TN 6 (07-24)

DI 55001.001 Ticket to Work and Work Incentives Improvement Act of 1999 (P. L. 106-170) -- Overview

A. Introduction

The Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170) was enacted on Dec. 17, 1999. The purpose of this law is to:

  • Provide health care and employment preparation and placement services to individuals with disabilities that will enable those individuals to reduce their dependence on cash benefit programs.

  • Encourage States to adopt the option of allowing individuals with disabilities to purchase Medicaid coverage that is necessary to enable such individuals to maintain employment.

  • Provide individuals with disabilities the option of maintaining Medicare coverage while working.

  • Establish a “Ticket to Work and Self-Sufficiency Program” (Ticket to Work program) that allows Social Security disability beneficiaries and disabled or blind SSI recipients to seek the employment services, vocational rehabilitation (VR) services, or other support services needed to obtain, regain, or maintain employment and reduce their dependence on cash benefit programs.

The provisions of the law become effective at various times, generally beginning one year after enactment. See a glossary of terms in DI 55001.995.

B. Description of P. L. 106-170 provisions

1. Ticket to Work and Self-Sufficiency Program

Social Security and Supplemental Security Income (SSI) disability and blind recipients and Social Security Disability Insurance (SSDI) beneficiaries who are ages 18 through 64 are eligible to participate in the Ticket to Work program. These beneficiaries and recipients may use their “ticket” to obtain employment support services from an approved Employment Network (EN) or State Vocational Rehabilitation agency (VR agency) of their choice. The Ticket to Work program is voluntary for beneficiaries/recipients and ENs.

2. Expanded availability of health care services

Beginning on October 1, 2000, the law expanded Medicaid and Medicare coverage to more people with disabilities who work.

a. Medicaid changes

States may provide Medicaid coverage to more people who are still working. Under P. L. 106-170, States also may permit working individuals with income above 250 percent of the federal poverty level to purchase Medicaid coverage. This provision creates an experiment in which medical assistance will be provided to workers with impairments who are not too disabled to work.

In addition, a Medicaid Infrastructure Grant program is available to support the State efforts to increase employment options for people with disabilities. To find out if these provisions are available in your State, call the State Medicaid Office in your area or go to

You can also access the following web site for more information:

b. Medicare changes

The law also expanded Medicare coverage to people with disabilities who work. It extended part A premium-free coverage for four and-a-half years beyond the prior limit (4 years) for most Social Security disability beneficiaries who work. This is a total of 8 and 1/2 years including the trial work period. Medicare now continues for at least 93 months after the end of the trial work period. (For more information on Medicare continuation, see HI 00801.146, HI 00801.170 and HI 00820.025.)

3. Expedited reinstatement of benefits

Effective January 1, 2001, when an individual's Social Security or SSI disability/blindness benefits have ended because of work activity, the individual can request reinstatement of benefits, including Medicare and Medicaid, if applicable, without filing a new application. The basic criteria for expedited reinstatement are:

  • is “not able” or “becomes unable” to work at the SGA level due to their medical condition,

  • is “not able” or “becomes unable” to perform SGA in the month of the EXR request,

  • stopped performing SGA within 60 months of their prior termination,

  • has a current medical impairment(s) that is the “same as or related” to the original impairment(s), and

  • is under a disability based on application of the medical improvement review standard (MIRS).

Claimants are “not able” to perform SGA if, in the month of their EXR request, they do not work or their work is not SGA.

Claimants “become unable” to perform SGA if, in the month of their EXR request, their work is SGA, but they stop performing SGA by the day they file their request. To meet the requirement of having become unable to perform SGA, they must also not perform SGA in the month following the EXR request.

NOTE: Closed periods do not apply to EXR entitlement and claimants whose prior entitlement is a closed period of disability are not eligible for EXR.

In addition, the individual may receive provisional benefits - as well as Medicare or Medicaid - for up to six months while their case is being reviewed. If the individual is found not disabled, the benefits generally would not be considered an overpayment. (For more information on expedited reinstatement, see DI 13050.001, DI 28057.000, HI 00801.164, and HI 00801.165.)

4. Deferral of medical continuing disability reviews (CDR)

a. Section [Comment: The provision referenced below is found in section 1148(I) of the Social Security Act, which was added, along with many other things, by section 101(a) of P.L. 106-170.]

Effective January 1, 2001, an individual who is "using a ticket" will not be subject to medical continuing disability reviews (see DI 55025.001). Cash benefits may be subject to termination if earnings are above the substantial gainful activity level.

b. Section 111 of P. L. 106-170

Effective Jan. 1, 2002, Social Security disability beneficiaries who have been receiving benefits for at least 24 months will not be medically reviewed solely because of work activity. However, regularly scheduled medical reviews can still be performed unless the beneficiary is using a ticket and, again, benefits can be terminated if earnings are above the substantial gainful activity (SGA) limits.

5. Ticket to Work and Work Incentives Advisory Panel

The law established a Ticket to Work and Work Incentives Advisory Panel within Social Security, composed of 12 members appointed by the President and Congress. The panel advises the Commissioner and reports to Congress on implementation of the Ticket to Work program. At least one-half of the panel members are individuals with disabilities or representatives of individuals with disabilities, with consideration given to current or former Social Security disabled or blind beneficiaries. (See for more information on the Advisory panel.)

6. Work incentives Outreach Program

The law directs SSA to establish a community-based work incentives planning and assistance program to provide disabled beneficiaries with information to make informed choices about employment. SSA established a program of cooperative agreements and contracts to provide benefits planning and assistance to all SSA disability beneficiaries, including information about the availability of protection and advocacy services (see DI 55001.005B). The Work Incentives Planning and Assistance (WIPA) Program replaced the Benefits Planning Assistance and Outreach (BPAO) program in 2006. The individuals employed by WIPA projects who provide benefits counseling are called Benefit Specialists (see DI 55001.005C).

The law also directs SSA to establish a corps of work-incentives specialists within SSA to provide timely and accurate information about SSA's employment support programs to b SSI recipients and SSDI beneficiaries who want to work.

7. Protection and Advocacy (P & A)

The law authorizes Social Security to make payments to protection and advocacy systems established in each state to provide information, advice and other services to SSI recipients and SSDI beneficiaries (see DI 55001.005B).

8. Demonstration projects and studies

The law provides Social Security disability insurance program demonstrating authority for five years. In addition, the law requires Social Security to conduct a demonstration project to test reducing Social Security disability insurance benefits by $1 for each $2 that a beneficiary earns over a certain amount. Enrollment in the Benefits Offset Pilot Demonstration (BOPD) began in August 2005.

C. Description of the Ticket To Work program

1. How will SSA administer the program?

The law requires that SSA contract with one or more organizations in the private or public sector for service as a Program Manager (PM) to help SSA administer the Ticket to Work program and manage Employment Networks (EN). Most questions about the Ticket to Work program should be referred to the PM, known as the Ticket Program Manager (TPM) (see DI 55005.001).

2. What is an employment network?

Under the Ticket to Work program, an Employment Network (EN) is any qualified private or public entity that enters into an agreement with SSA to provide employment support services to an eligible beneficiary or recipient. (See DI 55010.001 for more information.) A State Vocational Rehabilitation agency (State VR agency) may participate in the Ticket to Work program as an EN (see DI 55060.005C).

3. What is a ticket?

A "ticket" represents a beneficiary or recipient's eligibility to participate in the Ticket to Work program. SSA has mailed a physical "ticket," which is a document that SSA may issue to beneficiaries or recipients for participation in the Ticket to Work program (see DI 55002.020B and DI 55099.001). A beneficiary or recipient does not need a physical ticket to participate in the Ticket to Work program, to work with an Employment Network to receive services related to returning to work.

4. Who is eligible to receive a ticket?

In general, only an individual who is age 18 or older and has not attained age 65 is eligible for a ticket. Also, the individual must be:

  • a title II disability beneficiary (i.e., a disabled worker, a disabled surviving spouse, a disabled surviving divorced spouse, or a childhood disability beneficiary);

  • a title XVI recipient eligible for SSI benefits based on disability or blindness; or

  • both a title II disability beneficiary and a title XVI recipient eligible for SSI benefits based on disability or blindness.

See DI 55002.005C for information on the exceptions to these criteria for ticket eligibility.

5. What does an individual do with a ticket?

Participation in the Ticket to Work Program is voluntary for the beneficiary/recipient (referred to as a "ticketholder") and the EN. A ticketholder who chooses to participate in the Program may assign their ticket to any EN or the State VR agency. An EN has the right to select whom it will serve based on both its assessments of the needs of the individual and its ability to help the ticketholder.

6. What happens when an individual takes a ticket to an EN or the State VR agency?

The EN or VR agency will verify ticket eligibility through the TPM (see DI 55005.001A.3.e). The ticketholder and the EN or the State VR agency will discuss employment options, employment and earning goals, and a plan of services to attain these goals. If the ticketholder and the EN or VR agency agree to work together, they both will develop and sign an employment plan (see DI 55020.001).

7. How does an EN get paid?

SSA pays the EN when a ticketholder achieves certain outcomes based on employment (see DI 55060.005A). ENs cannot request or receive compensation from the ticketholder for the EN's services.

8. How does a State VR agency get paid?

On a case-by-case basis, a State VR agency has the option of being paid under the existing State VR agency traditional reimbursement program (see DI 13510.001) or as an EN under its selected EN payment system (see DI 55060.005C).


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DI 55001.001 - Ticket to Work and Work Incentives Improvement Act of 1999 (P. L. 106-170) -- Overview - 07/17/2024
Batch run: 07/17/2024