the greatest costs have been
+incurred. In addition, subsequent payments of $2000 at 6 months and
+$1000 at 1 year allow the Employment Networks to recoup a larger amount
+of their overall costs within a short period of time. This is done
+without discouraging the Employment Networks from continuing to work
+with the individual over the next 5 years as Employment Networks will
+continue to receive payments from the SSA system after the first year
+if the individual maintains employment.
+ Second, the CCP allows for payment to the Employment Network within
+the first year without requiring the individual to earn Substantial
+Gainful Activity (SGA) or greater within that first year. Employment
+Networks believe that the process of returning an individual to full-
+time employment at or above SGA can often be accomplished over time.
+For some individuals, particularly those receiving SSI benefits with no
+work history, securing employment at or above SGA can best be
+accomplished by first gaining some work experience, sometimes at a
+part-time level. For other individuals, the best way to return them to
+work at or above the SGA level is to first allow them to work at any
+level, gain confidence in their ability to maintain employment, and
+address their fears about returning to work and losing their cash
+benefits. Once this is done, the transition to full-time, self-
+sustaining employment is the next natural step and the Employment
+Networks can realistically assist them in getting there.
+ The current payment system will not pay the Employment Networks
+during the time in which they are gradually assisting the individual in
+gaining full-time employment. Therefore, it is not financially feasible
+for the Employment Networks to work with the large group of
+beneficiaries described above. On the other hand, the CCP makes
+payments to Employment Networks when they assist the individual in
+gaining competitive employment, regardless of that person's employment
+income. This is done without losing sight of the ultimate goal---self-
+sustaining employment. The Employment Networks must still create a plan
+for returning the individual to self-sufficiency, as required by
+current SSA regulations, and will receive payments through the SSA
+system when they do so.
+ __________
+ [Questions submitted from Mr. Matsui to Dr. Justesen, and
+his responses follow:]
+ Question: If a Social Security beneficiary assigns a ticket to an
+Employment Network, is he or she still entitled to services and
+benefits under title I of the Rehabilitation Act? Please describe the
+interpretation of ``comparable benefits and services'' as it relates to
+the ticket program. Are state agencies complying with this requirement
+of the Rehabilitation Act with respect to Social Security beneficiaries
+who have been assigned tickets? Is your agency monitoring state's
+compliance with this requirement?
+ Answer: VR is an eligibility program rather than an entitlement
+program but Social Security beneficiaries are deemed presumptively
+eligible. Assignment of a ticket to an employment network does not
+limit an individual's potential eligibility for VR services. That
+eligibility is governed by the Rehabilitation Act.
+ Section 101(a)(8)(A)(i) of the Rehabilitation Act requires the VR
+agency, except in very limited circumstances, to determine whether
+comparable services and benefits exist prior to providing services to
+an eligible individual. State VR agencies must comply with this
+requirement as a matter of law, and it is to the advantage of the
+agencies to do so because use of third-party resources allows the
+agencies to serve more clients or provide enhanced services. The
+Rehabilitation Services Administration is currently reviewing
+agreements that were developed by ENs and VR agencies in the 13 first-
+phase States and hopes to review all available agreements within the
+next six months. The reviews will necessarily involve consideration of
+the use of comparable benefits.
+ The VR regulations define ``comparable services and benefits,'' in
+pertinent part, as those services and benefits ``that are--(A) provided
+or paid for, in whole or in part, by other Federal, State, or local
+public agencies. . . .; (B) available to the individual at the time
+needed to ensure the progress of the individual toward achieving the
+employment outcome. . . .; and (C) commensurate to the services that
+the individual would otherwise receive'' from the State VR agency (34
+CFR 361.5(b)(10)). This means that VR must determine whether another
+appropriate source can provide the services that VR otherwise would
+provide in accordance with the individual's IPE in a timely manner. As
+you know, the intent behind this requirement was to ensure that VR
+funds could be maximized in order to meet the needs of more eligible
+individuals, especially those with the most significant disabilities.
+ We do not view a ticket by itself as representing a comparable
+service and benefit. Nor do we consider the fact that an individual has
+assigned his/her ticket to a private EN by itself as constituting a
+comparable service and benefit under the Rehabilitation Act. However,
+we do consider the ticket as being a comparable service and benefit
+under the Rehabilitation Act when: 1) the individual has assigned the
+ticket to an EN; 2) the EN has listed the service in its own
+individualized work plan (developed between the EN and the individual)
+pursuant to TWWIIA requirements; 3) the EN is capable of providing a
+service that is listed on the individual's IPE; 4) the service offered
+by the EN is commensurate to the service that otherwise would be
+provided by the State VR agency; and 5) the EN is capable of providing
+the service when it is needed by the individual. If any of the above
+factors are not met, the ticket does not constitute a comparable
+service and benefit for purposes of the VR program. In that instance,
+assuming comparable services and benefits do not exist from another
+source, the State VR agency should provide the services pursuant to the
+IPE.
+
+Question: A number of concerns have been raised about whether the
+ ticket program may be replacing, rather than supplementing,
+ other pre-existing publicly funded services such as VR services
+ provided under Title I of the Rehabilitation Act. The intent of
+ Congress in enacting the ticket program was not to deny access
+ to these other services. Does Congress need to clarify the law?
+ If so, where?
+ Answer: State VR agencies are serving the great majority of persons
+holding tickets and seeking services. Experience to date with
+implementation does not support concerns about the ticket program
+replacing services such as VR. This is unsurprising because the VR
+agencies are well-established entities with operating capital provided
+by their formula grants from the Department. The Department has not
+taken a position on the need for any legislative change. We would in
+any event expect to work closely with but defer to SSA as the
+administering agency if legislative recommendations are to be
+developed.
+
+
+
+ [Submissions for the record follow:]
+
+ California Department of Rehabilitation
+ Sacramento, California 95815
+ March 30, 2004
+Chairman E. Clay Shaw, Jr.
+Subcommittee on Social Security
+1102 LHOB
+Washington, DC 20515
+
+Dear Congressman Shaw:
+
+ As the Director of the California Department of Rehabilitation
+(DOR) I want to take this opportunity to provide written testimony for
+the official record of the above referenced hearing. This testimony
+will provide some information on DOR's activities relevant to the
+implementation of the Ticket to Work Program specifically as they
+relate to Transmittal 17 of the SSA VR Provider Handbook and the
+development of agreements between DOR and Employment Networks (EN).
+ Several months prior to Ticket rollout in California, DOR convened
+a Ticket to Work Workgroup that consisted of field and management
+staff, community partner agencies and several constituency groups
+representing a unified approach to DOR's role in the Ticket to Work
+Program. The workgroup was charged with the task of extensively
+reviewing Social Security Administration's Ticket to Work (TTW)
+regulations and policies related to TTW including the Transmittal 17
+document. In addition, the workgroup carefully researched, studied and
+compared policies implemented by first and second round ticket states.
+As a result, the workgroup developed guidance and procedures consistent
+with the TTW regulations and Title I of the Rehabilitation Act of 1973,
+as amended.
+ Transmittal 17 of Social Security Administration's (SSA's) Vocation
+Rehabilitation (VR) Provider Handbook allows for the ``automatic''
+assignment of a Ticket to State VR agencies when a consumer signs the
+Individualized Plan for Employment (IPE). The SSA's position has been
+that if a beneficiary receives a Ticket and then enters into an IPE
+they have decided to use their Ticket. California DOR does not practice
+this ``automatic'' ticket assignment. A statement has been added to our
+IPE template to emphasize the voluntary nature of the Ticket and
+consumer informed choice. All consumers eligible or potentially
+eligible for a Ticket are provided verbal and written information on
+TTW program including a fact sheet that emphasizes that TTW is a
+voluntary program. Finally, guidance has been developed so that DOR
+counselors review and revisit TTW with each consumer at the time of
+progress and annual reviews.
+ Concern has been raised about the various EN/VR agreements
+requiring full repayment of the entire VR costs out of the EN ticket
+payments and the reported ``one size fits all agreements.'' State
+Vocational Rehabilitation (VR) agencies have been working with SSA
+beneficiaries under a reimbursement program legislatively authorized by
+the Social Security Act since 1981. Under this reimbursement program
+SSA reimburses State VR agencies for reasonable and necessary service
+costs incurred in assisting consumers who engage in employment with
+earnings equal to or above SSA's standard for substantial gainful
+activities (SGA) for at least 9 months. Indirect and tracking costs are
+also reimbursed. The annual SSA Reimbursement report for Federal Fiscal
+Year 2003 indicates SSA realizes savings from this program. In FY 2003
+$84.6 million dollars were reimbursed to VR agencies nationwide. SSA
+projected the savings in benefits to be $458.7 million dollars.
+ As is true for many state VR agencies, DOR has come to rely on
+these reimbursements to maintain ongoing programming. The TTW program
+has introduced a new way of doing business. With an estimated 1,000,000
+Tickets scheduled to be released in California by September 2004, DOR
+certainly supports increased consumer choice and the addition of EN's
+to provide services. California's EN Agreement only requires the EN to
+reimburse DOR at the rate of 50% of each payment received from SSA
+until DOR's direct costs (not indirect and tracking costs) are
+reimbursed or until DOR has received 50% of all payments, whichever is
+first. Furthermore, DOR does not ask for more than 50% of the total
+payments the EN receives.
+ Finally, California DOR supports the proposals that have been made
+by others to this hearing and the Ticket to Work Advisory Panel for SSA
+to create a dual payment system in which state VR agencies continue to
+be reimbursed for services provided to assist beneficiaries in
+preparing for and entering the labor market. EN's then will be paid for
+the long-term follow up and support for beneficiaries to maintain their
+employment and freedom from reliance on cash benefits.
+ California DOR appreciates this opportunity to provide testimony.
+We look forward to future collaboration in improving the TTW program
+and support your ongoing efforts to help make this program a success
+for beneficiaries with disabilities.
+ Sincerely,
+ Catherine Campisi
+ Director
+
+
+
+ Statement of Robert Kilbury and Louis Hamer, Council of State
+ Administrators of Vocational Rehabilitation, Chicago, Illinois
+
+ In Illinois there are 60 ENs with 32 ENs having an active agreement
+with State VR. Since the Ticket program started two years ago in
+Illinois we have gone from 73 ENs to 60 ENs now. Many ENs have stopped
+taking the Ticket assignment from customers. Most community based
+providers have attributed the lack of Tickets accepted due to the
+payment system. In Illinois we do have an agreement that was developed
+with cooperation with community providers. The EN agreement calls for
+State VR to pay for services and to eventually receive payment back for
+its cost once the EN receives payment from SSA. The EN will keep any
+monies received over State VR's cost. In most cases it could be a large
+sum. Illinois does not ask for any cost reimbursement above what it
+pays out.
+ "Transmittal 17" allows State VR to submit the Ticket Registration
+Form (TRF1365) along with a copy of the signed IPE signature page for
+assignment when the customer does not sign the TRF1365. The customer is
+informed by State VR that by signing the IPE (Plan) they are assigning
+their Ticket to VR. In Illinois we only submit in this manner with the
+customer's approval. This is no different than when a customer goes to
+an EN and signs a Individual Work Plan (IWP), they are in essence
+assigning their Ticket to that EN. This happens and not all customers
+are informed they have assigned their Ticket to that EN. In Illinois
+over 98% of all Tickets to date have been submitted with customer
+signature on the TRF1365.
+ It is very unfair to vilify State VR agencies over the Ticket
+program. In Illinois not every customer that comes through the door is
+a SSA recipient. The funds captured from SSA reimbursement goes back
+into the pool to pay the cost for all it's customers, including SSA
+recipients. State VR does indeed continue to be woefully under-funded.
+The amount of reimbursement has been steadily shrinking over the last
+two years with a large reduction expected again this year.
+ We disagree with the recommendation of eliminating the requirement
+that there be agreements between ENs and State VR agencies when the EN
+refers a beneficiary to VR unless SSA allows cost reimbursement for
+State VR agencies separately from the Ticket program.
+ Illinois State VR spent significant resources the first year
+training staff, hiring Ticket operators, setting-up a Ticket Cost
+Center and meeting with ENs in development of the EN agreement. We
+continue to spend large amounts training staff on SSA revisions and
+communicating with Maximus and customers who have no intent to return
+to work. This program would be most effective if there were unlimited
+funding for State VR with some additional funds for ENs. Since there is
+no endless trail of money, SSA should not consider changing the system
+to reward ENs that are able to cherry-pick it's customers. We must
+remember that State VR must work with every customer that comes through
+the door.
+ Making further changes to provide more incentives to return to work
+would benefit customers more. Give the customer to try to work for a
+year if they assign there ticket and allow them to keep all their
+benefits would open the door to more customers making a real attempt to
+get off benefits, not making ENs rich on the backs of the customer.
+
+
+
+ Statement of Mike Hedden, Indiana Vocational Rehabilitation Services,
+ Indianapolis, Indiana
+
+ In regard to the Hearing on March 18, 2004, the testimony given
+does not accurately reflect the situation in Indiana. Indiana has
+invested significant resources in its training of Vocational
+Rehabilitation Counselors. We have held several training seminars
+explaining the Ticket program as well as developing detailed intake
+procedures, flow charts and updating our computer system. We do not use
+a ``stand alone, take it or leave it, one size fits all agreement''
+with the ENs with whom we have Memorandums of Understanding. Our
+agreement with ENs states that ``both the IWP and the IPE will be
+written by the respective party in a manner, consistent with law, to
+reinforce common goals, policies and procedures for Ticket customers
+referred by the EN to VRS.'' Our agreements do not necessarily require
+full and total repayment of all of VR's costs. Our reimbursement
+agreement states that VRS will be reimbursed by the EN for all actual
+service costs provided through VRS at the rate of 50% of all outcome or
+milestone payments to the EN until VRS is reimbursed for all actual
+service costs (these costs do not include the costs associated with VR
+Counselor time or in support of the VR Counselor). In other words, once
+an EN begins to receive payments, VR is entitled to 50% of each payment
+received until service costs are paid in full or until no further
+payments are made to the EN. The EN, in other words, will always
+receive 50% of the total payments and may receive more than 50% once
+VR's costs are reimbursed. If payments to the EN stop prior to full
+service costs being reimbursed to VR, VR expects no further
+reimbursement from the EN.
+
+
+
+ Statement of James Wallace, Louisiana Rehabilitation Services,
+ Department of Social Services, Baton Rouge, Louisiana
+
+ Louisiana Rehabilitation Services (LRS) has taken a very active
+role in promoting Ticket to Work (TTW) in the state of Louisiana. Our
+agency, which is located in a second phase Ticket rollout state, began
+training our personnel statewide in 2001. The agency has done follow-up
+training in 2002. Louisiana Rehabilitation Services (LRS) personnel
+also participated in providing training to beneficiaries, potential
+Employment Networks (ENs), and other entities in 2002 in conjunction
+with the Medicaid Buy In (MBI) program. The MBI training was repeated
+in 2003 with LRS participation. Furthermore, the agency was involved in
+statewide teleconference training in 2003.
+ In our agency training, beneficiary options with special emphasis
+on informed choice to the consumers was stressed. Additionally, the
+training stressed that Rehab Act guidelines preclude denying services
+to any eligible consumer even if a Ticket is assigned to another
+entity.
+ The LRS does have EN agreements with four Employment Networks
+throughout the state. The agreements do call for Ticket assignment to
+LRS and payment to the EN on typically a fee-for-service basis. LRS
+would be reimbursed under the traditional cost method. Any excess
+payments from Social Security would be split on a 50/50 basis.
+ The LRS has neither solicited ENs nor coerced them into
+partnerships to ``control competition.'' ENs in the state appear to be
+reluctant to accept Ticket assignments because of the uncertainty and
+duration in payment and tracking. ENs and LRS negotiated so that in
+instances where the EN can independently serve the recipient, that
+recipient will not be referred to LRS. That said, current TTW
+procedures do allow appeals to Maximus and Social Security when Ticket
+assignment and payment is in question.
+ The LRS, as a whole, is as well trained or in many cases better
+trained on Ticket issues, including informed choice, as any other
+entity in the state. In our state, as in many others, LRS has over 90%
+of the Ticket assignments. It is our viewpoint that Ticket indifference
+is due to the payment system for ENs and the burdensome administrative
+and tracking system. Further the lack of marketing to recipients by ENs
+contributes to the very low number of cases handled through them.
+ Thank you for the opportunity to respond to this very topical
+subject.
+
+
+
+ Maryland Division of Rehabilitation Services
+ Baltimore, Maryland 21201
+ March 31, 2004
+The Honorable Benjamin L. Cardin
+Member of Congress
+2207 Rayburn HOB
+Washington, DC 20515
+
+ I want to respond to testimony that was provided by the Consortium
+of Citizens with Disabilities (CCD) at the March 18th hearing convened
+by the House Social Security Subcommittee on SSA's Ticket-to-Work
+program. The comments of Paul Seifert stating ``State VR agencies have
+developed stand alone, take it or leave it, one size fits all
+agreements for ENs in their states'', comes as a shock to this
+administrator of the Maryland VR program. Let me assure you that Mr.
+Seifert's statement could not be further from the reality of what has
+occurred in our state.
+ First, Maryland Division of Rehabilitation Services (DORS)
+implementation planning was guided by the following principles:
+
+ Persons with disabilities in Maryland are entitled to the
+opportunities, rights and remedies afforded under Title I of the
+Rehabilitation Act regardless of ticket status or assignment.
+ Maryland DORS implementation will foster the goals of the
+Ticket-to-Work legislation: to expand service delivery capacities; and
+provide greater choice to ticket-holders to prepare for and obtain
+employment.
+ Implementation will occur in a manner that is fiscally
+responsible and fair to ticket-holders, our community partner agencies
+and DORS.
+
+ We have steadfastly adhered to those principles throughout the
+process.
+ Second, Maryland DORS initiated an interagency implementation team
+to ensure that our roll-out strategies were consistent with our
+principles. Representatives from a number of community rehabilitation
+programs participated on the state team in addition to representatives
+from Maryland's benefits planning assistance and outreach (BPAO)
+organizations; the Client Assistance Program; and the state's
+protection and advocacy program.
+ Third, Maryland does not have a ``one size'' agreement with ENs but
+rather varies the agreement based on which entity will provide the
+Ticket-to-Work administrative functions. We also tailor specific
+elements of the agreements to the unique relationship we have with each
+provider.
+ While disagreeing categorically with Mr. Seifert's comments
+regarding implementation of the Ticket-to-Work for Maryland, I agree
+with his support of a recommendation of the Adequacy of Incentives Work
+Group. The current design of Ticket-to-Work by the Social Security
+Administration is seriously flawed. I strongly support the Work Group
+recommendation to reestablish cost reimbursement for state VR agencies
+separate from the Ticket-to-Work program and thereby keep intact the
+Ticket option for the consumer.
+ I appreciate your consideration of these comments, and would ask
+that this letter be submitted as part of the official record of the
+hearing. Please do not hesitate to call me if you need additional
+information. Thank you.
+ Sincerely,
+ Robert A. Burns
+ Assistant State Superintendent in Rehabilitation Services
+
+
+
+Statement of Elmer C. Bartels, Massachusetts Rehabilitation Commission,
+ Boston, Massachusetts Introduction
+
+ The Massachusetts Rehabilitation Commission (MRC) thanks Chairman
+Shaw for the opportunity to provide the Committee with its comments
+concerning the implementation of the programs of the Ticket to Work and
+Work Incentives Improvement Act, with particular attention focused upon
+the Ticket Program. Massachusetts was among the first states to roll
+out the Ticket Program and the MRC has actively worked to fashion a
+collaborative system of specialized training, support, and placement
+services with the state's community rehabilitation program providers,
+working as Employment Networks, in an effort to maximize choice and
+value for its consumers.
+
+BPAO Program Success
+ The Benefits Planning Assistance and Outreach Program (BPAO) has
+been an unqualified success in Massachusetts. The MRC operates its
+``Project IMPACT'' BPAO program in partnership with state independent
+living programs, non-profit community based organizations, and One-Stop
+Career Centers. The collaboration has resulted in referrals exceeding
+expectations and the development and implementation of over 1600
+benefits plans. Reauthorization of the Program in HR 743 will have a
+direct and positive impact on the employment efforts of hundreds of
+individuals with significant disabilities in the Commonwealth.
+Traditional Cost Reimbursement and the Ticket Program
+ A tension has existed in the Ticket program since the issuance of
+the first SSA instructions concerning State Vocational Rehabilitation
+Program participation in the Ticket Program and the continued relevance
+of the SSA/VR cost reimbursement program. That tension has continued to
+grow during the first several years of program implementation and it
+threatens to undermine the Ticket Program's potential for success.
+ From the time the idea of the Ticket Program was first discussed in
+Congress, the CSAVR and interested state programs have emphasized the
+need to preserve the successful and vitally important SSA/VR cost
+reimbursement program. We believe that the SSA has promulgated policy
+regarding the administration of the Ticket Program, through its
+regulations and Transmittal 17 that is contrary to the intent of
+Congress, the language of TWWIIA, and the law as it relates to the
+administration of the VR cost reimbursement program. The Ticket Program
+has great potential to stimulate creative collaboration among community
+rehabilitation providers and state VR agencies. That collaboration
+could result in increased choice, quality, and funding for SSI/DI
+recipients interested in obtaining and retaining employment. However,
+as others have stated in their testimony, the programs working to
+assist individuals with disabilities to obtain real and meaningful work
+are woefully under-funded. A Ticket Program designed to redistribute
+rather than supplement existing funds is destined to fail. The work
+that State VR agencies and community rehabilitation providers perform
+is difficult, it is important, and it has real value to people with
+disabilities. It can be improved upon but what is good must be
+maintained. The threat of a new program diverting scarce funding from a
+collaborative system of proven effectiveness causes apprehension and at
+times conflict rather than promoting enthusiastic and creative
+participation.
+ It is in the interest of the Social Security Administration, ENs,
+State Vocational Rehabilitation Programs and most importantly people
+with significant disabilities hoping to work, that this tension be
+relieved. Congress and the SSA should make it clear that the Ticket
+Program and the VR cost reimbursement program complement one another;
+supplement one another, and together work to creatively address the
+needs of individuals with disabilities seeking to maximize their
+economic independence.
+
+How the Ticket Program and VR Cost Reimbursement Program Could Together
+ Improve the Prospect of Long Term Employment for Individuals
+ With Disabilities
+ The State VR Program is mandated to provide an eligible individual
+with any service described in an individualized plan of employment
+necessary to assist them in preparing for, securing, retaining, or
+regaining an employment outcome that is consistent with the strengths,
+resources, priorities, concerns, abilities, capabilities, interests,
+and informed choices of the individual. It is neither uncommon nor
+unrealistic for many individuals with significant disabilities to seek
+and obtain costly vehicle modifications or payments for the costs of
+college degrees from the State VR Program. Yet, such expectations are
+justifiably viewed as unrealistic or beyond the scope of the capacity
+of ENs to address.
+ Many individuals with disabilities require long-term ongoing
+supportive services to enable them to successfully obtain and retain
+employment. Long-term supports to employment are often beyond the scope
+of services available to consumers from the State VR agency. Community
+rehabilitation providers, serving as ENs, have the expertise and staff
+to provide this necessary and relatively low cost on the job service to
+individuals with disabilities. All that is needed is a funding
+mechanism. In Massachusetts, we have developed some means by which we
+are able to support these activities. However, the need is only
+partially met.
+ A Ticket payment mechanism that supports EN efforts to provide the
+services necessary to ensure that individuals with disabilities are
+able to retain employment, complimented by a VR reimbursement system
+funding the up front costs associated with all aspects of individuals
+preparing for and obtaining employment, will undoubtedly result in
+increased, long-term, quality employment for SSI/DI recipients who
+desire increased social and economic autonomy.
+
+In Conclusion
+ The TWWIIA BPAO Program has been a tremendous success. There has
+been positive cooperation among state and community based partners that
+has resulted in an impressive number of consumer referrals with a very
+high level of consumer satisfaction. The reauthorization of the BPOA
+Program is a very positive development.
+ It is not the belief of the MRC that a lack of interested and
+qualified Employment Networks is threatening the success of the Ticket
+Program. 1,100 ENs is a sizeable network of service providers. It is
+our belief that ENs make business decisions based upon their assessment
+of what is in their and their consumers' best interests. A Ticket
+Program that secures the funding base of ENs, through the preservation
+of the VR cost reimbursement program, and provides ENs an opportunity
+to expand existing services and resources, through a Ticket payment
+system that funds the provision of long term support services, will go
+a long way toward assuring the success of the Ticket Program.
+ Thank you again for providing the Massachusetts Rehabilitation
+Commission with the opportunity to share with you some of its concerns
+regarding the operation and improvement of the Ticket to Work Program.
+
+
+
+ Statement of Dan O'Brien, Oklahoma Department of Rehabilitation
+ Services, Oklahoma City, Oklahoma
+
+ Chairman Shaw, Ranking Member Matsui and Members of the
+Subcommittee, thank you for holding this Hearing to evaluate the state
+of Ticket to Work implementation. The Oklahoma Department of
+Rehabilitation Services was one of the 13 initial rollout states for
+the Ticket to Work in 2002.
+ The reality of the Ticket from the street level perspective is that
+the system is broken and if not fixed will go the way of the failed
+Alternate Participant (AP) Program. Most of the problems have been
+predictable and the Adequacy of Incentives (AOI) Interim Report and the
+Ticket Panel's Employment Network (EN) Summit report summarize both the
+problems and make workable recommendations for solutions. We would
+encourage Congress and SSA to adopt their recommendations forthwith
+before any more potential energy is squandered. As they say in
+Oklahoma, beneficiaries are beginning to wonder if they have been sold
+a ``pig in a poke'', at this point the Ticket seems long on promise and
+short on delivery.
+ It is our position that there is a substantial consensus among
+experts and EN's alike that the Ticket can be salvaged if quick and
+decisive action is taken soon. The market based competitive model
+envisioned for the Ticket was undone by the lack of funding of the
+Ticket payment structure. Baring a huge influx of new funding, a
+blended funding approach, using existing resources to complement the
+Ticket, is the only logical solution. The AOI Committee recommendations
+(report link below), which operationalize this approach, should be
+implemented rapidly and to the fullest extent possible.
+
+ http://www.dri.uiuc.edu/research/p03-08h/interim_report_03-08h.pdf
+
+ Oklahoma DRS has made every effort to ensure the Ticket's success
+in Oklahoma. To that end we conducted the following activities:
+ Recrkuitment of EN's: When the Ticket legislation passed the DRS
+agency assumed that it would be structured as complementary to the
+traditional VR reimbursement program, much like the AOI study group has
+recently recommended. We recruited our traditional partners in
+delivering Supported Employment, a total of 26 Community Rehabilitation
+Programs, to be Alternate Providers under the previous SSA return to
+work program. It was our understanding that these organizations would
+be grand fathered into the Ticket EN system, thus ensuring Oklahomans a
+health EN network once the Ticket rolled out. However, SSA decided not
+to grandfather in the AP providers and required them to resubmit an
+application. The combination of this paperwork burden with the low
+rates of payment resulted in few of our CRP recruits becoming EN's.
+Those that did complete the paperwork have not been active. The primary
+problem is the low payment rates, the Ticket milestone payments
+represent a small fraction of what it costs for CRP/EN's to provide
+Supported Employment services. Implementation of the AOI Interim Report
+recommendations #1, to increase Milestone payments and allow payment
+for partial self-sufficiency, and #3 known as the Partnership Plus,
+would address the EN underfunding/undercapitalization problems that are
+restricting the Ticket's EN provider systems growth.
+ Ticket Outreach Pilot: Under an SSA state partnership grant,
+Oklahoma DRS piloted an assertive outreach/marketing effort combined
+with Work Incentive education and choice of vendor using a vocational
+voucher, similar to the Ticket but better funded. Beginning in 1999 and
+ending in 2003 the ODRS developed systems for recruiting, educating on
+work incentives and providing Job Coaching services to beneficiaries
+with a Mental Health diagnosis. The techniques developed under this
+grant were used to develop the procedures described in #3 through #7
+below.
+ Required Benefits Planning: Supported Employment Contractors are
+required to provide benefits planning assistance to all beneficiaries
+who are placed in a job.
+ Active Recruitment of Ticket holders: Oklahoma DRS created a Ticket
+Unit that works with the Workforce system to actively recruit Ticket
+holders. Since February 2002 the Ticket staff have invited all callers
+to the agency toll free Ticket hotline to Ticket Orientation meetings
+held at the Workforce One Stop Centers. Thousands of Ticket holders
+received basic work incentive training at a One Stop to enable them to
+make use of their Ticket and plan their return to work.
+ Expected Eligibility Process: Oklahoma DRS developed an expedited
+eligibility process for Ticket holders that resulted in determination
+of eligibility and assignment to a VR/VS counselor within 3-5 days
+after application. This is significantly faster than the normal
+paperwork processing time prior to the Ticket rollout.
+ Training of DRS Staff: All DRS staff including front line staff
+received training on the Ticket to Work and the agencies assertive
+collaboration with Workforce on Ticket rollout.
+ Direct Marketing of the Ticket with the Disability Program
+Navigators: The DRS and Workforce system have recently collaborated on
+a pilot direct Marketing campaign designed to reinvigorate the Ticket.
+Beginning in February and ending in April 2004 a pilot is being
+conducted where every Ticket holder in a suburban county near Oklahoma
+City is being invited to attend a Ticket Orientation meeting at the
+Local Workforce One Stop conducted by the Disability Program Navigator.
+In addition the SSA funded Benefits Planner, SSA's Area Work Incentive
+Coordinator and local VR staff are present to answer questions about
+available work incentives. This effort has received excellent feedback
+from those involved and will be evaluated for it's expansion potential.
+ We share the CCD's concern, expressed in Paul Siefert's written
+testimony, about SSA's rule on automatic assignment of the Ticket. As
+one of our staff has said, ``We don't make the rules, we just abide by
+them.'' SSA considers the signature on the IPE to be an indication that
+an individual decided to use the ticket to obtain services from the
+State VR Agency. SSA memos state ``. . . the Ticket is assigned when
+the IPE (VR Individualized Plan for Employment) is signed.'' The
+separation of the Ticket and Reimbursement systems, as recommended by
+the AOI study group, would resolve this problem.
+ SSA reimbursement funds, over $100 million per year nationally,
+provide services to thousands of additional beneficiaries each year.
+Loss of reimbursement funds, as is happening this year across the
+country, primarily due to the slow economy, reduces our ability to
+serve beneficiaries. The VR system is the only part of the Ticket
+system that is providing a significant level of services. SSA seems to
+be in the process of dismantling the Reimbursement program without
+having a working system to replace it. The logical step is to cross
+breed the two systems, as the AOI group has recommended, which will
+correct the deficiencies in both systems.
+ Our agency has collaboratively developed an EN agreement with our
+EN/CRP partners, which both parties consider fair. Any funds recouped
+under these agreements, strictly a theoretical case as to date there
+are none, would allow the agency to serve additional SSA beneficiaries.
+Our VR-EN agreement only requires EN's to pay VR 50% of payments
+received from SSA under the Ticket up to the amount actually expended
+by VR on direct client services. Theoretically, as no shared cases have
+been developed, this is only necessary in the small minority of cases
+where beneficiaries actually leave the SSA rolls. It is our
+understanding that only one out of 14 beneficiaries who have work
+activity ever leave the rolls, so most likely DRS will only receive any
+reimbursement in less than 7% of the cases where we expend money. And
+most beneficiaries do not work the entire 60 months of the outcome
+period. Therefore DRS, hypothetically, would expend an average of
+$10,000 per case and on 93% of the cases get nothing back from the EN
+and on 7% of the cases would get back considerably less than the cost
+of services. One would not be far wrong if you said this argument is
+much ado about nothing.
+
+
+
+ Pennsylvania Office of Vocational Rehabilitation
+ Harrisburg, Pennsylvania 17102
+ November 24, 2004
+Kim Hildred
+Majority Staff Director
+1025 Connecticut Avenue NW
+Suite 205
+Washington, DC 20036
+
+Dear Kim:
+
+ The Pennsylvania Office of Vocational Rehabilitation (OVR) takes
+exception to the testimony provided by Paul Seifert on March 18, 2004
+to the House Social Security Subcommittee on Social Security's
+Management of the Ticket to Work Program. OVR has invested a lot of
+time, energy and resources into the Ticket to Work program in order to
+maintain and continue the partnerships we have established over the
+past years with other employment programs, schools, agencies and
+facilities.
+
+Employment Network Referral Agreements
+
+ A committee composed of representatives from the Pennsylvania
+Association of Rehabilitation Facilities (PARF) and OVR staff spent
+considerable time developing an agreement that met with the approval of
+the committee. The federal guidelines established for Social Security
+reimbursement were followed when determining reimbursement for services
+provided. OVR's agreement does require repayment of services provided
+whereby OVR receives fifty percent of each payment that the Employment
+Network (EN) collects from Social Security until repaid. However, OVR
+does not require repayment from the EN if the EN takes a loss on a
+Ticket customer. OVR only receives payment from the EN if the EN
+receives a payment.
+
+Training and Outreach
+
+ OVR has invested significant resources to provide outreach and
+training to the community and OVR staff about the Ticket to Work
+Program. Individual training programs were designed and directed
+specifically to OVR staff. In addition to training staff, the OVR
+Ticket to Work Coordinator has presented to special interest groups,
+advisory councils, schools, parents and Career Link staff. Many of
+these presentations have been co-presented with members from the
+Benefits Program Assistance and Outreach Programs, Social Security and
+Employment Networks.
+ A letter has or will be sent to all OVR Pipeline cases as Tickets
+are distributed informing them of the program. Included in the mailing
+is a Fact Sheet that explains the Ticket program and the choices
+available.
+
+Transmittal #17
+
+ OVR does not involuntarily assign a beneficiary's Ticket without
+his/her knowledge. OVR is following the guidelines established by
+Social Security in Transmittal #17.
+ OVR counselors have been instructed to discuss the assignment of
+the Ticket per Social Security regulations. In addition, a form has
+been developed for counselors to give the beneficiary that specifically
+addresses the assignment of the Ticket when the Individual Plan of
+Employment is signed.
+
+Employment Networks
+
+ OVR staff has reported that there are beneficiaries coming to OVR
+with their Ticket, as other ENs have not accepted them for services.
+Some of the reasons for refusal include:
+
+ Ticket holders only want to work part time
+ The EN doesn't have the resources to provide the services
+needed
+ Lack of EN providers
+ EN can receive direct payment for services from OVR
+faster than through Social Security
+ If customer isn't employment ready, they are referred to
+OVR
+
+ OVR strives to facilitate and maintain viable working relationships
+with agencies, schools, rehabilitation facilities, employers and all
+other entities interested in providing services to people with
+disabilities. Partnering with others is an intricate link in providing
+quality services to those we serve.
+ Sincerely,
+ Stephen R. Nasuti
+ Executive Director
+
+
+
+Statement of Larry C. Bryant, South Carolina Vocational Rehabilitation
+ Department, West Columbia, South Carolina
+
+ Based on the hearing that took place on March 18, 2004 regarding
+the Social Security Administration's (SSA's) Management of the Ticket
+to Work Program, it is evident that the concerns regarding the Ticket
+to Work program continue to escalate. The South Carolina Vocational
+Rehabilitation Department believes that the successful services that
+the state vocational rehabilitation departments are providing to social
+security beneficiaries are being over looked due to the unresolved
+issued that have resulted from the 1999 Ticket to Work and Self-
+sufficiency legislation. Therefore, we feel that it is necessary to
+provide written documentation regarding the positive services to social
+security beneficiaries that take place in South Carolina.
+ Since the program's inception in 1999, the South Carolina
+Vocational Rehabilitation Department has actively supported the
+program. Our agency has invested a significant number of resources to
+train our staff regarding the ticket program and the impact that this
+program has on social security beneficiaries who desire to obtain
+independence through employment. Not only do we feel that our staff
+members should be educated about the ticket program, we feel strongly
+that our clients should have a full understanding of the program and
+work incentives that go along with it. Therefore, we request that ALL
+of our applicants and existing clients in the VR program who are
+receiving SSI and/or SSDI meet with a Benefit Specialist to discuss
+these issues. We encourage this regardless of ticket ``assignability.''
+ Our agency is especially proud of the relationship that we have
+developed with our local Social Security offices. During the roll out
+phase of the ticket program in our state, we invited Social Security
+staff to attend and present at our ticket to work training sessions.
+Currently, we are working closely with the Work Incentive Coordinator
+in our state to provide additional ticket training in our 22 local
+offices located through the state. We feel that this relationship with
+SSA exemplifies the importance that South Carolina Vocational
+Rehabilitation Department places on providing services to the social
+security beneficiaries of South Carolina.
+ We are also in the process of fostering a positive working
+relationship with the Employment Networks that serve South Carolina. We
+feel that it is necessary to develop an Employment Network (EN)/
+Vocational Rehabilitation (VR) agreement that caters to the needs of
+the client not to the needs of ``reimbursement.'' It is our intention
+to provide the best services to social security beneficiaries as
+possible. Therefore, as we establish agreements with Employment
+Networks, not only will they outline an agreed method of payment, but
+most importantly shared service provisions. We do not agree with a
+``take it our leave it, one size fits all'' attitude toward EN/VR
+agreements. Service provision is our number one priority. The
+reimbursement that we receive is to supplement our services to social
+security beneficiary, not to supplant these services. Again, our
+client's needs and employment objectives drive the services provided to
+them. We encourage input from employment networks and other agencies
+regarding service provision for our clients. I will say, however, that
+the negative attitude displayed by other entities regarding Vocational
+Rehabilitation and Ticket to Work activities has been discouraging.
+ As the Ticket to Work program continues to evolve, we feel that it
+is imperative to continue obtaining input from all parties who have
+been affected by this legislation. Resolutions to the issues
+surrounding the ticket program need to occur quickly in order to
+maintain the highest quality of service to social security
+beneficiaries.
+
+
+
+ Tennessee Division of Rehabilitation Services
+ Nashville, Tennessee 37248
+ April 1, 2004
+The Honorable E. Clay Shaw, Jr.
+Chairman
+Subcommittee on Social Security
+U.S. House of Representatives
+1102 Longworth House Office Building
+Washington, DC 20515
+
+Dear Chairman Shaw:
+
+ On March 18, 2004, the Subcommittee on Social Security held a
+hearing on the Social Security Administration's Management of the
+Ticket to Work Program. The Division of Rehabilitation Services (DRS),
+with Tennessee Department of Human Services, would like to submit
+written comments for the hearing record in rebuttal to testimony
+presented by Mr. Paul J. Seifert, with the Social Security Task Force,
+Consortium for Citizens with Disabilities.
+
+Staff Training on the Ticket Program
+
+ Tennessee DRS State Office staff has traveled the state training
+its field counselors on the Ticket to Work Program. The agency also
+trains all new Vocational Rehabilitation (VR) Counselors on the Ticket
+to Work Program as part of its New Counselor's Training. Additionally,
+the agency often and regularly communicates to its staff updated and
+important information on this subject.
+Informing SSA Beneficiaries of the Ticket Program
+
+ A couple of months before the Ticket to Work Program was to be
+implemented in Tennessee, the agency sent out thousands of letters to
+its SSI/SSDI clients informing them of the forthcoming Ticket Program.
+The letter explained the program and pointed out that this new program
+was soon to start up in Tennessee. Clients were told that they may be
+getting a ``ticket'' to use to help enable them to get employment.
+Clients were told about the options they would have in choosing service
+providers, as well about the CDR benefit in using the Ticket.
+
+The Agreement with Employment Networks
+
+ The agency has a standard Employment Network agreement that is
+applicable to all those ENs who wish to partner with the agency. There
+are currently five such agreements in place in Tennessee. No EN has
+voiced any concern to the State Office about the contents of this
+Agreement.
+ According to the Ticket to Work regulations, if an EN holds a
+ticket on an individual that they want to refer to a state VR agency,
+they must first have an agreement in place with that agency. The
+agency's agreement with ENs allows these referrals to be made under the
+ticket rules.
+ As partners under the agreement, the Ticket Program lets the EN and
+the state VR agencies decide how they wish to share the Ticket payments
+from SSA.
+ Tennessee's agreement with their EN partners lets the state VR
+agency recover monies it spends in serving the EN referrals. The money
+comes through a percentage of the periodic payments the EN gets from
+SSA via the EN payment system. This way, the EN always gets a portion
+of the SSA payment and the state VR agency gets a portion up until the
+state VR agency recovers its actual costs in serving the individual.
+The state VR agency receives no monies above its actual costs.
+
+A Possible Solution
+
+ Most state VR agencies across the nation would possibly welcome the
+recommendation of the Adequacy of Incentives Work Group--i.e., that
+cost reimbursement be made to state VR agencies separately from the
+Ticket Program, with the Ticket money going to ENs serving the
+beneficiary. In his testimony, Mr. Seifert seems to support this
+recommendation. This solution lets state VR agencies recover their
+costs and lets ENs receive money via the Ticket Program.
+ Sincerely,
+ Carl Brown
+ Assistant Commissioner
+
+
+
+ Statement of Terrell I. Murphy, Texas Department of Assistive and
+ Rehabilitative Services, Austin, Texas
+
+ I would like to take a moment to comment on the March 18,
+2004 Hearing on the Social Security Administration's Management
+of the Ticket to Work Program.
+ The Department of Assistive and Rehabilitative Services
+(DARS) administers the public vocational rehabilitation program
+in Texas. DARS has invested a significant amount of time and
+other resources in order to train VR counselors about the
+Ticket program. We have responded to numerous calls from
+consumers inquiring about the program, and do our best to
+explain not only the program but also the options available to
+them. We routinely refer consumers to the Benefits Planning
+Assistance and Outreach programs around the State, and
+encourage consumers to contact other Employment Networks (EN)
+in Texas so they can make informed decisions regarding the
+service provider that can best meet their individual needs.
+ We originally developed a template for an EN agreement
+based on models from other States. This template basically
+required full repayment of VR's costs. For example, when VR
+expends less than $10,000 on a beneficiary referred by an EN
+that holds the beneficiary's ticket assignment, VR may ask for
+50 percent of the EN's outcome payments until VR has received
+full reimbursement for the services purchased for that
+beneficiary. For cases where VR expends more than $10,000, VR
+may seek a greater percentage of the EN's outcome payments. Our
+rationale was that it was in the best interest of our consumers
+for us to reclaim as much money as possible in order to be able
+to serve additional consumers. Our experience has been that
+Employment Networks have demonstrated little interest in
+entering into this type of agreement. As a result, we have
+initiated a process to meet with representatives from
+Employment Networks to discuss creating an agreement that would
+be more suitable.
+ Our goal is to work cooperatively with Employment Networks
+and all other interested individuals and organizations in order
+to best meet the employment needs of individuals with
+disabilities.
+
+
+
+ Utah State Office of Rehabilitation
+ Salt Lake City, Utah 84114
+ April 1, 2004
+Committee on Ways and Means
+U.S. House of Representatives
+1102 Longworth House Office Building
+Washington D.C. 20515
+
+Dear Honorable Congressmen E. Clay Shaw Jr. and Members of the
+Subcommittee,
+
+ In regard to the March 18th Hearing on the Social Security
+Administrations management of the Ticket to Work program, we
+respectfully provide the following input.
+ We applaud the efforts of Congress and Social Security to create
+work incentives for individuals with disabilities. These new provisions
+have created countless opportunities for individuals who otherwise
+would not have engaged in work activity. We respect an individual's
+right to choose how and whether rehabilitation services will be
+provided. Furthermore, we support the efforts of Congress, the Social
+Security Administration and the Ticket to Work Advisory Panel to make
+improvements to the Ticket to Work program. It is due to our interest
+in helping make this program a viable and affable program for
+beneficiaries and Employment Networks (EN's) (including State
+Vocational Rehabilitation Agencies), that we want to ensure Congress
+have access to accurate information regarding states implementation of
+the Ticket to Work program.
+ Many of the concerns regarding the Ticket to Work program have been
+well documented over the past two years. Others have not. The Utah
+State Office of Rehabilitation (USOR) agrees with the recommendations
+made recently by the Ticket to Work Advisory Panel. The problems
+associated with low EN participation have been attributed to the high
+amount of risk involved in assigning tickets with little or no hope for
+claiming any payment from Social Security. However USOR feels that EN
+participation has not been affected in the manner espoused by Mr.
+Seifert. In Paul Seifert's testimony, he asserts that ``State VR
+agencies have developed stand alone, take it or leave it one size fits
+all agreements for EN's in their states''. He further asserts that
+these agreements ``require full and total repayment of all of VR's
+costs''. In the state of Utah, we have conducted focus groups with our
+EN's to explore the fairness of our draft agreement. The Employment
+Networks were given a draft copy of the agreement and encouraged to
+make comments. We have maintained the position that EN's in our state
+are not obligated to sign any agreement, and we have encouraged them to
+draft their own agreements for our consideration. Furthermore, we have
+conducted countless focused training sessions in conjunction with our
+Area Work Incentive Coordinator to ensure that EN's were up to date on
+the provisions of the Ticket to Work legislation and to empower them to
+draft their own agreements. We held our own ``EN recruitment''
+symposium and dedicated almost \1/2\ day to discuss creative
+partnerships. Despite our outreach efforts and openness to creative
+partnerships, none of the EN's have submitted an EN agreement for our
+consideration and have unanimously agreed to sign the agreement posed
+by our agency.
+ The reasons cited by the EN's remain consistent with earlier and
+well documented implementation issues with the Ticket to Work program.
+The EN's in Utah are afraid of the financial risk involved in accepting
+tickets, with or without VR as a partner. The EN's in Utah including
+USOR meet periodically to discuss ticket issues and to provide general
+support to each other. At all times, this has been done in a spirit of
+cooperation and collaboration, not just between USOR, but also among
+all seven of the Utah EN's. On one occasion, one of the EN's called the
+Ticket to Work coordinator at USOR to ask her technical assistance in
+assigning a ticket to his EN. She walked him through the process of how
+he could assign a ticket to his company. In the end, the EN made the
+decision not to accept the ticket, and referred the individual to VR
+because he felt that the administrative work associated with the ticket
+was burdensome. Our state has worked hard to create a healthy working
+relationship with Employment Networks, and to emphasize the importance
+of those relationships in our own staff training.
+ Frankly, we are offended by Mr. Seifert's testimony to the
+contrary.
+ In further testimony, Paul Seifert criticizes the state VR agencies
+who failed to register tickets in a timely fashion, with the
+unfortunate circumstance of benefits being reduced (and later restored)
+for a beneficiary. We would just like to assure Congress as well as Mr.
+Seifert that our state database system allows us to track where all our
+tickets are during the entire assignment process. We have created an
+electronic system of completing the SSA1365 form and recording when the
+ticket is actually assigned by Maximus thereby hoping to alleviate any
+of the potential problems mentioned in testimony.
+ Finally, Mr. Seifert addresses transmittal 17. The Utah State
+Office of Rehabilitation shares concern over this policy decision made
+by the Social Security Administration. Informed Consent has been a
+guiding force in our daily operations prior to Ticket to Work, and
+remains integral to our Ticket policy and procedure today.
+ During the first two years of the Ticket Implementation process I
+chaired the Council of State Administrations of Vocational
+Rehabilitation (CSAVR) Committee on Social Security Relationships. The
+committee had numerous meetings with SSA, RSA and others to identify
+issues and seek solutions regarding implementation problems associated
+with the Ticket to Work and Work Incentives Act. Quarterly
+teleconferences were held between the states currently implementing the
+ticket, CSAVR, RSA, and SSA to determine how the ticket was being
+implemented and to provide technical assistance. In addition CSAVR, SSA
+and RSA sponsored national training conferences prior to each group of
+states that were implementing the Ticket program. Even before the
+ticket program began, CSAVR was providing input to SSA and Congress
+regarding these issues. In the last four years, upper management from
+SSA and Maximus have participated in every CSAVR conference.
+ Contrary to Mr. Seifert's testimony, it has been my observation
+that State VR agencies have bent over backwards to assist in the
+development of the ticket program. Yes, a few states have made some
+mistakes which have been corrected. In the final analysis the Ticket
+program would be dead in the water without the State VR agencies.
+ The State of Utah is still in early implementation phase. There
+have only been 11,698 tickets mailed thus far, with 72 tickets
+assigned. Utah, like other states has made great preparations for this
+program. We are hopeful that measures will be taken to ensure the
+success of this program. We support the recommendations made by the
+Adequacy of Incentives Advisory Committee and as well, the Ticket to
+Work Advisory Panel recommendations. We urge Congress to seek input
+from all states regarding Ticket to Work Implementation. The Ticket to
+Work and Work Incentive Improvement Act holds much potential for job
+seekers with disabilities, but to realize the potential of this program
+we must work together to overcome the barriers rather than pointing
+fingers. The Utah State Office of Rehabilitation is committed to
+working with Congress and the Social Security Administration in
+realizing the potential of this important program.
+ Respectfully,
+ Blaine Petersen
+ Executive Director
+
+
+
+ Statement of Michael O'Brien, Washington Department of Social and
+ Health Services, Division of Vocational Rehabilitation, Lacey,
+ Washington
+
+ Mr. Chairman, Mr. Matsui, and members of the House Social Security
+Subcommittee, I am writing on behalf of Washington State Division of
+Vocational Rehabilitation (DVR) in order to provide written testimony
+in connection with the hearing on the Social Security Administration's
+implementation of the Ticket to Work and Self-Sufficiency Program,
+authorized under the Ticket to Work and Work Incentives Improvement Act
+of 1999.
+ I am writing in response to the comments made in Mr. Seifert's
+testimony under the heading ``State VR Agencies, Employment Networks
+(ENs) and Beneficiaries.'' Mr. Seifert's written testimony states:
+``State VR agencies have developed stand-alone, take-it-or-leave-it,
+one-size-fits-all agreements for ENs in their states. These agreements
+all contain one common provision--the full and total repayment of all
+of VR's costs out of the EN's ticket payment by an EN who refers a
+beneficiary to VR.''
+ This is not our practice in Washington State. The fact is, we want
+and need ENs. Washington State has a capacity issue and we believe ENs
+can assist in addressing this issue. Our agreements with ENs do not
+require more than a forty percent reimbursement to DVR on a shared
+Ticket. We have provided technical support to the local Workforce
+Development Councils to assist them in becoming Employment Networks. We
+are in the process of providing training on Ticket and work incentives
+to One-Stop staff. We will be holding focus groups this spring with ENs
+to figure out what else can be done to assist them.
+ Washington State DVR took an active role a year prior to the phase
+three roll-out in order to ensure that Ticket was successful in our
+State. We formed an interagency Ticket Advisory Group whose purpose was
+to prepare the state for Ticket, to encourage and support the
+development of Employment Networks, and to ensure that work incentives
+were understood throughout the system so that customers would take
+advantage of the incentives. Sixteen of DVR's staff have gone through
+the SSA certification to become benefits planners. Washington State DVR
+developed its own training modeled after the SSA training and has
+trained one third of its staff in benefits planning.
+ The Ticket Advisory members also have coordinated numerous joint
+and solo presentations on Ticket to Work, SSA work incentives, and the
+Medicare Buy-In program. Washington State DVR sponsored and coordinated
+two spring conferences on Ticket to Work to encourage EN development.
+Those conferences were attended by over 400 people. Washington State
+DVR paid for national experts on Ticket to speak.
+ Under the leadership of Washington State DVR, this committee
+developed a Ticket brochure with basic information on Ticket that could
+be used system wide, as well as a Ticket brochure for transition
+students. We compiled a list of frequently asked questions which is
+posted on all partners' websites. We currently are planning six one-day
+conferences statewide that will enable customers to better understand
+Ticket and the related work incentives.
+ Washington State DVR set up a toll-free line that anyone with a
+Ticket question can call. What we are finding is that, as a state,
+there is a serious problem of Ticket holders having nowhere to use
+their Ticket. Few ENs in our state are accepting Tickets and many
+Ticket holders are very frustrated. Unfortunately, DVR cannot be the
+answer because we are in ``order of selection'' and have a long waiting
+list.
+ Mr. Seifert, in his testimony, faults VR agencies for delaying or
+failing to assign a beneficiary's Ticket, resulting in the beneficiary
+being subjected to a Continuing Disability Review (CDR). I would like
+to state that this does not occur in Washington State. We have made it
+very clear to Ticket holders and DVR staff that a Ticket is assigned
+only when the 1365 form and the Individualized Plan for Employment
+(IPE) is signed. We have held four statewide trainings on the Ticket
+program, and 31 additional trainings at every DVR office in the state
+to insure our staff understands when and how a ticket is assigned.
+ However, there is a problem. Transmittal 17 states that a
+beneficiary's signature on the IPE indicates that the beneficiary has
+decided to use the ticket to obtain services from the State VR agency,
+if the ticket is assignable. This effectively takes away any choice
+from the individual. If ticket holders sign the IPE--which must occur
+in order to receive services--then according to TM 17 they have
+assigned their ticket.
+ Washington State has chosen to submit only Tickets that the
+beneficiary has deliberately assigned to us. I would suggest that the
+problem is with TM 17, not with public rehabilitation.
+ Thank you for the opportunity to share information about Ticket
+implementation and issues in Washington State.
+
+
+
+ Statement of West Virginia Division of Rehabilitation Services,
+ Charleston, West Virginia
+
+Reference Hearing on SSA Management of the Ticket to Work program held
+ on M arch 18, 2004
+
+ The West Virginia Division of Rehabilitation Services (WV DRS)
+provides the following comments as it relates to the above referenced
+hearing:
+
+ 1. WV DRS has invested significant resources to train all VR
+Counselors and administrative staff in the Ticket to Work program,
+developed a brochure to educate beneficiaries about the program and
+updated the Electronic Case Management system to collect additional
+data needed for the program.
+ 2. WV DRS has provided training to our Consumer Advisory
+Committee, State Rehabilitation Council and Statewide Independent
+Living Council on the ticket program, as well as, facilitated training
+provided to the Community Rehabilitation Programs in our state.
+ 3. WV DRS has worked with Social Security Administration and asked
+for their input into developing our processes and procedures for
+implementing the Ticket to Work program.
+ 4. WV DRS refers all Social Security recipients to the Benefits
+Planning Assistance and Outreach program specialist to discuss how
+working will effect their benefits and any incentives they can take
+advantage of when entering or re-entering the workforce.
+ 5. Our interpretation of the SSA Transmittal 17--If an individual
+applies for VR services, is determined eligible, meets our order of
+selection of having a most significant disability and works with the
+Rehabilitation Counselor to develop their Individual Plan of Employment
+and would not agree to assign their ticket to the agency; then DRS
+would send MAXIMUS the front and back page that includes signatures of
+the IPE and the unsigned SSA 1365. This effectively establishes that
+DRS is working with the individual and gives MAXIMUS the data it needs
+to determine ticket assignment and/or sharing of reimbursements.
+
+ Since West Virginia is a third round state, we do not yet have any
+agreements with Employment Networks in our state but we are not
+experiencing negative relationships with other Employment Networks.
+
+
+
+