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Center for Studying Disability Policy Research Mathematica Policy Research

Disability Research Consortium:
A cooperative agreement with the Social Security Administration

 

Selected News/Research

March 31, 2014

Disability news and findings from around the world.

In the News: "VA Disability Claims Backlog Drops by 44 Percent." American Forces News Service.
More highlights

 

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Statue of FDR photographWelcome to the Center for Studying Disability Policy

The Center for Studying Disability Policy was established in 2007 by Mathematica to inform disability policy formation with rigorous, objective research and data collected from the people disability policy aims to serve. The Center supplies the nation's policymakers with the information they need to navigate the transition to 21st-century disability policy. For over two decades, Mathematica has conducted many significant disability studies, including some of the first rigorous evaluations of employment supports for people with severe disabilities and the largest surveys of people with disabilities. More than 30 staff continues this pioneering work today through a wide range of innovative disability research and data collection. Read more about the Center for Studying Disability Policy.


What's New


Highlights

Managing Care Transitions in Medicaid

Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the Uninsured to author this brief, the second of three case studies examining key operational aspects of coordinated care initiatives in Medicaid, which focuses on the Transitional Care Program conducted by Community Care of North Carolina (CCNC). CCNC is a medical home program that serves 83% of all North Carolina Medicaid beneficiaries. The Transitional Care Program identifies high-risk enrollees when they are admitted to a hospital, and plans, coordinates, and arranges their transition back to the community.

 

 

International Efforts to Serve Youth with Disabilities

U.S. policymakers at all levels are dissatisfied with the current system of transition supports for youth with disabilities—supports that are rather limited in promoting employment and self-sufficiency in adulthood. Information on the supports developed in other countries, whose youth with disabilities face similar issues, could be helpful for developing new solutions in the United States. A recent brief summarizes the findings from two studies that examined programs and policies in 10 countries addressing transition barriers faced by youth with disabilities. It also provides an overview of promising strategies from two countries—Germany and the Netherlands—with potential transferability to the United States.

May Forum Focuses on Employment

Right on Time? Early Interventions and Initiatives for Promoting Employment
Thursday, May 8, 2014

Over a million individuals under age 40 receive Supplemental Security Income(SSI) or Social Security Disability Insurance (SSDI) benefits. Federal and state vocational rehabilitation (VR) agencies offer unique opportunities for early intervention services to individuals with disabilities, including youth and young adults who are transitioning from school to work, to help them enter, re-enter, or remain in the labor force and reduce their reliance on disability benefits. Click here for more information.

 

Disability Policy for People with Brain Injury and Other Disabilities

Despite increases in program participation and spending, the economic independence of people with disabilities, including those with brain injury, has eroded. Media stories continue to highlight gaps in services for people with brain injury acquired in the Iraq and Afghanistan conflicts and the impact lack of health and employment services can have on their lives. Failure to address the underlying structural issues will perpetuate program inefficiencies and poor outcomes and could negatively impact this population. A recent article in Brain Injury (p. 18) outlines an alternative approach to slowing expenditure growth while improving the economic status of Americans with disabilities.

Latest Work

  • About Accessible Documents (*=accessible)
  • "Promoting Readiness of Minors in SSI (PROMISE) National Evaluation Data Collection Plan." Thomas Fraker, Gina Livermore, Jacqueline Kauff, and Todd Honeycutt, January 2014. PROMISE—Promoting Readiness of Minors in Supplemental Security Income (SSI)—is designed to address many of the barriers to economic independence SSI youth and their families face and, ultimately, to promote positive changes in educational and employment outcomes and reduce reliance on SSI benefits. Mathematica recently outlined its evaluation plans for conducting the nonsurvey data collection activities and sampling and surveying youth and their families 18 months after enrollment for this joint initiative of the Social Security Administration (SSA) and the U.S. Departments of Education, Health and Human Services, and Labor. SSA, the lead agency for the national evaluation, has contracted with Mathematica to conduct a nine-year evaluation of the six PROMISE programs, including implementation, impact, and cost-benefit analyses, to answer key policy questions.
  • *"Employment, Earnings, and Primary Impairments Among Beneficiaries of Social Security Disability Programs." David R. Mann, Arif Mamun, and Jeffrey Hemmeter, November 2013. Despite recent growth in Social Security Administration (SSA) disability programs, little is known about the relationship between employment, earnings, and specific primary impairments among the beneficiaries of these programs. Our study used linked 2011 SSA administrative data to create 25 primary impairment groups and examine the employment and earnings distribution of recent DI beneficiaries and working-age SSI disability benefit recipients. The findings reveal that much heterogeneity exists in employment and earnings across primary impairment groups. We also find that some impairment categories strongly associated with employment are not as strongly associated with higher earnings, after conditioning on employment status.

  • *"Recent Developments in State Efforts to Rebalance Long-Term Services and Supports." The National Evaluation of the MFP Demonstration, Reports from the Field #13. Rebecca Sweetland Lester, Carol V. Irvin, and Wilfredo Lim, October 2013. This report examines the progress states in the Money Follows the Person (MFP) demonstration have made with their rebalancing programs—efforts to make community-based long-term care services and supports more accessible. States have spent MFP rebalancing funds on initiatives such as helping people access community-based services, financing these services, and supporting provider workforce initiatives. This report examines the progress states in the Money Follows the Person (MFP) demonstration have made with their rebalancing programs—efforts to make community-based long-term care services and supports more accessible. States have spent MFP rebalancing funds on initiatives such as helping people access community-based services, financing these services, and supporting provider workforce initiatives.

  • *"Money Follows the Person 2012 Annual Evaluation Report." Carol V. Irvin, Noelle Denny-Brown, Matthew Kehn, Rebecca Sweetland Lester, Debra Lipson, Wilfredo Lim, Jessica Ross, Alex Bohl, Victoria Peebles, Samuel Simon, Bailey Orshan, Susan R. Williams, Eric Morris, and Christal Stone, October 2013. The fourth annual report of the Money Follows the Person (MFP) Evaluation includes analyses on (1) program implementation for the first five years; (2) descriptions of MFP participants and costs and types of services received; (3) trend analyses to detect shifts in the balance of state long-term care systems that may have occurred; and (4) an assessment of how participant quality of life changes after they leave the program. Executive summary

  • *"Disparities in Post-Transition Outcomes by Level of Care Needs Among Former Nursing Home Residents." The National Evaluation of the MFP Demonstration, Reports from the Field #12. Wilfredo Lim and Carol V. Irvin, September 2013. This report looks at short-term outcomes for people in the Money Follows the Person (MFP) demonstration. It found nursing home residents who had low care needs and transitioned to community living, through MFP or by other means, were slightly more likely to remain in the community and avoid reinstitutionalization than those with higher care needs.

  • "Improving Post-High School Outcomes for Transition-Age Students with Disabilities: An Evidence Review." R. Brian Cobb, Stephen Lipscomb, Jennifer Wolgemuth, Theresa Schulte, Abigail Veliquette, Morgen Alwell, Keriu Batchelder, Robert Bernard, Paul Hernandez, Helen Holmquist-Johnson, Rebecca Orsi, Laura Sample McMeeking, Jun Wang, and Andrea Welnberg , August 2013. This report uses evidence-based standards developed by the What Works Clearinghouse to review the research literature on programs that help students with disabilities make transitions after high school. Community-based work programs had mixed effects on employment and potentially positive effects on postsecondary education. Functional life skills development programs had potentially positive effects on independent living although the extent of evidence was small.
  • “BOND Implementation and Evaluation: Stage 2 Early Assessment Report,” Daniel Gubits, Rachel Cook, Stephen Bell, Michelle Derr, Jillian Berk, Ann Person, David Stapleton, Denise Hoffman, and David Wittenburg, August 2013. Findings indicate that the Stage 2 implementation is likely to successfully serve its purpose of testing impacts of the offset and of enhanced counseling as an add-on to the offset. However, start-up problems have slowed entry into the offset.
  • "Participant and Provider Outcomes Since the Inception of Ticket to Work and the Effects of the 2008 Regulatory Changes." Jody Schimmel, David Stapleton, David R. Mann, and Dawn Phelps, July 2013.This report details the extent to which Social Security Disability Insurance and Supplemental Security Income beneficiaries had their cash benefits suspended or terminated because of work activity from 2002 through 2010, focusing on the period around the Ticket to Work (TTW) regulation changes in July 2008. It focuses on employment, earnings and nonpayment of benefits due to work statistics for TTW participants. Findings in the report show that TTW participants forgo cash benefits for work more often than other beneficiaries, but that the economic recession from 2007 to 2009 adversely affected their employment outcomes.
  • "Executive Summary of the Seventh Ticket to Work Evaluation Report." Gina Livermore, Arif Mamun, Jody Schimmel, and Sarah Prenovitz, July 2013. This report summarizes seven studies conducted for the final Ticket to Work (TTW) evaluation report that examine beneficiary work activity and effects of the original and revised TTW regulations, the experiences of providers under the revised regulations, and the employment outcomes of beneficiaries using Work Incentive Planning and Assistance services.
  • "Initial Impacts of the Ticket to Work Program for Young New Social Security Disability Awardees: Estimates Based on Randomly Assigned Mail Months." David Stapleton, Arif Mamun, and Jeremy Page, July 2013. This report presents impact estimates for the original Ticket to Work program, prior to the 2008 regulatory changes. Although distribution of Tickets significantly increased service enrollment, there was little evidence of increased suspensions or terminations of benefits due to work.
  • "Medicaid Analytic Extract Provider Characteristics (MAXPC) Evaluation Report, 2010." Deo Bencio, July 2013. This report describes the motivation for creating the MAXPC file and its design and content. It also examines the quality and completeness of each of the six types of provider IDs (inpatient billing provider, long-term care billing provider, other services billing and servicing provider, and prescription drug billing and prescribing providers). The analysis focuses on the 45 states that had the requisite Medicaid Statistical Information System files available for calendar year 2010 services (Idaho, Kansas, Maine, New Jersey, North Dakota, and Utah are excluded). The quality and completeness vary substantially by state and type of provider ID.
  • "Money Follows the Person Demonstration: Overview of State Grantee Progress, July to December 2012." Susan R. Williams, Eric Morris, Bailey Orshan, Noelle Denny-Brown, Matthew Kehn, Jessica Ross, and Christal Stone, July 2013. A new report summarizes progress made between July and December 2012 by Money Follows the Person (MFP) grant programs. MFP grants support state efforts to help individuals living in institutions move to home and community settings if that is where they wish to receive long-term services and supports. By the end of 2012, the fifth full year of the MFP demonstration, the number of MFP transitions continued to grow by all measures. From July to December 2012, states reported 4,882 new transitions, an increase of 13 percent compared to the previous six month period.
  • “BOND Implementation and Evaluation: First-Year Snapshot of Earnings and Benefit Impacts for Stage 1,” David Stapleton, David Wittenburg, Daniel Gubits, David Judkins, David R. Mann, and Andrew McGuirk, May 2013. This report notes that the benefit offset had no impacts on the primary outcomes of total earnings and total SSDI benefits paid in the first partial year for Stage1—not surprising at this early point.
  • "Addressing Return-to-Work Issues in the Federal Employees' Compensation Act with Administrative Data." Nan Maxwell, Albert Liu, Nathan Wozny, and Caroline Massad Francis, April 2013.This study examines the characteristics of workers’ compensation cases using administrative data reported under the Federal Employees’ Compensation Act (FECA) from 2005 to 2010. Findings suggest three areas that might inform workers’ compensation program design: (1) a small proportion of cases received a large percentage of the services provided; (2) occupational illness cases, which are caused by repeated exposure to conditions in the work environment, were more likely to be severe and to receive more benefits than traumatic injury cases; and (3) injured workers who did not return to work quickly were unlikely to return to work within three years of the report date of the injury. .
  • *"Evaluation of the Work Incentives Planning and Assistance (WIPA) Program in 2011: Beneficiaries Served, Services Provided, and Program Costs." Jody Schimmel, Sarah Prenovitz, Gina Livermore, and Alex Bryce, April 2013. This report presents findings on the activities of 102 organizations receiving Social Security Administration (SSA) grants under the Work Incentives Planning and Assistance (WIPA) program in 2011. SSA created the WIPA program to educate beneficiaries about SSA work incentives with the goal of assisting them in their return to work. In 2011, WIPA grantees provided services to nearly 60,000 beneficiaries, including nearly 43,000 receiving WIPA services for the first time. Enrollment, service, and cost trends are identified and discussed.
  • "Return-to-Work Outcomes Among Social Security Disability Insurance Program Beneficiaries." Yonatan Ben-Shalom and Arif Mamun, June 2013. This report follows a sample of working-age Social Security Disability Insurance program beneficiaries for five years after their first benefit award to learn how certain factors help or hinder achieving four important milestones: (1) first enrollment for employment services provided by a state vocational rehabilitation agency or employment network, (2) start of trial work period, (3) completion of trial work period, and (4) suspension or termination of benefits because of work. Younger beneficiaries are more likely than older beneficiaries to achieve the milestones, and the likelihood of achieving them varies substantially across impairment types. Other factors, including state of residence and month of award, also play an important role.
  • *"Services and Supports People with Disabilities Need to Stay Employed." Noelle Denny-Brown, Bonnie O'Day, and Stephanie McLeod, May 2013. This study explores the types of services, supports, and accommodations workers with disabilities use on and off the job and the strategies workers use to obtain the supports they need to find and maintain their employment. It also examines the extent to which employment supports and services were paid for by public or private sources, were no-cost supports, or were paid for out of pocket by the worker.
  • *"Enrollment, Employment, and Earnings in the Medicaid Buy-In Program, 2011." Matthew Kehn, May 2013. This report, prepared for CMS, is the last in a series of annual reports on participation in the Medicaid Buy-In program. It provides updates on both national- and state-level trends in enrollment, employment, and earnings among the 35 reporting Medicaid Infrastructure Grant (MIG) states with a Buy-In program in 2011. Additionally, it addresses recent changes to state program rules and policies, and identifies factors that have affected recent Buy-In program enrollment, as reported by the states in an annual questionnaire.
  • "Enrollment, Employment, and Earnings in the Medicaid Buy-In Program, 2010." Matthew Kehn and Jody Schimmel, May 2013. This report, prepared for CMS, is part of a series of annual reports on participation in the Medicaid Buy-In program. It provides updates on both national- and state-level trends in enrollment, employment, and earnings among the 38 reporting Medicaid Infrastructure Grant (MIG) states with a Buy-In program in 2010. Additionally, this annual report presents findings from a geographical analysis that used participant zip code data to determine where Buy-In participants live, the level of program penetration, which areas have the most successful Buy-In participants, and whether local economic factors are associated with both program penetration and participant success.
  • "Medicare Health Plans and Dually Eligible Beneficiaries: Industry Perspective on the Current and Future Market." Marsha Gold, Winnie Wang, and Gretchen Jacobson, March 2013. Federal and state governments have begun to test ways to financially align Medicare and Medicaid benefits for beneficiaries served by both programs. Some of these demonstrations will enroll dually eligible beneficiaries into capitated managed care plans for both their Medicare and Medicaid benefits, and many will be managed by some of the firms that also offer Medicare Advantage plans. To inform the ongoing policy debate surrounding these dual-eligible beneficiaries, the authors interviewed senior executives at 13 diverse insurance firms that contract with the programs to learn more about how insurance firms view various proposals to better align the way Medicare and Medicaid work for individuals served by both programs.
  • *"Characteristics and Service Use of Medicaid Buy-In Participants with Higher Incomes: A Descriptive Analysis."Denise Hoffman, Kristin Andrews, and Valerie Cheh, May 2013. This study examined the characteristics and service use of Medicaid Buy-In participants with higher incomes (above above 250 percent of the federal poverty line), relative to other participants with lower incomes. The study found higher income participants were less likely to enroll in Medicare and more likely to be enrolled in third-party insurance. Service use for higher income Buy-in participants concentrated on prescription drugs and durable medical equipment, and Medicaid expenditures for a selected set of services among higher-income participants were generally less than expenditures for the same services among all Buy-In participants.
  • *"Medicaid Analytic eXtract 2008 Encounter Data Chartbook." Rosemary Borck, Ashley Zlatinov, and Susan Williams, February 2013. This chartbook uses Medicaid Analytic eXtract (MAX) 2008 data to describe the service utilization of Medicaid enrollees in managed care plans. The chartbook extends the analysis of the previous MAX chartbooks, which focused on the service utilization of Medicaid enrollees covered on a fee-for-service basis. This chartbook also supplements recent MAX issue briefs that focused on the quality and completeness of encounter data. This chartbook provides valuable information for the Centers for Medicare & Medicaid Services and researchers on the availability of and uses for encounter data in MAX data. Appendix Tables
  • "Social Security Numbers in Medicaid Records: Reporting and Validity, 2009. Final Report."ohn L. Czajka and Shinu Verghese, January 2013. Social Security numbers (SSNs) are the only effective means of linking data from the Medicaid Statistical Information System (MSIS) to other research databases. This study uses Census Bureau data to assess the validity of reported SSNs in recent MSIS data by age group and state of residence and presents integrated findings on both the reporting and validity of MSIS SSNs at the state and national levels. Valid SSNs were present on 91.7 percent of the MSIS records submitted by the states and were nearly always correct (99.3 percent we judged to be valid). The exceedingly high validation rate for MSIS SSNs is significant because the validity of any research based on these linked data are directly dependent on the quality of the SSNs recorded in the MSIS files.
  • More reports
  • "Initial Impacts of the Ticket to Work Program: Estimates Based on Exogenous Variation in Ticket Mail Months." David Stapleton, Arif Mamun, and Jeremy Page, March 2014. This paper presents results from an impact analysis of the Ticket to Work (TTW) program, as implemented by the Social Security Administration (SSA) from 2002 through 2007. For new, young Social Security Disability beneficiaries, we use exogenous variation in the month of Ticket mailing to rigorously estimate impacts of TTW on beneficiary outcomes over a 48-month period following the start of Ticket mailings in the beneficiary’s state. We find substantial impacts on enrollment for employment services with TTW-qualified providers, but no consistent evidence of impacts on the number of months in which beneficiaries did not receive benefits because of work, or on other outcomes.

  • "A Roadmap to a 21st-Century Disability Policy for People with Brain Injury and Other Disabilities." David R. Mann, David C. Stapleton, and Bonnie L. O'Day. Brain Injury Professional, January 2014. Despite decades of growth in federal disability expenditures, the economic status of people with disabilities has eroded relative to the status of those without disabilities. Rather than tighten eligibility or reduce program benefits to slow expenditure growth, this article outlines an alternative approach consisting of gradual programmatic reforms and evidence-based structural changes to slow federal disability expenditure growth and, at the same time, improve the economic status of people with disabilities.
  • "State and Demographic Variation in Use of Depot Antipsychotics by Medicaid Beneficiaries." Jonathan D. Brown, Allison Barrett, Emily Caffery, Kerianne Hourihan, and Henry T. Ireys, January 2014.This study in Psychiatric Services (subscription required) found the use of injectable antipsychotics varied substantially among state Medicaid programs. African Americans received a disproportionate share in many states.
  • "Striking While the Iron is Hot: The Effect of Vocational Rehabilitation Service Wait Times on Employment Outcomes for Applicants Receiving Social Security Disability Benefits." Todd Honeycutt and David Stapleton. Journal of Vocational Rehabilitation, September 2013. State vocational rehabilitation (VR) agencies play a significant role in supporting the employment goals of people with disabilities, but delays in the receipt of vocational services could adversely affect employment outcomes of applicants for services. This study explores the effect of waiting for VR services on employment outcomes for Social Security Disability Insurance (SSDI) beneficiaries. Using multivariate models based on agency order of selection characteristics and a measure of the usual wait time for VR services, the study found that longer wait times are associated with lower employment outcomes at VR closure and throughout SSA administrative data.
  • "Early Interventions to Prevent Disability for Workers with Mental Health Conditions: Impacts from the DMIE." Gilbert Gimm, Denise Hoffman, and Henry T. Ireys. Disability and Health Journal, August 2013, published online ahead of print (subscription required). This rigorous study found that early intervention programs with a personal navigator can reduce dependence on federal disability benefits for adult workers with mental health conditions.
  • "Medication Continuity Among Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder." Jonathan D. Brown, Allison Barrett, Emily Caffery, Kerianne Hourihan, and Henry T. Ireys. Psychiatric Services in Advance, June 2013. This study examines whether medication continuity among Medicaid beneficiaries with schizophrenia and bipolar disorder was associated with medication utilization management practices (prior authorization, copayment amounts, and refill and pill quantity limits); managed care enrollment; and other state and beneficiary characteristics. The study found that prior-authorization requirements and copayments for medications can present barriers to refilling medications for Medicaid beneficiaries with schizophrenia or bipolar disorder.
  • "Assessing the Usability of MAX 2008 Encounter Data for Comprehensive Managed Care." Vivian L.H. Byrd and Allison Hedley Dodd. Medicare & Medicaid Research Review, 2013. As growing numbers of Medicaid enrollees receive health benefits through comprehensive managed care, researchers and policymakers must rely on encounter data to understand their service use. An article in Medicare & Medicaid Research Review assessed the availability, completeness, and quality of outpatient service (OT), inpatient (IP), and prescription drug (RX) encounter claims to judge the usability of the 2008 Medicaid Analytical eXtract (MAX) encounter data. The encounter data were considered usable for at least one basis of eligibility category for 22 of the 25 states that submitted OT encounter data, 20 of the 24 states that submitted IP data, and 13 of the 15 states that submitted RX data.
  • "The Disability System and Programs to Promote Employment for People with Disabilities." David Wittenburg, David R. Mann, and Allison Thompkins. IZA Journal of Labor Policy, April 2013. This paper examines employment-focused interventions in the U.S. disability system. The review illustrates the challenges of developing and implementing these types of initiatives, despite substantial policy interest. Findings indicate that none of the demonstrations has the potential to lead to substantial caseload reductions that could reverse program growth. However, they can inform future designs and point to the importance of customizing supports to very well-defined target populations.
  • "Is Timing Everything? Disability Onset of Youth and Their Outcomes as Young Adults." David R. Mann and Todd C. Honeycutt. Journal of Disability Policy Studies, April 2013 (subscription required). This study uses data from the National Longitudinal Survey of Youth to examine how employment and degree completion outcomes for young adults vary by the timing of disability onset during childhood and adolescence. The authors find people with disabilities whose conditions persist into adulthood have poorer employment and education outcomes than those without disabilities. In addition, employment and education outcomes are poorest for young adults with psychiatric and intellectual impairments.
  • "National and State Trends in Enrollment and Spending for Dual Eligibles Under Age 65 in Medicaid Managed Care." Jenna Libersky, Allison Hedley Dodd, and Shinu Verghese. Disability and Health Journal, April 2013 (subscription required). This article uses 2005 and 2008 Medicaid Analytic eXtract (MAX) data to present spending and enrollment trends for adults with disabilities who are dually eligible for Medicare and Medicaid. Nationwide, the proportion of adult duals in managed care increased from 2005 to 2008, with the expansion of prepaid health plans (PHPs), particularly behavioral health PHPs, driving the increase. Although overall use of managed care has increased, there has been little expansion in the use of comprehensive managed care among adult dual eligible beneficiaries, particularly when compared with their Medicaid-only disabled adult peers. This imbalance suggests room to remove barriers preventing dually eligible adults, from enrolling in comprehensive, integrated managed care.
  • "The Effects of Mental Health Parity on Spending and Utilization for Bipolar, Major Depression, and Adjustment Disorders." Alisa B. Busch, Frank Yoon, Colleen L. Barry, Vanessa Azzone, Sharon-Lise T. Normand, Howard H. Goldman, and Haiden A. Huskamp. American Journal of Psychiatry, February 2013. This article counters concerns that benefit expansion under parity would increase spending. The study finds that mental health parity provisions in the Federal Employees Health Benefits program reduced total out-of-pocket spending for patients with more-severe behavioral health conditions, while the level of services they received remained largely unchanged. The study also found, however, that individuals with less-severe but acute mental health conditions received fewer services, suggesting that health plans manage benefits selectively.
  • "How to Provide and Pay for Long-Term Care of an Aging Population is an International Concern." Marsha Gold. Israel Journal of Health Policy Research, January 2013. As populations age, most industrialized nations are seeking to review their long-term care programs and better allocate better limited public resources to meet expanding needs. This commentary piece examines critical questions that define the way individual nations provide for the long-term care needs of their aging populations.
  • "Matching Study Designs to Disability-Related Comparative Effectiveness Research Questions."Jeffrey Ballou, Eugene Rich, and Matthew Kehn. Journal of Comparative Effectiveness Research, January 2013. To better address the need for high-quality and informative research on the effectiveness of interventions for people with disabilities, an article in the Journal of Comparative Effectivenessthe authors conducted a comprehensive review of existing standards for assessing evidence quality in order to determine their applicability to disability research. This article presents methodological and design issues for researchers to consider when addressing disability-related comparative effectiveness research questions.
  • More journal articles
  • About Accessible Documents (*=accessible)
  • "Promoting Integrated Employment: Lessons Learned from States' Efforts to Transform Their Employment Service Systems for People with Intellectual/Developmental Disabilities." State Technical Assistance Resources Brief. Noelle Denny-Brown, Leah Guanga, and Daniella Sehgal, December 2013. Integrated employment is defined as participation in competitive employment in which people with disabilities work alongside people without disabilities for at least minimum wage. This issue brief describes five states' efforts to increase integrated employment for people with intellectual or developmental disabilities. It discusses barriers that have hindered states' progress toward expanding integrated employment outcomes and highlights lessons that can help other states advance their efforts to transform their employment service systems.
  • "Integrating Care for Adult Medicaid Beneficiaries with Serious Mental Illness." February 2014. This issue brief describes two Pennsylvania pilot programs that sought to integrate Medicaid’s physical and behavioral health care to improve care for beneficiaries with serious mental illness (SMI). To build the evidence base for Medicaid systems’ integration, the Pennsylvania Department of Welfare launched the SMI Innovations Project in 2009. Each pilot was a collaboration between physical health managed care organizations, behavioral health managed care organizations, and county behavioral health offices. Mathematica’s mixed-methods evaluation suggests that states can develop strategies to promote integration across separate financing and delivery systems and thereby improve the quality of care for Medicaid beneficiaries with serious mental illness.
  • "Managing Care Transitions in Medicaid: Spotlight on Community Care of North Carolina."Julia Paradise, Marsha Gold, and Winnie Wang. October 2013. Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the Uninsured to author this brief, the second of three case studies examining key operational aspects of coordinated care initiatives in Medicaid, which focuses on the Transitional Care Program conducted by Community Care of North Carolina (CCNC). CCNC is a medical home program that serves 83% of all North Carolina Medicaid beneficiaries. The Transitional Care Program identifies high-risk enrollees when they are admitted to a hospital, and plans, coordinates, and arranges their transition back to the community.

  • "Home- and Community-Based Service Use Among Medicare-Medicaid Enrollees with Functional Limitations 2007–2008." MAX Medicaid Policy Brief #20. Allison Hedley Dodd and Rosalie Malsberger, September 2013. This issue brief presents the results of the first study conducted using data from Medicaid Analytic eXtract (MAX) data and the Medicare Current Beneficiary Survey to assess the use of home- and community-based services by the presence and level of functional limitations, as measured by limitations in activities of daily living.
  • *"The HCBS Taxonomy: A New Language for Classifying Home- and Community-Based Services." MAX Medicaid Policy Brief #19. Victoria Peebles and Alex Bohls, August 2013. This brief describes the home and community-based services (HCBS) taxonomy—a uniform classification system composed of 18 categories and more than 60 services—and presents findings on expenditures and users for the 28 states whose MAX data files were approved by June 1, 2013.
  • "New Evidence on the Role of Provider Business Model in the Economic Viability of Employment Networks Under Ticket to Work." Issue Brief 13-04. Jody Schimmel, July 2013. To assist Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries in their return-to-work efforts, the Social Security Administration launched the Ticket to Work (TTW) program in 2002. TTW provides beneficiaries with a Ticket that they can assign to an employment network (EN) to help them find employment and reduce dependence on cash benefits. In July 2008, SSA made regulatory changes to TTW designed to spur provider involvement. This brief summarizes findings about TTW participant work activity for five EN business models and considers the implications for EN financial viability.
  • "Medicare Basics: An Overview for States Seeking to Integrate Care for Medicare-Medicaid Enrollees." ICRC Technical Assistance Brief. Jenna Libersky and James Verdier, July 2013. States seeking to better integrate care for Medicare-Medicaid enrollees need to understand Medicare benefits and enrollee cost-sharing provisions in order to better structure and coordinate the Medicaid beenfits they will be offering to these enrollees. This technical assistance brief provides an overview of these Medicare issues and, where relevant, highlights important areas of overlap with Medicaid, including coverage of nursing facility services, home health, durable medical equipment, hospice, transportation, and prescription drugs. It also provides a brief summary of how rates are set in Medicare Advantage managed care programs.
  • "Implications of State Methods for Offering Personal Assistance Services." MAX Medicaid Policy Brief #18. Laura Ruttner and Carol V. Irvin, June 2013. This brief examines the differences in the use and cost of personal assistance services in states that do and do not provide these services through their state plans. States that offer these services through their state plans appear to provide them to a greater number of beneficiaries at a lower cost per beneficiary than states that do not. The states that offer services also have long-term care systems that are more balanced toward home- and community-based rather than institutional long-term care services.
  • "Medicare Part D Prescription Drug Coverage for Medicare-Medicaid Enrollees in the Capitated Financial Alignment Demonstration." James Verdier, 2013. This technical assistance brief provides targeted information on the prescription drug benefit provided by Medicare Part D for states participating in the CMS capitated Financial Alignment Demonstration covering Medicare-Medicaid enrollees , including how beneficiaries are enrolled in Part D, how Part D drugs are paid for, what drugs are and are not covered in Part D, how drug utilization is managed in Part D, and how the Part D Medication Therapy Management Program works. As a technical assistance document, the brief focuses only on what states need to know about Part D in the context of the Financial Alignment Demonstrations.
  • "Trends and Patterns in the Use of Prescription Drugs Among Medicaid Beneficiaries: 1999 to 2009." MAX Medicaid Policy Brief #17. James M. Verdier and Ashly Zlatinov, March 2013. This issue brief highlights trends in the use and costs of prescription drugs for Medicaid beneficiaries between 1999 and 2009. Findings are drawn from a series of annual tables and chartbooks that Mathematica prepared for CMS. Highlighted trends include per person changes in drug costs and the volume of drugs used as well as changes in the use of generic drugs. Among drug types, antipsychotics accounted for 15 percent of expenditures in 2009, and for 25 percent of the total growth in expenditures between 1999 and 2009. Other costly drugs were antiasthmatics and antivirals, which each accounted for about 8 percent of Medicaid’s total drug expenditures in 2009.
  • "Ticket to Work Participants: Then and Now." Issue Brief #13-02. Crystal Blyler, Denise Hoffman, and Gina Livermore, May 2013. Created by Congress to help disability beneficiaries find employment, the Ticket to Work (TTW) program was revised in 2008 to make it more attractive to employment service providers. This brief discusses how the TTW participant population has changed under the revised regulations, and examines how the regulations may have affected beneficiaries’ service use, employment outcomes, and satisfaction with TTW.
  • "Toward a More Perfect Union: Creating Synergy Between the Money Follows the Person and Managed Long-Term Services and Supports Programs." The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #11. Debra J. Lipson and Christal Stone Valenzano, February 2013. This report examines how five states have structured the interface between Money Follows the Person (MFP) demonstration grants and Managed Long-Term Services and Support (MLTSS) programs to promote transitions from institutional care to home- and community-based settings. It describes how eligibility rules for each program affect the overlap between enrollees, how Medicaid payment rates to contracted managed care organizations (MCOs) promote transitions, how MFP and MCO staff divide responsibility for transition planning, and how states track quality of care and performance indicators for MFP participants enrolled in MLTSS plans.
  • "The Youth Transition Demonstration: Lifting Employment Barriers for Youth with Disabilities." Issue Brief 13-01. Thomas Fraker, February 2013.
  • "Using the MAX-NHANES Merged Data to Evaluate the Association of Obesity and Medicaid Costs." Allison Hedley Dodd and Philip M. Gleason, January 2013. This brief presents the results of the first study conducted using the newly merged Medicaid Analytic eXtract (MAX) and National Health and Nutrition Examination Survey (NHANES) data. The study evaluated the association between Medicaid costs and obesity among adults in 1999–2004. Although the estimated costs were higher for obese adults than for non-obese adults, the combination of a small sample size for NHANES data, wide variation in costs among Medicaid enrollees, and the necessity of controlling for state variation yielded an unstable model with imprecisely estimated relationships. The results demonstrate the hazard of using a small national survey (NHANES) with a state-based data system (MAX) to perform cost analyses, particularly when the range of realistic costs is large.
  • More issue briefs
  • "Experiences of Germany and the Netherlands in Serving Transition-Age Youth." Todd Honeycutt and Lorenzo Moreno, February 2014. This study explores transition strategies Germany and the Netherlands use to address issues faced by youth with disabilities. Using a case study methodology, the study finds these countries have a number of comprehensive, coordinated, efficient, and inclusive transition strategies and programs for youth and young adults with disabilities. However, only a handful of these programs are likely candidates for transferring, entirely or in part, to the U.S. disability support system.
  • "The Earnings Consequences of the Americans with Disabilities Act on People with Disabilities." Allison V. Thompkins, November 2013. To improve labor market outcomes of people with disabilities, Congress passed the Americans with Disabilities Act (ADA) in 1990. Immediately following enactment, the wages of people with disabilities decreased, but longer-term wage consequences have not been studied. Using data from the March Current Population Survey for 1988-2010, this working paper shows that the ADA led to a longer-term increase in the weekly wages of those with disabilities. Furthermore, the wage effect of the ADA varies according to level of education.
  • "State Differences in the Vocational Rehabilitation Experiences of Transition-Age Youth with Disabilities." Todd Honeycutt, Allison Thompkins, Maura Bardos, and Steven Stern, August 2013. This working paper presents new state-level statistics on the outcomes for a cohort of transition-age youth with disabilities who applied for vocational rehabilitation (VR) services from 2004 through 2006. Across states, the percentage of transition-age youth applying for VR services ranged from 4 to 14 percent, the percentage of applicants receiving VR services ranged from 31 to 82 percent, and the percentage of youth who closed with an employment outcome after receiving VR services ranged from 40 to 70 percent.
  • "Trends in the Composition and Outcomes of Young Social Security Disability Awardees." Yonatan Ben-Shalom and David Stapleton, July 2013. This paper provides new descriptive information on trends in the composition and outcomes of young (under age 40) Social Security Disability (SSD) beneficiaries first awarded benefits between 1996 and 2007, particularly differences between disabled workers and disabled adult children (DAC), and between beneficiaries with and without a Supplemental Security Income (SSI) history as children or adults. In 2007, compared to 1996, relatively more SSD awards to individuals under age 40 went to DAC versus disabled workers, to disabled workers and DAC who had received SSI benefits (especially as children) versus those with no SSI history, and to disabled workers and DAC with psychiatric disorders versus those with other types of impairments.
  • "Return-to-Work Outcomes Among Social Security Disability Insurance Program Beneficiaries." Yonatan Ben-Shalom and Arif Mamun, June 2013. This report follows a sample of working-age Social Security Disability Insurance program beneficiaries for five years after their first benefit award to learn how certain factors help or hinder achieving four important milestones: (1) first enrollment for employment services provided by a state vocational rehabilitation agency or employment network, (2) start of trial work period, (3) completion of trial work period, and (4) suspension or termination of benefits because of work. Younger beneficiaries are more likely than older beneficiaries to achieve the milestones, and the likelihood of achieving them varies substantially across impairment types. Other factors, including state of residence and month of award, also play an important role.
  • "Vocational Rehabilitation on the Road to Social Security Disability: Longitudinal Statistics from Matched Administrative Data." David C. Stapleton and Frank H. Martin, September 2012. This study describes the extent to which vocational rehabilitation (VR) applicants receive Social Security Disability (SSD) benefits before or after VR application. SSD entry varies with VR applicant characteristics; those with relatively high SSD entry include non-Hispanic whites, those not employed at application, those with more than a high school education, and especially those already receiving Supplemental Security Income but not SSD. There is also wide variation in SSD entry across states, with some states having entry percentages twice as high as others.
  • "Conducting Surveys with Proxies: Evaluating a Standardized Measure to Determine Need." Sara Skidmore, Kirsten Barrett, Debra Wright, and Jennifer Gardner, July 2012. This working paper describes a three-question telephone screener used with the National Beneficiary Survey to standardize interviewers' assessments of whether sample members had the capacity to complete a survey or if a proxy was needed. Results show that interviewer training on how to use the screener dramatically improved the accuracy of determining the need for a proxy.

CSDP Forum: Right on Time? Early Interventions and Initiatives for Promoting Employment (May 8, 2014)

National Children’s Mental Health Awareness Day
May 8 is National Children’s Mental Health Awareness Day. On May 6, the national event will be launched at the National Council for Behavioral Health conference in DC. To watch the live webcast of the event on May 6 from 1:45-2:45 p.m. (EDT) click here.

Employment & Disability State of the Science Conference
The Disability Statistics and Demographics Rehabilitation and Research Training Center (RRTC), funded by the Department of Education and the National Institute for Disability and Rehabilitation Research (NIDRR), will hold a State-of-the-Science conference on April 8 and 9 in Bethesda, MD. The theme is “Advancing Evidence-Based Practices and Policies to Close the Employment Gap,” and the conference will showcase research that enhances the scientific evidence to reduce the employment gap between people with and without disabilities.