Ticket to Work Evaluation (January 2006)

CHAPTER 5
EN Participation in Ticket to Work

The participation of ENs in TTW and their effectiveness in promoting the employment of beneficiaries are critical determinants of program success. An EN is a public or private agency that has signed a contract with SSA to provide employment services under TTW. ENs vary in size and capacity from small, family-owned businesses to large, multi-faceted agencies serving 1,000 clients or more. Most ENs served SSA beneficiaries before contracting as an EN; others wished to expand their services to include that population. To participate as an EN in TTW, agencies must agree to help beneficiaries leave the benefit rolls by providing services intended to foster employment. In this chapter, we discuss several issues related to the level and nature of EN participation in TTW. Major sections address EN availability nationwide and by state, factors affecting agencies’ decisions to participate as ENs, the financing of TTW services, variation in ENs’ financial success in the program, marketing and Ticket assignment decisions, services provided by ENs, and ENs’ suggestions for improving the program.

Our findings are based on analyses of administrative data from SSA and the Program Manager, and on interviews with 29 ENs selected from Phase 1 and 2 states, 10 former ENs, 14 organizations that decided not to become ENs, and staff from the Program Manager and SSA. This information supplements the findings documented in the initial evaluation report and the preliminary process evaluation report. In particular, we examined whether the new interviews yielded different impressions from those based on our interviews in 2003 with seven successful ENs and one SVRA as well as the 2001 interviews with a mix of Phase 1 ENs and SVRAs. Our latest findings generally substantiate previous findings.

For instance, we found scant evidence that the supply of rehabilitation providers for SSA beneficiaries has increased through EN participation in TTW. Although the number of ENs has continued to grow, there are still fewer than two ENs for every 10,000 beneficiaries. We noted a slower pace of enrollment and an increasing dropout rate during this evaluation period. Barely 40 percent of ENs had accepted any Ticket assignments as of July 30, 2004, over half of which had accepted fewer than four Tickets. Our interviews revealed that several factors continue to impede EN participation, including a perceived lack of financial incentive; an unwillingness to substitute TTW funding, which is seen as risky, for more stable funding sources from other programs; a perceived lack of beneficiary demand for the services ENs are offering; concern that Ticketholders will be unwilling to leave the benefit rolls; cumbersome EN payment mechanisms; and a poor economy.

ENs were reluctant to expand services or otherwise alter their processes and structures for a revenue stream they viewed as shaky. Although we discovered a few innovative service models, most ENs provide the same services to SSA beneficiaries that they always have. Some provide low levels of service, such as assisting with resume preparation and referral to job openings. Other ENs simply refer Ticket holders to SVRAs, who then refer the beneficiary back to the EN for payment under an existing service agreement. Almost all of the ENs we interviewed had served SSA beneficiaries before TTW was initiated.

ENs typically were paying for overhead and direct services out of other existing funding sources, not with revenues from Ticket payments. Only 31 percent of ENs nationwide who had accepted Tickets had received any payments; 76 percent of them had received less than $5,000. Not surprisingly, the ENs we interviewed for this report overwhelmingly suggested changes to the payment systems, such as larger milestone or up-front payments. We return to this issue in Chapter VIII which simulates the financial incentives TTW provides to ENs.

A major goal of the TTW legislation is to increase the supply of rehabilitation providers by offering payments to ENs who assist SSA beneficiaries to leave the benefit rolls. Before the TTW legislation was passed, SSA offered payments to SVRAs (and, for a few years, organizations in the Alternate Participant Program) for serving beneficiaries. The legislation is based upon the assumption that agencies with the potential to serve SSA beneficiaries will participate as ENs to the extent that there is demand for return-to-work services and the payments cover their costs. The purpose of this section is to review the availability of ENs and draw conclusions as to whether the supply of rehabilitation providers has actually increased through their participation.

Since the initial evaluation report was prepared in fall 2003, the number of providers participating in TTW as ENs has continued to grow, reaching 1,164 at the end of June 2004 (Figure V.1). The slower pace of EN enrollment in spring 2004 was, according to the Program Manager, the result of market saturation and increasing difficulty in selling “a product that nobody wants to buy.” In early fall 2004, as TTW neared full implementation,¹ the Program Manager was beginning to focus EN recruiting efforts on specific provider groups, such as nontraditional or faith-based providers, and on ENs in major metropolitan areas where large numbers of beneficiaries reside.

Although the number of ENs has grown over time, most ENs still have not accepted any Tickets, continuing a trend discussed in the initial evaluation report (Figure V.1). Of the more than 1,100 ENs enrolled in TTW at the end of June 2004, only 454 (40 percent) had any Ticket assignments (Table V.1). Furthermore, most of the ENs that have accepted Tickets have accepted 4 or fewer. Less than 3 percent of ENs had 30 or more Tickets.

Click for Figure V.1. Cumulative Number of ENs, by Month (Opens in new window)

Source: Ticket Research File, March 2004, and EN Provider File, June 2004.

As of July 2004, there were about 1.8 ENs for every 10,000 Ticket eligible beneficiaries in Phase 1 states, on average, and slightly fewer in Phase 2 states, but EN availability varied considerably by state (Table V.2). For example, Mississippi had just 0.23 ENs per 10,000 Ticket eligible beneficiaries, while North Dakota had over 5. This number, although quite small, overstates the availability of ENs given that most ENs are not taking Tickets and therefore not actively providing services. In addition, some of the ENs that are taking Tickets are small and do not currently have the capacity to serve more than a few beneficiaries. For the next report we will explore other indicators of EN availability, including the number in each county.

From February through October 2004, we collected qualitative data through 47 in-person and telephone interviews. We spoke with representatives of 29 ENs, 8 SVRAs, and 10 former ENs (organizations that had formally withdrawn from the program). We also interviewed representatives of 14 agencies that had attended an EN Opportunity Conference sponsored by the Program Manager but decided not to become ENs. Except where specified, the information in the remainder of the chapter is drawn from these interviews. Appendix D describes sampling and data collection activities. This section explores the factors affecting EN participation in the program, which ENs have received TTW payments, and the factors that influence their financial success in this early period of TTW implementation. The experiences of these ENs may be a harbinger of future program participation and success.

1. Factors Affecting EN Participation

a. Current Participation

To participate as an EN, agencies must submit an application to the Program Manager. Once the application is reviewed by the Program Manager and approved by SSA, the EN may start accepting Tickets from beneficiaries.

Many representatives of the participating ENs we interviewed in 2004 cited the same basic reasons for joining TTW that were cited by those interviewed in 2002. For instance, most of the 29 EN representatives we interviewed saw TTW as a program that would be congruent with their mission, which revolves largely around the delivery of human services. In the words of one organization president, “This is what we do. Ticket to Work fits perfectly with our work.” Some EN representatives saw TTW as a way to extend their services to a new area or to different types of clients. ENs generally did not approach TTW from a business perspective. Indeed, only eight ENs had developed a formal business plan. Most of the rest treated assessments of potential profitability as little more than “back-of-the-envelope calculations.” Because nearly all had provided services to SSA beneficiaries before TTW, they saw in TTW the potential to bring in an unknown amount of additional revenue, blending program services into those they regularly offer.

Sources: Number of ENs from MAXIMUS Summary Ticket Roll Out Status #124, July 6, 2004; number of Ticket-eligible beneficiaries from Ticket Research File as of March 2004.
Note: Table excludes 11 “national ENs” not assigned to any state and all ENs in Phase 3 states.

But most EN representatives saw TTW as a small supplement to existing funding and not as a major source of revenue. The following comment is typical:

“Most of our employment services are fee-for-service from VR. The fees we collect are insufficient to serve all of the clients we would like, so we hoped that funds derived from Ticket to Work participation would supplement funds to maintain our existing programs.”

Very few of the EN representatives we interviewed said that their organization began serving SSA beneficiaries after becoming ENs. Thus, the experiences of our selected (and not necessarily representative) sample of ENs suggest that TTW has not substantially expanded the number of rehabilitation providers for SSA beneficiaries.

Our most recent interviews also provided an opportunity to explore two new topics related to EN participation: the factors that have influenced organizations’ decisions not to become ENs and the factors that have led some ENs to withdraw from TTW.

b. Reasons for Not Becoming an EN

We discussed the rationale for not becoming an EN with 14 representatives of service providers that had attended a Program Manager-sponsored EN Opportunity Conference in 2003 to obtain information about TTW but did not become ENs. They gave several reasons for their decision:

• Lack of Funds and Financial Risk. About half of the 14 service providers either said that they did not have the funds to pay for up-front services such as training and job placement, or that TTW was too financially risky. One provider described the payment system as “paying too little money to a provider and requiring the provider to assume too much financial risk up front.” Another provider said, “Potential financial rewards under the Ticket were not worth the financial risk.”
  
  
• Clients Are Unlikely to Generate Payments. About a third of the providers we spoke to said their usual clients had such severe disabilities that they probably would never work at levels high enough to reduce cash benefits to zero, which meant that providers would have a slim chance of receiving substantial payments under TTW.
  
  
• Administrative Complexity. To several providers, TTW seemed too complex in terms of the application process, payment structure, or the requirement to collect pay stubs. In the words of one provider, “The program is just too complicated.”

Other reasons given by providers for not participating as ENs in TTW included satisfaction with their existing SVRA referral and service arrangements and a belief that TTW would not add any benefit above and beyond that arrangement; sufficient funding from other sources to provide employment services to their SSA beneficiary clients; and internal resource issues such not having enough staff to follow up on the application.

Most of these 14 organizations were not planning to reassess their decision regarding participation in TTW. A few providers said they might reconsider the program, however, if the payment structure were changed to provide up-front payments, thus reducing financial risk. A few others were planning to reconsider the program at some point in the future, depending on changes in their organizations’ priorities and staffing.

c. Reasons for Leaving TTW

Through June 2004, according to data provided by the Program Manager, 73 ENs had terminated their participation in TTW by contacting the Program Manager and formally withdrawing from the program (Figure V.2). These 73 ENs represented about six percent of the total number of entities that had ever become ENs by that time.

Subsequent interviews with the Program Manager’s staff revealed that, by the end of September 2004, the cumulative number of ENs that had left the program reached 116, or about 8 percent of all applicants and 10 percent of approved ENs, a substantial increase over just a few months.

According to Program Manager staff, some ENs have dropped out of the program because of a lack of beneficiary demand for their services, others have had difficulty collecting the earnings documentation necessary to receive payments, and still others found that the costs of participating in TTW far outweighed the revenues. We also addressed this question directly with representatives of 10 former ENs,² only 4 of which had accepted more than 15 tickets, while 4 had accepted 10 or less, and 2 had accepted none. Their answers generally echoed those offered by the Program Manager. That is, 9 former ENs cited a lack of demand for services and/or insufficient interest on the part of beneficiaries. According to the interviewees, a high proportion of the beneficiaries who contacted them became disinterested in the program when they learned that the goal was to go off cash benefits; these beneficiaries viewed going off of cash benefits as undesirable or risky.

Representatives of former ENs also gave a number of other reasons for leaving TTW:

• Inability to Accommodate the Ticket Holders Seeking Services. Some former ENs could not accommodate beneficiaries who had contacted them. One official noted that a high percentage of callers lived outside the organization’s service area; another explained that her agency was accustomed to working with people with spinal cord injuries, but most of the beneficiaries who contacted them about TTW had various other kinds of disabilities.

Click for Figure V.2. Number of EN Terminations, by Month (Opens in new window)

• Financial Problems. Six of the former ENs mentioned financial problems as a reason for discontinuing participation in TTW. Their common concern was not having the funds to cover program operating costs (for example, screening callers, getting Tickets assigned, working with Ticket holders) until clients generated a revenue stream. In short, they found the program financially infeasible. Two of the six dropped out of TTW before even accepting a single Ticket. Of the four that accepted Tickets, three placed a total of about six clients in jobs, but it was clear to these providers that most of these clients would never generate payments.
  
  
• Administrative Issues. Four former EN representatives cited a variety of administrative difficulties, including the burden of obtaining clients’ pay stubs; lack of access to relevant client information from SSA, the Program Manager, and the Benefits Planning, Assistance, and Outreach program (BPAO); and inadequate or inconsistent assistance from the Program Manager.
  
  
• Mismatch Between Beneficiary Needs and EN Services. Some former EN officials reported that although some Ticket clients were interested in working, they were not well qualified for employment. Many Ticket holders had never worked or acquired work skills or training, so they never had the opportunity to develop realistic expectations about job content or availability. To serve these individuals, ENs would have to offer a plethora of long-term services for which they would probably never be paid.

Because of problems such as these, nine of the 10 former EN representatives said they had no firm plans to reassess their decision to leave TTW; only one planned to reconsider the program relatively soon. Some saw termination as permanent, but others were more open to rejoining the program under certain circumstances—for example, if the payment system were changed substantially (providing up-front payments or payments for beneficiaries who go to work part time), or if they could identify other funding sources that would enable them to provide up-front services to TTW beneficiaries.

2. Financing TTW Services

ENs’ participation and success in TTW depends heavily on their ability to finance the services necessary to return TTW beneficiaries to work. How to pay for services—when it could be a long time before those costs are recouped through Ticket payments if they are recouped at all—has been a significant issue for ENs since the beginning of the program and was discussed in both the initial evaluation report and the preliminary process evaluation report. Recent interviews with 29 EN representatives suggest that ENs dealt with the financing of TTW services in two ways. First, most of them took a cautious approach to service provision, reducing risk by keeping costs down and selecting clients with the most potential for success. Second, they paid for the up-front services to TTW clients with general agency funds or other existing funds such as profits from fee-for-service contracts or grants from developmental disabilities, mental health, and vocational rehabilitation programs. None of the ENs we contacted had obtained new funding sources specifically to finance up-front TTW costs.

Only one of the EN officials we spoke with said her agency had sought formal approval from its government funding sources to use their funds to serve Ticket holders. Although neither funding source objected, this official expressed concern that if the EN began to bring in significant revenue from TTW, the funding agencies might begin to object, seeing the EN as “double-dipping”—that is, getting funds from two sources for the same services to the same clients. She worried that if this perception took hold, the more stable government funding sources might withdraw their support.

One EN representative from a private for-profit staffing agency serving multiple states described a financing approach that apparently none of the others had taken. The agency devotes one-quarter of a full-time equivalent (FTE) position, funded through existing revenues, to certain upfront services such as client screening, but uses part-time contractors on a commission basis to provide job placement and follow-up services to beneficiaries. These contractors provide generally similar services for a variety of other agencies and worked for this EN to earn extra cash. They receive no base pay but are paid $100 for each individual work plan (IWP) they develop as well as an additional amount for each milestone or outcome payment a beneficiary eventually generates. Thus far, however, the agency has received a total of just about $2,000 on its 10 to 15 employed Ticket holders, which did not come close to covering its costs.

The 29 EN officials we interviewed said that an SSA-funded effort to help ENs nationwide secure financing for up-front Ticket services has been of little or no help. The effort was intended to acquaint ENs with grants, loans, and other resources through a “capitalization initiative” developed by the Program Manager. The initiative involves written resource materials and presentations at conferences and workshops around the country. All ENs were reportedly notified about the initiative in the mail and sent a copy of the materials, which can also be accessed on the Program Manager’s TTW website. About half of the EN representatives we interviewed, however, were unaware of this initiative. Among those who had heard of it, most had only a vague notion of what it was about. Only a few EN officials claimed any real familiarity with it, but none of them had used the information to secure funds for three reasons: they did not see the need for the initiative, they felt that it would not be a good fit for their agency, or they did not have the time or staff to devote to such an effort. One EN Ticket coordinator who had attended an information session on the initiative saw it as an attempt to transfer the responsibility for what was essentially a basic program design problem to ENs. According to this interviewee, “We’re not interested in fundraising. We’re doing SSA a favor” by operating as an EN. Rather than promoting fundraising, she said, SSA should adjust the payment system so that participating organizations do not need to go out and raise funds.

3. EN Financial Success Under TTW

A comprehensive analysis of EN financial success would require detailed cost and revenue information, which was beyond the scope of our data collection activities this year. However, we can provide a national overview of Ticket revenues based on data on payments made to ENs, and for the 29 ENs we studied we can discuss their self-reported financial success and their experience with the factors that affect revenues—placements and the operation of the payment system. We return to the issue of ENs’ financial success in Chapter VIII, which documents a simulation of the net financial incentives provided to ENs by TTW.

a. National Data on Payments to ENs

As of late July 2004, a cumulative total of about $900,000 in milestone and outcome payments had been made to ENs for Ticket holders who had returned to work³ (Figure V.3). Most of this money (79 percent) was paid to ENs for Ticket holders residing in Phase 1 states, which is to be expected because ENs in those states have generally been taking Tickets longer than those in Phase 2 states. The dollar amount of monthly payments has generally been increasing, although there was a pronounced dip in the second half of 2003 (Figure V.4).

Click for Figure V.3. Cumulative Payments to ENs (Opens in new window)

Click for Figure V.4. Payments to ENs by Month (Opens in new window)

Relatively few ENs have received any payments, and for most of those who did, the value of those payments has been relatively low (Table V.3). As of late July 2004, just 142 ENs had received at least one payment. This represents about 31 percent of all ENs with Ticket assignments but only about 13 percent of all ENs in the program at the time. The majority of the ENs receiving payments (108 of 142, or 76 percent) had received total payments amounting to less than $5,000. On the high end, 7 ENs, representing about 5 percent of those that had received any payments, had received total payments amounting to $20,000 or more.

Source: Ticket Research File, March 2004, and EN payment data provided by OESP as of July, 20, 2004.
*Phase 1, 2, and 3 columns may not sum to the numbers below, because this column includes ENs operating in more than one phase.

b. ENs’ Reported Financial Success

Our interviews with ENs suggest that financial success has eluded most ENs thus far. This finding confirms the results covered in the initial evaluation report. At that time, officials from the seven non-SVRA ENs with the highest number of Ticket assignments all reported “losing money on TTW.” Some had dramatically scaled back their operations, and others saw that choice as being inevitable unless the payment systems were changed to make the program more profitable. For this report, we interviewed a larger, more diverse sample of 29 ENs and found that only 2 of them appeared to be succeeding financially under TTW. Twenty-three of the recently interviewed EN officials said they had accepted one or more Tickets, making it theoretically possible for them to earn milestone or outcome payments directly (as opposed to sharing payments for clients whose Tickets were held by SVRAs). But most of these ENs were experiencing financial difficulties under TTW, including some of those with the most Ticket assignments. While several had received some payments, most had received none. Below we summarize the experiences of the 23 ENs that had accepted at least one Ticket by grouping them according to the revenue that they have generated from TTW.

ENs with Substantial Payment Revenues. Three of the 23 ENs had received over $5,000 in Ticket payments, substantially more than all the others. Only two of the three, however, considered their activities under TTW to be successful. One is a large, nonprofit organization that provides job training and career services. The other is a modest-sized, for-profit organization operating in a Phase 1 state.

The nonprofit EN has seven local contracts with federal agencies under the Javits Wagner O’Day (JWOD) program,⁴ which pre-dated TTW. Under these contracts, the EN hires individuals, including Ticket holders, who provide janitorial, cleaning, and cafeteria services in local military installations. Of its 15 Ticket clients who are employed, 14 obtained their jobs through these employment contracts. Because these employees are paid through the EN, the EN had no trouble acquiring earnings documentation necessary for receiving payments. A representative of this EN said he was “totally amazed” by the amount of revenue generated by TTW clients. Although it took a year to generate the first payment, the EN had reportedly received more than $10,000 in total payments on behalf of nine clients at the time of the interview.

An official at the for-profit EN reported that TTW revenue has “kept me in business.” EN staff have chosen clients selectively, looking for highly interested, skilled beneficiaries who wanted to work full time. The EN did not advertise because it felt that clients who took the initiative to seek out the organization would be more of an asset. Eight of the EN’s clients were working above SGA, and twice that number were looking for jobs. Staff tell clients that they are doing themselves a favor by submitting their earnings documentation because this proves to SSA that they are working, which will facilitate administration of their benefits and expedited reinstatement, if that is necessary. According to one official, clients have responded favorably to this approach, and aside from making some reminder phone calls, the EN had had no problems getting pay stubs. At the time of the interview, the organization reported having received 12 to 15 payments, and more were expected.

The third EN that received over $5,000 in Ticket revenues had a substantially different experience than the other two; it had lost money on the program. At the time of the interview, the organization had decided to enter “hold” status in the program, meaning that it would not accept any new Ticket assignments even though it would continue working with beneficiaries whose Tickets it had already taken. The TTW coordinator reached this decision after she realized that payments from SSA covered only 25 to 30 percent of program costs. She also said it was more lucrative for this organization to work with its SVRA under the traditional reimbursement system, which was established pre-TTW.

ENs with Modest Payment Revenues. Six of the 23 ENs that accepted at least one Ticket generated total payments of less than $5,000. All six of them, however, had spent significantly more on TTW than they had received in payments. In the words of one representative, “We’re like a charity. We’re interviewing people, taking calls, handling all this, yet there’s no money.” These six ENs had two main complaints about the process for collecting payments: (1) it was difficult to obtain the earnings documentation required for payment claims, and (2) payment processing time has been slow.

According to their representatives, most of these modest-revenue ENs would accept more Tickets if they had more money to cover costs. The absence of up-front funding, the slow revenue stream, and the payments foregone for lack of documentation made it difficult for these ENs to grow. If their revenue streams pick up, most of them would devote more resources to TTW, such as hiring new staff or devoting more existing staff time to the program. One EN official said, “If we had more funding to hire another staff member, the [placement] numbers would definitely go up. But we’re always waiting to get paid.”

ENs with No Payment Revenues. Fourteen of the 29 ENs that accepted at least one Ticket had not generated a single payment at the time of the interview. As explained below, 3 of the 14 showed some promise for success, as they were expecting to generate payments in the near future.

• One EN helped 12 Ticket holders leave the rolls, but it had not submitted any payment claims to SSA because it had not been able to collect earnings documentation. A representative said he planned to establish a system to collect the documentation and submit invoices to SSA.
  
  
• The second EN was going to employ TTW beneficiaries directly because the owner felt that this would greatly facilitate the collection of earnings documentation.
  
  
• The third EN’s president reported that 6 beneficiaries were earning an income above the SGA level, and she was aiming to have 10 beneficiaries generating payments by 2005.
  

For the remaining 11 ENs that generated no payments, there was little or no sign that they could expect payments anytime soon. Their level of participation in the program was very low. Two of them, in fact, essentially did not consider themselves as TTW participants at the time of the interview despite the fact that they had accepted one or more Tickets in the past. One reported being shut out of the market by the SVRA; the other reported that it did not fully understand the responsibilities of an EN when it joined the program and was unwilling to make the effort necessary to help beneficiaries find jobs. A variety of factors explains why the other nine had low participation levels that seemed to limit their potential for collecting Ticket payments. For example, two are small organizations with limited capacity; a few prefer to serve beneficiaries whose Tickets are held by an SVRA, so they are compensated under a fee-for-service agreement; one typically refers beneficiaries to a national EN that shares payments with the beneficiaries; and one rarely encourages clients to leave the benefits rolls, believing that most of the beneficiaries they serve need cash assistance.

Like the ENs with modest payment revenues, ENs with no payment revenues complained most often about the TTW payment system and sometimes about the burden of responding to telephone inquiries from Ticket holders. Virtually all would like SSA to change the payment system so that funding is provided for up-front services. One representative suggested that the ENs should be able to request up-front funding in the IWP based on a beneficiary’s needs. Another EN official said, “I don’t know of any agency that could afford to work with someone for a year without getting paid for it.” ENs also reported that educating callers about TTW is time consuming and particularly burdensome for organizations whose TTW clients are not generating any payments. One EN representative highlighted a disjuncture between what his organization wants to do and what it is equipped to do. While his staff want to “help steer people in the right direction,” it has been difficult for the organization to cover all of the staff time required to deal with the heavy volume of calls.

c. Challenges Related to Placing TTW Clients and Receiving Payment

Placing Ticket holders in jobs (or helping them to find employment on their own) is the first critical step on the path to receiving payments for services. Our interviews made it clear, however, that placing TTW clients can be a substantial challenge for a number of reasons, including client characteristics and external circumstances.

Client Characteristics. EN officials who said that client characteristics were a challenge to placement had, in many cases, not used a very careful or extensive screening process in deciding to accept beneficiaries’ Tickets. Others tried to screen out potentially difficult-to-place individuals, with the idea that placement would be easier. Overall, however, ENs cited a variety of characteristics that made it difficult to place clients appropriately.

Just under half of the EN officials we interviewed felt that some clients did not show enough interest in moving completely off of cash benefits. Many were interested only in part-time work, which would enable them to keep some cash and medical benefits. This is particularly true for two groups of individuals: those with only a few work skills who felt they could not earn enough to offset the loss in benefits and those with extensive work experience, which qualified them for very high DI payments.

The second characteristic most often mentioned by ENs is related to human capital—specifically, a lack of education, skills, or work experience. EN officials said that it was difficult to work with beneficiaries who have been out of the labor market for a number of years, who have limited skills and need to enroll in school or a training course, or who have been working in a sheltered workshop program.

About one-third of the EN representatives cited psychiatric or other disabilities as a challenge to placing TTW beneficiaries. Other characteristics mentioned included lack of a support network, no reliable transportation, fear of the system, and unreasonably high job expectations.

External Circumstances. About one-third of the EN officials cited a poor local economy as a challenge to placing clients. The tight job market has apparently caused more beneficiaries to turn to the ENs for help, but job openings are few and far between, and the competition for each available position is tough. A good example of the state of the local economy comes from one EN official, who said that her staff cannot even find volunteer positions, let alone ones that would pay at the level of SGA.

Five EN officials recognized that internal organizational factors have made placement difficult. For instance, three of them had little experience finding the types of jobs needed by their TTW clients. One representative said, “It’s slow because we don’t have the search end of it going to where we can find them a job.” The other two said that limited funding for TTW clients curtails the services they can provide without taking on too much financial risk.

Two EN representatives encountered employers who were hesitant to hire individuals with disabilities. One EN representative said that he is teaching his staff strategies for explaining to employers the advantages of hiring workers with disabilities. Recognizing that employers may need more information before they are comfortable hiring workers with disabilities, another EN uses job developers to aggressively educate employers about the advantages of hiring workers with disabilities.

d. Challenges to Getting Paid

Even when ENs place TTW clients in jobs, milestone and outcome payments can be difficult to get. According to EN officials, two factors contribute to this problem. First, it is difficult to obtain copies of beneficiaries’ pay stubs to provide to the Program Manager, and second, the payment process itself is time-consuming. These concerns are also documented in the initial evaluation report and in the preliminary process evaluation report, suggesting that little progress has been made in finding a solution to the payment problem.

Obtaining Adequate Earnings Information from Beneficiaries. Only 11 of the EN officials we interviewed had submitted payment claims, but 9 of them said that obtaining the required earnings evidence was problematic—so problematic, in fact, that some of them had foregone payments they had earned. (Three of the former EN representatives also cited this challenge.) One EN official said getting earnings documentation was “the problem” with TTW. Another said, “It is one major pain to collect pay stubs. It’s almost worse than placing the person in the first place. I’m not kidding.”

Earning information can be obtained from two sources: the beneficiary and the employer. According to some EN officials, it is difficult to obtain the information from beneficiaries because they want to distance themselves from the EN or cut off contact altogether once they have found a job. ENs said that some beneficiaries stop returning phone calls once they have jobs, and others forget to submit earnings documentation. According to one former EN official, “Once beneficiaries were employed, they hid from us, and I was chasing them down. That’s why I quit.” An official from an EN that had placed 23 people said, “It’s very, very, very hard. I constantly have to send out letters once a month to [beneficiaries].” This EN included self-addressed stamped envelopes in the request for information and even offered to meet beneficiaries at their homes to get pay stubs.⁵ But beneficiaries would argue, “SSA knows I’m working, so why do I have to give you my pay stub?” The official said collecting pay stubs is a problem for about a quarter of TTW beneficiaries they have placed. Some clients were employed for about a year but never sent in a pay stub.

Theoretically, employers can provide earnings information, but asking them directly for the information was not always an option for these ENs. Some employers are reluctant to release information because of privacy laws, and others charge a fee for earnings verification. In some cases, the EN cannot communicate with an employer because they want to respect beneficiaries’ wishes that their employers not find out they have a disability.

Another problem is that pay stubs, even if the EN can obtain them, may not have the information needed for the claim to be processed, such as the beginning and ending date of each pay period. This issue has resulted in protracted discussions between the Program Manager and some ENs about obtaining the needed documentation, adding cost and time to the claims payment process.

To respond to these concerns, SSA and the Program Manager implemented the Certification Outcomes Payment Process (COPP), a simplified outcome payment request option that enables ENs to receive payments without submitting beneficiary earnings documentation. As of July 2004, a relatively small number of payments had been made under this system. See Chapter VII for more discussion of this process.

Payment Processing Time. Four of the 11 EN officials that submitted payment claims said that it took too long to get paid, particularly for the first payment, which was received three to nine months after the claim was submitted. Most EN officials indicated, however, that once the first payment was received, the rest generally came more quickly and smoothly.

As mentioned, many ENs have not accepted any Tickets, and many of those that have are serving very few Ticket holders. Our recent findings on factors related to EN marketing and Ticket-taking behavior largely confirms our earlier findings in this area.

1. EN Outreach and Marketing

It appears that ENs generally did not feel it was worth their time to market the program extensively. According to our interviews, they found it difficult to reach beneficiaries who were truly interested in and could benefit from TTW. As one official said, “When we called beneficiaries from the CD Maximus provided, their response was, ‘What is this Ticket?’ ‘Is SSA going to force me back to work?’ Once they found out the nature of the program, they were not interested.”

On the other hand, many ENs received a large flow of inquiries from beneficiaries immediately following SSA’s Ticket mailings. In fact, some ENs reported that the initial volume of inquires was so large that it overwhelmed their intake and information resources. This was particularly true for some Phase 1 ENs because SSA concentrated its mailings in fewer months for that phase. However, call volume fell dramatically over time. For example, one EN official said his agency received about 500 calls per month after rollout, compared to only about 10 to 15 calls per month a year later. Another said calls had dropped from 20 per month to just 2 or 3. Only a few said that the stream of calls remained relatively steady since rollout began, and one-third of the EN representatives we interviewed said they had never received more than a few calls (one said his agency had received none at all).

EN officials had a mixed reaction to the fall-off in calls, expressing both relief and concern. The relief stems from their sense that the volume of applicants would not overwhelm their programs because most callers were not interested in TTW once they learned more about it or were in some way inappropriate for the EN. For example, many callers lived outside the EN’s service area or had impairments that were not addressed by the EN. The concern stems from the ENs’ sense that the fall in calls would mean that they would not get enough clients to make their programs viable because despite the fall, self-referrals from beneficiaries are still seen as ENs’ best source of new participants. Only a handful of ENs found TTW clients in their existing caseload or received referrals from SVRAs or other organizations.

This is not to say, however, that ENs did not conduct any outreach or marketing. In fact, half of the 29 ENs interviewed for this report indicated that they marketed their program in some way. Seven said that they publicized TTW services in general marketing materials about the agency, or that they had publicized TTW within their host agency or with other providers. Another seven marketed their services more aggressively; a few worked with EN consortia in their states to hold educational forums, contact the media, or educate employers. Four called TTW beneficiaries on the list provided by the program manager. But all of these ENs eventually halted these efforts because of low interest from beneficiaries. They generally found the efforts ineffective and/or not worth the time and cost. For example, one EN said staff had made 500 calls to beneficiaries in the program manager’s list and found two people interested; another had organized a forum and no one showed up.

Overall, our discussions with 29 EN officials suggest that these providers face a difficult situation with respect to demand for their services. Broad efforts to contact beneficiaries, whether initiated by the ENs or the result of SSA’s Ticket mailings, seem to produce too few Ticket assignments to justify the ENs’ costs. At the same time, none of the EN officials we interviewed reported that they have found a way to target their efforts to the smaller group of beneficiaries who would be interested in and appropriate for their services. As a result, they seem to rely primarily on a small flow of calls from interested beneficiaries who are looking for employment assistance and tend to have obtained the EN’s contact information from the program manager.

2. Screening Potential Ticket Clients

EN interviews conducted in 2002 and documented in the preliminary process evaluation report indicated that screening potential Ticket clients is problematic. The reasons are threefold: (1) beneficiaries did not typically have a clear understanding of the TTW program, requiring ENs to educate them as part of the screening process, (2) ENs had to spend considerable time identifying, from among all the inquiring beneficiaries, those who were good candidates for Ticket assignment, and (3) screening typically yielded relatively few Ticket assignments.⁶ These findings are substantiated by findings from more recent EN interviews, which indicate that few beneficiaries are interested in the program once it is explained, and that EN officials are quite selective in terms of which Tickets to accept.

Educating Beneficiaries About the Program. ENs frequently begin the screening process by discussing the basic purpose of TTW and the significance of a Ticket. They reported that the program is widely misunderstood especially with regard to whether work is mandatory, whether jobs are guaranteed, and how work affects current benefits. Many EN officials pointed out that much of this initial exchange about TTW would not be necessary if key program information was effectively explained to Ticket recipients by SSA or the Program Manager, and if all recipients would read, fully understand, and trust the accuracy of such information. The topics covered would include, for example, the voluntary nature of the program, that its goal is to help beneficiaries to earn enough to leave the benefit rolls, and that participation alone is no guarantee of a job.

Determining Suitability for TTW. Next in the screening process, ENs typically try to determine whether a Ticket holder is a good candidate for TTW. They discuss and assess the individual’s willingness and ability to work at a level that will bring them to zero cash benefits status or, in other words, whether full-time employment is desirable and feasible. Virtually all the EN officials we interviewed discuss the objective of leaving the benefit rolls when screening potential clients, typically in a brief, straightforward way, by asking directly whether the person wants to work full time and go off cash benefits. As described below, only 2 of 29 EN officials reported that they somewhat downplayed the objective of achieving zero cash benefits status in hopes of increasing Ticket assignments.

• One Ticket coordinator screens for beneficiaries who want to work full time but does not talk about reaching zero cash benefits. Instead, he emphasizes that continuous involvement in TTW will help beneficiaries avoid having “their case closed,” so that they will not lose health benefits or have to “jump through hoops” to get back on the disability rolls if they have to discontinue work.
  
  
• Another EN representative found that discussing zero cash benefits with potential clients up front dissuaded many of them from participating, so she changed her approach. While being honest about the goal, she emphasizes the positive aspects of financial independence and assures beneficiaries that it is easier now than it was in the past to get back into SSA disability programs as well as Medicare and Medicaid. With so many beneficiaries relying on expensive medication, she explained, the thought of losing health insurance can be more frightening than losing cash disability benefits.
  

EN officials commonly reported that a high proportion of beneficiaries have little interest in TTW once they understand the details. For instance, many Ticket recipients are unwilling or unable to work full time, do not want to go off cash SSI or DI benefits, or fear that leaving these programs would have negative repercussions for other benefits they rely on, such as health insurance benefits. One EN representative explained:

“Two-thirds to three-fourths of the people lose interest in the program when we mention full-time employment. When we explain zero cash benefits and that the goal of the program is that they’ll get off the rolls, people get leery and are worried about losing their health insurance. That’s when they balk. Once they learned what we were doing, they were gone.”

Determining Suitability of a Particular Beneficiary. A willingness to pursue employment that will lead to zero cash benefits is not necessarily the criteria that ultimately determines whether an EN will accept a Ticket.

• Some EN representatives seek out beneficiaries whose characteristics, needs, and goals matched services offered by the organization.
  
  
• Some ENs screen for employment-related knowledge, skills, abilities, and education. One seeks people who have transferable skills. Another said that if beneficiaries cannot list their skills, he will not work with them. Beneficiaries needing education or further training are typically referred to an SVRA or another EN. As one EN representative explained, his organization cannot afford a service as potentially expensive as education, having not received any Ticket payments to date. Another said that his EN is interested in placing people in jobs, not retraining them.
  
  
• Some EN representatives think it is critical to gauge the strength of the beneficiary’s desire to work. Even if beneficiaries express a willingness to work full time toward zero cash benefits status, these ENs still might reject a potential client if they perceive that the individual is not dedicated to achieving that goal.⁷
  
  
• Several ENs decide whether to serve potential clients on the basis of proximity and reliable transportation. Some ENs serve only clients in a particular area. Others reject people who do not have transportation out of concern that they will miss job interviews or fail to meet a work schedule.
  
  
• Some ENs will not serve candidates with certain types of disabilities, preferring instead to work with people similar to their existing clients or with people whose disabilities make job placement or retention extraordinarily difficult (as mentioned, examples include psychiatric disabilities and vision impairment). The closely related issue of whether ENs are basing a service decision on which disability program beneficiaries are in—SSI or DI—almost never arose in our interviews, and when it did, it did not appear that type of benefit was being used as a hard-and-fast criterion for Ticket acceptance decisions. One EN official said she generally believes SSI-only beneficiaries are not good candidates for TTW because their typically limited employment history may be associated with lower skill levels, yet she had not rejected anyone based on their participation in SSI; indeed, her sole assigned Ticket was for an SSI beneficiary.

Although the preceding screening factors were among the most common, they were by no means the only factors cited. Several other screening criteria were mentioned by just one or two EN officials. For example, some ENs will serve only Ticket holders who are already an agency client receiving agency services under other programs; do not need potentially expensive equipment such as assistive technology; are capable of working independently without EN follow-up support services or other assistance from EN staff; are complying with a regimen prescribed by their mental health treatment program; have a telephone answering machine or voicemail; or are independent enough to go on job interviews alone so as not to create the impression that they will need an on-the-job assistant.

Ticket Assignments. Beneficiaries who meet an EN’s screening criteria are typically invited to assign their Tickets, yet many ENs found that relatively few beneficiaries were good candidates for Ticket assignment. (This is consistent with findings from earlier interviews.) Even screenings of many beneficiaries yielded few Ticket assignments, as illustrated by the following anecdotes.

• After initially screening many callers by telephone, one EN sent applications to 47 beneficiaries; only two of them returned the forms, and the EN accepted both Tickets.
  
  
• Another EN conducted “mini-intake” interviews with about 300 callers by telephone; about 25 or 30 of these individuals later came into the office for a full, one-hour intake interview; those who were still interested then met with a benefits counselor; at the time of our interview, the EN had taken a total of three Tickets.
  
  
• A third EN received 50 calls since rollout in the state; about 20 or 30 potential clients were invited to the office for intake appointments; the EN had accepted one Ticket as of the interview.

Some EN officials were disappointed that such a small percentage of beneficiary contacts resulted in Ticket assignments. They were bothered by the effort and resources they expended in the screening process for so little yield. But they also understood the economics of the program and were quite pragmatic about not serving Ticket holders who either did not buy into the program’s objectives or were unlikely to achieve the desired employment outcomes. As one EN representative said with regard to potential clients who want to work only part time, “I can’t get any money out of that, so I can’t invest a dime in that.” If Ticket holders do not understand that the program goal is to achieve earnings above the SGA level, another official said, “There’s no point in us taking them as a client.”

3. Ticket Unassignments

After Tickets are assigned, beneficiaries and providers are not inextricably linked to one another. In the market-oriented, flexible design of TTW, Ticket unassignment represents a way for Ticket holders to officially sever relations with an EN, and vice versa. A majority of the EN representatives we interviewed reported that some of the Tickets they accepted had been unassigned. In most cases, the number was very low, typically one to three, and represented a relatively small proportion of the total number of Tickets the ENs had accepted, although there were exceptions.⁸

In some cases, Ticket unassignment was initiated by clients and, in other cases, by the ENs themselves. EN officials did not always know why clients had unassigned their Tickets (clients are under no obligation to inform them), but a few reported that clients were apparently unhappy with the services they received and thought that they might end up in better jobs if they took their Tickets elsewhere. According to EN representatives, their organizations initiated unassignments for three primary reasons: (1) clients either did not make enough of an effort to get or keep a job or failed to maintain contact with the EN; (2) clients with special problems made placement and continued employment very difficult—examples include not being able to get along with anybody or having a past felony conviction; and (3) an EN lost money on the program.

It seems likely that some of the ENs that had never unassigned a Ticket will eventually do so at least once. One EN representative said she was about to unassign 2 of her 21 Tickets. Two other officials, one with over 100 Tickets, said that until our interview, they were not aware that they could unassign a Ticket.

4. Current and Future Level of Participation

in TTW Now we address factors that may affect ENs’ level of participation in TTW—that is, how actively they seek new Ticket assignments—for those that have decided, for the time being at least, to remain in the program. In the initial evaluation report, we described how financial problems were forcing some ENs—even those that had accepted substantial numbers of Tickets—to scale back their involvement. The recent round of interviews, however, provided an opportunity to address this issue with a larger, more diverse sample of ENs.

While most of the 29 ENs were still accepting or attempting to accept Tickets at the time of the interview, some of them had reservations about their level of participation in TTW. One EN was cautiously limiting the number of new clients until it had enough revenue to support an additional full-time individual to work on TTW.⁹ Another official noted that his EN would accept Tickets only from beneficiaries with no link whatsoever to the SVRA in order to avoid what it viewed as a highly negative SVRA-EN agreement. A third EN was willing to accept new Ticket clients but was not aggressively seeking any because it viewed the current payment systems as financially unattractive.

Five of the 29 EN representatives interviewed in 2004 said that their organization was not accepting new assignments at that time for various reasons. One reported that it had never really intended to accept Tickets because it was perfectly satisfied to work with beneficiaries who had assigned their Ticket to the SVRA and were then referred to the EN for services under a partnership agreement. A second EN needed to devote its resources to a large backlog of clients, which had developed because of difficulties finding good job placements under other programs it administered. The remaining three ENs had decided not to accept new assignments unless or until the payment systems were changed.

When asked about future participation in TTW, about two-thirds of the 29 EN officials said that they planned either to maintain or to reduce their current level of participation. Five of them had taken no Tickets and planned to remain inactive, citing mainly financial reasons. They wanted to see changes to the TTW payment systems, such as up-front payments, that would better cover their service costs. In the words of one EN official, “In this day and age, the bottom line is the bottom line, no matter where your heart is.” Two other factors suppressing participation were problems identifying people interested in going off the benefit rolls and an SVRA-EN agreement that put ENs in “a stranglehold.”

The eight ENs that were interested in participating more fully described various plans or ideas for doing so. One planned to start a janitorial service staffed with Ticket holders. Another, which had about 20 Tickets at the time, hoped to double this number within a year, funding some additional services through a grant from the U.S. Department of Education’s Projects with Industry program. Two of the ENs hoping to take more Tickets needed to resolve administrative issues such as staff turnover and the need for a system to collect pay stubs and submit invoices to the Program Manager.

Most EN representatives we interviewed blend TTW into their usual operations, providing Ticket holders with the same or similar services provided to their non-Ticket clients. The same was true for ENs interviewed for the two earlier reports. Most of the 20 ENs that were serving, or had served, beneficiaries under TTW offered resume assistance, skills assessment, interview training, job search assistance or job placement, vocational training, counseling, and follow-up or job retention services, all of which they provided to clients before TTW.

Some ENs, however, modified their services to accommodate TTW clients. For example, one EN, whose typical clients had little work experience and limited skills, found that some TTW clients were better educated and more qualified. Staff had to change their job search tactics to seek high-level, white-collar jobs for clients with experience as, for example, a surgeon, a nurse, and a graphic designer. A second EN typically worked with people with cognitive and physical disabilities, but most of its Ticket clients had psychological disorders. For some of these clients, EN staff needed to focus less on traditional job placement and more on job retention. A third EN found that, compared with its usual clients, certain Ticket holders—those with depression, for example—can be more difficult to motivate. EN staff ensure that these individuals have a support network and began the practice of having them call in once a week, to “pump them up.” These follow-up services were a greater challenge than anticipated because of the size of this group of clients.

Another noteworthy service trend, which did not emerge from the earlier EN interviews, is that some ENs are not accepting Tickets themselves but are referring beneficiaries to the SVRA (which would take the Tickets), then waiting for the SVRA to refer them back for services under a fee-for-service arrangement. ENs have taken this approach mainly for financial reasons: they refer clients with expensive service needs they cannot afford to cover on their own. Getting such clients (back) from the SVRA or, in other words, sharing their Tickets with the SVRA, is effectively the only way they can serve individuals with major service needs. These ENs essentially forfeited the chance to collect milestone or outcome payments in exchange for the opportunity to receive funds guaranteed to cover service costs.

It is also noteworthy that several of the ENs are taking an almost hands-off, low-intensity approach to Ticket clients, providing relatively little in the way of direct services. These ENs have provided a bit of initial assistance—for example, such as resume development or a list of job openings—but then expect clients to conduct a job search independently. The rationale for this approach is twofold. First, staff feel that this is the best way for clients to demonstrate both their initiative and their ability to succeed in the workplace. An EN representative explained, for example, that staff would not accompany clients to job interviews because “employers don’t want to hire someone with a helper.” Second, these ENs are trying to keep operational costs down. “We’re providing a bare-minimum service,” said one provider. “That’s all we can afford to provide because we get zero cash up front.”

A few ENs described notably different or interesting service approaches that had not been described in previous interviews.

• A taxi company operating as an EN accepts Tickets from individuals who want to work as independent-contractor cab drivers.
  
  
• Another employer registered as an EN contracts with major corporations to assess, train, hire, and place information technology professionals who have physical disabilities. The EN trains individuals on software applications during a one-year trial contract period with a corporation, after which the corporation decides whether to hire them directly. (This EN had not yet taken any Tickets but is willing to do so for TTW participants who meet the company’s regular eligibility criteria.)
  
  
• An EN that operates a job development and job coaching business is planning to start a janitorial business that would be staffed with Ticket holders. As the employer, the provider will have the pay stubs necessary for receiving payments from SSA.
  

The EN officials we interviewed for this report overwhelmingly proposed changes to the payment systems. This should not be surprising, given the extent to which financial issues have been raised consistently by ENs in response to questions about their level of participation. Their ideas, many of them very similar to the suggestions offered by ENs interviewed for past evaluation reports, include the following:

• Provide larger front-end milestone payments—for example, for job placement, job retention for 30 days, and retention for 60 days—so that ENs can more readily recoup costs as they are incurred. One EN representative suggested that the total for the first three milestone payments should be about $5,000. Another suggested a large lump-sum payment about 60 to 90 days after placement and “bonus” payments later on for successful retention.
  
  
• Provide funds so that ENs can purchase vocational training services for beneficiaries, similar to services available through the One-Stop system.
  
  
• Shorten the payment schedule from five years to two or three, but maintain the current maximum payment level.
  
  
• Pay ENs for services provided on a fee-for-service basis.
  
  
• Provide payments for part-time work or partial reduction in cash benefits.
  
  
• Raise payments for SSI beneficiaries. A few EN officials suggested that payments equal to those for DI beneficiaries would motivate them to serve SSI beneficiaries.
  
  
• Reduce payment processing time. EN officials believe that they should be able to expect a payment 30 to 60 days after submitting documentation.
  
  
• Develop ways to help ENs either collect employment documentation or obtain greater cooperation from clients in the process of collecting pay stubs.

| It should be noted that the ENs’ suggestions for changes were not constrained by considerations regarding their cost to SSA, nor their ease of implementation; changes to the fundamental nature of the program, such as moving it away from an outcome-based payment system, would require Congressional action.

The following are the most important recent findings on the level and nature of EN involvement in TTW:

ENs Are Not Widely Available. By mid-2004, about 1,160 organizations had enrolled in TTW as ENs, but in Phase 1 and 2 states, there was an average of fewer than two ENs for every 10,000 Ticket-eligible beneficiaries. Also, the rate of increase in EN participation has slowed throughout the rollout period, and a number of ENs have recently left the program. Low participation is most often attributed to an apparent lack of demand for EN services, beneficiary reluctance to pursue full-time work and leave the benefit rolls, insufficient funds to pay for up-front services, and the financial risks inherent in the program.

SSA Has Made Substantial Payments to ENs, but Those Payments Appear to Fall Far Short of Expenses. By mid-2004, a total of about $900,000 in milestone and outcome payments had been made to non-SVRA ENs. These funds went to just 157 ENs, representing about 35 percent of ENs with Ticket assignments and only 13 percent of all ENs. About 80 percent of ENs receiving payments had received less than $5,000. Of the three ENs we interviewed that reported over $5,000 in TTW payments, two believe that things were going well, but the third is losing money on the program and has decided not to accept any more Tickets. The handful of ENs that had received some payments, but less than $5,000, all reported that revenues have fallen far short of expenses.

Several Barriers Impede EN Success. Several ENs had trouble placing beneficiaries for a variety of reasons, including client characteristics (e.g., level of interest in working full time and leaving the benefit rolls, and the nature of their disabilities) and other circumstances (e.g., a slow economy or an internal shortage of resources for helping clients find jobs). When identifying challenges to success under TTW, some ENs also pointed to aspects of the payment system, particularly the difficulties associated with obtaining earnings documentation. Accordingly, most suggestions for improving the program have to do with restructuring the payment systems and revising related processes.

Ticket Assignments Are Few and Far Between. Sixty percent of all ENs have taken no Tickets; over 20 percent have taken fewer than four Tickets. EN representatives told us they devoted considerable effort to answering basic questions from potential clients about TTW, educating them about the program’s purpose. These ENs frequently found, however, that many callers were not interested in pursuing employment at a level that would lead to zero cash benefits. And even when they were, ENs sometimes screened them out for other reasons, such as not matching well with the service model, requiring expensive or long-term services, or not showing sufficient likelihood of succeeding in the workplace. ENs often found that screening efforts yielded few Ticket assignments—or even none at all. While most ENs remain interested in taking Tickets and are willing to continue participating in the program at some level, some have decided against taking any Tickets or want to reduce their involvement. EN representatives in both groups cited financial concerns, among other factors, as deterrents to participation.

Services Are Not Being Expanded. ENs typically serve Ticket clients much as they serve other clients; that is, there appears to have been very little service expansion in the interest of Ticket holders. A few ENs employ Ticket holders themselves. Some have taken a relatively hands-off approach, providing a minimum of direct services or assistance, either because they believe that this is the best way to ensure client success (e.g., they need to do things for themselves) or because they do not have resources to cover more extensive services. Some ENs have consistently referred clients to SVRAs, for example, for high cost services. In addition, ENs typically pay for overhead and direct services out of other existing funding sources, not with revenues from Ticket payments. Most know little or nothing about the “capitalization initiative” that was designed to help them find new operating revenues.

In conclusion, our recent findings on EN participation in TTW echo the findings documented in both the initial evaluation report and the preliminary process evaluation report. This body of evidence strongly suggests that the program continues to struggle to meet its goal of giving beneficiaries a greater selection of providers.

Conceptually speaking, the notion that underpins the program’s design—that entities other than SVRAs will enter the provider market and help beneficiaries move off of the disability rolls in exchange for a performance-based payment stream—is questionable. The most significant operational problem seems to be that ENs are finding that they are generating revenue streams that are “too little, too late,” given the need to cover the upfront costs of overhead and direct services. Absent the funding they need, ENs say they must screen out individuals with significant service needs and offer less intensive services to TTW beneficiaries who can return to work most easily. EN officials continue to call for a substantial overhaul of the TTW payment systems. Even if the systems are radically revised, however, ENs may still have trouble finding enough suitable Ticket holders—those who will generate a funding stream that would sustain their TTW efforts without other resources.¹⁰

Finally, the real and perceived work disincentives inherent in the SSI and DI benefits systems make it unlikely that most beneficiaries will pursue full-time work in lieu of benefits. EN representatives stated that many beneficiaries would not earn enough from full-time work to counter a loss in benefits, would not be able to obtain sufficient medical coverage, or would have difficulty sustaining full-time work because of the nature of their disability. Indications are that the TTW program is not likely to succeed without broader benefits reforms.

¹ Phase III was fully implemented by October 2004. Return to Text.

² See Appendix D for information on the characteristics and selection of these entities. Return to Text.

³ This figure does not include payments made to SVRAs for beneficiaries being served under one of the two TTW payment systems. Payments to SVRAs are reported in Chapter VI. Return to Text.

⁴ The JWOD Program is a federal initiative that offers organizations that employ people with severe disabilities priority in obtaining service contracts with federal government agencies. Return to Text.

⁵ Another EN had tried incentive payments of $10 plus a self-addressed, stamped envelope, but this had not worked very well. Officials there were considering raffling off a chance to win $125 or a 25-inch TV to attract more pay stubs. Return to Text.

⁶ In Chapter II we used results from national administrative data to explore differential program participation rates by beneficiaries with various characteristics. As to whether certain beneficiaries feel the TTW program is not benefiting them, the best data will come from our national beneficiary survey, some early results from which were presented in Chapter III. Return to Text.

⁷ Later in this chapter we describe how a perceived lack of seriousness and effort on the beneficiary’s part is a common reason why ENs initiate Ticket unassignment. Return to Text.

⁸ One EN had unassigned 12 of its 13 Tickets, a second had unassigned 15 of its 74 Tickets, and a third had unassigned 31 of its 42 Tickets. These unassignments were initiated by the EN or the beneficiary. Return to Text.

⁹ The interviewee did not specify whether revenues would need to come from Ticket payments. Return to Text.

¹⁰ More information on EN costs appears in Chapter VIII. Return to Text.