Evaluation of the Ticket to Work Program, Implementation ...

66ENs were reluctant to expand services or otherwise alter their processes and structuresfor a revenue stream they viewed as shaky. Although we discovered a few innovative servicemodels, most ENs provide the same services to SSA beneficiaries that they always have.Some provide low levels of service, such as assisting with resume preparation and referral tojob openings. Other ENs simply refer Ticket holders to SVRAs, who then refer thebeneficiary back to the EN for payment under an existing service agreement. Almost all ofthe ENs we interviewed had served SSA beneficiaries before TTW was initiated.ENs typically were paying for overhead and direct services out of other existing fundingsources, not with revenues from Ticket payments. Only 31 percent of ENs nationwide whohad accepted Tickets had received any payments; 76 percent of them had received less than$5,000. Not surprisingly, the ENs we interviewed for this report overwhelmingly suggestedchanges to the payment systems, such as larger milestone or up-front payments. We returnto this issue in Chapter VIII which simulates the financial incentives TTW provides to ENs.A. OVERVIEW OF EN AVAILABILITYA major goal of the TTW legislation is to increase the supply of rehabilitation providersby offering payments to ENs who assist SSA beneficiaries to leave the benefit rolls. Beforethe TTW legislation was passed, SSA offered payments to SVRAs (and, for a few years,organizations in the Alternate Participant Program) for serving beneficiaries. The legislationis based upon the assumption that agencies with the potential to serve SSA beneficiaries willparticipate as ENs to the extent that there is demand for return-to-work services and thepayments cover their costs. The purpose of this section is to review the availability of ENsand draw conclusions as to whether the supply of rehabilitation providers has actuallyincreased through their participation.Since the initial evaluation report was prepared in fall 2003, the number of providersparticipating in TTW as ENs has continued to grow, reaching 1,164 at the end of June 2004(Figure V.1). The slower pace of EN enrollment in spring 2004 was, according to theProgram Manager, the result of market saturation and increasing difficulty in selling “aproduct that nobody wants to buy.” In early fall 2004, as TTW neared full implementation, 1the Program Manager was beginning to focus EN recruiting efforts on specific providergroups, such as nontraditional or faith-based providers, and on ENs in major metropolitanareas where large numbers of beneficiaries reside.Although the number of ENs has grown over time, most ENs still have not acceptedany Tickets, continuing a trend discussed in the initial evaluation report (Figure V.1). Of themore than 1,100 ENs enrolled in TTW at the end of June 2004, only 454 (40 percent) hadany Ticket assignments (Table V.1). Furthermore, most of the ENs that have acceptedTickets have accepted 4 or fewer. Less than 3 percent of ENs had 30 or more Tickets.1 Phase III was fully implemented by October 2004.V: EN Participation in Ticket to Work