Ticket To Work and Self Sufficiency

A Part of the Ticket to Work and Work Incentives Improvement Act of 1999

• The Ticket is a new source of funding for vocational rehabilitation services.
• It is funded by the Social Security Administration (SSA).
• SSA regularly issues “Tickets” to Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) beneficiaries.
• The Ticket allows an individual to obtain services from an employment network.

Governing Regulations

• The existing regulations have been effective since January 2002. Amended regulations are expected to be published during the middle of 2007.

Distribution of Tickets in New York

• The Ticket program started in New York during 2002.

SSA to Issue “Tickets” to SSI or SSDI beneficiaries

•  “to obtain employment services, vocational rehabilitation services, or other support services from an employment network … of the beneficiary’s choice ....”
• Tickets will be issued to all beneficiaries, ages 18 to 64, who are classified as “medical improvement possible” or “medical improvement not expected.”
• If classified as “medical improvement expected,” a Ticket will be issued if a beneficiary goes through one continuing disability review and keeps collecting SSI or SSDI.

“Program Manager” (PM) Will Oversee Program for SSA

• SSA has picked Maximus as the PM to administer the Ticket nationwide.
• The PM will recruit employment networks.
• The PM will monitor use of Tickets for compliance with SSA’s requirements.

Ticket Services to be Delivered Through “Employment Networks” (ENs)

• An EN can be any public or private entity.
• NY’s state vocational rehabilitation agencies, the office of Vocational and Educational Services to Individuals with Disabilities (VESID) and Commission for the Blind and Visually Handicapped (CBVH), will both serve as ENs.
• VESID/CBVH must follow federal vocational rehabilitation regulations in delivering Ticket services
• Other ENs are not governed by federal policies which govern VESID/CBVH

Services to be Provided Under Individual Work Plans (IWPs)

•  “may include case management, work incentives planning, supported employment, career planning, career plan development, vocational assessment, job training, placement, follow-up services, and such other services as may be specified by [SSA] under the Program.”
• For individuals served by VESID/CBVH, services will be provided through the traditional individual plan of employment (IPE).
• The written IWP must include, among other things, statements referencing: the employment goal; services and supports necessary to achieve the goal; terms and conditions for receiving services; conditions under which the EN may amend the IWP or terminate the relationship; the individual’s right to seek amendment of the IWP; the individual’s right to retrieve the Ticket from the EN if dissatisfied in any way.

What Services is a Beneficiary Entitled to Receive from EN?

• If EN is VESID or CBVH, beneficiary entitled to receive all services necessary to achieve a vocational goal.
• If EN is VESID or CBVH, right to services is governed by extensive regulations.
• If EN is other than VESID/CBVH, beneficiary is entitled to what can be negotiated with the EN.
• There is no body of regulations governing a right to services from an EN other than VESID/CBVH.

Employment Network’s Election of Payment System

• The EN must elect one of two payment systems to be used on all Ticket cases.
• Periodically, the EN will be offered the opportunity to change its selection to the other payment option.
• VESID and CBVH can decide, on a case-by-case basis, whether to participate in the Ticket program as an EN or under the longstanding “cost reimbursement” system¹
• Outcome Payment System - schedule of up to 60 monthly payments during “outcome payment period,” for which SSI or SSDI benefits are not payable because of earnings
• Outcome Milestone Payments - provides up to four milestones directed toward the goal of permanent employment, with earlier payments based on the attainment of milestones; plus up to 60 outcome payments at reduced rate
• Outcome payment system offers chance for the highest level of payments to ENs

Calculation of Payments to Employment Networks

• Outcome Payment System:

1. allows the EN to collect up to 60 monthly payments (the months need not be consecutive)
2. the EN is paid for each month that the individual, as a result of work activity, is rendered ineligible for both SSI and SSDI
3. each month’s payment will be 40 percent of the previous year’s average national payment rate for SSI or SSDI benefits (i.e., the “payment calculation base”), as applicable to the individual case
4. in 2007, this would allow payments as follows:

• for SSI, monthly payments of $218 per month, or a total of $ 13,080 for 60 months
• for SSDI, monthly payments of $ 378 per month, or a total of $22,680 for 60 months

• Outcome Milestone Payments:

1. would allow up to 4 milestone payments
2. Milestone 1 would be met when the individual has worked 1 calendar month with gross earnings above the substantial gainful activity (SGA) level ($900 per month, or $1500 per month for legally blind in 2007)(based on current figures, the total milestone payment to the EN would be $ 186 for individuals on SSI and $322 for individuals on SSDI)
3. Milestone 2 would be due when the individual has worked 3 calendar months within a 12 month period, with gross earnings above the SGA level (based on current figures, the total milestone payment to the EN would be $371 for individuals on SSI and $643 for individuals on SSDI). The month used to meet milestone 1 can be included in the three milestones needed to meet milestone 2.
4. Milestone 3 would be due when the individual has worked 7 calendar months within a 12 month period, with gross earnings above the SGA level (based on current figures, the total milestone payment to the EN would be $742 for individuals on SSI and $1,287 for individuals on SSDI). Any of the months used to meet the first two milestones can be included in the 7 months needed to meet milestone 3.
5. Milestone 4 would be due when the individual has worked 12 calendar months within a 15 month period, with gross earnings above the SGA level (based on current figures, the total milestone payment to the EN would be $928 for individuals on SSI and $ 1,608 for individuals on SSDI). Any of the months used to meet the first three milestones can be included in the 12 months needed to meet milestone 4.
6. thereafter, the EN can be paid for up to 60 non-consecutive months under the same terms, but at a lower payment rate than available under the outcome payment system
7. based on figures currently available, this would allow payments as follows

• for SSI, monthly payments of up to $186 per month, for a total of $11,160.
• for SSDI, monthly payments of up to $322 per month, for a total of $19,320 .

NOTE: Because the payment formula is based on a percentage of the national average for monthly SSDI checks in the case of SSDI recipients, or SSI checks in the case of SSI recipients, the EN can make more money by serving an SSDI recipient (or a person dually entitled to both SSI and SSDI). This is because the national average for an SSDI check is much higher than the national average for an SSI check.

Suspension of Continuing Disability Reviews (CDRs)

• Under existing law, most SSDI and SSI recipients will have a CDR every 3 years.
• During the period for which a beneficiary is “using a ticket,” SSA may not initiate a CDR or similar review to determine if the individual is no longer disabled.
• Under final regulations, “using a ticket” has been defined:

1. A person needs to be making “timely progress” toward their employment goals
2. During the initial 2 year period, person does not have to be working, but must be doing things specified in IWP
3. During the 3rd year, person must work for at least 3 of 12 months and earn at or above the SGA level for the non-blind
4. During the 4th year, must work 6 of 12 months at the SGA level for the non-blind
5. During the 5th year, and succeeding years, must work at least 6 of 12 months, and earn enough so that person does not receive an SSI (federal benefit amount)² or SSDI check for those months

Dispute Resolution: Disputes between Beneficiaries and VESID/CBVH

• VESID or CBVH must follow requirements of federal vocational rehabilitation regulations
• An individual who is dissatisfied with a decision of the agency has the right to seek mediation or an administrative hearing

Dispute Resolution: Disputes between Beneficiaries and Other ENs

• the Ticket program provides a three-step dispute resolution process

1. the beneficiary can file a complaint through the EN’s internal grievance procedures
2. if the internal grievance procedures do not result in an agreeable solution, either the beneficiary or the EN may seek a resolution with the Program Manager
3. if either the beneficiary or the EN is dissatisfied with the resolution proposed by the PM, either party may file a request for review by SSA

• SSA’s decision, rendered through a dispute resolution board, is final not appealable.

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1  The cost reimbursement system allows VESID or CBVH to receive full reimbursement for its rehabilitation costs if the SSI or SSDI beneficiary works for 9 months at the substantial gainful activity level after receiving services.

2  For 2007, the SSI federal benefit rate is $623. New York supplements that amount by $87 for persons who live alone and by $23 for persons who live with others. The person meets the “using a ticket” requirements if getting no SSDI and no more than the state supplement rate during the six months in question.

Prepared by Neighborhood Legal Services, Inc. - Updated January, 2007
(716) 847-0650 • Work Incentives Hotline: 1-888-224-3272 • www.nls.org

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