With better access to health care and employment supports, individuals with physical and mental impairments can stay employed, maintain health, and avoid becoming dependent on federal disability benefits. To help American workers with potentially disabling conditions achieve these goals, Congress authorized the Demonstration to Maintain Independence and Employment (DMIE) under the Ticket to Work and Work Incentives Improvement Act of 1999. This report is an interim assessment of the national DMIE program. Early findings from four states using random assignment show that DMIE programs can be implemented in a wide range of settings and can be customized to meet the needs of different target populations. A total of 4,099 baseline DMIE participants were enrolled as of September 2008.