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Applicability of the ADA to Ticket to Work Employment Networks. Presentation based on article by Peter Blanck, Lisa Clay, James Schmeling, Michael Morris, & Heather Ritchie. Ticket to Work and Work Incentives Improvement Act. Passed in 1999 Recipients of SSDI and SSI receive “ticket”

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Applicability of the ADA to Ticket to Work Employment Networks

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applicability of the ada to ticket to work employment networks

Applicability of the ADA to Ticket to Work Employment Networks

Presentation based on article by Peter Blanck, Lisa Clay, James Schmeling, Michael Morris, & Heather Ritchie

ticket to work and work incentives improvement act
Ticket to Work and Work Incentives Improvement Act
  • Passed in 1999
  • Recipients of SSDI and SSI receive “ticket”
  • Ticket used to receive services from qualified Employment Network (EN)
  • The ADA is applicable to EN’s in several ways
reflects paradigm shift
Reflects Paradigm Shift
  • From charity and compensation …. TO
  • Medical Oversight …. TO
  • Civil Rights
disability policy framework federal initiatives
Disability Policy FrameworkFederal Initiatives

Workforce Investment Act of 1998 (WIA)

Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA)

Americans with Disabilities Act of 1990 (ADA)

intersection of ada and twwiia
Intersection of ADA and TWWIIA
  • Complimentary, but different policy purposes
  • TWWIIA to facilitate work
  • ADA to provide equal opportunity for persons with disabilities, full participation, independent living, and economic self-sufficiency
title i twwiia
  • Establishes Ticket to Work and Self-Sufficiency Program
  • Voluntary program
  • Implemented nationally over 3 years
  • SSDI and SSI recipients receive “ticket” to purchase services from qualified EN’s (Employment Networks)
  • EN’s provide employment, vocational rehabilitation services, and other supports
ada overview
ADA Overview
  • First comprehensive law preventing discrimination against persons with disabilities
  • Intended to improve lives and employment prospects of qualified people with Disabilities
  • Establishes rights, obligations, and protections in a range of areas
ada titles
ADA Titles
  • I. Employment discrimination on basis of disability
  • II. Governs discrimination in programs and services by state and local governments
  • III. Prohibits discrimination in accommodations and services offered by private entities that affect commerce
disability under the ada is defined as
Disability under the ADA is defined as….
  • “a physical or mental impairment that substantially limits one or more of the major life activities of such an individual”
a person also may be disabled if
A person also may be “disabled” if
  • He or she has a “record of such impairment”


  • Is “regarded as having such an impairment”
bragdon v abbott
Bragdon v. Abbott
  • First ADA case decided by Supreme Court
  • Title III case
  • Supreme Court endorsed a broad reading of the ADA’s definition of disability, as well as of its public accommodation anti-discrimination provisions
trilogy of title i employment cases 1999
Trilogy of Title I Employment Cases-1999
  • Sutton v. United Airlines
  • Murphy v. United Parcel Service
  • Albertson’s Inc v. Kirkingburg
  • “Mitigating measures” must be considered
  • Not substantially limited in major life activity if impact of impairment effectively mitigated
olmstead v l c 1999
Olmstead v. L. C.-1999
  • Title II Anti-discrimination provisions
  • Placement of qualified persons with mental disabilities in state institutions into community settings
  • Supports ADA’s goal to prevent unjustified exclusion of persons with disabilities from programs and services of Title II entities
pga tour v martin 2001
PGA Tour v. Martin 2001
  • Broad reading of Title III’s anti-discrimination provisions
  • Accommodations do not fundamentally alterthe nature of the golf tournament
historical barriers to independence inclusion of persons with disabilities
Historical barriers to independence & inclusion of persons with disabilities
  • Economic disincentives to work
  • Lack of choice in rehabilitation services
  • Lack of early access to rehab services in SSDI and SSI programs
ssa program inadequacies
SSA Program Inadequacies
  • Lack of adequate and affordable health insurance for beneficiaries/working disabled
  • Lack of choice in and access to employment services, vocational rehabilitation, and other supports
  • Attempts of beneficiaries to work frustrated by potential loss of benefits
ticket to work and work incentives improvement act twwiia of 1999
Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999
  • Initiated to address barriers & compounding factors of SSA programs
purposes of twwiia
Purposes of TWWIIA
  • Reduce dependence on government cash benefit programs by providing health care and employment training for persons with disabilities
  • Encourage states to allow those qualified to purchase Medicaid insurance, allowing them to retain employment
purposes of twwiia cont
Purposes of TWWIIA, cont.
  • Allow working persons with disabilities the option of maintaining Medicare coverage
  • Encourage persons with disabilities to seek employment and rehabilitation services to reduce dependence on cash benefits program
prior to twwiia
Prior to TWWIIA
  • SSDI and SSI recipients who would benefit from vocational rehabilitation were referred to state VR agencies
  • VR agencies were reimbursed for their services after beneficiary found work deemed “substantial gainful activity” (SGA)
after twwiia enacted
After TWWIIA Enacted
  • SSA is no longer required to refer individuals to state VR agencies
  • Benefits may continue while beneficiary receives VR services or is a participant in the Ticket Program
beneficiaries eligible until
Beneficiaries eligible until…
  • Until SSDI benefits end
  • A Social Security disabled widow(er) turns 65
  • A blind or disabled SSI participant turns65 and qualifies for SSI benefits because of age
how twwiia works
How TWWIIA Works
  • Most SSI and SSDI recipients between ages of 18-64 are eligible
  • Ticket participants receive a voucher or a “ticket” to obtain vocational services
  • Services are available from qualified Employment Network (EN) to help them return to gainful employment
twwiia cont
TWWIIA, cont.
  • Continuing disability review (CDR) by SSA is not triggered by return to work of participant using a Ticket while making progress
  • Progress toward discontinuation of cash benefits through SGA for purposes of CDR suspension is evaluated by program standards
twwiia cont1
TWWIIA, cont.
  • EN works with participant to form “individual work plan”
  • Participant has up to 2 years to prepare for employment
  • By year 3 of Program, participant is required to work at least 3 of 12 months at SGA (not necessarily consecutive)
twwiia cont2
TWWIIA, cont.
  • By year 4, participant works 6 of 12 months at SGA
  • By year 5, participant works 6 of 12 months at a level high enough to eliminate SSI or SSDI benefits
  • If participants do not meet requirements a medical CDR may be initiated by SSA
employment networks en
Employment Networks (EN)
  • Provide employment, vocational rehabilitation, and other supports and services to beneficiaries
  • Any public or private organization may apply to be an EN
  • Must meet qualification requirements
  • An EN may be one or multiple organizations
ens cont
ENs cont.
  • EN’s are compensated through “outcome based reimbursement” (OBR) payments
  • Payments represent a portion of cost savings from SSDI or SSI cash benefits
  • EN receives outcome payments for the months (up to 60) that the participant does not receive SSDI or SSI
ens cont1
ENs cont.
  • Milestone payment system available for ENs with beneficiaries who achieving goals of IWP, but not yet employed
  • EN services include:
    • Case management
    • Workplace accommodations
    • Peer mentoring and training
    • Transportation assistance
applicability of ada to the ticket program
Applicability of ADA to theTicket Program
  • EN classification affects applicability of ADA
    • Individuals
    • Cooperatives
    • Community rehab providers
    • WIA “One-stops”
    • State VR agencies
    • Private companies
ens and governing law

Protects employees of EN’s


Governs relationship between EN and Ticket participant

(private entity)


Governs relationship between EN and Ticket participant (public entity)


Governs EN’s receiving federal grants or contracts

ENs and Governing Law
olmstead court usdj
Title II of ADA is to prevent public entities from excluding qualified individuals with disabilities from enjoying benefits of public services and activities

Interprets Title II as requiring covered entities to make reasonable accommodations in services to avoid discrimination on basis of disability

Olmstead CourtUSDJ
under title iii
Under Title III
  • Places of public accommodation must provide equal access to all persons with disabilities, not just those who are “qualified”
  • Includes private social service centers
  • Includes those who own, lease,or operate a place of public accommodation as an EN
all title ii and title iii entities must provide ticket participants
All Title II and Title III entities must provide Ticket participants
  • Physicalandprogrammaticaccess to their facilities and services
ens may not discriminate
ENs May not Discriminate


They mayselect beneficiaries to whom they will offer services based on

- assessment of the needs of the ticket holder

- abilities to assist the individual

as title ii entities ens
As Title II Entities, ENs
  • Must be physically and programmatically accessible
  • Are not required to modify existing programs when these services are offered through alternative methods
  • Are not required to modify services when doing so would fundamentally alter programs, or cause undue financial or administrative burden
participant may choose to assign ticket to any public or private en
Participant may choose to assign ticket to any public or private EN


Participant is also free to reassign the Ticket to another EN, and may choose to, for various reasons

as title ii entities ens1
As Title II Entities, ENs
  • Must be physically and programmatically accessible
  • Not required to modify existing services when these services are offered through alternative methods
  • Not required to modify services if to do so would fundamentally alter the programs, or cause financial or administrative burden
under ada title iii entities
Under ADA, Title III entities
  • Must remove barriers or provide services through alternative methods when “readily achievable”
  • Have a less stringent “undue burden” defense compared to Title II entities, because Title II is presumed to enable persons with disabilities to participate in governmental programs
both title ii and title iii
Both Title II and Title III
  • Require covered entities to ensure effective communication with those with disabilities
    • Applicants
    • Participants
    • Members of the public
  • Covered ENs are required to provide auxiliary aids and services when necessary to allow equal program access
ticket program requires ens
Ticket Program requires ENs
  • To have policies and procedures that protect the confidentiality of participants & those seeking services
  • To prevent discrimination on the basis of a participant’s age, gender, race, color, creed, or national origin
if en is not qualified to serve a particular individual
If EN is not qualified to serve a particular individual,
  • The ADA’s undue burden provision does not require the EN to serve that Ticket holder
  • Where ADA accommodations are possible and reasonable, public or private ENs may not charge an individual to cover the cost of accommodations
implementation questions
Implementation Questions
  • What is an ENs responsibility under the ADA to serve individuals with multiple disabilities?
  • Does the ADA prevent ENs from choosing to provide services only to the pool of least disabled or so-called “creamed” participants?
Concerns about program implementation expressed by disability advocates reflect the potential emergence of
  • Two separate and perhaps unequal markets for EN services:
  • Those served by private specialized ENs
  • Those served by state VR programs
potential en market imbalance
Potential EN market imbalance
  • As of August 1, 2002, in the 13 states piloting the Ticket program, less than 1% (.21) of Ticket holders have been assigned to 374 ENs
  • In Iowa, for the same period, less than 1% (.34) of Ticket holders have assigned Tickets to 27 EN’s
virtually all program participants have either
Virtually all program participants have either:
  • Not used their Tickets


  • Remained in state VR system instead of assigning their Ticket to an EN of their choice (85-95% of program participants who have assigned their tickets)
although ssa is monitoring outcomes to ensure service choice
Although SSA is monitoring outcomes to ensure service choice

Analysis of the Ticket payment structure is needed to assess the incentives and disincentives for employment providers and EN program specialization

the statute requires
The statute requires:
  • SSA to design and implement a payment structure that allows individuals with significant disabilities to participate in the Ticket Program
  • SSA is required to report to Congress on the adequacy of incentives for ENs to serve this population prior to full implementation of the program
ssa will need to maintain information on
SSA will need to maintain information on:
  • Types of individuals with disabilities served
  • Data on: disability type and severity

economic status


geographical location

placement rates

acceptance & rejection standards

information needed cont
Information needed, cont.
  • Placement information on a regional basis by EN type, organizational size, and nature of disability served
  • About how exclusion of individuals between ages 16 and 17, and those who have not had a CDR affects subsequent employment outcomes
qualitative quantitative research needed on the ticket program in these areas
Qualitative & Quantitative research needed on the Ticket Program in these areas:
  • Who is being served in the Ticket Program?
  • Who is being rejected, and why?
  • What is the quality of service and employment outcomes?
  • What information or supports are needed to facilitate use of the Ticket?
research questions cont
Research questions, cont.
  • What are the economic incentives & disincentives to participants and ENs?
  • What is the nature of program access and accommodation for beneficiaries with multiple disabilities? And what are the associated costs and benefits?
  • What are the characteristics of participating ENs and service providers not participating?
research questions cont1
Research questions, cont.
  • How does the restriction of Ticket eligibility to those 18 years or older affect youth with disabilities transitioning from school to work?
  • Have service alternatives and programs expanded, diminished, or stayed the same for Ticket holders with different types and severity of disability?
research questions cont2
Research questions, cont.
  • How has Ticket implementation enhanced or diminished participants’ informed choice and decision making about employment options?
  • What information is gathered and disseminated to Ticket holders and others about EN performance & customer satisfaction?
research questions cont3
Research questions, cont.
  • What types of economic, attitudinal, and employment information are necessary to inform policy makers about the successes and challenges of Ticket Program implementation?
  • 13. Will the ADA’s anti-discrimination provisions and TWWIIA’s reform of the work incentives affect attitudes towards workers with disabilities?
research questions cont4
Research questions, cont.

14. Will the ADA and TWWIIA impact the attitudes of individuals with disabilities themselves with regard to their employment needs?

broader issues about the american work force
Broader issues about the American work force
  • What types of skills will be needed for employers to remain competitive in the U.S. and abroad with the development of the knowledge-based economy?
  • Will our increasingly diversified and aging work force include millions of persons with emerging disabilities, such as TBI, repetitive stress conditions and multiple disabilities?
broader issues cont
Broader issues, cont.
  • What will be the educational characteristics and job qualifications of the work force of young persons with disabilities?
  • What types of job training, assistive technology, and accommodations will be available to that work force?
  • How will the specific and generic policy changes in disability, welfare and healthcare affect that work force?
the ticket is an important experiment in social policy
The Ticket is an important experiment in social policy
  • The Ticket program prohibits discrimination not on the basis of disability per se, but on the basis of age, gender, race, and other status and service characteristics
  • The program’s goals reflect the disability policy framework and the ADA, which emphasize choice, equality of opportunity, and economic independence
new outcome measures needed
New outcome measures needed
  • Reduced dependence on government benefits
  • Asset accumulation
  • Use of federal and state tax credits and incentives to foster provision of workplace accommodations
  • Perceived satisfaction of participants and ENs
Non-traditional measures of inclusion and self-determination need to be examined, augmented by a review of range of employment activities:
  • Self-employment
  • Entrepreneurial activities
  • Temporary employment
  • Tele-work
researchers and policy makers must assess
Researchers and Policy Makers must assess:
  • The impact of Ticket Program OBR payment

systems on service delivery options and quality

  • Customer satisfaction with customized vocational service interventions
  • The scope and intensity of work supports and training
  • Barriers and facilitators to expanded service choice for Ticket holders
research needs
Research needs
  • Review relation among generic and disability policies (WIA & TWWIIA) to assist Ticket holders to obtain & retain employment through
    • Integration of job-related supports
    • Enhancement of work incentives
    • Access to affordable health care benefits
research needs cont
Research needs, cont.
  • Researchers must begin to cumulate information in ways that include Persons with Disabilities in
    • The research design
    • The data collection
    • The analysis process
    • The development of a body of research on the disability policy framrwork
    • The cummulative research endeavor highlights perspectives and assumptions embedded in policy and research
as knowledge about ticket program implementation emerges
As knowledge about Ticket Program implementation emerges:

Education and training must be available to improve understanding of the protections afforded by the ADA to Ticket holders

Information should be disseminated to ENs about:

- ADA responsibilities

- Rights to enhanced services, programs, and accommodations that promote equal participation and supports


The goals of full inclusion and equal employment opportunity for qualified persons with disabilities in the Ticket Program is grounded in the disability policy framework

in 2002 the supreme court reiterated these objectives in us airways v barnett
In 2002, the Supreme Court reiterated these objectives in US Airways v. Barnett:

[The ADA] seeks to diminish or to eliminate the stereotypical thought processes, the thoughtless actions, and the hostile reactions that too often bar those with disabilities from participating fully in the Nation’s life, including thee workplace…..These objectives demand unprejudiced thought and reasonable responsive reaction on the part of employers annd fellow workers alike.

The Court’s enunciated goal is to ensure opportunity, participation, independent living and economic self-sufficiency by all those with disabilities in all aspects of society The common purpose is to develop policies that advance economic independence of all Americans with disabilities.
thank you


PowerPoint prepared by

Susan Michaelson