20 Years of Social Security Disability “Ticket to Work”: Well-Intended Legislative Failure

Congress had high hopes for the Ticket to Work and Work Incentives Improvement Act of 1999 (“Ticket to Work Act”) . The legislation sought to address what was considered to be several major  disincentives for individuals with disabilities to securing vocational rehabilitation and returning to the work force.   Ticket to Work Act sought to to establish a Ticket to Work and Self-Sufficiency Program (TWSSP) under which a disabled beneficiary may use a TWSSP ticket issued by the social security to get employment, vocational rehabilitation services, or other support services.

Services are furnished through the current system of state vocational rehabilitation (VR) agencies or a ticket holder’s choice of an approved public or private sector, program-specific employment network (EN) to assist them in entering or re-entering the workforce.

The Ticket to Work Act also expanded medical coverage in the form of incentives for states to expand to Medicaid, and provided for continued Medicare for those participation in a TWSSP.   At the time the Ticket to Work Act was passed, policymakers estimated that if an additional one-half of 1 percent of disability beneficiaries went back to work and ceased benefits for the rest of their lives, the savings to the Social Security Trust Funds and Treasury would total $3.5 billion.

The Ticket to Work Act  has been the law of the land now for about 20 years now.  So how has it done?  By the looks at the various government agency studies, not well.  Let’s look at the government assessments of Ticket to Work Act over the years:

2008 OIG Report

The OIG published findings in 2008 with regard to data from calendar years 2002 through 2006.  The OIG key finds are as follows:

  • Overall participation rate remains low (i.e, disability recipients continued to decline to participate in the Ticket to Work program)
  • The percentage of beneficiaries who ceased benefits as a result of employment had remained unchanged from before Ticket to Work
  • Less than 1 percent of all ticket holders assigned their tickets to ENs
  • Since 2005, SSA has not consistently monitored or enforced ticket holders’ progress toward self-supporting employment—a
    regulatory requirement.

2011 OIG Report

This report reflects little improvement in the implementation and effectiveness of the Ticket to Work Act.  Ticket to Work participation had increased, but remained very low.  The report again indicated that SSA was not doing a good job in administering, monitoring and assessing the effectiveness of the program.  The report also indicated that “service approaches among some ENs that are out of line with the general goal of the Ticket program, which is to reduce beneficiaries’ dependence on benefits through earnings from work”.

2013 study by private firm “Mathematica” for SSA

Mathematica found that participants in Ticket to Work were more likely than nonparticipants to have months of not receiving disability benefits because of work.  However, they were unable to determine “whether such changes in disability benefits and other outcomes were because of (1) the effect of Ticket, or (2) the greater motivation or better employment prospects of individuals who participated in Ticket compared to those who chose not to participate.”  This is a little hard to follow, but I think is it saying there is no way to tell if Ticket participants were simply more likely to be highly motivated to return to work anyway.  It seems to me, however, one could easily inform a highly level of work under the Ticket to Work must be attributable to the program.  Mathematica also found that  there was no way “to determine whether the program was self-financing”.  Wonder how much money SSA paid for this apparently worthless report.

2013 Congressional Research Service study

Analyst in Income Security William R. Morton of the Congressional Research Service published an evaluation of the Ticket to Work Act on September 13, 2013.  Key findings are as follows:

  • Continued poor participation: “For every 100 tickets that have been issued, fewer than three have ever been assigned to an EN or state VR agency”.
    However, in 30 found the percentage of beneficiaries who ceased benefits as a
    result of employment had remained unchanged from before Ticket31 and cost savings had not materialized

October 2021 GAO Report

The most recent evaluation of the Ticket to Work evaluated data for the years 2002 to 2015.  Alas, the findings were not pretty:

  • The cost of the program exceeds savings by $806 million
  • An additional $133 million was lost due to unrecovered overpayments for Ticket to
    Work participants
  • Participants were slightly more likely to leave the rolls (9.7 percent) than nonparticipants

The report does attempt to temper the otherwise dire picture it paints of the the Ticket to Work Act’s effectiveness.  Its notes that the time period concerned – 2002 to 2015 – included a major economic recession.  The report also indicates the problem with overpayments may be “masking” the effectiveness of Ticket to Work.  It also notes that “estimating the rates at which individuals leave the disability rolls—whether Ticket participants or nonparticipants—is subject to significant uncertainty due to numerous factors such as the impact of CDRs and behavioral changes as individuals age”.  A CDR is a “continuing disability review”.  This is where SSA reviews a claim and determines the person is no longer medical disabled.  It is frankly not clear to me why researcher could not account for the effect those leaving the disability rolls due to a CDR or “aging out” of disability (reaching social security retirement age).

But there is little to disguise the apparent failure of the the Ticket to Work Act.  My colleague and fellow social security disability lawyer Charles T. Hall points out that in fact this study overestimates the effectiveness of Ticket to Work because there is no way to correct for those leaving disability under Ticket to Work who would have left anyway – without Ticket to Work.  Attorney Hall points out that all who volunteer for Ticket to Work are accepted, and that proper science would have had a “control group” of people who applied for Ticket to Work and were rejected.

The glaring reality of the Ticket to Work Act is that disability claimant participation is dreadful.    The premise of the Ticket to Work Act was that social security law includes insufficient incentives for disability workers to leave the disability rolls.  Clearly either the incentives remain insufficient or there is another reason Ticket to Work is a failure.  But the incentives of the Ticket to Work Act are pretty strong.

In looking at other explanations for poor Ticket to Work participation, I would suggest the following alternatives:

  • Most of those on disability in fact are unable to work.  They do not sign up for Ticket to Work because they simply cannot work.
  • Many disability recipients are lazy or simply “grifters” who do not want to work (a view I do not subscribe to).
  • Disability recipients – whether they have a clear disability or a marginally inability work – have been through significant trauma centering on lack of money and the long waiting time in winning social security disability.  They are simply extremely risk averse, and unwilling to take a risk on Ticket to Work, even if the result could be a better life.
  • Omission bias is “the tendency to favor an act of omission (inaction) over one of commission (action).”  Accepting the offer of rehabilitation services under the Ticket to Work

I would suggest the failure of Ticket to Work may indicate that the social security administration has not, in contrast to the position of today’s conservative media, put unqualified persons on social security disability, and that disability recipients need more specific and targeted paths to return to work.

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