Reports

• About Accessible Documents (*=accessible)

• *"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." John 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.
  
• *"Longitudinal Statistics for New Supplemental Security Income Beneficiaries." Yonatan Ben-Shalom, David Stapleton, Dawn Phelps, and Maura Bardos, November 2012. Using Social Security Administration data, this paper presents findings from a longitudinal analysis of the extent to which new Supplemental Security Income (SSI) disability beneficiaries return to work and use SSI work incentives. Longitudinal statistics show that more than 8 percent of those first awarded SSI benefits as adults in 2001 had their benefits suspended due to work for at least a month by December 2007.
• "An Assessment of Consultative Examination (CE) Processes, Content, and Quality: Findings from the CE Review Data."  David Wittenburg, Gordon Steinagle, Sloane Frost, and Ron Fine, November 2012. The consultative examination (CE) is a physical or mental health examination or test requested by the Social Security Administration to determine eligibility for Supplemental Security Income and Social Security Disability Insurance. Mathematica worked with Comprehensive Occupational Medical Services to develop a data extraction tool that allowed medical consultants to extract information regarding the processes, content, and quality of CEs. The final report indicates that most CEs included most information called for in federal regulations, though potential inefficiencies exist in the process that might affect content and quality.
• "Inter-Rater Reliability Analysis of Data to Document the Consultative Examination Process: Volume 1." David Wittenburg, Debra Wright, Sloane Frost, Gordon Steinagle, and Ron Fine, November 2012.  
  
• "Inter-Rater Reliability Analysis of Data to Document the Consultative Examination Process: Volume 2." David Wittenburg, Debra Wright, Sloane Frost, Gordon Steinagle, and Ron Fine, November 2012.
• *"Money Follows the Person 2011 Annual Evaluation Report." Carol V. Irvin, Debra Lipson, Samuel Simon, Matthew Hodges, Alex Bohl, Victoria Peebles,, Jeremy Bary, Matthew Sweeney, Laura Ruttner, Sean Orzol, and John Schurrer, October 2012. This annual report finds the national Money Follows the Person (MFP) demonstration, now in its fourth full year of implementation, appears to be achieving its broad goals. They include (1) successfully transitioning people who need long- term care and supports from institutions to the community, and (2) helping states establish the infrastructure necessary to increase the capacity of long-term care systems to serve people in the community.
• "Executive Summary of the Sixth Ticket to Work Evaluation Report." Gina Livermore, Bonnie O'Day, Yonatan Ben-Shalom, Sarah Prenovitz, Jody Schimmel, and Craig Thornton, September 2012. This summary presents key findings from four studies conducted under the Ticket to Work and Self-Sufficiency Program (TTW) evaluation through 2012. The studies focus on the employment efforts of working-age (age 18 to full retirement age) Supplemental Security Income (SSI) and Disability Insurance (DI) beneficiaries and the Social Security work incentives and support designed to encourage and facilitate beneficiary employment. Two of the reports presented in this summary specifically concern TTW program issues, and the other two address more general topics related to beneficiary employment and Social Security work supports other than TTW.
• "Ticket to Work Participant Characteristics and Outcomes Under the Revised Regulations." Gina A. Livermore, Denise Hoffman, and Maura Bardos, September 2012. This report compares the characteristics and outcomes of two cohorts of TTW participants—one whose members assigned their Tickets before the implementation of the revised regulations of 2008, and one whose members assigned their Tickets after. Compared with the pre-regulation-change cohort, the post-regulation-change cohort had a larger share of younger beneficiaries, was more likely to have psychiatric conditions, and was less likely to have ever worked for pay. The service-use patterns of the two cohorts were similar, but the post-regulation-change cohort was less likely to report unmet service needs, more likely to report satisfaction with TTW, and less likely to be employed.
• "Identifying Transition-Age Youth with Disabilities Using Existing Surveys." Todd Honeycutt and David Wittenburg, July 2012. Using the International Classification of Functioning, Disability, and Health as a framework, this paper identifies definitions of disability for transition-age youth that can be used to compare and contrast statistics on the characteristics and outcomes of this population across different surveys.
• *"Medicaid Enrollment Gaps, 2005-2007." John Czajka, June 2012. This issue brief, based on a previous report , uses data from a new source—Medicaid administrative records that have been unduplicated and linked over time—to investigate discontinuities in Medicaid enrollment by eligibility group and state over the period January 2005 through December 2007.
• *"BOND Stage 1 Early Assessment Report." BOND Implementation and Evaluation. David Wittenburg, David Stapleton, Michelle Derr, Denise W. Hoffman, and David R. Mann, May 2012. As part of the Ticket to Work and Work Incentives Improvement Act of 1999, Congress asked the Social Security Administration to conduct the Benefit Offset National Demonstration (BOND). BOND tests alternative Social Security Disability Insurance (SSDI) work rules that increase the incentive for SSDI beneficiaries to return to work. Benefits are reduced gradually when a beneficiary has earnings exceeding a specific amount, instead of being cut to $0 (as under current law). As a subcontractor to Abt Associates, Mathematica provides implementation support and co-leads the evaluation. This is the first evaluation report on Stage 1, which involved implementing benefit offset rules for a random, nationally representative sample.
• *"Money Follows the Person Demonstration: Overview of State Grantee Progress, July to December 2011." Susan R. Williams, Debra Lipson, Noelle Denny-Brown, Rebecca Lester, Bailey Orshan, Christal Stone, and Matthew Kehn, June 2012. This report summarizes the progress of Money Follows the Person (MFP) grant programs in 33 states and the District of Columbia. It examines numbers of people who transitioned, reinstitutionalization rates, achievement of spending goals on Medicaid home and community-based services, and major accomplishments and implementation challenges. 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. Enrollment in MFP by people transitioning to the community continued to grow throughout 2011, the fourth full year of program operations, although new enrollment growth leveled off during the second half of 2011. Overall, states reported nearly 4,000 new transitions from July through December 2011, 6 percent more than the number transitioned in the previous six-month period.
• *"Work Incentive Simplification Pilot (WISP): Recommendations of the Technical Advisory Panel Regarding the Evaluation Design." David Wittenburg, David R. Mann, and David C. Stapleton, April 2012. Still in its early design stages, the Work Incentive Simplification Pilot is a Social Security Administration demonstration to test major simplifications to the Social Security Disability Insurance work incentives. This report comprises recommendations from a technical advisory panel, developed and administered by Mathematica, composed of seven members from the academic, nonprofit, and governmental fields with a wide range of evaluation and policy experience to provide input on evaluation design options.
• "Integrating Care for Dual Eligibles in New York: Issues and Options." James M. Verdier, Jenna Libersky, and Jessica Gillooly, February 2012. This report for the New York State Health Foundation provides recommendations to improve the coordination and integration of care dual eligibles receive through Medicare and Medicaid in New York. Key recommendations include using the federal dual eligible demonstration to support and enhance current state initiatives for dual eligibles and encouraging greater integration of all Medicaid and Medicare services in capitated managed care programs.
• *"Promoting Readiness of Minors in Supplemental Security Income (PROMISE): Recommendations of the Technical Advisory Panel Regarding the Use of Incentive Payments and the Evaluation Design." Thomas Fraker and Todd Honeycutt, February 2012. PROMISE, a joint program of the Social Security Administration and several federal departments, aims to improve outcomes for children who receive Supplemental Security Income. This report summarizes the technical advisory panel's recommendations for incentive payments and evaluation design. It also assesses relevant evaluation issues. Appendices
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Journal Articles

• "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.

• "The Effects of Health Care Benefits on Health Care Use and Health: A Randomized Trial for Disability Insurance Beneficiaries." Charles Michalopoulos, David Wittenburg, Dina A.R. Israel, and Anne Warren. Medical Care, September 2012 (subscription required). Under current law, most Social Security Disability Insurance (SSDI) beneficiaries are not eligible for Medicare until 29 months after the Social Security Administration confirms the onset of their disability. During this waiting period, more than one in five beneficiaries lacks health insurance. This article investigates the effects of providing health care benefits on the health, employment, and other services of uninsured beneficiaries. Individuals with health care benefits used more health care, had fewer unmet medical needs, spent less out of pocket on health care, and reported improved health. In addition, they were more likely to look for work, but the supports did not affect work or SSDI benefits at this very early period.
• "The Financial Repercussions of New Work-Limiting Health Conditions for Older Workers." Jodi Schimmel and David C. Stapleton. Inquiry, summer 2012. Using a nonexperimental analysis, this article examined earnings and income for older workers who later experience the onset of a medical condition that limits their ability to work. Income from unemployment insurance, workers' compensation, and retirement and disability benefits offset only a small amount of the earnings declines, resulting in decreased overall household income after onset of the work-limiting condition.
• "Employment Experiences of Young Medicaid Buy-In Participants with Psychiatric Disabilities." Jody Schimmel, Su Liu, and Sarah Croake. Psychiatric Rehabilitation Journal, January 2012 (subscription required). The Medicaid Buy-In program enables people with disabilities to buy into Medicaid when their earnings or assets would typically make them ineligible. Using buy-in employment data, this article assessed the differences in employment outcomes between young participants (ages 18 to 30) with psychiatric disabilities versus young participants with other disabilities and found the former achieve larger average increases in earnings around the time of enrollment in the program than those with other disabling conditions, though average earnings while employed are lower.
• "Competitive Employment Outcomes of Vocational Rehabilitation." Frank H. Martin, Richard T. Walls, Martin Brodwin, Randall Parker, Frances Siu, and Edward Kurata. Journal of Applied Rehabilitation Counseling, Spring 2012 (subscription required). This article examines occupational outcomes for state-federal vocational rehabilitation consumers whose cases were successfully closed in 2008 using the Standard Occupational Classification system. It investigates the top 50 job titles and top 5 occupations by disability categories after vocational rehabilitation. Median hourly wages for participants are reported and compared with those of the general labor force. The authors discuss findings and implications and offer suggestions to rehabilitation counselors about how to expand consumers' job and career options.
• "Adult Employment Assistance Services for Persons with Autism Spectrum Disorders: Effects on Employment Outcomes." John D. Westbrook, Chad Nye, Carlton J. Fong, Judith T. Wan, Tara Cortopassi, and Frank H. Martin. Campbell Systematic Reviews, March 2012. This systematic review of the research on the effectiveness of adult employment assistance interventions for individuals with autism spectrum disorder (ASD) found two quasi-experimental studies that met inclusion criteria. However, the review was not able to identify definitive interventions that predictably and positively supported the development of employment outcomes for individuals with ASD. Qualitative studies and other relevant research studies were also reviewed. While qualitative studies point to a number of promising issues for future research, they do not provide a definitive statement about what works.
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Issue Briefs

• About Accessible Documents (*=accessible)
• "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.
• "Assessing the Usability of Encounter Data for Enrollees in Comprehensive Managed Care Across MAX 2007-2009." MAX Medicaid Policy Brief #15. Vivian L.H. Byrd and Allison Hedley Dodd, December 2012. This brief informs researchers and policymakers on the availability and usability of encounter data for Medicaid managed care. It builds on previous reviews of MAX 2007 and 2008 encounter data by evaluating the MAX 2009 physician, outpatient and clinic services, inpatient hospital services, and prescription drug services encounter data. The analysis found that, in many states, data quality improved from 2007 to 2009.
• *"The Work Experiences of New SSI Beneficiaries: A Longitudinal Perspective." Issue Brief #12-06. Yonatan Ben-Shalom and David Stapleton, December 2012. This issue brief uses longitudinal data to follow a group of Social Security Insurance beneficiaries and examine their efforts to return to work. Compared with shorter-term cross-sectional data, the longitudinal statistics show higher levels of employment and suspensions of benefits due to work.

• *“Which Medicaid Buy-In Participants Use SSA Work Supports?” Denise Hoffman and Jody Schimmel, November 2012. This issue brief describes the use of SSA work supports among the nearly three-quarters of Buy-In participants who also receive Social Security Disability Insurance. To better understand who might benefit most from program outreach, the researchers explored variation in use rates by age, education, and disabling health condition. The brief also examines the relationship between work-support use, employment, and earnings.

• "Institutional Level of Care Among Money Follows the Person Participants." The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #10. Jessica Ross, Sam Simon, Carol Irvin, and Dean Miller, October 2012. The Money Follows the Person (MFP) demonstration supports states' efforts to help Medicaid beneficiaries living in long-term care institutions transition back to community-based residences and make long-term care services and supports more accessible. Using nursing home assessment data, this report compared needs of MFP participants with (1) a cohort of Medicaid long-stay nursing home residents who transitioned to home and community-based services in grantee states but were not enrolled in MFP, and (2) a cohort of long-stay residents in MFP states who did not transition.
• "Back to Work: Recent SSA Employment Demonstrations for People with Disabilities." Issue Brief, 12-05. David R. Mann and David Wittenburg, June 2012. This issue brief summarizes short-term impacts from four large scale- demonstration projects by the Social Security Administration designed to increase the economic self-sufficiency of Supplemental Security Income recipients and Social Security Disability Insurance beneficiaries. Results from these rigorous assessments include modest improvements in employment.
• *"Post-Institutional Services of MFP Participants: Use and Costs of Community Services and Supports." The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #9. Carol V. Irvin, Alex Bohl, Victoria Peebles, and Jeremy Bary, February 2012. This report uses aggregate data from annual financial reports and service claims records submitted by grantees to examine the costs and types of community-based services received by participants in the Money Follows the Person program.
• *"How Many Disability Beneficiaries Forgo Cash Benefits Because of Work? Evidence from a New Measure." Issue Brief 12-03. Jody Schimmel and David Stapleton, February 2012. This issue brief summarizes findings from a longer report by Mathematica's disability experts, who used a new indicator to determine how many beneficiaries receiving Social Security Disability Insurance and Supplemental Security Income forgo cash benefits because of work.
• *"The Work Incentives Planning and Assistance Program: Promoting Employment Among Social Security Disability Beneficiaries." Issue Brief 12-02. Jody Schimmel, Bonnie O'Day, and Allison Roche, February 2012. This issue brief summarizes findings from the Work Incentives Planning and Assistance program, a Social Security Administration program to promote employment by providing beneficiaries with information about federal work supports.
• *"Service Providers' Experiences Under the Revised Ticket to Work Regulations." Issue Brief 12-04. Sarah Prenovitz, February 2012. In 2008, Congress revised the regulations for Ticket to Work, a federal program created to improve incentives and supports for people who receive disability benefits to seek employment. This issue brief discusses how Ticket to Work participation by service providers and beneficiaries has changed under the revised regulations. It also describes providers' early experiences with these regulations.
• "A Roadmap to a 21st-Century Disability Policy." Issue Brief, 12-01. David Mann and David Stapleton, January 2012. Despite decades of increases in program participation and spending, the disability support infrastructure in the United States and the economic independence of people with disabilities have eroded. Rather than tighten eligibility or reduce program benefits, this issue brief proposes gradual programmatic reforms and evidence-based structural changes to improve the economic status of Americans with disabilities.
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Working Papers

• "Lessons for Programs Serving Transition-Age Youth: A Comparative Analysis of the U.S. and 10 Other Countries in the Organisation for Economic Co-Operation and Development (OECD)." Lorenzo Moreno, Todd Honeycutt, Stephanie McLeod, and Claire Gill, April 2013.This working paper summarizes policies and programs of 10 countries in the Organisation for Economic Co-Operation and Development (OECD) that aim to improve the transition of youth with disabilities to appropriate and gainful employment. It highlights the following themes: (1) countries have engaged in a range of efforts to promote employment, (2) large-scale pilots have helped identify effective programs, (3) most countries have programs to improve access to adult services for people with disabilities, and (4) all countries have actively pursued ways to coordinate youth and adult services.
• "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.
• "Is There a Trade-off Between Quality and Cost? Telephone Versus Face-to-Face Interviewing of Persons with Disabilities." Debra Wright, Matt Sloan, and Kirsten Barrett, February 2012. This working paper suggests that mode of interview has a modest impact on data quality for people with disabilities. It offers survey design steps that can minimize mode effects and maximize data quality.

Other

• These codebooks describe the content and format of the Public Use Representative Beneficiary data files from rounds 1 to 3 of the National Beneficiary Survey (NBS). The NBS, a component of the Social Security Administrations evaluation of the Ticket to Work and Self-Sufficiency program, collected data from a national sample of Social Security Disability Insurance and Supplemental Security Income beneficiaries, as well as a sample of Ticket to Work participants.
  
  "National Beneficiary Survey: Round 3 Public Use File Codebook." Debra Wright, Shilpa Khambhati, and Beatrice Jones, January 2010.
  "National Beneficiary Survey: Round 3 Public Use Data Files." Debra Wright, Shilpa Khambhati, and Beatrice Jones, January 2010.
  "National Beneficiary Survey: Round 2 Public Use File Codebook."  Debra Wright, Shilpa Khambhati, and Beatrice Jones, December 2009.
  "National Beneficiary Survey: Round 2 Public Use Data Files."  Debra Wright, Shilpa Khambati, and Beatrice Jones, December 2009.
  "National Beneficiary Survey Round 1: Public Use File Codebook." Debra Wright, Shilpa Khambhati, and Beatrice Jones, September 2009.
  "National Beneficiary Survey Round 1: Public Use Data Files."  Debra Wright, Shilpa Khambhati, and Beatrice Jones, September 2009.