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The United States Social Security Administration’s Ticket to Work and Self-Sufficiency Program is the centerpiece of the Ticket to Work and Work Incentives Improvement Act of 1999. This voluntary program is designed to help people who are receiving disability benefits from Social Security "find good jobs, good careers, and better self-supporting futures." To be eligible for the program people must be ages 18 through 64 and receive Social Security Disability Insurance (SSDI) benefits under Title II of the Social Security Act and/or Supplemental Security Income (SSI) payments under Title XVI of the Social Security Act. The Ticket program provides these beneficiaries more choices for receiving employment and other support services they need to reach their work goal.
Participants in this program may assign their Ticket to an Employment Network (EN) or receive services from the public Vocational Rehabilitation Agency in the State, in which they reside. Whichever provider they choose, beneficiaries will receive career counseling, job placement, and ongoing employment support services. Other services, such as transportation and workplace accommodation assistance may be available depending on the offerings of individual providers and the needs of beneficiaries. An EN works with each beneficiary to identify employment goals and write an Individual Work Plan (IWP) that both the beneficiary and EN agree upon.
The Ticket to Work and Work Incentives Improvement Act of 1999 (the Act) sought to provide SSDI and SSI beneficiaries a range of new or improved work incentives and employment-related services to support their movement to financial independence through work. The Act’s improved work incentives, including for example, the new Expedited Reinstatement provisions and improvements to the extended Medicare and Medicaid buy-¬in provisions, created a more secure financial and healthcare framework that encouraged more beneficiaries to work. The Act also directed the Commissioner of Social Security to establish a Ticket to Work and Self Sufficiency program. The purpose of the Ticket program was to expand the universe of service providers available to Title II disability and SSI disability beneficiaries by awarding ENs with cash payments based on the work-¬related success of beneficiaries they served. Social Security (SSA) initially implemented the program in 2002 through 2004 by delivering Tickets to most Title II disability beneficiaries and SSI adult disability recipients in all 50 States, the District of Columbia, and five U.S. Territories. The information and Tickets mailed to beneficiaries informed them that they could voluntarily assign their Ticket to the EN of their choice or their State’s VR agency in return for receiving services to support their move toward financial self-¬sufficiency.
The new Ticket program as implemented from 2002 through 2004 was straightforward and designed to create incentives for providers to sign up as ENs and serve beneficiaries with Tickets. However, as Mathematica Policy Research reported in the 2004 Adequacy of Incentives Study, the original provider compensation schedule proved to be inadequate, even with annual increases related to average Social Security disability benefits. Most providers who signed up as ENs quickly realized that the original payment structure would not support their participation in the program.
These obstacles to EN and beneficiary participation in the original Ticket program brought about the need for change and by 2005, Social Security began the process of revising the regulations to make the program work better for ENs and beneficiaries alike.
The Ticket to Work program underwent a major overhaul in 2008 with the publication of new regulations in the Federal Register on May 20, 2008. These regulations, which became effective on July 21, 2008, amended regulations originally issued on December 28, 2001. The new regulations dramatically revised the payment structure available to ENs, providing more money when beneficiaries make progress in their employment plans but before they reach the level of earnings that would terminate their benefits. Social Security, in its introductory summary to the final regulations, explained its approach to these amendments:
“We are revising our prior rules to improve the overall effectiveness of the program to maximize the economic self-¬sufficiency of beneficiaries through work opportunities. We have based these revisions on our projections of the future direction of the Ticket to Work program, our experience using the prior rules, and the recommendations made by commenters on the program.” 
Social Security, in substantially revising its Ticket program regulations, maintained the overall principles that are the foundation of this program, that private providers will participate and serve beneficiaries in the Ticket program, even if 100 percent of funding for the program is outcome-¬based. Beneficiaries will be more likely to participate in the program if:
Social Security has notified more than 17 million beneficiaries concerning their eligibility for participation in the Ticket program. As of December 2011, approximately 12.3 million beneficiaries are eligible to participate in the Ticket program, and on average, 89,000 new beneficiaries become Ticket eligible each month.
Social Security has established two collaborative entities to manage Ticket to Work and ensure the program’s continuity and operations for all participants (beneficiaries, ENs, and VRs). Beneficiary Access & Support Services (BASS) helps Social Security reach millions of eligible beneficiaries. BASS in turn helps beneficiaries find an EN by providing information, assistance, and outreach through web-based and traditional means, including a free, national Work Incentives Seminar Event (WISE) webinar held the fourth Wednesday of each month. The Operations Support Manager (OSM) provides information, training, activation, and technical assistance to existing ENs and State VR agencies, and recruits new qualified providers to serve Ticket program participants. OSM also oversees the payment process for all ENs and for those VRs that choose to act as ENs and to be paid by means other than the traditional cost reimbursement payment process. The overall tasking to support the Ticket program is fixed around the following roles:
Conduct Outreach to Beneficiaries
Ticket Assignment Administration and Support
Facilitate Beneficiary Access to ENs
EN Payment Administration and Support
Ensure Timely and Accurate Communication
Ticket Program Continuity and Operations for Beneficiaries, ENs, VRs
Conduct a National Survey to Measure Beneficiaries’ Satisfaction with the Ticket to Work Program
Recruiting service providers to become ENs
An EN is a qualified Social Security-approved organization or agency that has entered into an agreement with Social Security to provide employment services, vocational rehabilitation services, and other types of support to beneficiaries under the Ticket to Work program. All ENs are required to provide career counseling, job placement (including job search, job development and job placement assistance) and ongoing employment support. Beneficiaries can contact any EN in their area or that services beneficiaries nationally to see if the services and supports the EN offers are right for them. The beneficiary and EN must agree to work together and develop an Individual Work Plan (IWP) that describes the beneficiary’s employment goal and outlines the free services and supports the EN will provide to help the beneficiary reach that goal. Beneficiaries are free to talk with as many ENs as they choose without having to assign their Ticket. If a beneficiary assigns the Ticket to an EN and later changes his or her mind about working with that EN, the beneficiary can un-assign the Ticket and take it to another EN. Similarly, the EN can un-assign the Ticket at any time.
The Ticket Holder and EN work together until the beneficiary reaches his or her work goal. The EN will continue to provide ongoing support services even after the beneficiary gets a job if the beneficiary needs help keeping the job or getting a better paying one. Once the Ticket Holder is earning income at a level that justifies a payment to the EN, according to the Ticket program’s predetermined standards, the EN applies to the OSM for payment from Social Security. The EN cannot charge the beneficiary for any services it provides through the Ticket Program.
Any qualified entity can apply to become an Employment Network. Groups and organizations that have become ENs include Arc of the United States, Career OneStops and other Workforce Development System entities, Easter Seals (U.S.) affiliates, local Goodwill Industries International organizations, Centers for Independent Living, United Cerebral Palsy affiliates, mental health and faith-based organizations, high school and youth transition organizations, employment agencies, and other employment service providers. Many vocational rehabilitation vendors are also ENs.
Work Incentives are special rules that make it possible for a beneficiary to attempt work while still receiving health care and cash benefits. For beneficiaries who receive SSDI, cash benefits continue for a defined time period and are eliminated only when the beneficiary reaches a level of earnings, known as Substantial Gainful Activity (SGA), through his or her job. SSDI beneficiaries who receive Medicare may be able to keep the coverage for at least eight-and-a-half years after returning to work. A Social Security provision known as 1619(b) allows SSI and concurrent SSDI/SSI beneficiaries who receive Medicaid coverage and depend on it in order to work to keep that coverage if their annual earnings from work are below State specific thresholds and they have limited resources. If a beneficiary’s earned income is high enough to disqualify him or her from coverage under 1619(b), many states enable beneficiaries who have returned to work to purchase Medicaid coverage at affordable rates through State-administered “Buy-In” programs. Social Security’s Red Book provides more information on Medicare and Medicaid continuation. Work Incentives, like these, help beneficiaries stay in control of their finances and healthcare benefits while they re-enter the workforce or often, work for the first time.
Sponsored by Social Security, Work Incentives Seminar Events (WISE) feature information to help Social Security disability beneficiaries make the decision to re-enter the workforce or to work for the first time. Various employment service providers, including Vocational Rehabilitation agencies, Protection and Advocacy Services, and Employment Networks discuss the services and supports they offer, while former beneficiaries who have used the Ticket to Work program to become employed offer first-hand accounts of their success. As of January 2012, all WISE will take place via free internet-based webinars. Some of the webinars are designed to address a broad range of disabilities, while others target people in specific disability categories or age ranges. The webinar-based format allows beneficiaries to learn about vital employment resources without having to travel to another location, and to access the information 24 hours a day, at their convenience.