Lessons Learned From the Provision and Funding of Employment Services for the MR/DD Population

Abstract

The goal of Ticket to Work is to support job acquisition and job retention among Social Security Administration (SSA) disability beneficiaries in job situations where earnings are sufficient to move these individuals off SSA disability cash benefits. This article considers the adequacy of provider payment incentives through the Ticket to Work for helping persons with mental retardation/developmental disabilities (MR/DD) achieve employment outcomes. It examines the work support strategies that have demonstrated their effectiveness in assisting persons with MR/DD acquire and retain employment, particularly with SSI and SSDI recipients. It analyzes the experience to date in using performance-based funding to purchase job acquisition and retention services, and the implications of this experience for the implementation of the Ticket to Work reforms. Specific areas related to the Ticket to Work addressed in the article include: the ceilings on current proposed milestone-outcome and outcome payments in the Ticket compared to what is known about providers' cost structures in other performance-based funding systems; and the factors likely to influence the decision-making of Employment Networks in accepting or rejecting Tickets. The article concludes with recommendations for restructuring the Ticket to Work to improve the adequacy of access to the Ticket program for SSI/SSDI recipients who are potentially viewed by Employment Networks as highly challenged in achieving an employment outcome.