Center for Health Policy and Research (CHPR) Publications


Estimated payments to employment service providers for persons with mental illness in the Ticket to Work program

UMMS Affiliation

Department of Family Medicine and Community Health; Center for Health Policy and Research; Clinical and Population Health Research

Publication Date


Document Type



Adolescent; Adult; Costs and Cost Analysis; Employment; Female; Humans; Interviews as Topic; Male; *Mental Disorders; Rehabilitation, Vocational; Reimbursement Mechanisms; United States; United States Social Security Administration


Health Services Administration | Health Services Research | Public Health


OBJECTIVE: The Ticket to Work and Work Incentives Improvement Act of 1999 removes work disincentives and promotes access to vocational services for people with disabilities. This study calculated the amount of payments that would have been made to employment service providers if study participants had been enrolled in the Ticket program.

METHODS: Data were from 450 Social Security Disability Insurance beneficiaries with psychiatric disabilities enrolled in a multisite study of supported employment. Earnings over two years were used to calculate provider payments under two reimbursement formulas used in the Ticket program.

RESULTS: Only a quarter of service recipients (26 percent) reached earnings levels that would have triggered provider payments under the first reimbursement formula. Only 4 percent would have completed their trial work period and left the rolls, generating payments under the second formula.

CONCLUSIONS: The current provider payment systems of the Ticket to Work program do not reflect the reality of rehabilitation for individuals with severe mental illness. Reforms should take into account outcomes of return-to-work services for this population.

DOI of Published Version



Psychiatr Serv. 2006 Apr;57(4):465-71. Link to article on publisher's site

Journal/Book/Conference Title

Psychiatric services (Washington, D.C.)

Related Resources

Link to Article in PubMed