APPENDIX B

Provider-Specific Case Study Summaries - EN Case Studies

1. AAA TakeCharge

a. Implementation and Service Delivery Approach

The President of TakeCharge had been working as a provider of employment and placement services for people with disabilities prior to TTW. When TTW came about, she developed the idea of sharing the payments with beneficiaries, and developing a web-based resource for clients based on information she had collected during her years as an employment service provider. When the organization for which she works decided not to participate as an EN, she was free to pursue the development of TakeCharge as a side activity.

Through TakeCharge’s password-protected portion of its website, TakeCharge clients can obtain information and links to additional resources to:

  • Learn about the five best and five worst ways to hunt for a job.
  • Access vocational tests so clients can narrow their choice of occupation.
  • Obtain detailed information on the 250 most common occupations in the country and find out what occupations are in demand in clients’ local areas. 
  • Locate government-subsidized training programs in clients’ local area that prepare them for high-demand occupations. 
  • View samples of good resumes, obtain tips on how to develop a resume, obtain tips on how to prepare for a job interview, and get advice about whether to tell potential employers about a disability. 
  • Consult with adaptive equipment experts who can help determine how to adapt a particular job or task to the clients’ needs. 
  • Obtain information on government health care coverage, how to resume Social Security benefits if needed, and how to communicate effectively with Social Security.

After a client has become employed, he or she must print out a one-page Payment Request form and mail it to TakeCharge, along with the necessary earnings documentation, to start the Ticket payment process. As noted previously, TakeCharge pays clients 75 percent of the Ticket payments it receives from SSA. This amounts to approximately $245 per month for SSDI beneficiaries and $150 per month for SSI-only recipients. The client will receive the payment after TakeCharge is paid by SSA. TakeCharge selected the outcome payment system, primarily because it was more straightforward than the outcome-milestone method. The interviewee believed it would be easier for Ticket clients to understand the outcome payment system and the resulting payments they would receive as clients of TakeCharge.

The interviewee noted that she has a patent pending for her model of web-based service delivery and cash payments to clients under TTW. She believes it to be a very simple idea, which will only succeed if administrative costs are kept at a minimum. Most of the burden of program administration is placed on the beneficiary. She described her development and involvement in TakeCharge as more of an interesting hobby than a business. In addition to the President and owner, TakeCharge has two other part-time staff persons, both family members of the President.

At the time of initial interview, TakeCharge had not had any interactions with state VR agencies. Several months subsequent to initial interview (in October 2002), TakeCharge began to negotiate agreements with state VR agencies.

 

b. Early Experiences Implementing TTW

Beneficiary Outreach and Enrollment. At initial interview, TakeCharge did not conduct marketing or outreach. All Ticket clients were based on referrals from the PROGRAM MANAGER website or mailings. Staff interacted with clients entirely through the EN’s website and email. TakeCharge operated an 800 number that provided a two-minute recorded explanation of the program, but directed callers to the website. The website (www.aaatakecharge.com) described the services and conditions for participation. Potential clients had to print out the application/ Individual Work Plan form, complete it, and return it via mail to TakeCharge. Staff did not screen clients; instead, the website contained information for potential clients to assess for themselves whether the services of TakeCharge would be appropriate for them, and to discourage those for whom TakeCharge might be inappropriate. For example, the website noted that beneficiaries should sign up with TakeCharge if they intended to become financially independent of Social Security disability payments and believed they could find work on their own; or if they were already working, but were not yet making enough money—or making it for a long enough period of time—to stop their SSA cash benefits. If they intended to continue working or to increase earnings to the point where monthly SSA cash payments would stop, they were encouraged to sign with TakeCharge.

The website also suggested that if beneficiaries needed assistance getting a job, completing a college degree, or obtaining adaptive equipment, they should contact the state Vocational Rehabilitation (VR) agency and/or other ENs in their local areas. The website informed beneficiaries that state VR agencies were typically the organizations most likely to have the money to invest in equipment, college assistance, training or other special needs, and that local ENs were most likely to specialize in immediate job placement assistance.

Potential clients could email TakeCharge if they had further questions after reviewing the website information. The interviewee indicated that, at the time of initial interview, TakeCharge received about three to four emails per week. She also indicated that, by the nature of the questions, it appeared that beneficiaries interested in TakeCharge were very bright and savvy. They asked questions pertaining to Trial Work Period months and the amount of money they had to earn in order to receive payments from TakeCharge.

The interviewee noted that TakeCharge would have liked the Program Manager to be able to provide more descriptive information about ENs and how they operated. Cash payments to beneficiaries were not on the list of services the Program Manager used to describe and market ENs via the Program Manager website. TakeCharge had to describe its services as "other." The interviewee believed that the Program Manager’s prescribed list of services that ENs could choose from was too narrow and that ENs should have been given more flexibility.

Outcomes and Claims for Payment. As noted previously, TakeCharge had 30 Ticket assignments at the time of initial interview in late June 2002. TakeCharge was among the ENs with the largest number of Ticket assignments at that time, but had not yet submitted any claims for payment.

Program Administration. The TakeCharge interviewee noted few issues in administering TTW. She did report experiencing some confusion over the process for unassigning Tickets and determining inactive status. She said that the Program Manager was unable or unwilling to give advice to ENs regarding the actions they should take, or how the 24-month review process would be conducted. She also recommended that, in the EN trainings run by the Program Manager, the Program Manager suggest to ENs that they provide beneficiaries with some incentive to submit their pay stubs.

 

c. Status at Follow-up

Service Delivery. TakeCharge has not changed any aspects of its service delivery approach since initial interview. The EN has, however, begun to enter into agreements with two state VR agencies (Wisconsin and New York) to serve their clients. Under the terms of the agreement with the Wisconsin Division of Vocational Rehabilitation (DVR), TakeCharge will decline Ticket assignment for clients expected to consume $10,000 or more in DVR services. These individuals will be served exclusively by DVR (or jointly with another EN). For individuals expected to consume less than $10,000 in DVR services, TakeCharge will accept Ticket assignment. When Ticket outcome payments begin, and for their duration, the Ticket holder will receive $125 each month. AAA TakeCharge will receive $45 a month for DI clients and $30 a month for SSI clients. DVR will receive the balance of the payment. A similar agreement has been discussed with the New York state VR agency, but has not been finalized.

Subsequent to developing the agreement with TakeCharge, the Wisconsin DVR sent mailings to approximately 100 Social Security beneficiary clients believed to be working at SGA, or believed to have the potential to work at levels higher than SGA. The letter explained that if consumers assigned their Tickets to TakeCharge, they would receive $125 per month for every month they are working and not receiving Social Security. Only one or two dozen beneficiaries responded by assigning their Tickets to TakeCharge. The low response surprised DVR and TakeCharge staff, both of whom had anticipated that at least half the group would assign Tickets to TakeCharge.

Ticket Assignments and Outcomes. At follow-up interview in August 2003, TakeCharge had 316 Ticket assignments. The EN has received just under $6,000 in payments on five beneficiaries since beginning its operations. A few additional beneficiaries are working and expect to be off of benefits and eligible for Ticket payments soon. The interviewee noted that, although costs are minimal, TakeCharge has been losing money on Ticket to Work. The EN now employs only one part-time staff person (in addition to the owner/director who manages the business as a part-time activity).

TakeCharge has not developed procedures for unassigning Tickets. This would add another level of administrative burden that the EN does not have the resources to support. At present, assigned Tickets are left assigned, regardless of activity.

Program Administration. Few problems with program administration were noted. Those reported centered on the claims submission and payment process. One problem is that beneficiaries have experienced difficulty submitting pay documentation that will meet SSA’s requirements. According to the interviewee, none of the 20 or so TakeCharge clients who have submitted pay documentation have done so without problems. The requirements for the pay documentation are very specific, and some employers do not provide information that will meet that level of specificity. TakeCharge’s procedure for correcting insufficient documentation is to return it to the beneficiary, indicating why it is deficient, and have the beneficiary address it. In some instances, however, it was unclear to TakeCharge staff why the documentation was insufficient and what was needed to rectify the situation.

Another issue noted was the time frame for receiving payments. The interviewee estimated that it takes three to four months, on average, to receive payment on a claim. Some claims have taken as long as five or six months. The Program Manager has indicated that the payment turnaround time is largely beyond its control and is driven primarily by SSA processing.

The interviewee notes that, in general, administering TTW has turned out to be more work for far lower returns than initially anticipated.

Concerns and Expectations Regarding Future Success. Although she has been losing money on TTW thus far, the owner of TakeCharge will continue to participate in the program. She indicates that she needs to receive payments on five or six beneficiaries each month in order to break even, and is just beginning to achieve that. She also feels a sense of responsibility to the beneficiaries who have signed up with TakeCharge and is committed to trying to help them through her program. The interviewee believes that TakeCharge could be considerably more successful if SSA were to concentrate its TTW marketing activities. In her opinion, TTW marketing efforts have been too broad and have not focused on the 7 to 10 percent of the beneficiary population most likely to work their way off benefits – those already working, but working at levels low enough to maintain benefits. The information about Ticket to Work seems to focus on getting a job and returning to work, rather than on increasing work levels among those already employed. She believes that a targeted mailing to working beneficiaries, advertising the fact that support in the form of money (as opposed to return-to-work services) is available under TTW, might induce a significant proportion to use their Tickets, increase their work activity, and go off benefits. The interviewee says that she has discussed with SSA OESP staff the concept of a test mailing targeted to those working and receiving benefits; but to date, she has not found support for this idea.

 

2. Arizona Bridge to Independent Living Employment Services

a. Implementation and Service Delivery Approach

ABIL’s Employment Services start-up operations were funded by a $100,000 matching grant from the Nina Mason Pulliam Charitable Foundation. According to the business plan developed at start-up, the organization expected to break even after two and a half years; after that, TTW would become profitable.

ABIL acts as a staffing agency, conducting job development, job search, and job placement activities on behalf of its clients. Counselors do not teach clients resume or job search skills, nor do they provide rehabilitation, assistive technology, or other costly services. The only requirement of clients is that they attend the job interviews ABIL has arranged for them. ABIL conducts interviewing workshops for clients to prepare them for job interviews, emphasizing the importance of promptness and preparedness when interacting with potential employers. When describing the Ticket program to clients, ABIL staff stress the voluntary aspect on both sides. Clients must understand that they are entering a long-term relationship with ABIL. As a full-service staffing agency, ABIL will act as an advocate for clients, provide peer support, and assist them with any work issues or barriers they encounter. Clients who fail to fulfill their responsibilities are not given a second chance; clients who do not show up for employment have their Ticket unassigned and returned to them.

ABIL paid a contractor to develop a Microsoft Access-based PC management information system specifically to administer TTW. The database maintains an electronic file on all TTW clients, includes fields to record all information necessary to serve the client and administer TTW, creates flags for follow-up actions, and generates forms. For example, the software can generate the completed Individual Work Plan; has a component that electronically tracks earnings documentation requests and receipts and EN payment claim submissions; and can generate reports on actions that require follow up after some period of time (e.g., non-receipt of earnings documentation, non-receipt of EN payment, non-receipt of Ticket assignment confirmation). The database also stores information on TTW beneficiaries who contact ABIL, but who do not assign their Tickets. The database permits ABIL staff to record the reason for non-assignment of the Ticket (i.e., whether the beneficiary did not pursue assignment; whether ABIL refused the Ticket, and the reasons for the refusal).

Whether the individual is an SSI or DI beneficiary and the type and severity of an individual’s disability are not significant factors in accepting a Ticket. However, ABIL only accepts Tickets from individuals who demonstrate a strong willingness to work. The goal of ABIL’s screening process is to identify job-ready individuals who are motivated, skilled, and seeking full-time employment. They do not accept Tickets from clients who want to work part-time or from home. If the reason is related to fear of benefit loss or a barrier that could be easily addressed, ABIL staff counsels the individual and may still invite him or her in for the orientation session. Usually, however, staff refers these individuals to other providers or tells them to contact ABIL again at a later date when they are ready to work full-time.

When clients require education, training or other resources to address employment barriers before they are ready for employment, ABIL refers them to other area providers. Clients can be referred to the One-Stops for basic computer skills training, although ABIL does not share Ticket revenues with the One Stop. ABIL has established an agreement with the state VR agency that would allow ABIL clients to access long-term training and high-cost accommodations. Though these resources are available, at initial interview ABIL was not accepting Tickets from individuals requiring long-term training.

 

b. Early Experiences Implementing TTW

Beneficiary Outreach and Enrollment. At the time of the initial interview, ABIL had not actively marketed to Ticket holders, but planned to do so in the future. The organization was maintaining data on all Ticket holders that had contacted ABIL, as well as reasons why their Tickets were not assigned; e.g., the individual did not want to work full-time or failed to keep an appointment. This database would serve as a marketing list in the future. At the time of initial interview, the demand for TTW services seemed sufficient to support ABIL’s business model, with 10-15 telephone inquiries daily.

At the first interview, ABIL had screened and counseled roughly 900 Ticket holders and had accepted about 100 Tickets. Potential clients underwent a 15-minute phone screen, during which they had to demonstrate enthusiasm for work. According to the interviewee, of those who completed the initial phone screening, about 15 to 25 percent were still interested in the program and participated in an orientation session. Potential clients were given two opportunities to attend the orientation session. Those who did not attend were referred to another provider. During the orientation, potential clients were told about TTW and SSA work incentive provisions. ABIL staff members encouraged attendees to shop around for other service providers before making a decision about where to assign their Tickets. About 50 percent of those who attended the orientation wanted to continue pursuing Ticket assignment with ABIL. After the orientation, those Ticket holders still interested in ABIL were scheduled for an individual appointment with the program Director. During this meeting, which lasted 60 to 90 minutes, she talked with clients about their goals and skills and identified any possible barriers that might emerge as they formulated a plan for employment. The Director also continued to educate clients about TTW and motivated them for employment. It was during this interview that the Director would decide whether ABIL would accept the Ticket. She accepted the Tickets of most individuals who reached the interview component of the process; however, in a few instances, she required them to first address specific barriers to employment before she would accept the Ticket.

Outcomes and Claims for Payment. At initial interview, about 28 of ABIL’s clients were working. Of these, about 67 percent were DI-only, 23 percent were SSI-only, and 10 percent were concurrent beneficiaries. Employment retention rates were higher among ABIL’s DI beneficiary clients.

At initial interview, a major issue ABIL had encountered was the length of time it took for the Program Manager and SSA to validate and pay claims. The interviewee said that ABIL usually did not receive payment until 120 days after filing the claim. She believed that four months was far too long to process EN payments, and thought it imperative that SSA rectify this problem in order for TTW to succeed.

The interviewee noted that BPAO staff was very important to the success of TTW clients and ENs, but funding was insufficient to meet the demand for benefits planning services. Health insurance coverage was also important for TTW clients. About 75 percent of the jobs obtained for ABIL clients included health insurance, but there was often a waiting period before coverage began. Arizona’s Medicaid Buy-in program was not operational at the time of initial interview, so ABIL sought assistance from drug companies and local doctors in an attempt to obtain coverage for some clients. According to the interviewee, 10 to 12 ABIL clients worked below capacity to maintain their Medicaid coverage.

Program Administration. As noted above, ABIL developed a PC management information system used specifically to administer TTW. The ABIL interviewee noted how instrumental the database had been in managing the program, and how useful it had been, given the potentially long client follow-up period, in tracking client earnings and EN payment claim submissions.

ABIL tried to reduce the burden of the long-term earnings tracking with the automated Access database, as well as by providing clients a $25 dollar stipend in return for submitting their pay stubs each month. The interviewee said these factors greatly facilitated the tracking of client earnings and that ABIL had not encountered too much difficulty tracking clients’ employment. During a follow-up contact with the interviewee approximately one month after initial interview, however, she noted that ABIL recently had experienced problems getting several clients to submit copies of their pay stubs. The interviewee said that the $25 stipend helped in most cases, but the earnings tracking was still a major administrative burden. 

 

c. Status at Follow-up

Service Delivery. ABIL has made minimal changes in its service delivery approach during the last year. The most significant change is in staffing the Employment Services Division. Previously, the two employment coordinators were responsible for keeping up with consumer needs, returning consumer telephone calls, and making employer contacts. These responsibilities have been modified so that now there is one internal and one external coordinator. The internal coordinator serves as a case manager. She keeps in touch with the participants who are waiting to be placed and provides ongoing support to those who have been placed. The external coordinator is responsible for meeting with employers and circulating resumes. She has strong networking and presentation skills. The internal and external coordinators meet daily to discuss the cases. The new system has been a great improvement because the internal coordinator is always in the office to communicate with consumers, thereby improving contact with consumers and creating the capacity to serve more beneficiaries.

ABIL makes extensive use of the Internet to locate jobs and assist job seekers in submitting resumes. ABIL staff members are certified as Senior Professionals in Human Resources, which enables smooth communication with Human Resource professionals. Staff attendance at American Society of Personnel Administrators (ASPA) provides valuable networking with employers.

Since the first interview, ABIL has taken several steps to help the participants navigate the SSA bureaucracy. ABIL has established a strong working relationship with the local SSA FO and has changed its work CDR protocol. Staff members now start a work CDR for each participant when the IWP is completed. They help participants complete form 821 and follow the appropriate steps to help their participants get CDR credit.

To publicize TTW, ABIL has contracted with a PR firm that provides PR services for ABIL in general and for the Employment Services Division in particular. The PR firm assisted with the development of an informational video when Tickets were initially rolled out, which is still shown from time to time. ABIL has tried to recruit people with cold calls, but beneficiaries often do not remember receiving their Ticket and perceive the caller to be a telemarketer. Therefore, ABIL has largely given up on this approach for now. The SSA FO has not been very involved in increasing awareness about the Ticket program, and the interviewee stated that involvement of the FO is essential for TTW success.

One final change is the implementation of Arizona’s Medicaid Buy-In Program. This program has largely removed a disincentive to work based on individuals’ fear of inadequate health insurance coverage.

Ticket Assignments and Outcomes. Since initiation of TTW service, 1377 people have called for information and 220 IWPs have been written. As of August 2003, ABIL had 117 Ticket assignments, and had received payments on behalf of 26 individuals. The interviewee reported that ABIL has made 119 placements, but the ratio of placements to payments is low because several individuals have been placed more than once; e.g., one woman was placed seven times before she found a job that suited her. Several clients are working but are still receiving SSI or DI benefits. The low ratio of payments to placement is a major source of program deficit, but ABIL is still accepting Tickets. The interviewee believes ABIL has some extra capacity with its current staff and needs the revenue that additional participants would generate.

According to the interviewee, two types of Ticket holders are hard to place. First, some clients have expectations of employers that are too high; e.g., they expect accommodations that are unreasonable, or expect to be hired for jobs for which they are unqualified. Second, some clients have extensive qualifications and experience, but have been out of the labor market for significant periods of time. Their high benefit levels and experience make entry-level jobs unappealing, and their time out of the labor force makes higher-level jobs hard to obtain. ABIL is willing to work with both groups, but it is harder to find suitable employment for these populations.

Program Administration. The most significant issue in program administration is holding down costs. The interviewee stated that the program is "horrendously expensive." ABIL’s business plan over-estimated demand and under-estimated the administrative difficulties and related costs, and predicted more Ticket assignments and more placements. ABIL Employment Services has invested $500,000 in the last two years and has filed claims for about $50,000 in payments. The interviewee estimates that ABIL needs $227,000 in payments (on behalf of about 100 Ticket holders) to continue operating. ABIL has had to supplement TTW revenues with about $200,000 in general operating funds. The interviewee stated that ABIL will likely be willing to support the program for another 12 months, but participation in TTW after that time is doubtful if the program does not produce more revenue.

A significant problem has been obtaining the pay stubs from clients, which is necessary to receive outcome payments from SSA. Although the $25 stipend for submission of pay stubs has helped, this has been a "nightmare" for the organization and large financial losses have resulted. Many of ABIL’s clients have psychiatric disabilities; these individuals find keeping track of pay stubs and other paperwork extremely stressful. Rather than hassling them about submitting pay stubs and potentially creating an issue at the beneficiary’s job, ABIL has decided not to pursue payment for individuals who do not submit pay stubs. Earnings documentation that ABIL does receive from clients is often missing information, such as the pay period start or end date. These problems have resulted in significant financial losses for the organization. The interviewee proposes a simple short-term fix: if a participant turns in his first pay stub and is earning above SGA, then SSA should begin payments to the EN. She believes that an ideal long-term solution would be for the IRS to submit the earnings records of Ticket holders to SSA on a monthly or even quarterly basis.

Program Concerns and Expectations for Future Success. In terms of service delivery to clients, the Ticket has been a positive experience for ABIL. The interviewee stated that ABIL’s current level of success with its TTW services could be attributed to the following:

  • Other ENs in the area are not accepting Tickets so more Ticket holders are bringing Tickets to ABIL;
  • Base funding at start-up;
  • The staff is made up of people with disabilities, who can easily relate to clients;
  • ABIL Employment Services operates like a staffing agency rather than a rehabilitation program;
  • The EN is located within a Center for Independent Living, which provides peer counseling and other services;
  • Strong support from BPAO, the state VR agency, and local SSA FOs; and
  • A solid relationship with local SSA FOs that enables participants to obtain timely work CDRs.

ABIL Employment Services would like to expand the program to provide job training and assistive technology. Program expansion is on hold, however, until TTW becomes profitable.

The interviewee stated that the TTW provisions are extremely helpful in assisting beneficiaries to find employment. She expressed two primary concerns that have negatively affected ABIL and, if unresolved, may cause the EN to withdraw from TTW. First, she expressed concern about SSA’s lack of marketing for TTW. She stated that a national marketing campaign, including radio and television advertisements, is necessary to adequately market the program. Second, she stated that ABIL’s continued involvement with TTW is dependent on a change in the pay stub submission requirements. SSA should require submission only of the first pay stub. Relaxing this requirement would permit ABIL to collect some back pay for clients who did not submit all pay stubs and enable them to continue running the program. If the pay stub requirement is not changed, the interviewee projects that ABIL will withdraw from TTW.

 

3. Career Consulting Services of America (CCSA)

a. Implementation and Service Delivery Approach

Career Consulting Services of America (CCSA) provides job development and placement services to individuals with disabilities throughout Wisconsin and Illinois. It is staffed by a husband and wife team and is funded with contracts through the Wisconsin VR agency, the Veterans Administration, and other state agencies. In addition to employer contacts, services include resume assistance, interview coaching, and acting as an employee advocate and liaison with employers.

CCSA will ensure that Ticket holders do not at any time constitute the majority of CCSA clients. CCSA participated in SSA’s Alternate Participant (AP) program, and the organization experienced substantial difficulty collecting payments from SSA for services provided under that program. The interviewee indicated that CCSA left the AP program after failing to receive $20,000 in reimbursements from SSA for services provided to one client over a four-year period. The interviewee anticipated encountering similar difficulties collecting payment under TTW and, consequently, wished to limit CCSA’s exposure.

CCSA selected the milestone-outcome payment system because it would become eligible for milestone payments earlier than outcome payments. CCSA was also concerned about the requirement that clients must remain employed and CCSA must document employment for five years to collect the full outcome payment.

 

b. Early Experiences Implementing TTW

Beneficiary Outreach and Enrollment. CCSA did not conduct marketing or outreach to initiate the program, but relied on calls from beneficiaries seeking to assign their Tickets. Initially, CCSA operated an 800 number, but shut it down because costs were prohibitive. At the time of the first interview, CCSA received an average of about four or five calls per day, which increased to about 20 calls per day on or near Ticket distribution dates. CCSA received calls from beneficiaries referred by the Program Manager, as well as from former clients of other local ENs who were dissatisfied with the job placement services provided by those ENs.

Initially, CCSA screened only for interest in working full time, but found that individuals interested in working full time were not necessarily good candidates for immediate return to work. The interviewee said that CCSA began to screen out individuals with vision and hearing impairments, severe mental illness (those with active psychotic symptoms), and individuals over the age of 60 because of difficulty in finding employment for such individuals. The interviewee also indicated that CCSA tended not to accept Tickets from married individuals with working spouses because of a belief that such individuals are likely to be less motivated to work than individuals with less generous or stable sources of support. The interviewee said that CCSA also began to ask all callers about their trial work period (TWP) and extended period of eligibility (EPE) status, and referred clients to Goodwill Industries for BPAO services, if clients had additional questions about benefits. When CCSA staff identified service needs that CCSA could not provide (e.g., assistive devices or other equipment, vocational training), CCSA referred the caller to the state VR agency.

Each applicant for services receives a letter describing the responsibilities of the EN and of the individual, and includes the IWP and a release to obtain additional information about the beneficiary. If the individual does not return those forms, another letter is sent. Only after the completed forms are returned does CCSA begin providing services.

Ticket Assignments and Outcomes. At the time of initial interview in August 2002, of the 40 Tickets assigned to CCSA, five Ticket holders were employed and had held their jobs for at least 30 days.

Program Administration. The CCSA interviewee reported that he was generally pleased with the performance of the PM. He noted that the PM had addressed a problem he had encountered with the originally-assigned staff member by assigning another staff member. He was also pleased with the CD-ROM provided to him by the PM, which contained numerous high-quality ideas and suggestions for participating in and administering TTW.

The CCSA interviewee said he understood other ENs to be concerned that the TTW employment and earnings verification requirements are burdensome. At the time of the first interview, however, he had experienced few problems. In preparation for collecting the earnings information and as a condition of service receipt, he had all clients sign a release for any wage information. He also contacted employers directly, providing a copy of the release, and requesting that the employer send the wage documentation directly to him. The release included language to the effect that the federal government requires CCSA to substantiate wages, and clients are required to provide copies of their pay stubs. In the written communication to both client and employer, CCSA included a warning that failing to disclose wage information is a violation of federal law.

The interviewee also indicated that, when submitting resumes to employers on behalf of clients, CCSA included a similar notice to employers, warning that employment discrimination against individuals with disabilities is a violation of federal law. The interviewee believed that including warnings in various materials improves both placement rates and compliance.

 

c. Status at Follow-up

Service Delivery. At follow-up interview in September 2003, the CCSA interviewee indicated that his organization has made no changes in operation since the initial interview.

Ticket Assignments and Outcomes. The interviewee stated that significant numbers of beneficiaries who have assigned their Tickets to CCSA are not actively participating in services or looking for work. He does not undertake the added paperwork required for Ticket unassignment, however. If the beneficiary requests unassignment, the Ticket holder is required to submit a written request to the Program Manager him or herself.

CCSA has a contract with the state VR agency, but the interviewee did not believe the contract to be beneficial to CCSA. The EN is sharing a number of Tickets with the state VR agency, but specific payment arrangements have not been worked out. One problem is that individual counselors and office directors do not understand the details of TTW. Second, many of the counselors presume it is their responsibility to "grab the Ticket" before an EN can accept it; this is alienating CCSA. Having the state VR agency accept the Ticket offers beneficiaries only one advantage—the state VR agency may offer a costly service that the EN cannot provide.

CCSA staff estimated that they currently have 60 or 70 Ticket assignments and the organization is eagerly accepting more.

CCSA has had excellent outcomes with assigned Tickets, even though other service providers advised the director not to become involved with TTW. CCSA has an easier time placing SSA beneficiaries than placing VR clients because the former are more motivated to work. CCSA has placed its TTW clients in a variety of jobs, ranging from professionals and top-level executives to janitors and truck drivers.

The poor economy has significantly hampered job placement for TTW beneficiaries; the CCSA director noted that the industrial sector has declined consistently for the past 36 months. People with disabilities still encounter discrimination. The interviewee stated that individuals with disabilities need twice as many contacts and ten times the number of interviews to get a job. He sees his marketing role as very important, describing how he needs to sell individuals to an employer and sell the employer to the individuals. He does not make specific references to a disability, SSA or the state VR agency in conversations with employers. He presents himself as someone in the legal or personnel profession.

CCSA has received few payments thus far, but the interviewee believed that greater than 50% of its receivables will come from TTW in the near future. TTW has the potential to be a major source of revenue for CCSA, with revenues ultimately outweighing costs. He believed TTW could be a more viable source of income than its current contracts if the administrative issues described below are addressed.

Program Administration. The interviewee sends beneficiaries an Employment Status Verification form to ascertain whether they are working. He informs beneficiaries that it is a federal violation not to report their work activity. The interviewee said that he often has to go beyond simply requesting information; he needs to intimidate clients a bit to get them to send pay stubs. Before providing service, he asks beneficiaries to sign a form that gives him permission to obtain pay stubs from employers, although he would prefer not to do so.

The interviewee said that CCSA has had a "terrible problem getting paid," and added that, "SSA has a terrible system in place." CCSA has claims that are four months old that have not yet been paid. He said, "Any other business would seek help from a collection agency!" The problem has not improved in recent months. The Program Manager processes and passes along CCSA’s invoices exactly as they are supposed to be processed, and SSA then sits on them, to the point where CCSA must conduct an investigation to find out what is happening with its payments. This problem occurs with initial milestone and outcome payments, as well as with subsequent payments. Another problem is that, occasionally, SSA will deny a claim, but fail to inform the Program Manager why the claim was denied. According to the interviewee, SSA does not provide adequate cooperation and support for ENs, which he considers a very poor practice. Communication with the Program Manager, however, continues to be excellent.

Concerns and Expectations Regarding Future Success. The CCSA director had two main concerns with TTW: (1) Improving the payment/reimbursement process; and (2) Improving the channels of communication. With regard to the payment process, he stated that SSA must handle payments more promptly if ENs are to remain in the program. He stated that communication between the ENs and SSA is nonexistent. He said he recognized the Program Manager’s role as an intermediary, but said it limited communication between the EN and SSA. He pointed out that SSA had direct communication with providers under the AP Program. He sees SSA as his employer, not the PM; yet he has no interface whatsoever with SSA. Another distinction between being an AP and being an EN is that, as an AP, the organization had direct access to SSA files. Under the Ticket program, SSA will not provide ENs with basic information, such as the nature of an individual’s disability. ENs must obtain information directly from the client or the local SSA field office. The interviewee indicated that CCSA receives no cooperation or support from the local field office, however. The interviewee notes that CCSA requests to use field office space for meetings with clients have been denied.

The interviewee stated that he recently received information regarding the new Certification Payment Request Process from the Program Manager. He is hopeful that the new process will assist ENs in solving the pay stub issue.

 

4. Employment and Employer Services

a. Implementation and Service Delivery Approach

Although EES had not targeted SSI and DI beneficiaries previously, the organization decided it wanted to serve this population when TTW was initiated. EES hired two staff members who had experience working with people with disabilities to work exclusively with TTW clients. Early on, a local P&A representative was invited to provide advice and to assist them in understanding the issues they would encounter in serving beneficiaries. The P&A conducted on-site seminars and provided on-going guidance.

TTW services are provided within a separate and distinct unit with its own funding stream. EES would not have been able to participate as an EN had it maintained its previous, non-profit corporate status. For-profit status has allowed EES to become sufficiently capitalized to cover the start-up costs of a program like TTW, where revenues may not be immediately forthcoming. EES hired two counselors: one with a background in mental health issues, the other an occupational therapist. This combination, in addition to having one female and one male counselor, provided valuable expertise and gave participants a choice in counselors.

As noted previously, EES provides primarily job preparation and placement services. The EN offers weekly job club meetings, where clients practice interview skills and discuss employment issues. Staff members provide services such as interview preparation and skills, resume assistance, job search, computer training for data entry and clerical positions, and job placement.

 

b. Early Experience Implementing TTW

Beneficiary Outreach and Enrollment. EES began taking Tickets in April 2002. The program did not undertake any marketing activities. All calls received were a result of the information provided to beneficiaries by the Program Manager via mail or web site. EES had experienced, from its perspective, a tremendous demand for its services. Early on, the program received 25 to 30 TTW-related calls per day. Although the no-show rate was rather high compared to the program’s experience with other populations (60-65 percent of those that came in for an initial appointment did not follow through) about 50-60 percent of those who do had assigned their Tickets.

At initial interview in August 2002, EES was operating at full capacity. The two TTW counselors were serving a total of about 130 clients. The program was not accepting any more new clients until it could reduce the wait for an initial appointment to below the current wait of six weeks. One reason for the tremendous demand EES had experienced might have been that, according to what staff had heard from clients, other Chicago-area ENs were not accepting Tickets.1

In deciding whether to serve a potential TTW client, counselors assessed his or her ability to work full-time. If a potential client was looking for part-time work, the program was generally not able to serve the individual. EES’s goal was to place clients in full-time jobs with a wage of no less than $7 - $8 per hour. If an applicant appeared unwilling or unable to meet this goal, the program did not accept the Ticket. DI versus SSI status did not appear to be indicative of Ticket acceptance or job placement success.

Staff also took into account the likely needs of the clients and whether or not EES had the ability to serve them. EES was not equipped to provide vocational or job readiness training, or long-term rehabilitation. If EES believed it was unable to serve a particular individual, staff attempted to refer the individual to a more appropriate service provider, such as the State VR Agency.

Outcomes and Claims for Payment. EES provided similar services to TTW clients that it provided to its other, non-TTW clients (interview preparation and skills, resume assistance, job search, training for computer skills for data entry and clerical positions, and job placement). The program was accustomed to operating under a pay-for-performance system, but staff noted that EES’ non-TTW clients did not generally take as long to place as TTW clients. TTW clients, as a group, seemed to take more time envisioning themselves in a job. This meant that a large counseling element was necessary to deal with the fear, attitudes, and insecurities related to the ability to find and maintain employment. Many challenges faced by TTW clients were similar to those faced by EES’ other client populations, but EES staff members tried to tailor the classes and supports to the specific issues of TTW clients (e.g., when/if it would be necessary or appropriate to disclose a disability to an employer, or explaining gaps in the employment history).

EES staff worked with TTW clients to track earnings and benefits so as to avoid overpayments when a client’s trial work period ceased. The EN had difficulty, however, obtaining information about trial work periods from FOs. Counselors also conducted an initial training with beneficiaries about benefits, but did not claim to be experts. Counselors referred beneficiaries to the local BPAO when beneficiaries started to work.

During the initial interview, EES staff indicated that it was too soon to determine which types of clients would be successful. EES continued to hold Tickets that were inactive (i.e., the client was not actively engaged in services). The EN had not yet established a process for unassigning Tickets.

Program Administration. At the first interview, staff indicated that EES had not yet encountered difficulty obtaining pay stubs from clients, but was considering ways to work with employers to make the process easier. Interviewees were not hopeful, however, about their ability to develop links with employer human resource departments. EES staff viewed the earnings documentation as very burdensome for both the EN and beneficiaries, a burden that significantly reduced the EN’s ability to provide services. Interviewees indicated that when sufficient payments were received as the program matured, EES would seek to add an additional staff person devoted to completing the necessary administrative activities associated with TTW.

 

c. Status at Follow-up

Service Delivery. EES is no longer accepting Tickets and plans to fully withdraw from the program. It is still submitting claims for payment for a few beneficiaries, but no longer considers itself a TTW participant. Before deciding to withdraw from TTW, EES tried several strategies to reduce costs. For example, EES originally started its TTW service delivery with two staff; then it dropped down to one counselor, who provided services on a group, rather than individual, basis. This was efficient and provided beneficiaries with the opportunity to give each other feedback and support. Even with this added efficiency, however, EES was subsidizing TTW services at an unacceptable level.

Ticket Assignments and Outcomes. EES did not need to market its program; few ENs in the Chicago area were taking Tickets and EES continued to receive more referrals than it could handle. Initially, EES had accepted most Tickets; but it later became more discriminating, accepting Tickets only for those individuals who could most benefit from its services and referring other beneficiaries to more appropriate agencies. The interviewee believes that many of these individuals went unserved, however, because few ENs were accepting Tickets. Some were referred to the state VR agency, which subsequently accepted their Tickets.

EES records show that, as of May 2003 when it dropped out of TTW, the EN had 203 Tickets assigned. EES had completed 208 IWPs with beneficiaries, made 102 referrals to other ENs including the State VR Agency, coached 132 resumes, and provided 793 training sessions. EES had unassigned 93 Tickets and made 58 job placements.

EES has received payments for only 13 individuals thus far. Some beneficiaries required more than one placement before sustaining employment; this is not unusual for the EES’ service population. Many beneficiaries who were placed in jobs did not earn enough to lose all benefits; therefore, EES did not receive the payment. The requirement that beneficiaries receive zero benefits is considered by staff to be a major flaw in the program. The nine-month TWP and the level of SGA enable beneficiaries to retain benefits long after they find employment. Although EES attempts to find full-time jobs for its clients, many are unable to sustain full-time work, particularly those who have psychiatric disabilities or those who have been out of the work force for a number of years. The interviewee stated that encouraging beneficiaries to accept full-time work before they are ready will ultimately result in failure. Another problem was the economy—some beneficiaries who had full-time jobs were reduced to part-time and again became eligible for benefits, resulting in no payment for EES.

The Director estimated that EES spent $80,000 administering TTW and brought in less than $10,000 in revenue. Terminating participation in TTW was a difficult decision for EES to make, but the EN could not cover staff costs.

Program Administration. The most significant concern with program administration was the collection of pay stubs. The interviewee noted that other government programs, such as WIA, allow alternative forms of documentation. Difficulties also arose when a pay period crossed calendar months, but EES and Program Manager staff worked through these difficulties. The interviewee stated that she had not tracked the length of time between submission of bills and receipt of payment, but noted that even if payments had been received promptly, the payments were too low to enable the program to continue.

Concerns and Expectations Regarding Future Success. The EES interviewee stated that high program costs and low revenue made it impossible for EES to remain a TTW provider, noting that payments were too low to make the program viable. Another problem was the requirement that beneficiaries receive zero cash benefits before the EN is eligible for payment. EES clients were not able to sustain SGA consistently enough for EES to receive regular payments. A final problem was the requirement that beneficiaries submit pay stubs—a procedure that EES staff considered burdensome for both beneficiaries and the EN.

The interviewee stated that TTW should be amended to allow for an initial payment upon completion of an IWP, to enable the EN to cover staff costs; followed by an additional payment for job placement; and then the original performance-based payment schedule. When asked about the milestone payments, the interviewee stated that the milestone payments were too small to cover up-front staff costs.

In conclusion, EES staff said it would reactivate its participation in TTW if the payment structure were modified to enable the organization to cover staffing costs. The interviewee stated that TTW fits in well with EES’ mission and staff enjoyed working with beneficiaries. The organization had developed a good model, with successful placements and significant employer support. Unfortunately, the program was not viable from a financial perspective.

 

5. Glick and Glick

a. Implementation and Service Delivery Approach

Implementation. In deciding to become an EN, Glick and Glick developed a business plan and established a specific time frame in which it would allow the program to operate to assess its viability. The TTW business unit would need to generate sufficient revenues to become self-supporting during its first year of operations. Glick and Glick selected the outcome-milestone payment system because it wanted to gauge the employment experiences of TTW clients before accepting what staff believed to be a greater risk associated with the outcome-only payment system.

In preparation for TTW, Glick and Glick hired four new staff members to work exclusively on TTW. The firm’s management thought it would be easier to hire new staff to work on TTW than to train existing staff. TTW represents a slight departure from Glick and Glick’s traditional business practice; under TTW, job candidates come to them, whereas under their traditional operations, Glick and Glick staff conduct targeted outreach to recruit job candidates. The four TTW case managers were each assigned to clients from a specific state.

Service Delivery. Once Glick and Glick receives confirmation of Ticket assignment from the Program Manager, case managers begin working with the Ticket holder to find a job. The case manager assists the Ticket holder with interview skills and resume building. All interactions are conducted by phone or mail. Once the Ticket holder appears prepared to enter the workforce, Glick and Glick matches him or her with positions that its employer clients want to fill. Glick and Glick maintains a database of available positions categorized by the location, skill requirements, job description, wages, benefits, and hours required.

Case managers schedule interviews for Ticket clients, provide job leads, and inform Ticket clients of upcoming job fairs. Clients are generally given four or five job leads at a time. If, on multiple occasions, a client fails to attend any of the scheduled interviews or job fairs, the case manager will unassign the Ticket. Glick and Glick will only unassign a Ticket when it seems clear that a client is not making progress towards the IWP employment goals, or in rare cases where a client has been verbally abusive to a case manager.

While case managers frequently send mailings to clients (e.g., notices of upcoming interviews and job fairs, interview guidelines), most of the substantive casework is conducted over the telephone. Services provided by phone include: help developing resumes, practicing interview skills; and debriefing clients after job interviews. Interviewees noted that most Ticket clients do not have an up-to-date resume, and in many cases, have no resume at all. Case managers collect the information necessary to develop a resume over the phone, then construct a well-formatted resume for the client.

TTW has not resulted in a change in the firm’s core activities. As a placement agency hired by employers, Glick and Glick already had substantial experience working with unemployed, disadvantaged populations through what interviewees referred to as the outreach program. As noted previously, this part of the firm’s business attempts to recruit job candidates from clients of public and non-profit service agencies nationwide. Through this program, the firm provides value to its employer clients by screening for appropriate job candidates from among populations that will offer the employer tax credits for hiring such individuals. In addition, the outreach program has demonstrated highly successful employment retention rates. The primary change under TTW is that job candidates now come to Glick and Glick unsolicited.

Another change under TTW is that case managers are now required to have a more complete understanding of benefits and work incentive issues. Ticket holders frequently require information about the impact of employment on their benefits. Initially, case managers would refer clients to SSA or to their local Benefits Planning, Assistance, and Outreach (BPAO) representative. After a bad experience with one BPAO, however, Glick and Glick decided that all case managers would develop the knowledge necessary to counsel beneficiaries on basic benefit issues, and that clients would be referred to SSA, and not a BPAO, to address complicated issues.2 Interviewees noted that it took considerable time and effort to obtain the information they needed to understand all of the benefit and work incentive issues. They had requested information from the Program Manager, but interviewees indicate that they received the information piecemeal, and that it took some time before they believed they had complete information.

Glick and Glick has not combined its Ticket program with its traditional outreach program. Many of the agencies the firm uses to recruit job candidates through its outreach program are state VR agencies and ENs. The only change in the outreach program since TTW is that, when staff members receive a new job opening, they first check to see if any of their Ticket clients qualify for the position before attempting to recruit more broadly through the outreach program.

Glick and Glick has not signed any agreements with any state VR agency with respect to serving TTW clients. EN representatives have considered the possibility of working with VR agencies, but because Glick and Glick is a national EN, decided it would be a large undertaking. Glick and Glick also wants to maintain a visible distinction between its outreach program and TTW placement efforts. This is to avoid giving state VR agencies, and other agencies it works with that might be ENs, the impression that it is attempting to steal their TTW clients when doing job candidate recruitment under the outreach program. Such perceptions could undermine the success of the outreach program.

 

b. Early Experiences

Beneficiary Outreach and Enrollment. At initial interview, Glick and Glick had not actively marketed its services to Ticket holders. Call volume generated from Program Manager referrals had been sufficient to keep staff busy. Glick and Glick had also been receiving calls from Ticket holders indicating they had contacted other ENs and were referred to Glick and Glick by the ENs contacted. Glick and Glick staff did not interact with other ENs. Staff presumed that other ENs were referring callers to them because they knew that Glick and Glick was accepting Tickets.

Glick and Glick was initially overwhelmed by TTW calls, receiving more than 100 per day. Because staff had not yet gained experience with TTW, it took as long as 30 minutes to conduct an initial screening interview. During the months following the initial TTW rollout, Glick and Glick staff became more proficient at asking key questions, the responses to which they believed indicated whether a caller was a good candidate for their services. By the time of initial interview, staff spent only a few minutes on the phone conducting the initial screening. Call volume dropped since the initial roll out; at the time of the initial interview (November 2002), staff were taking between 10 and 15 calls per day.

When Ticket holders called, if possible they were directed to the case manager responsible for the state where the caller resided. Often, the case managers had to explain TTW to the callers. Many beneficiaries did not understand that the program was voluntary. Case managers also had to frequently correct a common misconception —that a Ticket holder would automatically get a job because they had a Ticket. Many callers also expressed concern about how participation in TTW would affect their benefits. When explaining the effect of the Ticket on Social Security, Medicare, and Medicaid benefits, case managers stressed the fact that the program was designed to help beneficiaries become self-sufficient. Interviewees noted that the calls were sometimes time consuming, but staff wanted to make sure that beneficiaries understood the program before assigning their Tickets to Glick and Glick.

After case managers answered the initial questions, they tried to determine why callers wanted to participate in TTW. Glick and Glick staff asked questions intended to gauge the individual’s level of motivation. If an individual appeared to be motivated and likely to benefit from Glick and Glick’s services, the case manager explained the enrollment process and mailed the firm’s policies and the Individual Work Plan (IWP) to the Ticket holder so that he or she could sign and return it to Glick and Glick. Candidates determined not to be a good match were told to contact another EN or their state VR agency. Interviewees noted that, as of November 2002, about 30 to 40 percent of the initial phone interviews had actually resulted in a Ticket assignment. They had generated about 300 Ticket assignments from approximately 800 phone screens.

A major administrative issue reported by interviewees related to the amount of information the PROGRAM MANAGER provided to Ticket holders before referring them to ENs. Glick and Glick staff members believed that they would be able to reduce the amount of time they spent explaining TTW to clients if the Program Manager and/or SSA devoted more efforts to better informing beneficiaries about the program early in the process.

Outcomes and Claims for Payment. Glick and Glick had always received payments based on its ability to place individuals in employment, and on the length of time individuals remained employed.3 Because of this, staff were not overly concerned about the nature of TTW’s payment structure. The company has always assumed the risk that some placements will not be successful.

At the time of the initial interview, Glick and Glick had placed 31 Ticket clients in employment and had begun to collect TTW payments. Interviewees noted that as many as ten of their TTW clients had an interview or submitted a job application on any given day. Staff indicated that it was still too early at first interview to determine whether a substantial share of their TTW clients would experience success, however, they were optimistic. If the trend were to continue, Glick and Glick expected to begin showing a profit in January 2003 – five months ahead of their original projections. At the initial interview, staff also indicated that Glick and Glick had unassigned roughly 70 Tickets. Staff members believed that, unless a client was motivated and actively pursuing employment, it was a waste of their time and the client’s time for the Ticket to remain active.

At initial interview, staff did not anticipate significant problems tracking the employment and earnings of TTW clients. The company’s experience with outcome-based contracts had given its staff significant experience tracking employment for periods as long as two years. Glick and Glick used the same tracking mechanisms it already had in place under the outreach program, which involved aggressive pursuit of information, generally by telephone, through both the employee and employers. Glick and Glick added a stipulation to its contract with Ticket holders that required TTW clients to provide the necessary wage documentation. Clients might also be asked to sign a release that allowed Glick and Glick to obtain earnings information directly from employers. At initial interview, staff reported experiencing few problems tracking earnings for employed TTW clients. On two occasions, TTW clients had quit their jobs when asked for their pay stubs, because they feared losing their benefits. Glick and Glick addressed this potential problem by revising its screening process to emphasize that the goal of TTW was self-sufficiency, and by screening out potential clients who feared losing cash benefits after going to work.

Program Administration. At initial interview, Glick and Glick interviewees noted few problems administering TTW, but said a major administrative issue was the length of time it took to receive TTW payments. Glick and Glick staff were originally told that it would take 60-90 days to receive payment. The firm’s experience had been that it took 90-120 days. The Program Manager had not been able to provide Glick and Glick a clear explanation of why it took so long to receive payment, even when all appropriate information had been submitted.

At initial interview, Glick and Glick interviewees thought they would have benefited greatly if, prior to becoming an EN, they had spoken with other organizations that had already implemented, or were in the process of implementing, TTW. Interviewees believed that it would be beneficial for ENs to exchange ideas and teach each other how to address problematic issues that arose in implementing the program. Glick and Glick staff noted that they were open to working with other ENs and potential ENs to exchange best-practices and their own experiences with TTW.

 

c. Status at Follow-up

Service Delivery. At follow-up interview in August 2003, Glick and Glick had substantially reduced its involvement in TTW. The EN is now only serving beneficiaries who reside in the state of Florida and has reduced the number of TTW case workers from four to one. Other than the change from operating as a national EN to serving only the state of Florida, the core activities and services Glick and Glick provides to Ticket holders have not changed.

The decision to scale back TTW operations was based on poor financial performance. The firm was expending a lot of resources on TTW and not recouping much of its costs. Because the company was "shoveling money out the door" the Vice President made the decision to restrict operations only to the state of Florida, and to unassign all other Tickets. All Tickets of beneficiaries not residing in Florida were unassigned by the EN in late May 2003. These unassignments included a number of beneficiaries that Glick and Glick had placed in employment.

The state of Florida was retained as a TTW service area because Glick and Glick had a large number of Tickets from the state, and was experiencing some success with those clients. The firm also wanted to stay minimally active in TTW with the hope that the program might undergo changes that would make it profitable to participate again as a national EN in the future.

Ticket Assignments and Outcomes. At follow-up interview, Glick and Glick had only 23 Ticket assignments, down from more than 200 assignments at initial interview. Even prior to the large number of unassignments that occurred as a result of restricting operations to the state of Florida, the firm had begun to implement more stringent criteria for accepting Tickets. Early on, staff used screening questions to attempt to ascertain the level of motivation of potential clients. Now, staff members instruct callers to contact and obtain information about other ENs before deciding to assign the Ticket to Glick and Glick. Glick and Glick will not complete an IWP and accept assignment of a Ticket during an initial phone contact. If a caller is interested enough in the services provided by Glick and Glick to re-contact the EN to assign the Ticket, and/or return the calls of the Glick and Glick case worker who contacts him or her, then the EN will proceed with the assignment process. Interviewees noted that often, substantial time and effort was often invested in finding job leads for clients whose eagerness and interest in the program waned considerably after the initial contact, or who subsequently revealed the need for services that Glick and Glick did not provide.

At follow-up interview, Glick and Glick had received EN payments totaling approximately $13,000 based on the work activity of 18 beneficiaries. As noted previously, the firm was losing money on its TTW operations. Interviewees were unable to provide an estimate of the financial loss, indicating that they did not have access to that information, but did provide examples of the factors that contributed to the losses. EES staff indicated that they have had more difficulty than anticipated placing clients in employment. The reasons for this include: a reduced number of jobs available in the current economy; some beneficiaries not actively participating in the effort (e.g., not returning phone calls or unwilling to cooperate); and some beneficiaries being very specific or particular about the types of jobs they are willing to accept.

Interviewees also indicated that it has been extremely difficult to obtain earnings information from those who were placed in employment. Contrary to early expectations that tracking earnings would not be a problem, Glick and Glick has found it very labor-intensive and difficult to obtain the necessary information. Interviewees note that neither beneficiaries nor employers have any incentive under TTW to provide the EN with the earnings information. Other Glick and Glick business dealings that require earnings tracking typically involve a contract with a large employer’s corporate office that is willing to provide the information because it is part of the terms of the agreement it has with Glick and Glick, and because the employer benefits from the services that Glick and Glick provides (filled vacancies and tax credits). No such relationship exists between the EN and many of the employers of Glick and Glick’s TTW clients.

Program Administration. Interviewees noted several ongoing issues encountered in administering TTW that center around the EN payment process. First, the primary struggle throughout implementation of TTW has been obtaining the pay information from beneficiaries. Although some of their TTW clients are very good about submitting pay information, many are not, and attempts to obtain the information directly from employers has met with very limited success. Second, Glick and Glick interviewees indicate that often it has taken a very long time for payment claims to be processed, stating that they are told by the Program Manager that these claims are "pending field action." Interviewees note that more recently, however, the payment turnaround time seems to be improving. Third, interviewees have been frustrated by the fact that beneficiaries do not know which benefits they are receiving (SSI, DI, or both). The EN’s inability to know what program(s) the client is participating in makes the EN payment process more difficult because: different pay documentation is needed; different earnings thresholds must be met to qualify for payment; and different payments are received depending on the program status of the Ticket client. Not knowing program status, and not being allowed to obtain that information from the PROGRAM MANAGER, makes it difficult for the EN to develop expectations regarding the likelihood that a claim for payment will be accepted.

Concerns and Expectations Regarding Future Success. Despite the challenges and financial losses experienced to date with TTW, Glick and Glick plans to continue its participation on a small-scale. The company will keep its "foot in the door" for a while and see if SSA makes any changes that might improve the profitability of TTW efforts. They do not believe that TTW will be successful unless something is done about the requirement to submit earnings information. Interviewees also expressed frustration with the requirement that benefits be zero before the EN receives payment. Glick and Glick staff have worked hard to help a beneficiary become employed, but do not receive payment because the client is still receiving benefits. As SGA continues to rise, interviewees note that it will become increasingly difficult to place beneficiaries in jobs yielding earnings sufficient to trigger EN payment. Many of Glick and Glick’s TTW clients do not have much experience and can only qualify for entry-level positions that offer the minimum wage.

 

6. Integrated Disability Resources (IDR)

a. Implementation and Service Delivery Approach

Integrated Disability Resources (IDR) is a national EN that provides employment services to private long-term disability clients referred by insurance companies. IDR works with these individuals to ascertain what services they will need; then, using a nationwide network of credentialed vendors, IDR contracts for the necessary services, including vocational rehabilitation, peer support, and job placement.

When creating a business plan for TTW, IDR expected to have three distinct groups of clients: individuals with long-term disability claims with whom IDR was already working; individuals identified by the providers in IDR’s network of vendors; and retail clients – Ticket holders who called the company after receiving their Tickets. The first category of beneficiaries seemed the most logical group to serve, and IDR anticipated a high success rate. IDR was expecting referrals from vendors within its network under the assumption that many of the smaller providers that IDR works with would be unable to afford the up-front costs of service provision under the TTW payment schedule. IDR did not anticipate that retail clients would represent a large client base without significant marketing, but ended up receiving a very high volume of calls despite minimal outreach efforts.

Initially IDR planned to use the outcome payment system with the expectation that the bulk of its Ticket assignments would come from beneficiaries who were already receiving services from IDR. This population posed little risk because IDR was already receiving payments from insurance companies for serving these individuals. However, as it became obvious that retail clients would comprise the majority of its customers, IDR administrators switched to the outcome-milestone payment system. With no outside funding sources for these clients, IDR was hesitant to assume any more risk than was absolutely necessary.

 

b. Early Experiences Implementing TTW

Beneficiary Outreach and Enrollment. The screening process evolved as staff became more experienced with TTW. IDR has put an increased emphasis on ensuring that potential clients have a good education and sufficient English skills. During the initial phone call from a beneficiary, IDR staff conducts a short interview and screens for education, work history, goals, and reason for wanting to participate in TTW. If the beneficiary seems motivated and a good fit, staff asks for the individual’s Ticket number to ensure that he or she is eligible prior to the development of the IWP. IDR rejects almost all SSI recipients. Representing roughly 30% of the calls, these beneficiaries require more assistance than IDR is able to provide. Staff also attempts to screen out any beneficiaries who appear to be interested only in obtaining part-time employment or who do not want to stop receiving Social Security benefits. IDR refers individuals who do not appear to be good candidates to other providers.

At the time of the first interview, roughly a quarter of IDR’s Ticket assignments were from individuals who had been working with IDR prior to their participation in TTW. The remaining assignments were from retail clients. In addition to the current Ticket assignments, IDR had another 100-120 retail clients with whom it was working to create IWPs. Staff expected that roughly half of these individuals would actually assign their Tickets to IDR. The remaining individuals were expected to assign their Tickets to competing ENs, fail to follow through with the process, or be screened out by IDR. In general, the calls from retail clients yielded a very low percentage of Ticket assignments: IDR received one Ticket assignment for every 20-30 initial inquiries it fielded.

Ticket Assignments and Outcomes. To date, IDR has not been able to meet the objectives it established in its original business plan. IDR projected that 80% of its assigned Tickets would yield at least one payment, and that 50% would lead to payments over the entire 60-month period. However, at the first interview, staff expressed the view that these numbers might be overly optimistic, especially considering the potential difficulties in tracking clients over the full 60 months. IDR estimated that the Ticket program would enable it to spend $1,000 per client, but if it is able to increase the success rate this number could double. IDR also expressed concern about the length of time it takes for SSA to process payments. Although IDR had placed seven Ticket holders in employment at the time of the first interview, it had yet to receive a single payment on any of these claims—some of which were submitted more than four months ago. In one case where IDR worked with a Ticket holder for a period of time and helped him get a job, SSA terminated his benefits. Since SSA had not yet compensated IDR, the service provider lost the majority of the money it had invested in training this individual.

Program Administration. A major problem that IDR staff noted at the first interview was the lack of reliable and current information about Ticket holders. On a number of occasions IDR had worked with a Ticket holder to complete an IWP, only to be told by the PM that the beneficiary was ineligible. Although IDR staff had improved its screening techniques, interviewees believed that if the individual was ineligible, he or she should not have received a Ticket in the first place. Staff also believed they spent too much time working on administrative issues for clients. IDR’s business model assumed that staff would spend 25 hours working on each case. The hope was that 80 percent of this time would be devoted to directly serving the client, with the rest used for administrative tasks. However, staff was able to spend only 15 to 18 hours working with each client, because verifying the beneficiary’s eligibility, confirming the IWP with the PM, and securing payment from SSA proved too time consuming.

 

c. Status at Follow-up

Service Delivery. At the time of the second interview, IDR was receiving between 30-60 calls per day from retail clients. Over the past year, IDR has tightened its screening requirements. According to agency staff, extensive delays in receiving payments from SSA have made the program so costly to operate that IDR can only afford to accept Tickets from beneficiaries who it believes can be successfully placed with very low upfront costs. IDR has stopped accepting Tickets from SSI recipients altogether, because they are too costly to serve and because payment for services is lower. Screening procedures now attempt to identify SSDI Ticket holders viewed as "job ready". IDR no longer provides vocational training or other costly upfront services, but focuses on resume development, interview and job seeking skills, and intensive job placement services to assist Ticket clients.

IDR is currently in the process of shifting its outreach activities away from retail clients and towards its long term disability Ticket holders and the beneficiaries recommended by vendors in its national network. Since January 2002, approximately 50% of Ticket assignments have come from retail clients and the rest from clients on long-term disability. In the coming year, IDR estimates that the mix will shift to about 25% retail clients and 75% long-term disability clients.

Ticket Assignments and Outcomes. IDR estimated at the time of the second interview that it has 137 Ticket assignments, and has received about $7,000 in payments for over a dozen beneficiaries. IDR is not actively unassigning large numbers of Tickets but has unassigned the Tickets of specific beneficiaries who did not follow through with activities specified in the IWP.

IDR staff has not experienced significant problems actually serving Ticket holders. Staff members indicated that the effect of the recent economic downturn on job development and placement efforts has been negligible. For the most part, IDR feels it has been very successful in its job placement and employment retention efforts. The agency indicated that the services required by beneficiaries who are long-term disability cases are virtually identical to those needed by beneficiaries considered retail cases. The differences between the two groups primarily relate to available funding. For long-term disability clients, IDR is able to receive funding from both an insurance company and SSA. In contrast, the agency must rely exclusively on payments from SSA when serving retail cases.

Unlike many other ENs, IDR is still actively accepting Tickets, but it has become much more selective in the number of Ticket assignments it accepts from retail clients. To date, the operational costs of the program have far exceeded the revenue IDR collects through payments from SSA. The low return on the initial investment has made it difficult for IDR to raise additional capital from lending institutions to expand program operations. The insurance payments for serving long-term disability clients are used to meet its cash flow needs; IDR considers SSA payments a "bonus". The decision to serve fewer retail cases is based on the financial risk involved in serving these individuals, since IDR must rely entirely on SSA payments to offset the costs of serving these individuals. If the payment process does not change in the future, IDR may reluctantly stop serving retail clients altogether.

Program Administration. IDR staff feels very strongly that problems in the current payment process continue to jeopardize the entire TTW program. One staff member said, "This one issue is putting the entire program at risk." IDR estimates that it costs the agency $90-$120 to collect a $279 payment from SSA; approximately 40%-45% of program revenues are devoted to pursuing pay stub issues. Program participants are annoyed that they have to submit pay stubs twice - once to the PM and once to the local SSA office. A few of IDR’s participants who were working full-time have unassigned their Tickets for this reason.

IDR staff feels that in the past year, the PM has successfully streamlined the Ticket assignment and IWP process. The biggest communication problem today has centered on the issue of pay stubs. IDR has supported and placed participants whose Tickets have been assigned, but it is still unable to collect payments for them because the individuals are unwilling to provide earnings documentation. At one time, the PM offered to intervene and obtain pay stubs from the employer on behalf of the participants, but this never occurred. Other participants have submitted pay stubs to the PM that were never processed. In one case, IDR placed an individual, then had trouble obtaining pay stubs and the requisite payment from SSA. The PM assured IDR that the confusion would be worked out but later determined that the individual was ineligible for benefits, so IDR is unable to collect payments for the services it provided to her.

Another issue involves a participant who reassigned his Ticket from another EN to IDR. The original EN feels it is entitled to ongoing partial payments because of the services it provided; IDR feels it unfairly must assume the entire administrative burden to receive only half of the payment. If the PM will not grant IDR the full payments, the agency will modify its screening criteria so that it will not accept Tickets that have been previously assigned.

Finally, IDR is concerned that the PM has not maintained an updated list of active ENs. It often refers beneficiaries to ENs that are no longer accepting Ticket assignments. IDR also expressed frustration regarding the lack of Ticket holders’ knowledge about basic aspects of TTW. IDR feels that recently the PM has been providing less thorough information to Ticket holders, and IDR has begun to refer callers back to the PM for additional information.

Concerns and Expectations Regarding Future Success. IDR plans to remain very active in the TTW program for the foreseeable future. Agency staff point to many outstanding success stories among the participants it has served, and can point to many individuals whose lives have been dramatically improved through participation in the program. However, the ongoing inability of SSA and the PM to address the earnings documentation problem and other administrative issues will greatly reduce the number of beneficiaries the agency will be able to assist. For example, IDR worries that the program is becoming inaccessible to many Ticket holders, for example, those who require costly services.

The most pressing change requested by the agency is a new, streamlined payment system. At the very least, IDR would like a quick, accurate turnaround on the payments. IDR staff suggested that SSA rely on administrative data to document earnings and pay ENs, thereby reducing the excessive administrative burden on the providers. Elimination of the pay stub requirement would make the ENs more willing to use the program, and as a result, make the program more accessible to Ticket holders. ENs spend far too much time in administrative tasks such as explaining the basic aspects of the program to beneficiaries who are not interested in reducing their dependence on cash benefits, negotiating VR EN agreements, documenting earnings, and communicating with the PM about payment and other issues. The PM should provide ENs with the ability to track Ticket assignment, payments, and any other program information online. This would encourage all parties to use consistent terms and cut down the amount of time it takes to track down information.

IDR thinks that the outcome payment system should be modified so that the payments take place over three rather than five years. If a participant is still employed after three years, then chances are he or she will remain employed for an extended period of time, interviewees argue. In addition, IDR feels that SSA needs to offer higher payments for SSI recipients because they require more resources to place and support in employment.

IDR believes that SSA should not distribute Tickets to people over 60 years old, because they will likely retire before the EN collects all of its payments.

Finally, IDR believes that some of the resources developed in part to assist ENs, such as the EARN program, should be more widely publicized. If ENs knew more about the EARN program and other support programs that are available, they would utilize these resources to best serve participants.

 

7. Marriott Foundation Bridges from School to Work

a. Implementation and Service Delivery Approach

The Bridges program became an EN with the goal of tapping into an additional funding source for the SSI youth it serves under WIA. Bridges staff believed that as many as 50 percent of its WIA clients were potentially eligible for TTW. By aggressively recruiting SSA beneficiaries to participate in the WIA youth employment program, Bridges could use TTW funds to expand its services. Staff believed that TTW could be used to provide longer-term job retention and post-employment services to clients. If Bridges could get its clients working at SGA, TTW would provide a means to fund those activities. The hope was that WIA would serve beneficiaries for the first 18 to 24 months and TTW funding would be used to provide follow-up services.

Potential clients are invited to the office for intake, where they complete a questionnaire, have their skills, needs, and level of commitment assessed, and sign release forms permitting Bridges staff to obtain benefits information from SSA. If a client decides to assign the Ticket, he or she returns to complete the IWP. Participants then enroll in a ten-week employment preparation course, which consists of career exploration, job seeking and interviewing skills, and retention strategies. Skill development is offered to people under age 21 who have the motivation to work but no job experience.

At initial interview in August 2002, Bridges had one full-time staff person devoted to TTW clients over age 21. TTW clients 21 and under are served by WIA staff. Bridges provides primarily job placement assistance, referrals to other agencies, job coaching, assistance with obtaining job accommodation, and counseling about SSA and other benefits. Most Bridges clients have learning disabilities; a few have psychiatric or cognitive disabilities. Bridges still provides the 10-week assessment and job seeking skills training, but will place individuals immediately if the individual must enter the workforce more quickly for financial or other reasons. Bridges provides limited funds for transportation, purchases interview clothing or uniforms, and refers individuals to other agencies who fund childcare or other services.

Problems surfaced early in program implementation. Initially, Bridges had planned to serve TTW clients aged 17 to 25, and enrolled a few individuals over age 25 as space was available. However, WIA funding only permits the program to serve persons through age 21 and TTW funding did not cover up-front service costs. After the first six months, Bridges altered its strategy to restrict service to TTW participants age 18 to 21. Because the Program Manager website stated that Bridges would serve individuals through age 25, they received a high volume of calls from individuals who were not eligible for services. Another problem was the difficulty of promoting TTW to the Marriott Foundation, particularly in light of the delayed TTW rollout and the low levels of expected revenue.

 

b. Early Experiences Implementing TTW

Beneficiary Outreach and Enrollment. At initial interview, Bridges’ only marketing effort was to send fliers and brochures about its services to the SSA FO for distribution to beneficiaries. The FO explained that the materials had to be approved and Bridges never heard back from the FO. Bridges generated some of its Ticket assignments from among former clients whom staff knew to be SSI recipients. Bridges staff instructed these clients to request their Tickets and assign them to Bridges. At the time of the first interview, staff was still in the process of identifying SSI recipients from among its WIA participants. Bridges accepted 12-14 Tickets from outside its caseload. Interviewees believed these referrals came from the Program Manager, or from other ENs that were not accepting Tickets. At the time of the first interview, Bridges had stopped accepting Tickets from individuals who were not eligible for WIA.

In deciding which Tickets to accept, Bridges considered the following

  • Age – person had to be 18-21 years old

  • Motivation – demonstrated by the individual’s work history. If the beneficiary had no work history or training, Bridges determined that the client had no marketable skills for employment and declined the Ticket. Because Bridges was not a job-training program, staff referred these callers to an EN that offered skills training. Examples of skills and experience considered to be marketable included food service, janitorial, file clerking, and organizational skills. The program was more lenient about accepting people under age 21 who did not have work experience.

  • Ability to work – Based on information gathered from an initial phone screening, and through the intake interview, Bridges staff assessed the potential client’s ability to work. If a potential client appeared to be unable or unwilling to perform work above SGA, Bridges would not accept the Ticket.

  • Bridges interviewees noted during the first interview that beneficiaries were often confused about TTW, thinking that the Ticket guaranteed them a job at the Marriott hotel chain. They suggested that SSA and the Program Manager should provide more complete information to beneficiaries.

Outcomes and Claims for Payment. At the time of the first interview, Bridges had changed from the Outcome to the Milestone/Outcome payment method. Bridges did not expect its TTW clients to remain working above SGA for five years; therefore, Bridges would not be eligible for the full outcome payments. The young clients that the program served did not have employment stability. The primary goal was to serve those who would be able to generate milestone payments to supplement WIA funding.

The program sought to place TTW clients in full-time jobs that paid $7-$8 per hour. Placements included hotel, laundry, fast food, janitorial, and clerical work. The level of post-employment support for Bridges clients was extensive, due to the severity of clients’ disabilities. The TTW Coordinator monitored beneficiaries’ status by conducting ongoing case management. She documented employment and asked beneficiaries to check in on a weekly, then monthly, basis. She checked in with supervisors to monitor the individual’s performance. Beneficiaries could call her cell phone at any time, and she held individual meetings once a month. Bridges held a celebration when a beneficiary reached a milestone; e.g., a year of employment. Bridges also counseled beneficiaries about their concerns, including problems with coworkers, accepting direction from more than one supervisor, scheduling work and outside activities, marital and parenting issues, and housing problems.

Program Administration. Bridges staff stated at initial interview that a major administrative issue was the inability to obtain information about clients’ benefit status from the SSA FO; for example, whether the individuals were in a trial work period. The EN eventually resolved these issues by working with the Regional Employment Services Representative (ESR).

Another administrative issue discussed during the first interview was obtaining pay stubs and other documentation to substantiate earnings. As Bridges obtained more placements, it anticipated adding an additional staff person to collect pay stubs and process the paperwork necessary for payment.

 

c. Status at Follow-up

Service Delivery. Bridges reported no changes in service delivery at the follow-up interview one year later. The EN is only accepting Tickets from beneficiaries who are eligible for services under WIA. One staff person, the TTW Coordinator, still provides services to TTW clients once they have completed the 10-week program. The coordinator tracks submission of pay stubs and provides post-employment counseling and support. She was moved to this position to avoid a layoff when other grant funding expired. The Bridges interviewee stated that the agency would not have made the financial commitment to hire a staff person for TTW had they not wished to avoid the lay off. The staff member in charge of TTW has set up a telephone message that explains the program and eligibility criteria. While she used to have a policy of returning calls within 24 hours, she now returns calls within the week because Bridges is not currently accepting new tickets. Instead, she refers clients to neighboring ENs. She currently handles 23 ticket assignments, most of which were initiated in April 2002, and feels she is working very close to her capacity of 25 clients. Bridges stays in constant communication with the beneficiaries and tries to convince them to stay in touch because they can receive valuable services. The Bridges employee in charge of TTW obtains check stubs from the individual in some cases, and in other cases she obtains this information from the employer. Bridges will discontinue its participation if one person cannot accomplish these duties.

Ticket Assignments and Outcomes. During the first year of operation, Bridges reported receiving as many as 120 inquiry calls per month. The number has dwindled to about 20 to 25 calls per month. Bridges staff noted that the calls are from beneficiaries who had called previously, rechecking to determine their eligibility. However, most callers are over the age of 21 and are not accepted. Bridges predicted they would serve a higher number of WIA clients who were Ticket-holders, but most beneficiaries attend one or two of the EN’s sessions before dropping out of the program. Fear of benefit loss is not the problem; many beneficiaries lack the motivation and the desire to work.

Program Administration. The Marriott Foundation covers Bridges’ up-front costs, but these costs significantly outweigh revenues. Up-front costs include one FTE and office space totaling $45,000-50,000 a year. The agency has received about $10,000 from TTW. Interviewees explained that they cannot absorb the losses much longer. Although they had originally viewed TTW as a five-year commitment, they had anticipated higher revenues and will not be able to continue the program unless revenues increase.

Bridges is currently receiving payments under both the milestone-outcome and outcome-only payment systems. Citing confusion over the similar names of the payment systems (both contain the word "outcome"), staff explained that Bridges originally signed up for the outcome-only payment system. Some clients found jobs, then moved away and ceased working, leaving Bridges without any payment from SSA. Bridges staff realized that they could have received milestone payments in this situation, so they switched to the milestone–outcome system. Bridges would like to switch back to outcome-only payments, because they would receive regular monthly payments for the 23 individuals who are currently working over SGA. However, due to a waiting period that limits ENs to one change in payment system per year, Bridges cannot change at this time.

Interviewees said that obtaining pay stubs from participants is extremely cumbersome and time consuming. Beneficiaries are asked to bring pay stubs into the office; if this is not possible, the TTW Coordinator meets them to pick up the pay stub. Several clients are working and have not submitted pay stubs, which means that Bridges receives no payment. Clients forget to drop pay stubs off or lose them. In one case, a client did not want her employer contacted because she did not want her psychiatric disability revealed. All records are kept manually, but Bridges is considering development of a computerized tracking system, if it continues its participation.

When Bridges first began submitting claims for payment, SSA was not entirely clear about what earnings documentation was needed. This resulted in communication problems between Bridges and the Program Manager. Once requirements were clarified, communication improved and documentation for payment proceeded more smoothly. Bridges also had problems with the SSA FO; when Bridges asked the FO for work history information on one client, the FO charged $1 per page. Interviewees stated that they have built a relationship with the SSA FO and the relationship is proceeding more smoothly; e.g., Work Activity Reports are completed in a timely manner.

Bridges is unhappy with the timelines for payment. The EN submitted its first payment request in May 2002 and did not receive payment on the claim until February 2003. Today, payments usually take about three months. Payment denials occur when clients are still in the TWP. In one example of payment problems, Bridges staff cited confusion about the level of earnings needed for a man whose wife is also on SSI. The man’s benefits were not terminated as anticipated, so Bridges never received the payment.

Concerns and Expectations Regarding Future Success. Bridges would like to make TTW an ongoing component of its program. Staff members believe that TTW has had a positive impact on their clients. Bridges plans to continue its involvement with TTW on a limited basis until June 2004, at which time it will examine cost and revenues. Bridges will continue to limit eligibility to individuals who can receive services under another program; e.g., WIA.

Bridges’ suggestions for changing the program include:

  • Eliminating the requirement for pay stubs to document earnings

  • Allowing for selection of the payment system on a per client basis

  • SSA providing more information on work history and benefits status of Ticket holders

  • Increasing milestone and outcome payments. The current amount is insufficient to cover service costs of making TTW successful on a large scale.

  • Bridges has succeeded due to support from the Marriott Foundation. Based on Bridges’ experience, staff members believe that ENs could not operate the program solely on Ticket funds. Moreover, keeping 25 people working at SGA requires a great deal of attention. Bridges interviewees believe that one person can handle a caseload of 25, particularly with the current pay stub requirements. But TTW revenues do not support this level of effort. The EN cannot expand the program unless an additional staff person is hired, and Bridges lacks the resources for additional staff.

 

8. Oklahoma Department of Rehabilitation Services

a. Implementation and Service Delivery Approach

Implementation. Interviewees said that DRS welcomed opportunities to participate in early discussions with SSA regarding TTW. DRS wanted to be one of the program leaders, especially because the state had 10 years earlier developed a milestone payment system for purchasing services from CRPs.4 Under this system, CRPs receive up to six milestone payments totaling $9,000 ($11,000 if the consumer is highly challenged) for each successful rehabilitation. 5 Interviewees said that, initially, most state VR agencies were firmly against TTW and sought to oppose it. DRS, however, thought that attempts by state VR agencies to stonewall TTW would only perpetuate the perception that VR agencies were not primarily concerned with serving those people who needed the most help. Furthermore, DRS staff believed TTW had the potential to increase revenue, and offered DRS the opportunity to improve service delivery to SSA beneficiaries.

In 2001, DRS developed a formal plan in preparation for TTW rollout, based on an engagement/outreach voucher model developed in 1998 through an SSA State Partnership Initiative (SPI) Grant. Through this model (the "Oklahoma Model"), select VR technicians receive training on work incentives and on the use of benefits analysis software (WorkWORLD) that calculates the impact of employment earnings on benefits. This is used to provide individual counseling to Ticket holders at state One-Stop employment centers about the impact of TTW participation on benefits. The technicians refer individuals with complicated cases, including all concurrent beneficiaries, to the benefits planning, assistance, and outreach (BPAO) program for individualized benefits planning.6 VR technicians are also able to expedite applications and VR eligibility determinations.

Initially, every VR employee was required to be trained in the basics of TTW. To familiarize VR staff with TTW, DRS held meetings in both Tulsa and Oklahoma City just before the original date of TTW rollout, and again in advance of the revised rollout date. DRS staff also visited all the field offices in the state. DRS began training the technicians who would be working on TTW in January and February of 2002.7 Technicians received training in work incentives from DRS staff, as well as from the local SSA Employment Support Representative (ESR) and staff of the BPAO program. Technicians also received WorkWORLD training via video conferencing with Virginia Commonwealth University staff and SSA trainers. In total, each technician received approximately 10 days’ worth of training.

DRS’ TTW rollout plan was developed within a newly created Ticket Unit in the Oklahoma City central office. DRS chose to administer the program centrally to help ensure delivery of consistent, accurate information to Ticket holders. All follow-up necessary to document SGA level employment for payment under TTW will also be conducted by Ticket Unit staff.

DRS selected the milestone-outcome payment mechanism for clients it will serve as an EN, as it has a long history with a similar payment system. The staff person who manages the SSA reimbursement program will make determinations regarding which Tickets to use milestone-outcome payments, based on the agency’s past experience with persons of similar characteristics. DRS will utilize the cost reimbursement payment option for others.

DRS also developed a standard agreement for ENs that want to use DRS services for their TTW clients. As discussed further in Section III.D, under this agreement, the EN can purchase DVR services on behalf of TTW clients without having to pay for them up front, and DVR accepts considerable risk that it will never be fully paid for the services.

Service Delivery. DRS has invested substantial resources in training staff, conducting outreach, and redesigning internal screening processes to implement TTW. Even so, DRS does not anticipate that TTW will have a substantial impact on its delivery of VR services to SSA beneficiaries, with the exception of expanded delivery of benefits planning services through specially-trained Ticket Unit staff and through the BPAO.

 

b. Early Experiences Implementing TTW

Beneficiary Outreach and Enrollment. In preparation for TTW, DRS set up an 800-number at the Ticket Unit and sent letters to all beneficiaries on the VR caseload, alerting them to TTW and describing its features. At the time of the initial interview, DRS was preparing to send a mailing to all beneficiaries in the state, to stimulate interest. DRS had anticipated between 30,000 and 50,000 calls subsequent to the Ticket mailings, but had only received 1,500 calls by the time of our visit.

The Ticket Unit was meant to act as a funnel for all TTW-related inquiries, and was responsible for screening TTW-related calls so that field counselors would not be burdened with providing basic information about the program.

Ticket Unit technicians told potential clients about the benefits of TTW over the phone, but DRS found that in-person presentations were more effective. All callers were invited to attend a Ticket Orientation meeting. Meetings were conducted at local One-Stop career centers. During visits to One-Stops, technicians presented detailed information on work incentives, and advised clients individually using the WorkWORLD computer program. DRS presented a slide show that described available work incentives and used a variety of scenarios to illustrate the potential impact of work activity on benefits. These meetings were also a chance to make consumers aware of the many services available to them at the One-Stops.

Beneficiaries interested in assigning their Tickets to DRS began the application process with a Ticket Unit Technician. The application was then reviewed by a Ticket Unit VR Counselor to determine eligibility. DRS had an initial goal of securing same-day eligibility determinations for Ticket holders, but found they could not process the applications in that timeframe. At initial interview, DRS processed applications in three to five days, with Ticket assignment taking about one week to 27 days faster than for its usual eligibility determinations.8 To expedite eligibility determinations, DRS asked the applicants to sign releases for medical information at the time of application. Originally, one individual in the Ticket Unit was sending releases to all applicants herself, but she later trained her assistants to do this fairly time-consuming task.

Outcomes and Claims for Payment. Ticket Unit staff selected the payment system, based on disability characteristics and anticipated case costs. DRS elected the EN payment system for clients who were expected receive services totaling under $5,000, and cost reimbursement for others. DRS was also able to receive payment as an EN for services that, historically, they would not have received reimbursement. For example, by selecting the milestone-outcome payment system for individuals with mental retardation or developmental disabilities in supported employment, DRS might secure three or four milestone payments. DRS would not have been able to receive cost reimbursement payments for these individuals, however, because they typically did not work up to SGA for any length of time.

At initial visit in August 2002, DRS had approximately 225 milestone-outcome clients, which represented almost all the Tickets assigned under this payment system to VR agencies in the phase 1 states.9 Interviewees suggested that most VR agencies did not realize the potential revenue available by using the milestone system, most likely because few VR agencies had the infrastructure in place for tracking earnings beyond 90 days. This was a task that DRS technicians would assume responsibility for after counselors closed a case. DRS made arrangements with the Office of Child Support Enforcement within the Administration for Children and Families to use the New Hire database for access to wage data. DRS staff noted, however, that gaining access to these data was very difficult; they faced many restrictions regarding its use; and they only had access to it for six months. Their plan was to subsequently use Unemployment Insurance (UI) data.10 The disadvantage of using UI data was that the data were nine months old, and SSA had indicated that they would not pay right away based on these data, but rather, would wait until wages could be verified by a claims representative.

Program Administration. Interviewees noted a number of issues encountered in trying to administer TTW. These problems related to communications between DRS and the Program Manager. Most of these communication problems related to program start-up and had been resolved by the time of the initial interview. DRS also pointed to problems with verification of earnings, and cross-referencing individuals currently receiving VR services with those receiving a Ticket. The CD-Rom provided by the Program Manager for this purpose did not contain Social Security Numbers (SSNs), which were necessary for this purpose. DRS staff noted that about 20 percent of the addresses in the database were incorrect, and roughly 40 percent of the addresses in DRS files were incorrect. DRS staff also noted that some individuals who had been issued a Ticket (and who had presented to DRS for services) were not included on the CD-ROM.

 

c. Status at Follow-up

Service Delivery. DRS has made few significant changes in service delivery during the past year. DRS is providing more individual training on the Ticket program to its counselors and is re-emphasizing the information provided during the past year. Training for beneficiaries takes place in smaller groups with eight to ten participants and is more detailed than the training previously provided. During the past year, DRS staff presented the Ticket Program at all 12 One-Stops in the state. At present, staff members conduct bi-weekly orientation meetings in Tulsa and Oklahoma City, and in other portions of the state, as needed.

DRS invites organizations interested in becoming ENs to the orientation session at the nearest One-Stop. It then invites the organizations to apply to become ENs; approximately two thirds apply. However, DRS staff stated that interest in the program has "fizzled"; few if any organizations are applying. DRS has no signed agreements with other ENs to jointly serve Ticket holders, and noted a situation where one EN instructed beneficiaries to apply for DRS services without informing DRS that they had assigned their Ticket to the EN.

DRS has established close working relationships with SSA FOs. Interviewees noted a positive and productive relationship with the AWIC. Staff members obtain beneficiaries’ releases to obtain financial and medical information from the FO. DRS also works closely with the BPAOs, particularly in cases of concurrent beneficiaries who are receiving both SSI and DI benefits.

Ticket Assignments and Outcomes. DRS will accept the Ticket of any beneficiary who applies for service. DRS does not have a policy of unassigning Tickets of beneficiaries who are not making reasonable progress, because beneficiaries are entitled to services through Title I of the Rehabilitation Act. However, due to budget shortfalls, DRS was forced to place many Ticket holders on a waiting list for services—many were on the waiting list for up to six months and could not proceed with writing IWPs. Oklahoma state law permits agency budgets to be cut on a month-to-month basis and DRS’ budget was cut during eight of the 12 months last year. Staff reported that the backlog of Ticket holders has diminished; most have developed IWPs and are currently receiving services.

At follow-up in August 2003, Oklahoma DRS had 1125 tickets assignments, with 575 designated for milestone plus outcome payments. The agency has received 37 milestone payments on 21 beneficiaries and 50 outcome payments on 11 beneficiaries. The estimated service costs for a particular client continue to drive the decision of whether to accept milestone payment or the traditional cost-reimbursement payment for each individual. DRS interviewees estimate that the agency spent about $1.2 million on services for its 575 milestone beneficiaries, and has received about $26,000 in TTW revenue thus far. Staff members project that, in the long run, revenues of $250,000 to $500,000 per year from milestone payments will be achieved. Although revenues may not equal expenditures on these clients, DRS would receive no revenue on clients that do not obtain SGA under the traditional cost reimbursement system. Staff commented that ENs will tend to serve the "easy cases" and refer individuals with more complex and expensive training needs to the VR agency; this will not achieve one of the TTW’s goals: to provide individuals with more significant disabilities a choice in rehabilitation providers. Staff also noted, however, that more individuals may potentially be served.

Program Administration. DRS staff stated that the Program Manager is sometimes slow in making Ticket assignments and DRS often begins serving the individual before receiving confirmation of Ticket assignments. Another problem is that sometimes the Program Manager informs DRS that the Ticket is unassignable, but does not provide a reason; e.g., whether the individual has deposited the Ticket with another provider. The reason for unassignment is critical in determining whether DRS should commence service provision.

DRS interviewees noted their confusion over whether the beneficiary must sign Form 1365 to formally assign the Ticket to DVR, and whether the date of Ticket assignment is the date the IPE is signed or the date the Form 1365 is signed. Staff would appreciate formal SSA policy memoranda on such matters.

DRS continues to use Unemployment Insurance (UI) data to track earnings. Although these data are three to four months out of date, they provide the information DRS needs to track earnings. Tracking earnings is no more difficult under the milestone system than the cost reimbursement system. Staff members have, however, experienced problems submitting pay stubs for earnings verification. In some cases, the pay stubs are not accepted because they do not have adequate information; e.g., the dates the beneficiary actually worked in addition to the date of pay; in another case, payment for placement of an independent contractor was rejected because he had not yet filed a tax return. Staff members also expend significant energy breaking down UI quarterly earnings data into monthly earnings. DRS staff expressed frustration with the amount of time spent in gathering this documentation-- documentation that SSA also gathers to determine benefit payment amounts. DRS staff suggested that SSA should not reject payment claims based on insufficient documentation, but should hold them until the agency receives earnings documentation from its own sources.

Concerns and Expectations Regarding Future Success. DRS will continue accepting Tickets and actively participating in TTW. Staff suggested several enhancements to TTW:

DRS expressed the desire that RSA play a more active role in promoting the Ticket Program and assisting VR agencies to address ongoing policy problems. Staff noted that an RSA official had stated that, "The Ticket is not our program." This attitude is antithetical to successful implementation by VR agencies.

DRS staff also noted that private agencies would have a difficult time implementing TTW, due to the lack of up-front funds to capitalize the program and the three- to four-month waiting period for payments. ENs will likely provide services to individuals who need few services, leaving the VR agencies to serve those with more complex service needs. This is not necessarily a problem, because of the high demand for rehabilitation services.

DRS staff commented that TTW requires that beneficiaries assume responsibility for participation. Beneficiaries must sift through significant amounts of information and must go through several steps to assign their Tickets and receive services. This multi-step process causes some beneficiaries to lose their motivation. Beneficiaries sometimes become confused about what a Ticket provides, believing possession of a Ticket entitles them to a job. Responsibility for educating the beneficiary falls largely on the ENs, with the Program Manager providing only very basic contact information. Beneficiaries are often fearful of any communication from SSA, so additional marketing efforts to explain TTW would be extremely beneficial. They suggested that SSA provide VR agencies and other ENs funding to explain TTW at one-on-one outreach activities. Barriers to participation could be more effectively overcome by locally-focused outreach projects.

Staff expressed the opinion that a centralized Program Manager could be dropped out of the beneficiary education and outreach process. They suggested establishing a hotline in each state to provide introductory information to beneficiaries. The delay that occurs when beneficiaries must wait a week to obtain a list of ENs from the Program Manager curbs beneficiaries’ enthusiasm for the program. Instead, DRS staff advocated modeling TTW on the Oklahoma State Partnership Initiative project: ENs would be invited to the consumer orientation meeting and asked to make a marketing presentation about their services. Beneficiaries could ask questions on the spot, and see who is available in their local community to help them get a job.


Notes:

1 We subsequently learned that the Program Manager had been distributing information to beneficiaries about ENs that were not yet accepting Tickets. Some ENs did not expect the contracting process to be as quick as it was, and were not prepared to accept Tickets when awarded a contract. The Program Manager is now making efforts to identify active and inactive ENs and to only distribute information about active ENs to beneficiaries. Return to text.

2 According to interviewees, one of Glick and Glick’s Ticket clients was referred to the local BPAO because of complicated benefits issues. While counseling the client, the BPAO, who was also a state VR agency, convinced the client to unassign the Ticket from Glick and Glick and to reassign it to the VR agency. Return to text.

3 Glick and Glick’s compensation can be tied to the ability of its employer client to qualify for tax credits on the individuals recruited by Glick and Glick. An individual must work 120 hours for the Work Opportunity Tax Credit, and 400 hours for a higher level credit. The Welfare-to-Work tax credit is based on 400 hours of work. Return to text.

4 This payment system was a finalist in the 1997 Kennedy School of Government Innovations in American Government awards. Return to text.

5 We provide more details regarding this payment system in Section III.D. Return to text.

6 Interviewees said that approximately 5 to 10 percent of individuals are referred to the BPAO to receive additional benefits planning. Return to text.

7 Some field staff also participated in this training. Return to text.

8 While SSA beneficiaries have presumptive eligibility for VR services, state VR agencies must verify beneficiary status and have 60 days to do so. TTW speeds up this process substantially because verification of beneficiary status can be gained by confirming the validity of the Ticket through the Program Manager. DRS hoped to be able to provide same-day confirmation of eligibility, but found that this process, in practice, took about three to five days. For purposes of serving consumers, DRS backdated eligibility confirmation to the date the consumer requested assignment. Return to text.

9 According to the Ticket Assignment Report dated September 23, 2002, DRS held 227 of the 274 total Tickets assigned by VR agencies under the milestone-outcome system. Return to text.

10 Interviewees noted that ENs did not have access to UI data, making wage tracking substantially more difficult for them. Return to text.