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"Ticket" Slow to Achieve Goal of Consumer Choice

In addition to extended health coverage, TWWIIA also included a new "ticket" for rehabilitation and employment services designed to foster consumer choice. Under the program, SSI and DI beneficiaries were to receive "tickets" or vouchers that could be deposited with a provider of their choosing (a registered "Employment Network"). This Employment Network would be paid 40 percent of the cash assistance a former beneficiary would have received over the five-year period after the former beneficiary has returned to work. NAMI supported the Ticket program as a preferred alternative to the current monopoly that exists for most employment and rehabilitation services for state vocational rehabilitation programs. In addition, the program was intended to create a new funding stream for ongoing supports and services in the workplace – the most important intervention needed for working consumers with mental illness.

While the Ticket program will move toward national implementation later this year, the results thus far are not encouraging.

  • First, few alternative providers specializing in serving SSI and DI beneficiaries with severe mental illnesses (psychosocial rehabilitation agencies, clubhouses and consumer-run programs) have signed up as Employment Networks (ENs). Complicated rules governing payments to providers and requirements for ENs to collect payroll records over a five-year have kept many providers away.
  • In addition, vocational rehabilitation agencies in several states have squeezed many ENs out of the program. Of the more than 16,000 tickets that are now in use, more than 87 percent have been deposited with state vocational rehabilitation agencies, rather than non-profit ENs. Finally, Social Security’s 2001final regulations on the Ticket program delayed many SSI and DI beneficiaries with mental illness (who are classified as Medical Improvement Expected) from participating in the program.

While TWWIIA has not yet achieved its goal of easing the disincentives and penalties associated with work for SSI and DI recipients, there is room for optimism. Both Congress and the Bush Administration strongly support the law and remain committed to its full implementation. In addition, Social Security recently announced new efforts to recruit more ENs into the program and finally move forward to implement the study on the DI "cash cliff" penalty.

More information on TWWIIA is available at:

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