Social Security Administration: Better Planning Could Make the	 
Ticket Program More Effective (02-MAR-05, GAO-05-248).		 
                                                                 
The Social Security Administration (SSA) manages the two largest 
federal disability benefit programs and made approximately $75	 
billion in payments to about 8 million beneficiaries (ages 18	 
through 64) in 2003. Given the size of its programs, even small  
improvements in SSA's ability to return beneficiaries to work	 
offer the potential for significant savings. Until recently,	 
Social Security beneficiaries who needed help returning to work  
generally had to seek services from state vocational		 
rehabilitation (VR) agencies. Few beneficiaries used these	 
services or successfully returned to work. Therefore, Congress	 
passed the Ticket to Work and Work Incentives Improvement Act of 
1999 (Ticket Act, P.L. 106-170) to create a Ticket to Work and	 
Self-Sufficiency Program (the Ticket program). The program's	 
goals are to expand the availability of service providers and to 
help enable beneficiaries to return to work, become		 
selfsufficient, and stop receiving disability benefit payments.  
Eligible beneficiaries can use their tickets as vouchers to	 
request vocational rehabilitation, employment, or other support  
services from the traditional state VR agencies or from new	 
SSA-approved public or private providers, which are referred to  
as employment networks (EN). The act required SSA to implement	 
the Ticket program and make tickets available to all eligible	 
beneficiaries. SSA decided to use three phases to make tickets	 
available: (1) beginning with 13 states in February 2002, (2)	 
expanding to 20 more states and the District of Columbia in	 
November 2002, and (3) expanding to the final 17 states and 5	 
territories in November 2003. The act also required SSA to	 
perform several periodic and independent evaluations of the	 
program. For example, SSA was mandated to periodically review the
systems used to make payments to the providers and was also given
authority to make needed changes. The act also required SSA to	 
provide Congress with three independent evaluations of the	 
effectiveness of program activities. Finally, the act created the
Ticket to Work and Work Incentives Advisory Panel (the Advisory  
Panel) to include experts on employment and related services and 
representatives of individuals with disabilities to provide	 
advice and reports on the program to SSA, the Congress, and the  
President. The Congress also mandated in the Social Security	 
Protection Act of 2004 that GAO evaluate the Ticket program and  
provide a report to Congress by March 2, 2005. The statute	 
requires that GAO (1) examine the annual and interim reports	 
issued by the Commissioner of Social Security and the Advisory	 
Panel, (2) assess the effectiveness of the activities carried out
under the program, and (3) recommend legislative or		 
administrative changes, if appropriate. To meet these		 
requirements, our report examines: (1) the progress SSA has made 
in implementing and evaluating the Ticket program and achieving  
its goals, (2) the problems that have limited the program's	 
ability to achieve its goals, (3) the recommendations to better  
achieve the goals of the program made by the Advisory Panel,	 
researchers, and service providers, and (4) the challenges SSA	 
faces in implementing changes to achieve the program's goals.	 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-05-248 					        
    ACCNO:   A18516						        
  TITLE:     Social Security Administration: Better Planning Could    
Make the Ticket Program More Effective				 
     DATE:   03/02/2005 
  SUBJECT:   Beneficiaries					 
	     Disability benefits				 
	     Employment assistance programs			 
	     Federal aid programs				 
	     Federal social security programs			 
	     Performance measures				 
	     Program evaluation 				 
	     Vocational rehabilitation				 
	     Workfare						 
	     Program goals or objectives			 
	     Vouchers						 
	     SSA Ticket to Work and Self-Sufficiency		 
	     Program						 
                                                                 

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GAO-05-248

United States Government Accountability Office

GAO

                       Report to Congressional Committees

March 2005

                                SOCIAL SECURITY
                                 ADMINISTRATION

          Better Planning Could Make the Ticket Program More Effective

GAO-05-248

Contents

                                    Letter 1

Appendix I Briefing Slides

Appendix II Comments from the Social Security Administration

  Appendix III GAO Contacts and Staff Acknowledgments 44

GAO Contacts 44 Staff Acknowledgments 44

Abbreviations

DI Disability Insurance
EN Employment Network
SSA Social Security Administration
SSI Supplemental Security Income
VR Vocational Rehabilitation

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separately.

United States Government Accountability Office Washington, DC 20548

March 2, 2005

The Honorable Charles E. Grassley
Chairman
The Honorable Max Baucus
Ranking Minority Member
Committee on Finance
United States Senate

The Honorable William M. Thomas
Chairman
The Honorable Charles B. Rangel
Ranking Minority Member
Committee on Ways and Means
House of Representatives

The Social Security Administration (SSA) manages the two largest federal
disability benefit programs and made approximately $75 billion in
payments to about 8 million beneficiaries (ages 18 through 64) in 2003.
Given the size of its programs, even small improvements in SSA's ability
to
return beneficiaries to work offer the potential for significant savings.
Until recently, Social Security beneficiaries who needed help returning to
work generally had to seek services from state vocational rehabilitation
(VR) agencies. Few beneficiaries used these services or successfully
returned to work. Therefore, Congress passed the Ticket to Work and
Work Incentives Improvement Act of 1999 (Ticket Act, P.L. 106-170) to
create a Ticket to Work and Self-Sufficiency Program (the Ticket
program). The program's goals are to expand the availability of service
providers and to help enable beneficiaries to return to work, become self
sufficient, and stop receiving disability benefit payments. Eligible
beneficiaries can use their tickets as vouchers to request vocational
rehabilitation, employment, or other support services from the traditional
state VR agencies or from new SSA-approved public or private providers,
which are referred to as employment networks (EN).

The act required SSA to implement the Ticket program and make tickets
available to all eligible beneficiaries. SSA decided to use three phases
to
make tickets available: (1) beginning with 13 states in February 2002,
(2) expanding to 20 more states and the District of Columbia in November
2002, and (3) expanding to the final 17 states and 5 territories in
November
2003. The act also required SSA to perform several periodic and

independent evaluations of the program. For example, SSA was mandated to
periodically review the systems used to make payments to the providers and
was also given authority to make needed changes. The act also required SSA
to provide Congress with three independent evaluations of the
effectiveness of program activities. Finally, the act created the Ticket
to Work and Work Incentives Advisory Panel (the Advisory Panel) to include
experts on employment and related services and representatives of
individuals with disabilities to provide advice and reports on the program
to SSA, the Congress, and the President.

The Congress also mandated in the Social Security Protection Act of 2004
that GAO evaluate the Ticket program and provide a report to Congress by
March 2, 2005. The statute requires that GAO (1) examine the annual and
interim reports issued by the Commissioner of Social Security and the
Advisory Panel,1 (2) assess the effectiveness of the activities carried
out under the program, and (3) recommend legislative or administrative
changes, if appropriate. To meet these requirements, our report examines:
(1) the progress SSA has made in implementing and evaluating the Ticket
program and achieving its goals, (2) the problems that have limited the
program's ability to achieve its goals, (3) the recommendations to better
achieve the goals of the program made by the Advisory Panel, researchers,
and service providers, and (4) the challenges SSA faces in implementing
changes to achieve the program's goals. On February 25, 2005 we briefed
your staff on the results of our analysis. This report formally conveys
the information provided during the briefing (see app. I).

To assess the Ticket program, we reviewed and evaluated the quality of key
studies conducted for SSA on the implementation and effectiveness of the
program. We also reviewed reports by the Advisory Panel and other related
documents. To supplement information in these reports, we interviewed key
stakeholders involved in implementing or evaluating the program, such as
SSA officials, state VR officials, and Advisory Panel members. We also
interviewed representatives of selected disability organizations to obtain
their views on the Ticket program. However, our ability to evaluate the
effectiveness of the Ticket program was limited by SSA's lack of
information on beneficiaries' work efforts prior to the implementation of
the Ticket program. We conducted our work between

1While the mandate also required GAO to examine states' annual and interim
reports on the Ticket program, we were unable to undertake this effort
because states have not been required to, nor have they evaluated, the
implementation and effectiveness of the Ticket program.

August 2004 and January 2005 in accordance with generally accepted
government auditing standards.

In summary, we found:

o  	SSA has made progress implementing and evaluating the Ticket program,
but the agency has had limited success in achieving the program's goals of
expanding beneficiaries' choice of service providers and increasing
beneficiaries' efforts to work and become self-sufficient. Although SSA
experienced delays with the initial distribution of tickets, the agency
finished distributing tickets to eligible beneficiaries throughout the
nation in September 2004.2 As part of implementation, SSA has also
contracted for extensive assessments of its program's performance. Despite
SSA's completion of key implementation activities, it has had limited
success achieving its goal to encourage service providers to join the
program and provide services to beneficiaries. As of August 2004, although
SSA had contacted more than 50,000 potential new service providers, only
1,164 had become ENs and, as of May 2004, just 386 had accepted tickets
and agreed to provide services to beneficiaries. Furthermore, early
results indicate that the program has made little progress in achieving
its goal of increasing beneficiaries' efforts to work and to discontinue
receiving SSA's disability benefits. Of the 9.5 million beneficiaries
receiving tickets, less than 1 percent (62,901) have assigned their
tickets to an EN or state VR agency, as of August 2004. Lastly, about 160
beneficiaries have had sufficient earnings to result in the discontinuance
of their disability benefit payments and payments to ENs, as of March
2004.3

o  	The Ticket program's ability to achieve its goals has been hindered by
several factors, according to the Advisory Panel, researchers, and service
providers. First, service providers believe that the program's payment
system does not provide adequate compensation for the administrative costs
of participating. Second, participation of eligible beneficiaries has been
limited by the lack of ENs, the lack of outreach to provide information
about the program, and the lack of incentives to encourage beneficiaries
to participate. Beneficiary participation was also reduced by SSA's rules
that exclude from the Ticket program some potential participants, such as
adult beneficiaries who are expected to experience medical improvement.
Finally, external factors, such as a decline in the

2SSA continues to distribute tickets to additional beneficiaries as they
become eligible for the Ticket program.

3SSA was unable to provide us with more current data.

availability of jobs in the economy, may have discouraged program
participation or reduced the success of beneficiaries' work activities.

o  	The Advisory Panel and others have suggested numerous changes to
improve the Ticket program. The Advisory Panel and others believe that
reforming the payment system is critical to expanding participation. In
addition, they suggested numerous changes to reduce the administrative
burden for service providers, such as having SSA provide additional
services, guidance, and information to providers. To address limited
beneficiary participation, the Advisory Panel and others have a number of
suggestions, such as using a national campaign to market the program. The
Advisory Panel also suggested that SSA include in the Ticket program
beneficiaries it had previously excluded.

o  	SSA faces several challenges as it tries to improve the Ticket
program's ability to achieve its goals. Although SSA has made some
administrative changes to the program, the agency recognizes that
additional changes are needed. However, SSA has deferred other reforms
until it has performed additional assessments on changes that it believes
could be costly. For example, SSA officials explained that reforms to the
EN payment structure could increase Ticket program costs, but may not
provide a commensurate decrease in benefit payments. In addition, some
proposed changes go beyond the substantial authority provided to the
agency in the Ticket Act and may require legislative actions or
coordination with other agencies. To determine the most effective reforms,
SSA officials told us they needed more time to collect and evaluate
information on the program's performance, reasons for limited beneficiary
participation, and the potential impact of reforms. However, the agency
lacks a plan that defines when and how it will assess proposed changes and
identify cost-effective reforms.

In conclusion, we believe rigorous planning is needed to provide
sufficient and reliable information to adequately assess the numerous
proposed reforms put forth by the Advisory Panel and others. Thorough and
reliable analysis is particularly important because of the complexity and
potential costs of this nationwide program, as well as the opportunities
that it could provide to beneficiaries who want to become self-sufficient.
Without a well-defined plan to assess proposed changes, SSA may not be
able to provide stakeholders with cost-effective and timely solutions to
increase program participation and the number of beneficiaries who become
selfsufficient and move off the disability rolls.

GAO is making one recommendation to the Commissioner of Social Security.
We recommend that SSA's Commissioner provide to Congress a

plan that defines how and when the agency will assess proposed changes so
that it may provide timely and cost-effective solutions to increase
program participation and the number of beneficiaries who become
selfsufficient and move off the disability rolls.

In commenting on the draft of this report, SSA said that, although more
could be done, it already had a plan to improve the effectiveness of the
Ticket program. SSA pointed to its evaluation plan and other related
efforts as its plan for improving the program. In our draft report, we
recognized that SSA does have an extensive plan for evaluating the
performance of the Ticket program. But, the agency's current plan does not
specifically incorporate efforts to assess the potential costs and
benefits of implementing changes proposed by the Advisory Panel and other
stakeholders. As such, we continue to see a need for SSA to better
delineate how and when the agency will assess the numerous recommendations
put forth by the Advisory Panel and other stakeholders. We have revised
our recommendation to clarify this point and, as needed, have made changes
to address comments from the agency regarding appendix I. The agency's
comments are provided in appendix II.

Copies of this report are being sent to the Commissioner of SSA,
appropriate congressional committees, and other interested parties. This
report is also available at no charge on GAO's Web site at
http://www.gao.gov. If you have any questions about this report, please
contact me or Carol Dawn Petersen at (202) 512-7215. Other contacts and
staff acknowledgments are listed in appendix III.

Robert E. Robertson Director, Education, Workforce, and Income Security
Issues

Appendix II: Comments from the Social Security Administration

Appendix III: GAO Contacts and Staff Acknowledgments

GAO Contacts 	Carol Dawn Petersen, Assistant Director (202) 512-7215 Julie
DeVault, Analyst in Charge (415) 904-2269

Staff 	In addition to the individuals mentioned above, the following staff
members made major contributions to this report: Gretta L. Goodwin,

Acknowledgments 	Theresa Lo, Cady S. Panetta, Tovah Rom, Daniel Schwimer,
and Dianne Whitman-Miner.

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