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V. Experiences of TTW Participants: Use of Support Services

Disability beneficiaries may need to draw on a broad range of support services to help them work or live independently. Data from the 2004 NBS indicate that 34 percent of all beneficiaries in Phase 1 states used such services in 2003, a much larger share than the approximately 1 percent of Phase 1 participants who had assigned their Ticket by the time of the survey. It is apparent that beneficiary demand for such services substantially exceeds use of services under the TTW program. Services used include not only conventional work supports (e.g., training and job-search assistance), but also include a large volume of health-related services (e.g., occupational therapy, counseling, and adaptive equipment), which are seen by beneficiaries as enhancing their ability to work or to live independently.

Not surprisingly, TTW participants were substantially more likely than the average beneficiary to have used services, and those who used services did so for more hours and were more likely than the average beneficiary to report that they were using services to find a job. Interestingly, 46 percent of participants who used services did not report using them to find a job or to get a better job. It therefore appears that the objectives of many participants differ from the program objective of increasing earnings to the point at which an individual no longer receives benefits.

TTW participants who assigned their Ticket to an EN were significantly less likely than those who assigned their Ticket to an SVRA to report receiving any services. Moreover, participants who both assigned their Ticket to an EN and received services reported receiving fewer hours of services, on average, than those participants who received services from an SVRA. Similarly, EN participants who used services were also less likely to report using these services to find a job or to get a better job. This seems problematic for ENs, which can generate the full TTW payments only if participants earn enough to leave the benefit rolls. We also found that participants who assigned their Ticket to an EN as opposed to an SVRA were less likely to report that the services received were useful; more likely to report unmet service needs; and more likely to report problems with services and providers as the reason for these unmet needs.

Substantial differences between the EN and SVRA participants remain even after controlling for observed differences in their characteristics. It is likely that these differences reflect several factors, including differences in the ways the two types of providers recruit participants, unobserved characteristics and service needs between the people they recruit, differences in the services offered by the two types of providers, differences between the payment systems available to ENs and SVRAs under TTW, differences in the availability of other public funding for services, and start-up issues experienced by ENs that were not encountered by SVRAs in implementing a new program.

The fact that financial incentives for the ENs are out of line with the objectives of many of their clients might be an important explanation for these findings. For instance, as documented in an earlier evaluation report (Thornton et al. 2006), the current TTW payment system appears to offer ENs very little financial incentive to serve disability beneficiaries and may, in fact, cause ENs to lose money as a result of participating. Thus, ENs are likely either to look for low-cost ways to serve beneficiaries or to enroll beneficiaries who need few services in order to find and hold a job. In contrast, SVRAs have substantial non-TTW resources for assisting people with disabilities, so may offer more services to TTW participants or be willing to enroll beneficiaries who need more extensive services.

The rest of this chapter discusses the preceding findings in detail. This analysis focuses on service use during 2003 for all Phase 1 beneficiaries. We include findings for all beneficiaries as well as for those whose Tickets were in use during 2003.1

The NBS solicited information about a broadly defined set of services that beneficiaries saw as helping them to work or to live independently. These included job-search services; medical services; therapy or counseling; and the education or other training needed to secure a new job or to advance in a career. This broad definition was used to reflect the very broad latitude given to ENs and SVRAs to provide services that would help beneficiaries earn their way off the rolls.

Services reported by beneficiaries were not necessarily provided by an SVRA or an EN. Because of complexity and interview time limits, the survey did not include questions that allow us to identify the service provider by type. Instead, an initial set of questions was asked to allow us to document all providers from whom the respondent received employment-related services; a second set was then asked to determine whether any services were received from those providers during 2003. A third set of questions solicited more specific information about the nature and intensity of the services received during calendar year 2003.

It is important to recognize that the findings for TTW participants reflect all services reported by participants, not just those provided or arranged for by the provider holding the respondent’s Ticket. The rationale for this approach is that only 31 percent of Ticket participants were aware that they had assigned their Ticket (see Chapter IV). Many also used several providers. Hence, it is not possible to cleanly identify the services associated specifically with TTW participation.

A. Employment Service Use in 2003 and Characteristics of Users

Approximately one-third of all Phase 1 beneficiaries reported using employment services (Exhibit V.1). This suggests that the general demand for employment services that might be provided by ENs or SVRAs is substantial.

Exhibit V.1. Service Use by Beneficiaries and TTW Participants in Phase 1 States, 2003

Exhibit V.1. Service Use by Beneficiaries and TTW Participants in Phase 1 States, 2003
[D]

Source: 2004 NBS. Sample size = 2,932.

Note: EN and SVRA assignment and payment system classifications are based on the provider to which a Ticket was assigned for the longest period during 2003. However, only a handful of participants assigned their Ticket to more than one provider.

* Significantly different from all Phase 1 beneficiaries at the .05 level, two-tailed test.

+ Significantly different from TTW participants who assigned a Ticket to an SVRA at the .05 level, two-tailed test.

# Significantly different from TTW participants who assigned a Ticket to a provider under the traditional payment system at the .05 level, two-tailed test.

As might be expected, TTW participants were more likely than all Phase 1 beneficiaries to report using employment services in 2003 (Exhibit V.1). Among TTW participants, 57 percent used services in 2003, compared with 34 percent of all Phase 1 beneficiaries. Given that the primary purpose of TTW is to increase access to services and supports to facilitate employment, it is somewhat surprising that the share of TTW participants who assigned their Ticket and used services in 2003 is not greater. As noted in Thornton et al. (2006), the rather small percentage of TTW participants who reported using services in 2003 might be the result of a number of factors: they received services in 2002 and subsequently became employed or ceased to actively participate in TTW; they were waiting to receive services in the future; they did not recall receiving services; or they simply did not receive, or do not expect to receive, any services even though their Ticket was assigned. We are unable to determine the relative importance of these reasons from the NBS data.

Among TTW participants, those with Tickets assigned to SVRAs were more likely than those with Tickets assigned to ENs to use services in 2003 (59 percent compared with 48 percent, Exhibit V.1). This finding still holds after a statistical model was used to control for sociodemographic, programmatic, and health characteristics. The model indicated that, all else constant, TTW participants who assigned their Ticket to an EN were significantly less likely (by about 10 percentage points) to have received services in 2003 relative to those who assigned their Ticket to an SVRA (Appendix Table B.26).

We also examined service use among TTW participants by provider payment system. Beneficiaries who assigned their Ticket to a provider under the traditional or outcome-only payment system were somewhat more likely to use services in 2003 than were those who assigned their Ticket to a provider under the milestone-outcome system (58 percent, 61 percent, and 48 percent, respectively; Exhibit V.1). After controlling for differences in personal characteristics, however, there is no statistically significant difference in the likelihood of service use across payment systems (Appendix Table B.27).

B. Service Users: Reasons for Using Services, and Types, Amounts, and Usefulness of Services Received

1. Reasons for Using Services

As noted in Chapter II, beneficiaries who used services in 2003 reported a number of reasons for doing so, the most common being related to improving health or functioning. TTW participants, however, appear to differ significantly from other beneficiaries in their rationale for using services. Relative to all Phase 1 service users, TTW participants who reported using services were much more likely to report that they were using them to find a job or to get a better job (54 percent compared with 8 percent of all Phase 1 service users), but many did report that they were using services to improve health (45 percent compared with 69 percent of all Phase 1 service users, Exhibit V.2). Interestingly, among TTW participants who used services in 2003, those who assigned their Ticket to an EN were somewhat less likely than those who assigned their Ticket to an SVRA to report using services for the purpose of finding a job or getting a better job (47 percent compared with 55 percent).

Exhibit V.2. Selected Reasons for Using Services Among Subgroups of Phase 1 Beneficiaries Who Used Services in 2003 (Percentage Reporting Reason)

Exhibit V.2. Selected Reasons for Using Services Among Subgroups of Phase 1 Beneficiaries Who Used Services in 2003 (Percentage Reporting Reason)
[D]

Source: 2004 NBS. Sample size = 1,254.

Note: EN and SVRA assignment based on the provider to which the Ticket was assigned for the longest period during 2003.

*Difference between all TTW service users and all Phase 1 service users is statistically significant at the .05 level, two-tailed test.

2. Types and Volume of Services Used

Consistent with the differences between TTW participants and other service users in terms of reasons for service use, TTW participants were more likely to use services directly related to employment (Exhibit V.3).2 A much greater share of TTW participants who used services did so for job training or advice about job modification (67 percent compared with 24 percent of all Phase 1 service users), and for a work assessment or help in finding a job (62 percent compared with 22 percent of all Phase 1 service users). TTW participants and all Phase 1 service users were about equally likely to use various types of medical supports (counseling or group therapy; physical, occupational, or speech therapy; and medical procedures), but TTW service users were somewhat less likely to indicate that they received services related to special equipment or devices. For each type of service, TTW service users who assigned their Ticket to an EN were somewhat less likely than those who assigned their Ticket to an SVRA to use the service. This pattern reflects the fact that the former group used fewer services in general.

Exhibit V.3. Service Types Used in 2003 Among Service Users in Phase 1 States, by TTW Participant Status and TTW Provider Type (Percentage Reporting Type)

Exhibit V.3. Service Types Used in 2003 Among Service Users in Phase 1 States, by TTW Participant Status and TTW Provider Type (Percentage Reporting Type)
[D]

Source: 2004 NBS. Sample size = 1,254.

Note: EN and SVRA assignment based on the provider to which the Ticket was assigned for the longest period during 2003.

* Difference between all TTW service users and all Phase 1 service users is statistically significant at the .05 level, two-tailed test.

+ Difference between service users with Tickets assigned to ENs and users with Tickets assigned to SVRAs is statistically significant at the .05 level, two-tailed test.

In addition to the types of services used by TTW participants, we also looked at the volume of services used, as measured by reported hours of service receipt. The median for all Phase 1 service users during 2003 was 20 hours (Exhibit V.4). By comparison, the median for TTW participants who used services was more than twice as high, but this is because participants who assigned their Ticket to an SVRA typically received many more hours of service than the median user. In fact, the median for users who assigned their Ticket to an EN was somewhat lower than the median for all users.3

Exhibit V.4. Hours of Service Use in 2003 Among Service Users in Phase 1 States, by TTW Participant Status and Provider Type (Percentages)
Hours of Service Use All Phase 1
Service Users
TTW Participant Service Users
All
Participants a
Assigned to
EN b
Assigned to
SVRA
25 hours or less 47 39 58 37
26–100 hours 21 23 22 23
101–500 hours 9 17 10 18
Over 500 hours 6 12 3 13
Unknown 17 9 8 9
Median hours 20 42 15 49

Source: 2004 NBS. Sample size = 1,254.

Note: EN and SVRA assignment based on the provider to which the Ticket was assigned for the longest period during 2003.

a Distribution is statistically different from all Phase 1 service users at the .05 level, chi-square test.
b Distribution is statistically different from TTW service users with Tickets assigned to SVRAs at the .05 level, chi-square test.

3. Usefulness of Services

Respondents were asked to rate the usefulness of the services they received in 2003 by provider rather than by individual service received from a given provider. Among all Phase 1 service users, over 90 percent rated the services they received as either very or somewhat useful (Exhibit V.5). A similarly high percentage (79 percent) of those who assigned their Ticket to an SVRA rated their services as useful .4

Usefulness ratings can be affected by a number of factors, including the reasons for using services and expectations about services, which might be influenced by sociodemographic characteristics. Differences in usefulness ratings between TTW participants who assigned their Ticket to an EN and those who assigned their Ticket to an SVRA might therefore stem from differences in these factors. However, even though we used statistical methods to control for observed differences in these factors (Appendix Table B.28),5 we found that, all else constant, TTW participants who assigned their Ticket to an EN were still significantly less likely (by 10 percentage points) to rate their services as useful compared to those who assigned their Ticket to an SVRA.

Exhibit V.5. Beneficiary Ratings of Service Usefulness, Phase 1 States in 2003, by TTW Participant Status (Percentages)
Rating All Phase 1 Beneficiaries TTW Participants
All Participants Assigned to EN a Assigned to SVRA
Very useful 66 61 52 61
Somewhat useful 24 29 27 29
Not very useful 5 4 10 4
Not at all useful 5 6 11 6
Don't know 0 0 1 0

Source: 2004 NBS. Sample size = 1,254.

Note: EN and SVRA assignment based on the provider to which the Ticket was assigned for the longest period during 2003.

a Distribution is statistically different from TTW service users who assigned their Ticket to an SVRA at the .05 level, chi-square test.

C. School Enrollment and Degree-Seeking Behavior

Less than 3 percent of all Phase 1 beneficiaries were enrolled in school at the time of interview (Exhibit V.6), compared with 16 percent of all TTW participants who assigned their Ticket to an SVRA. The share of participants enrolled in school who assigned their Ticket to an EN was also larger than the share of all enrolled beneficiaries, but it was still less than half the size of the share of enrolled participants who assigned their Ticket to an SVRA.

Exhibit V.6. Percent of Phase 1 Beneficiaries Enrolled in School and Working Toward a Degree or License in 2003, by Selected Subgroup

Exhibit V.6. Percent of Phase 1 Beneficiaries Enrolled in School and Working Toward a Degree or License in 2003, by Selected Subgroup
[D]

Source: 2004 NBS. Sample size = 2,932.

Note: EN and SVRA assignment based on the provider to which the Ticket was assigned the longest during 2003.

* Significantly different from all Phase 1 beneficiaries at the .05 level, two-tailed test.

+ Significantly different from TTW participants with Tickets assigned to SVRAs at the .05 level, two-tailed test.

TTW participants who both assigned their Ticket to an SVRA and enrolled in school were much more likely than the average beneficiary enrolled in school to report working toward a degree or license (Exhibit V.7). Furthermore, that degree was more likely to be a postsecondary degree. Participants who both assigned their Ticket to an EN and enrolled in school were also much more likely than the average enrollee to be pursuing a degree or license, but we cannot draw a conclusion about the types of degrees they sought because that information was not reported by a relatively large number of these respondents.

Exhibit V.7. School-Enrolled Phase 1 Beneficiaries Working Toward a Degree or License in 2003, by Degree Type and Selected Subgroup (Percentages)
 Degree Type All Phase 1 Beneficiaries TTW Participants
All Participants a Assigned to EN Assigned to SVRA
GED or high school equivalent 19 3 5 3
Vocational program 12 15 9 16
Associate or undergraduate 50 62 53 63
Graduate 11 6 2 7
Other/Don't know 7 13 31 12

Source: 2004 NBS. Sample size = 2,932.

Note: EN and SVRA assignment based on the provider to which the Ticket was assigned for the longest period during 2003.

a Distribution is statistically different from all Phase 1 service users at the .05 level, chi-square test.

D. Unmet Service Needs

An estimated 11 percent of Phase 1 beneficiaries indicated that in 2003, they had unmet needs for services, equipment, or supports that would have improved their ability to work (Exhibit V.8). The share of TTW participants who felt the same way was nearly twice that. It seems likely that the difference reflects not the availability of services for one group or the other, but a stronger interest in working on the part of TTW participants. It is likely that those with unmet service needs were more likely to assign their Ticket, which might account for the elevated rate of reported unmet service needs among TTW participants relative to all Phase 1 beneficiaries. Presumably, participants’ unmet needs would have been even higher in the absence of TTW.

In answer to the question about why they did not receive needed services, all Phase I beneficiaries most commonly cited lack of information, inability to afford services, and ineligibility for services. Inability to afford services was less commonly cited by TTW participants, but lack of information and ineligibility were cited about as frequently. A relatively large number of TTW participants cited problems with the services or their provider—especially those who assigned their Ticket to an EN.

The next chapter examines the employment status of all Phase I beneficiaries and TTW participants, in particular when the NBS was conducted in 2004, and presents extensive information on the job characteristics for those who were employed.

Exhibit V.8. Phase 1 Beneficiaries with an Unmet Need for Services, Equipment, or Supports, and Reasons Why Needed Services Were Not Received in 2003, Overall and by Selected TTW Subgroups (Percentages)
  All Phase 1 Beneficiaries TTW Participants
All Participants Assigned to EN Assigned to SVRA
Did Not Receive Needed Services 11 21a 22 20
Reason(s) Why Services Were Not Received

Those with Unmet Service Needs

Lack of information 19 21 25 20
Could not afford services 19 11 6 12
Not eligible/request refused 18 19 15 19
Problems with services/provider 8 16 23 15
Too difficult/confusing 2 5 6 5
Did not try to get services 1 4 2 4
Other 28 21 19 21
Don't Know 5 4 4 4

Source: 2004 NBS. Sample size = 2,932.

Note: EN and SVRA assignment based on the provider to which the Ticket was assigned for the longest period during 2003.

a Significantly different from all Phase 1 beneficiaries at the .05 level, two-tailed test.

E. Service Use by TTW Rollout Phase

When interviewed in 2004, NBS respondents were asked about their service use during calendar year 2003. By the end of 2003, TTW had been fully implemented for just over a year in the Phase 1 states, had just completed full implementation in the Phase 2 states, and had just begun the first Ticket mailings in the Phase 3 states.6 The phased rollout allows us to use the survey data to explore whether implementation of TTW might have had an effect on service use by comparing 2003 service utilization patterns across the three phases, with a focus on comparing service use patterns in Phase 1 states, where TTW had been fully implemented for over a year, with the patterns in Phase 3 states, where TTW had not yet been implemented.

As noted elsewhere in this report, TTW participation in the Phase 1 states was extremely low in 2003. TTW participants represented just over one percent of all Phase 1 beneficiaries who used services in 2003. This suggests that TTW would likely have little or no effect on overall service use patterns. But implementation of TTW might have affected the service use patterns of nonparticipants. SSA’s greater focus on work incentives and return-to-work, along with the fact that nearly every beneficiary was mailed a Ticket encouraging them to seek return-to-work services, might have had a more generalized impact on the likelihood that beneficiaries would seek and receive services, the reasons they used services, and the types of services they received. In addition, SSA’s outreach, through the Program Manager, to recruit TTW providers and its interactions with SVRAs in implementing the new Ticket assignment and payment policies may have focused provider attention on SSA beneficiaries and influenced service delivery patterns in subtle ways, even among providers not serving beneficiaries under TTW. Comparing the service use patterns of beneficiaries in the three phases might provide some information about whether TTW had any kind of general influence.

In the sections below, we present information about the likelihood of using services, the reasons for using services, and the types of services used by phase of TTW implementation. The analysis is intended to be exploratory and descriptive in nature, and not intended to represent rigorous impacts of TTW on service use. More rigorous methods for estimating the impacts of TTW on service use using administrative data are presented in Chapter XIII. Because the survey data allow us to explore aspects of service utilization that cannot be addressed with administrative data, we present descriptive findings here to complement the analyses presented in Chapter XIII. The survey findings presented below suggest that, overall, TTW had no impact on service use. Although the findings discussed in previous sections of this chapter indicate that TTW participants used services at higher rates and for different reasons relative to all beneficiaries, the differences are not reflected in the overall patterns of service use across phases because TTW participants represent only a very small share of all service users. More general effects of TTW on service users and providers, regardless of attachment to TTW, are not suggested by the survey data findings.

1. Overall Rates of Service Use

In Exhibit V.9, we show the percentage of beneficiaries who used any services during 2003 by TTW implementation phase, and for Phase 1 beneficiaries, by TTW participation status. Overall, Phase 1 beneficiaries were somewhat more likely than either Phase 2 or Phase 3 beneficiaries to have used services in 2003 (34 percent in Phase 1, compared with 29 percent and 30 percent of Phase 2 and Phase 3 beneficiaries, respectively). As noted previously and shown in Exhibit V.9, TTW participants were significantly more likely to use services relative to nonparticipants, perhaps contributing to the slightly higher overall Phase 1 service utilization rate. But the small differences in the service use rates across phases might simply be due to differences in beneficiary characteristics that influence service needs and use. To examine whether the likelihood of service use was greater among Phase 1 beneficiaries after controlling for a variety of sociodemographic, programmatic, and health characteristics, we estimated a multivariate (logit) model of the likelihood of using services in 2003, including variables to represent the phase of TTW implementation (Appendix Table B.29). The model indicates that, all else constant, beneficiaries in Phase 1 states were no more or less likely to use services than beneficiaries in Phase 2 or Phase 3 states.

Exhibit V.9. Service Use Among Beneficiaries by Phase and TTW Participation Status (Percentages)

Exhibit V.9. Service Use Among Beneficiaries by Phase and TTW Participation Status (Percentages)
[D]
Source: 2004 NBS. Sample size = 2,775.

2. Reasons for Using Services

Although showing no detectible effect on the overall likelihood of using services after controlling for beneficiary characteristics, TTW might have influenced service users’ reasons for using services and/or the types of services they received. Given TTW’s strong employment focus we might expect that more service users in Phase 1 states would be using services for purposes related to employment. As shown previously, relative to all service users, TTW participants were significantly more likely to report using services for purposes of getting a job or to increase income. In Exhibit V.10, we show selected reasons for using services reported by beneficiaries in the three phases. There are not large differences across the phases in the percentage of beneficiaries reporting that they used services for purposes of getting a job or increasing income. In fact, the percentage of beneficiaries reporting these reasons is lower among Phase 1 service users than among Phase 2 and Phase 3 service users. Phase 1 service users were about as likely as those in other phases to report using services for purposes of improving their health, and were somewhat more likely to report using service to improve their ability to do daily activities. After controlling for other characteristics in a series of multivariate models estimating the likelihood of reporting the four reasons for using services shown in Exhibit V.10, we find that, with one exception, the differences across the phases are not statistically significant. The exception was with respect to the likelihood of reporting using services for purposes of improving ability to do daily activities. All else constant, Phase 1 services users were significantly more likely to report this reason relative to service users residing in Phases 2 and Phase 3 states (Appendix Table B.30).

Exhibit V.10. Selected Reasons for Using Services, by Phase (Percentage Reporting Reason)

Exhibit V.10. Selected Reasons for Using Services, by Phase (Percentage Reporting Reason)
[D]
Source: 2004 NBS. Sample size = 2,775.

3. Types of Services Used

If TTW had an impact on the types of services used, we would expect to find that service users in Phase 1 states were more likely to use services that would most directly affect the likelihood of employment than service users in Phase 2 or Phase 3 states. As shown in Exhibit V.11, Phase 1 beneficiaries were only slightly more likely than beneficiaries in other phases to use job-related services such as work assessments, help finding a job, job training, advice about modifying a job, and on-the-job training. However, after controlling for differences in beneficiary characteristics in a series of multivariate models estimating the likelihood of using different service types, the differences across phases in the likelihood of using employment-related services were not statistically significant. The only significant difference was with respect to the use of medical procedures. All else constant, Phase 1 beneficiaries were significantly less likely to use medical procedures relative to service users in Phase 2 and Phase 3 states (Appendix Table B.31). There were no statistically significant differences in the use of personal counseling or group therapy, OT/PT/speech therapy, or special equipment or devices across phases after controlling for differences in beneficiary characteristics.

Exhibit V.11. Types of Services Used in 2003, by Phase (Percentage Reporting Service Type)

Exhibit V.11. Types of Services Used in 2003, by Phase (Percentage Reporting Service Type)
[D]
Source: 2004 NBS. Sample size = 2,775.

 


1 Ticket participants are included in the sample for all Phase 1 beneficiaries, but they represent less than 1 percent of the sample after weighting. (back)

2 For each provider used in 2003, respondents were asked whether they received any of 12 specific types of services from the provider; they were then asked an open-ended question about any other services received from the provider not already queried. (back)

3 We also assessed service intensity by assigning unit costs to different types of services, multiplying the unit cost by the hours reported for the respective service type, and comparing the distribution of total costs across the groups shown in Exhibit V.4. The general findings were very similar to the findings using service hours as the measure of intensity: the median TTW participant received about three times the level of services compared with the median Phase 1 service user; and the median TTW participant with a Ticket assigned to an SVRA received about three times the level of services received by the median TTW participant with a Ticket assigned to an EN.  While the cost estimate levels were sensitive to the assumptions used to develop the unit costs, the relative differences across the groups being compared did not vary substantially when the unit cost assumptions were varied. Because of the somewhat arbitrary manner in which unit costs were assigned and the greater uncertainty associated with the estimates, we chose not to report the cost estimates and instead rely on reported service hours as the measure of service intensity to compare across groups. (back)

4 Note that TTW participants may have received services from several providers, including services not provided or arranged by TTW providers. The usefulness ratings from TTW participants in Exhibit V.4 include the ratings for all providers used in 2003, not just the EN or SVRA to which the Ticket was assigned. (back)

5 For this model, the ratings for each provider were assigned a value of 1 to 4, with 1 being the lowest. The average rating across all providers for each beneficiary was then calculated. If a beneficiary’s average rating for all providers was equal to 3.5 or higher, that beneficiary was considered to have rated the services used during 2003 as useful. (back)

6 Phase 3 TTW implementation began in November 2003, when 10 percent of eligible Phase 3 beneficiaries were mailed Tickets. No Tickets were mailed in December 2003, and the Phase 3 rollout resumed in January 2004. See Appendix A for the complete rollout schedule by phase. (back)

 

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