Statement of Charlene Dwyer, Ed.D., Division Administrator, Division of Vocational Rehabilitation
Wisconsin Department of Workforce Development, Madison, Wisconsin

Testimony Before the Subcommittee on Social Security
of the House Committee on Ways and Means

Hearing on Fourth in a Series on Social Security Disability Programs' Challenges and Opportunities

September 26, 2002

Thank you for the invitation to share our Ticket to Work rollout experience with you today.

In the next five minutes I'll pose and answer 7 questions to help you understand the impact of the Ticket to Work in Wisconsin from a public agency's perspective.

1. In general, how did the Ticket roll out fare in Wisconsin?

Early measures of success in the roll out are whether Ticket Holders elected to use their Tickets and where they are assigning those Tickets.  Another measure is whether the Ticket mailings are stimulating "new" return to work interest among the target group.

As if last week Friday (9/20/02), Maximus reported that with more than 2 million Tickets delivered across 13 roll out states, 6,471 (or .3%) had been assigned.

With .8% of available tickets assigned, Wisconsin is the state with the highest percentage of Ticket assignments of any of the 13 roll out states.  (126,449 Tickets mailed; 1,113 assigned in Wisconsin)

2. How much "new" interest has been stimulated by the mailing?

Based on our historical application patterns for the target group and the activity in our Ticket to Work Call Center, about 300 new applications from Ticket holders might be credited to the Ticket mailing.  We did hear from some callers that they had never heard of DVR before they received the Ticket mailing.  Others had been our customers in the past, but the mailing stimulated their interest in "trying again". 

In the big picture of the statewide mailing of over 126,000 Tickets, 300 individuals responding to the point of applying for services and assigning a Ticket equates to a .02% "new business" rate.

3. Where are Ticket Holders assigning their Tickets?

96% (1,069) of the Wisconsin Ticket holders who elected to use their Tickets assigned them to the DVR.  As of September 20th, only 44 Tickets were assigned to one of the other 20 ENs serving Wisconsin. 

4. Why such a high percentage of Tickets to VR?

Some preliminary answers:

Ticket recipients were already our customers (69% were already working with us prior to receiving their Ticket) or would have become our customers regardless of receiving the Ticket in the mail (SSA recipients were 15.4% of our customer base).

We have 650+ SSA beneficiaries engaged in an SSA work incentive demonstration in our State called "Pathways to Independence".  During the past 4 years, the DVR has funded a statewide network of return to work benefits specialists who provided information on the "added value" features of the Ticket to consumers in our demonstration.  We were able to "prime the pump" so to speak in Wisconsin - at least for that demonstration group. 

We know that some EN providers have referred Ticket holders to us after they received a request from a Ticket holder and following their outcome payment risk assessment. 

The EN decided that either the risk of achieving the outcome, or the cost to serve the individual was too high.  In short, based on the current outcome payment system, they couldn't afford to take the Ticket.    

VR is the only Ticket services provider that will not reject a Ticket holder.  Wisconsin DVR annually spends $35-40 million for the purchase of rehabilitation services from the private sector.    We have asked our EN partners who decided not to take a Ticket to give a positive message to Ticket holders and send them to us.  We can simply buy services from the EN if the Ticket holder wished to receive services from them.

Initial conclusion for Wisconsin VR

In the roll out period, we were very prepared, and have been extremely "underwhelmed" by the response from Ticket holders. 

Conversely, we have been somewhat "overwhelmed" by the additional administrative requirements for collecting the Tickets and getting them assigned.  Instructions for claiming the Ticket have been "varied and evolving" since January.  This has added to the confusion and complexity of getting this program off the ground in our agency.

6. What needs to be improved?

If we are to take on the higher cost and riskier Ticket business that other EN's refuse - and we are willing to do so - we need a more equitable system of SSA payment.  We only want to be paid when we are clearly responsible for assisting Ticket Holders in achieving employment goals that satisfy the Ticket to Work requirements.

Under our traditional “cost reimbursement” recovery – SSA “pays us back” in full for the costs associated with the rehabilitation plan.  You might think of these funds as SSA’s community reinvestment funds – or better yet employment reinvestment funds.

In a recent 12-month period we recovered $1.64 million for our SSA successes  - sufficient funding to take 700 people off of our wait list for services!

When we provide successful rehabilitation services under our regular cost reimbursement system, the Ticket works well for us when the consumer

• Decides to use the Ticket and assign it to us
• Decides to assign it to another EN who has an agreement with us (we have many EN agreements and have not qualms about sharing the Ticket challenge and payments with our private sector partners).

The Ticket does not work for us when

• The consumer uses our services, but then assigns the Ticket elsewhere with an EN that has refuse an agreement with us, effectively preventing us from claiming any portion of the reimbursement.

Under the final rules, when DVR chooses cost reimbursement,

1. An EN can refuse an agreement arrangement

2. The consumer can reassign the Ticket to an EN that can claim reimbursement after 1 month of SGA activity - under cost reimbursement VR has to wait for 9 months of SGA activity.  An EN can "trump" the claim.

3. VR receives $0 recovery if an EN places the claim first

4. VR has no appeal recourse with SSA.

According to the final regulations - reports from the CBO stated that the Ticket to Work Program would " . . . partially displace the current cost reimbursement program". 

Apparently the final rules are based on "cost savings to SSA" without regard for how the SSA reimbursements are "reinvested" into future rehabilitation efforts for the "next" customer - perhaps someone on a wait list.

7. What would work better for an agency electing the cost reimbursement payment system?

When a VR agency can demonstrate that services provided led to the desired employment outcome, the agency should:

a. be able to submit claims and recover their cost under the traditional cost reimbursement as the stand-alone program it was intended to be - when there is not another EN in the mix.

b. be put on an equal footing with other ENs and be able to appeal a reassigned ticket claim with SSA if the Ticket is reassigned to an EN who refuses an agreement, and the VR services and costs are clearly related to the successful employment outcome.

Why is it important to make these changes in the cost reimbursement system for the VR agencies?

Because of the reinvestment value of the SSA cost reimbursement.

Wisconsin currently has a wait list for services.  We already have several hundred people and it is growing. 

We are facing our next round of very significant state budget reductions (as most states are). 

Lost SSA cost reimbursements for our successes will mean that our wait list will be longer.

We believe that SSA and RSA can successfully work together to eliminate the major stumbling blocks so that we can concentrate less on Ticket assignment procedures and cost recover glitches and more on selling the benefits of the Ticket to the Ticket holder.

Thank you.