Disability Publications: 2011 and Earlier
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"Money Follows the Person Demonstration: Overview of State Grantee Progress, January to June 2011." Noelle Denny-Brown, Debra Lipson, Matthew Kehn, Bailey Orshan, and Christal Stone Valenzano, December 2011. This report summarizes the implementation progress of the Money Follows the Person (MFP) demonstration for 30 grantee states (29 states and the District of Columbia) from January 1 to June 30, 2011. Enrollment in MFP continued to grow steadily, with 15,818 cumulative transitions to the community as of June 30, 2011, a 33 percent increase from the end of 2010. During this period, grantees assisted 3,722 people living in institutions to return to the community, more than half of the annual goal. If states continue making progress at this rate throughout 2011, they will achieve or exceed the aggregate 2011 transition goal.
*"Fiscal Austerity and the Transition to Twenty-First Century Disability Policy: A Road Map." David R. Mann and David C. Stapleton, November 2011. Systemic problems with the current support system for working-age people with disabilities are failing to meet the economic aspirations of this population and driving up governmental expenditures for their support. In this paper, the authors describe the programmatic and financial structure of a support system that has the potential to change these outcomes. They also propose a focused demonstration period to build the evidence base and political consensus needed to support major structural change. This proposal could be incorporated into an effort to address the nation's long-term fiscal problems while protecting those relying on existing programs in the short term.
*"Money Follows the Person 2010 Annual Evaluation Report." Carol Irvin, Debra Lipson, Audra Wenzlow, Samuel Simon, Alex Bohl, Matthew Hodges, and John Schurrer, October 2011. This is the second annual report on the Money Follows the Person (MFP) demonstration, a federal initiative to help states reduce their reliance on institutional care for people needing long-term care and expand options for elderly people and individuals with disabilities to receive care in the community. During 2010, MFP increased the number of Medicaid beneficiaries transitioned by more than 50 percent over the previous year and expanded into 13 additional states. By the end of 2010, nearly 12,000 beneficiaries transitioned to community living through MFP programs, and participants generally fared well in the community and improved their quality of life.
*"Assessing the Need for a National Disability Survey: Final Report." Gina Livermore, Denise Whalen, and David C. Stapleton, September 2011. As state and federal agencies strive to meet the growing needs of people with disabilities while using fewer resources, better disability data are needed for monitoring and improving the health, economic status, and overall well-being of this population. A report by staff from the Center for Studying Disability Policy found gaps in survey data used to inform national disability policies and programs that could negatively affect the ability of state and federal governments to monitor the well-being of this group, and to manage and improve programs. The report identifies limitations in national survey data on disability and outlines a wide range of potential short- and long-term options for addressing them, including developing and fielding a national disability survey.
*"Provider Experiences Under the Revised Ticket to Work Regulations." Norma Altshuler, Sarah Prenovitz, Bonnie O'Day, and Gina Livermore, September 2011. This report presents findings on the experiences of employment service providers for the Ticket to Work Program, a program intended to increase Social Security beneficiaries’ access to and choice of quality rehabilitation and employment services. The Social Security Administration structured the revised regulations to address important challenges in the original program and successfully educated providers about the revised regulations and instituted related support systems. The revised regulations modestly expanded the number of providers and participating providers are, on average, more active in the program than under the original regulations.
*"Evaluation of the Recent Experience of the Work Incentives Planning and Assistance (WIPA) Program: Beneficiaries Served, Services Provided, and Program Costs." Jody Schimmel, Allison Roche, and Gina Livermore, September 2011. This report presents findings on the activities of the 103 organizations receiving Social Security Administration grants under the WIPA program, focusing on the period from April 1, 2010 through March 31, 2011. It counts the number of beneficiaries served by the WIPA program as a whole, documents the characteristics of beneficiaries served, and assesses the nature of the services and supports provided by the WIPA program to beneficiaries. It also relates costs and outputs for individual WIPA organizations.
*"Employment-Related Outcomes of a Recent Cohort of Work Incentives Planning and Assistance (WIPA) Program Enrollees." Gina Livermore, Sarah Prenovitz, and Jody Schimmel, September 2011. This report presents findings of an analysis of beneficiaries who first enrolled for Work Incentives Planning and Assistance services between October 1, 2009, and March 31, 2010. The findings suggest that the program is serving a select group of beneficiaries who are actively working, seeking employment, using the Social Security Administration work incentive provisions, and leaving the disability rolls at relatively high rates. The findings also suggest that Work Incentives Planning and Assistance services might be positively affecting some of these employment outcomes.
*"Disability Data in National Surveys." Gina Livermore, Denise Whalen, Sarah Prenovitz, Raina Aggerwal, and Maura Bardos, August 2011. The federal government collects extensive disability survey and administrative data used by federal and state agencies for a variety of purposes. This report presents the findings from a review of the disability-related information and other key features of 40 existing national surveys sponsored by the federal government.
"Demonstration to Maintain Independence and Employment (DMIE): Final Report." Denise Whalen, Gilbert Gimm, Henry Ireys, Boyd Gilman, and Sarah Croake, June 2011, revised February 2012. This is the third and final report on the national Demonstration to Maintain Independence and Employment (DMIE) evaluation. Authorized under the Ticket to Work and Work Incentives Improvement Act of 1999, the program awards funds to states to develop, implement, and evaluate early interventions for workers with potentially disabling health conditions. The evaluation examined impacts on three key outcomes: health and functional status, employment outcomes, and reliance on federal disability benefits. Overall, early interventions such as the DMIE could have positive impacts, although the extent of effects varied across states.
"The Social Security Administration's Youth Transition Demonstration Projects: Interim Report on the City University of New York's Project." Thomas Fraker, Alison Black, Joseph Broadus, Arif Mamun, Michelle Manno, John Martinez, Reanin McRoberts, Anu Rangarajan, and Debbie Reed, April 2011. This report presents first-year evaluation findings for the City University of New York project, which served youth ages 14 through 19 in Bronx County from August 2006 to May 2010. The program was well implemented and had statistically significant impacts on several important outcomes, including service use and paid employment.
"The Social Security Administration's Youth Transition Demonstration Projects: Interim Report on Colorado Youth WINS." Thomas Fraker, Peter Baird, Alison Black, Arif Mamun, Michelle Manno, John Martinez, Anu Rangarajan, and Debbie Reed, April 2011. This report presents first-year evaluation findings for the Colorado Youth WINS (Work Incentive Network of Supports) project, which served youth in four counties from August 2006 to December 2009. Using process analysis, the report found Youth WINS, as implemented, deviated from the program model in ways that may have reduced its potential to achieve certain critical objectives. However, Youth WINS participants were more likely to have used services to promote employment than the control group.
*"BOND Implementation and Evaluation: Evaluation Analysis Plan." Stephen Bell, Daniel Gubits, David Stapleton, David Wittenburg, Michelle Derr, Arkadipta Ghosh, Sara Ansell, and David Greenberg., March 2011.
"The Social Security Administration's Youth Transition Demonstration Projects: Interim Report on Transition WORKS." Thomas Fraker, Alison Black, Arif Mamun, Michelle Manno, John Martinez, Bonnie O'Day, Meghan O'Toole, Anu Rangarajan, and Debbie Reed, February 2011. The Social Security Administration is funding a random assignment evaluation of six demonstration projects to improve employment and other outcomes for youth ages 14 to 25 who are either receiving disability benefits or are at high risk of receiving them in the future. This report reviews the Youth Transition Demonstration (YTD) projects, located in Buffalo, New York, including findings from a process analysis on implementation, as well as an analysis of one-year impacts on youth’s use of services, employment and earnings, income and benefits, educational attainment, and attitudes and expectations.
*"The Accelerated Benefits Demonstration and Evaluation Project: Impacts on Health and Employment at Twelve Months." Volume 1. Charles Michalopoulos, David Wittenburg, Dina A. R. Israel, Jennifer Schore, Anne Warren, Aparajita Zutshi, Stephen Freedman, and Lisa Schwartz, February 2011.
*"The Accelerated Benefits Demonstration and Evaluation Project: Impacts on Health and Employment at Twelve Months."Volume 2: Appendixes. Charles Michalopoulos, David Wittenburg, Dina A. R. Israel, Jennifer Schore, Anne Warren, Aparajita Zutshi, Stephen Freedman, and Lisa Schwartz, February 2011.
"Highlights of the Fifth Ticket to Work Evaluation Report." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. Gina Livermore and David Stapleton, December 2010. This summary presents the key findings from a collection of nine studies conducted in 2009–2010 that focused on the employment efforts of working-age Supplemental Security Income and Social Security Disability Insurance beneficiaries and the Social Security Administration work incentives and supports.
"Longitudinal Statistics for New Social Security Disability Insurance Beneficiaries." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. David Stapleton, Su Liu, Dawn Phelps, and Sarah Prenovitz, December 2010. This paper presents the findings from a longitudinal examination regarding the extent to which new Social Security Disability Insurance beneficiaries return to work and use disability insurance work incentives, based on Social Security Administration data.
"Time that Beneficiaries Spend Off the Rolls Due to Work and the Payments Generated for Employment Networks." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. David Stapleton, Jody Schimmel, Miriam Loewenberg, and Sarah Prenovitz, December 2010. This report examines the extent to which Social Security Disability Insurance and Supplemental Security Income beneficiaries forgo benefits due to work (that is, were in non-payment status following suspension or termination because of earnings) from 2002 to 2006. The findings represent beneficiary experiences before the 2008 changes in the Ticket to Work regulations.
"BOND Final Design Report." BOND Implementation and Evaluation. David Stapleton, Stephen Bell, David Wittenburg, Brian Sokol, and Debi McInnis, December 2010. The Benefit Offset National Demonstration (BOND) will test innovations to address the financial disincentives and other obstacles to increasing incomes and reducing dependence on Social Security Disability Insurance (SSDI) benefits. The design to be tested replaces the SSDI "cash cliff," under which beneficiaries eventually lose all of their benefits if they earn over a minimal amount, with a "benefit ramp," a $1 reduction in benefits for each $2 earned above that minimal amount. The demonstration will also test the provision of more intensive counseling than offered under current law.
*"Money Follows the Person 2009 Annual Evaluation Report." Carol Irvin, Debra Lipson, Sam Simon, Audra Wenzlow, and Jeffrey Ballou, September 2010. The Money Follows the Person program is based on the premise that many Medicaid beneficiaries in institutions would rather live in the community and could do so with adequate support, which would cost less than the institutional care they receive. This report describes the program’s status through December 2009, including how states are progressing toward their goals, and provides baseline information for analyses of impacts and outcomes. States have faced considerable challenges but by the end of 2009, programs had helped approximately 5,600 people transition to community living.
"Benefits Planning, Assistance, and Outreach (BPAO) Service User Characteristics and Use of Work Incentives." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. Gina Livermore and Sarah Prenovitz, May 2010. This report presents findings of an analysis of beneficiaries who used benefits planning, assistance, and outreach services from 2001 to 2005.
"Longitudinal Experiences of an Early Cohort of Ticket to Work Participants." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. Gina Livermore, Allison Roche, and Sarah Prenovitz, May 2010. This report presents findings of an analysis of the longitudinal experiences of a group of Ticket to Work participants who enrolled in the program during the first 18 months of its implementation.
*"Use of One-Stops by Social Security Disability Beneficiaries in Four States Implementing Disability Program Navigator Initiatives." Gina Livermore and Silvie Colman, May 2010. With federal funding, states have worked to make One-Stop services more accessible to people with disabilities through the Disability Program Navigator (DPN) initiative. This report assesses the extent to which working age recipients of Social Security disability benefits used these services and looks at employment outcomes and differences in utilization and outcomes over time as the initiative matured in the four states studied.
*"The Social Security Administration’s Youth Transition Demonstration Projects: Implementation Lessons from the Original Projects." John Martinez, Thomas Fraker, Michelle Manno, Peter Baird, Arif Mamun, Bonnie O’Day, Anu Rangarajan, and David Wittenburg, February 2010. The Youth Transition Demonstration is developing and evaluating promising strategies to help youth with disabilities become as economically self-sufficient as possible as they transition from school to work. This report offers six implementation lessons to help policymakers and administrators develop, fund, and provide interventions for youth with disabilities.
*“2006 National Beneficiary Survey: Methodology and Descriptive Statistics.” Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. Gina Livermore, Debra Wright, Allison Roche, and Eric Grau, October 2009. The Social Security Administration’s National Beneficiary Survey is a key component of Mathematica’s congressionally mandated evaluation to assess the successes and shortcomings of the Ticket to Work program. This report describes the sampling design and data collection for the third round of the survey conducted in 2006. It also uses data from the survey to provide descriptive statistics about working-age Social Security disability beneficiaries.
*"Participation in Ticket to Work Continues to Grow but Assignments Under the Traditional Payment System Still Dominate." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. David Stapleton, Cindy Gruman, and Sarah Prenovitz, September 2009. Using data collected through December 2006, nearly five years since the launch of the first phase of the Ticket to Work program, this report found that eligible Social Security beneficiaries continue to use conventional state vocational agencies rather than public and private employment providers—a hallmark of the Ticket to Work program. During the first phase, overall state participation rates rose to 2.2 percent, up from 1.8 percent one year earlier. Participation in states during the second and third phases continued to grow, but at a slightly slower pace.
*"Findings from a Study of the SSI/SSDI Outreach, Access and Recovery (SOAR) Initiative.” Jacqueline Kauff, Jonathan Brown, Norma Altshuler, Noelle Denny-Brown, and Emily Sama Martin, September 2009. Although social security disability benefits can provide critical income support as well as job assistance and access to medical services for individuals who are homeless, the benefit application process can be challenging. Many homeless people have no consistent source of medical care, lack a stable address, have fragile social support networks, and have mental health and substance abuse disorders limiting their physical and cognitive functioning. This study found that the SSI/SSDI Outreach, Access, and Recovery (SOAR) initiative can help homeless people access benefits more successfully by encouraging states to bring together social service providers and other agencies to devise strategies on improving the application process. When implemented effectively, SOAR can help prevent chronic homelessness and reduce state and local spending on other assistance programs and health services.
"Health Insurance and Health Care Access Before and After SSDI Entry." Gina Livermore, David Stapleton, and Henry Claypool, May 2009. This report uses National Health Interview Survey (NHIS) data linked to data from the Social Security Disability Insurance (SSDI) and Medicare programs to create profiles of SSDI beneficiaries during the three years before and after SSDI entry to illustrate changes in insurance status, health care access, and utilization. SSDI beneficiaries were less likely to be insured, even three years prior to SSDI entry, and utilization and access problems peaked right before and after entry. At the time their SSDI applications were approved, 11 percent had completed the entire 24-month Medicare waiting period and about one-third had completed 12 months or more. Eliminating the Medicare waiting period could help many beneficiaries who lack health insurance. However, this policy alone would not help those who are uninsured before entry and approved a long time after SSDI entitlement.
*"Analysis of Medical Expenditures and Service Use of Medicaid Buy-In Participants, 2002-2005." Gilbert Gimm, Kristin Andrews, Jody Schimmel, Henry Ireys, and Su Liu, October 2009. When workers with disabilities “buy into” Medicaid by paying monthly premiums, states can offer them Medicaid coverage when their income and assets would otherwise make them ineligible. Using MAX data and Medicare claims files, this report provides the most comprehensive information to date on patterns of Medicaid and Medicare spending and service use among Medicaid Buy-In participants. Researchers found that combined inflation-adjusted Medicaid and Medicare expenditures for Buy-In participants more than doubled from $887 million to $1.9 billion between 2002 and 2005, as did program enrollment. However, they also found that, when compared with other working-age disabled Medicaid enrollees, Buy-In participants in 2005 incurred lower annual Medicaid expenditures. This difference suggests that Buy-In participants who are working may require fewer services or a less expensive mix of services than other adult disabled Medicaid enrollees. Executive Summary
"Characteristics, Employment, and Sources of Support Among Working-Age SSI and DI Beneficiaries." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. Gina Livermore, David Stapleton, and Allison Roche, April 2009. Helping people with disabilities find and keep jobs is a key component to reducing dependency on Social Security disability benefits. The Ticket to Work program aims to do that by offering people with disabilities greater choice in service providers and access to more employment options. The latest report from Mathematica’s Ticket to Work program evaluation presents results from the National Beneficiary Survey, administered each year from 2004 through 2006. The findings indicate that many beneficiaries of Social Security disability insurance were working and engaging in work-preparation activities, and many more saw themselves working in the future. However, a host of common experiences among beneficiaries stood between them and employment including poor health, inaccessible workplaces, low levels of education that may limit their employment opportunities, and fear of jeopardizing their benefits by earning above the Substantial Gainful Activity limit. The Ticket to Work program has the potential to address some of these issues by providing greater economic incentives for employment and reducing the varied employment-related obstacles many beneficiaries face.
"Interim Report on the Demonstration to Maintain Independence and Employment." Gilbert Gimm, Noelle Denny-Brown, Boyd Gilman, Henry T. Ireys, and Tara Anderson, April 2009. 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. Executive Summary
"Employment Support for the Transition to Retirement: Can a New Program Help Older Workers Continue to Work and Protect Those Who Cannot?" David C. Stapleton, April 2009. Older workers whose employment prospects are cut short can claim reduced Social Security benefits beginning at age 62, the earliest eligibility age. This option provides a floor of protection for workers who are forced by circumstances to retire early, but it also provides benefits to people who may not have a pressing need and might be better off waiting. A leading proposal to extend working years involves increasing the earliest eligibility age for Social Security, but this proposal might inflict hardship on some older workers. The author presents a framework for a new program that could address the harm that increasing the earliest eligibility age might inflict on some older workers. The report identifies circumstances that would call for expanded assistance for workers nearing retirement if early benefits were no longer available. It also describes a range of benefits, tailored to individual needs, including wage subsidies and other work supports, health insurance subsidies, disability benefits, extended unemployment benefits, and employment counseling. Executive Summary
"A Review of Recent Evaluation Efforts Associated with Programs and Policies Designed to Promote the Employment of Adults with Disabilities." Gina A. Livermore and Nanette Goodman, February 2009. This report reviews recent evaluation activities being conducted for 27 state and federal programs, policies, and initiatives designed to promote the employment of people with disabilities. The review provides information on the nature of the initiatives and evaluation efforts that have been recently completed or are currently under way, as well as findings to date related to effectiveness. Suggested avenues where further efforts and progress might be warranted are also included.
*"Process Evaluation of the Work Incentives Planning and Assistance Program." Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations. Bonnie O'Day, Allison Roche, Norma Altshuler, Liz Clary, and Krista Harrison, February 2009. This report from Mathematica’s Ticket to Work program evaluation looks at the Work Incentives Planning and Assistance (WIPA) program, a grant initiative established by the Social Security Administration (SSA) in 2006. WIPA provides SSA beneficiaries with disabilities information and guidance about work incentives and how to effectively use them to find jobs and stay employed. This evaluation of the WIPA program captured important information about start-up experiences and early opportunities for program improvement. Most notably, more funding may be needed to ensure that available staffing and budget levels are met in order for WIPA, a critical element in SSA’s return-to-work policy, to succeed over the long term.
"The Social Security Administration's Youth Transition Demonstration Projects: Evaluation Design Report." Anu Rangarajan, Thomas Fraker, Todd Honeycutt, Arif Mamun, John Martinez, Bonnie O'Day, and David Wittenburg, January 2009. This report describes the research and policy context for the evaluation, logic model underlying the projects, and selection of the random assignment sites and enrollment of youth. It also presents comprehensive designs for the process, cost, impact, and benefit-cost analyses, and concludes with a timeline and a schedule for major reports.
"A Government Performance and Results Act (GPRA) Report: The Status of the Medicaid Infrastructure Grants Program as of 12/31/07." Cindy Gruman, Sarah Croake, Jody Schimmel, and Su Liu, December 2008. The Medicaid Infrastructure Grant (MIG) program provides funding to states to develop the necessary infrastructure to promote competitive employment for people with disabilities. Grantee states use MIG funding to support a range of activities, including developing and implementing a Medicaid Buy-In program; improving access to personal assistance services; developing supported employment programs; providing benefits counseling; and more. This report examines outputs and outcomes of MIG funding in 2007. Forty-one states had a MIG program, and funding increased by 21 percent between 2006 and 2007 to $34.1 million. In addition, the funding has encouraged states to develop and sustain Medicaid Buy-In programs for people whose earnings would otherwise make them ineligible for publicly financed health benefits.
"The Social Security Administration's Youth Transition Demonstration Projects: Profiles of the Random Assignment Projects." John Martinez, Michelle S. Manno, Peter Baird, Thomas Fraker, Todd Honeycutt, Arif Mamun, Bonnie O'Day, and Anu Rangarajan, December 2008. This report profiles six projects participating in the random assignment evaluation. The projects are up and running in the Bronx; four counties in Colorado; Erie County (Buffalo), New York; Miami-Dade County; Montgomery County, Maryland; and 19 counties in West Virginia.
"Programmes to Promote Employment for Disabled People: Lessons from the United States." Anu Rangarajan, David Wittenburg, Todd Honeycutt, and Debra Brucker, December 2008. This report reviews findings from U.S. evaluations of return-to-work supports for people with disabilities that have been influential in informing best practices and discusses implications for similar efforts in the U.K. The U.S. experience offers lessons for delivering intervention services, tracking services, and evaluating U.K. employment initiatives for people with disabilities. Some suggestions include adding incentives to allow people to work more than 16 hours a week, developing additional supports—especially supported employment services—for participants with psychiatric conditions, providing more intensive supports for long-term claimants, identifying outcomes to measure success of the program before implementation, and creating a research database from administrative files to track progress of disability policies.
"Research Design Report for the Evaluation of the Money Follows the Person (MFP) Grant Program." Randall Brown, Carol Irvin, Debra Lipson, Sam Simon, and Audra Wenzlow, October 2008. This report presents the research design for the evaluation of the Money Follows the Person program implementation and effects on participants and the long-term care system. Under the program, 31 participating states are providing enhanced services to help interested Medicaid beneficiaries in long-term care institutions move back to the community. States receive funds from the program’s augmented federal matching rate for support services provided to those who make the transition. States are expected to use these funds to improve long-term care systems and options for beneficiaries wishing to remain in the community.
"Ticket to Work at the Crossroads: A Solid Foundation with an Uncertain Future." David Stapleton, Gina Livermore, Craig Thornton, Bonnie O'Day, Robert Weathers, Krista Harrison, So O'Neil, Emily Sama Martin, David Wittenburg, and Debra Wright, September 2008. The Ticket to Work and Self-Sufficiency program (TTW) was designed to enhance the market for services that help SSI and SSDI beneficiaries successfully enter the workforce. This report looks at how well the TTW market functions and the extent to which the introduction of TTW changed enrollment in employment-support services, employment, and receipt of SSDI or SSI benefits. The study found that program participation remains low but continues to grow, and survey findings indicate substantial potential for growth in participation. In addition, new payment regulations for providers may breathe new life into the market.
“Out of Sight, Out of Mind: Including Group Quarters Residents With Household Residents Can Change What We Know About Working-Age People With Disabilities.” David Stapleton, Todd Honeycutt, and Bruce Schechter. Demography (online before publication), November 2011. Information about institutional and noninstitutional residents of group quarters, particularly those with disabilities, is limited. This article uses the 2006 and 2007 American Community Surveys to produce descriptive statistics on the working-age population with and without disabilities by major residence type and to assess the sensitivity of disability statistics to residence.
"How Common Is 'Parking' Among Social Security Disability Insurance Beneficiaries? Evidence from the 1999 Change in the Earnings Level of Substantial Gainful Activity." Jody Schimmel, David C. Stapleton, and Jae Song. Social Security Bulletin, November 2011. Anecdotal evidence suggests that Social Security Disability Insurance (SSDI) beneficiaries intentionally restrain, or "park," their earnings at a level below substantial gainful activity to retain cash benefits. But there is limited empirical evidence documenting such behavior. This article in Social Security Bulletin looks at the impact of the 1999 change in the substantial gainful activity earnings level on two cohorts of SSDI beneficiaries—one affected by the change and one not. The results show that, in a typical month from 2002 through 2006, between 0.2 and 0.4 percent of all SSDI beneficiaries were parked below the substantial gainful activity level in a typical month.
“Health Care Costs Are a Key Driver of Growth in Federal and State Assistance to Working-Age People with Disabilities,” Gina Livermore, David C. Stapleton, and Meghan O'Toole. Health Affairs, September 2011. A large and rapidly growing share of U.S. government expenditures pays for assistance to working-age people with disabilities. In 2008 federal spending for disability assistance totaled $357 billion, representing 12 percent of all federal outlays. The states’ share of joint federal-state disability programs, more than 90 percent of it for Medicaid, was $71 billion. The increased cost of health care—which represented 55 percent of combined state and federal outlays for this population in 2008—is one of the two main causes of spending growth for people with disabilities.
"The Evaluation of the Demonstration to Maintain Independence and Employment." Henry T. Ireys and Paul Wehman. Journal of Vocational Rehabilitation, March 2011 (subscription required). This introduction presents early findings from the evaluation of the Demonstration to Maintain Independence and Employment (DMIE), which used random assignment to test whether a program of enhanced health and employment supports for working adults with potentially disabling conditions can reduce the likelihood of applying for federal disability benefits and improve employment retention.
"Impact of Early Intervention Programs for Working Adults with Potentially Disabling Conditions: Evidence from the National DMIE Evaluation." Gilbert Gimm, Henry Ireys, Boyd Gilman, and Sarah Croake. Journal of Vocational Rehabilitation, March 2011 (subscription required). This article examines results from a study using random assignment and data from Social Security Administration files and state-based surveys to assess whether the DMIE, as implemented in these states, had a significant impact on the number of applications submitted for federal disability benefit programs and changed participants’ employment outcomes. Among other findings, the study showed that the early intervention programs were effective in reducing applications to federal disability programs 12 months after enrollment in the two states (Minnesota and Texas) with the largest number of participants.
The Social Security Bulletin has published a special issue (2011) on employment of Social Security Disability Insurance and Supplemental Security Income beneficiaries, based on a series of projects conducted by Mathematica researchers. The following articles are included:
"Employment of Individuals in the Social Security Disability Programs," Paul O'Leary, Gina A. Livermore, and David C. Stapleton.
"Employment Among Social Security Disability Program Beneficiaries, 1996–2007," Arif Mamun, Paul O’Leary, David C. Wittenburg, and Jesse Gregory.
"Longitudinal Statistics on Work Activity and Use of Employment Supports for New Social Security Disability Insurance Beneficiaries," Su Liu and David C. Stapleton.
"Social Security Disability Beneficiaries with Work-Related Goals and Expectations," Gina A. Livermore.
"Disability Benefits Suspended or Terminated Because of Work," Jody Schimmel and David C. Stapleton.
"Longitudinal Outcomes of an Early Cohort of Ticket to Work Participants," Gina A. Livermore and Allison Roche.
“Racial Variation in Vocational Rehabilitation Outcomes: A Structural Equation Modeling Approach." Frank H. Martin. Rehabilitation Counseling Bulletin, October 2010 (subscription required). This study tested a new conceptual model for the relationship between race, personal history characteristics, and quality of employment outcomes for white, black, and Hispanic participants to examine an old question: Are there still racial disparities in vocational rehabilitation employment outcomes?
"Health Care When Workers Need It Most: Before and After Entry into the Social Security Disability Insurance Program." Gina A. Livermore, David C. Stapleton, and Henry Claypool. Inquiry, summer 2010. This study analyzed survey data on Social Security Disability Insurance (SSDI) beneficiaries during the six-year window surrounding SSDI entitlement to illustrate changes in characteristics, insurance status, and health care access. SSDI beneficiaries were less likely to be insured than the general working-age population (22 percent versus 16 percent), even three years before their SSDI entitlement, and their uninsurance rates remained high until the third year after SSDI entitlement when nearly all became eligible for Medicare.
"Closures Are the Tip of the Iceberg: Exploring the Variation in State Vocational Rehabilitation Program Exits After Service Receipt." David Stapleton, Todd Honeycutt, and Bruce Schechter. Journal of Vocational Rehabilitation, February 2010 (subscription required). State vocational rehabilitation (VR) agencies provide important employment services for people with disabilities. Yet little is known about the characteristics of individuals who have received VR services compared to the general population of people with disabilities. Using 2007 data, we found that 1.3 of every 100 working-age adults with a disability received services from a VR agency, with some states’ rates ranging from 0.6 percent in Washington and Puerto Rico to 4.0 percent in Vermont. We also found large differences in some states across demographic, educational, and disability subgroups. Further research could answer questions about why some groups are more likely to use VR services than others and whether VR agencies should target more resources to certain groups.
“The Effects of State Policy Decisions on the Employment and Earnings of Medicaid Buy-In Participants in 2006.” Henry Ireys, Gilbert Gimm, and Su Liu. Journal of Disability Policy Studies, (subscription required) December 2009. This article examines the Medicaid Buy-In program, so named because workers with disabilities “buy into” Medicaid coverage with monthly premiums. In 2006, over 97,000 individuals were enrolled in 32 state Buy-In programs. States have taken different pathways toward the program’s dual objectives: expanding Medicaid coverage to vulnerable populations and promoting employment of working-age adults with disabilities. Analyses indicate that some states appear to have accomplished both objectives, whereas other states have emphasized one over the other. In addition, certain program features (such as higher earned-income limits) contribute to both larger percentages of Buy-In participants who are employed and higher earnings of employed participants.
Youth who receive benefits from the Supplemental Security Income (SSI) program, the largest federal program providing cash payments to low-income youth with severe disabilities and their families, face notable challenges transitioning to adulthood. Six articles in the September 2009 issue of the Journal of Vocational Rehabilitation, by researchers from Mathematica, TransCen Inc., and the Social Security Administration (SSA), explore the nature of these challenges and related policy responses. Articles include:
"A Life-Cycle Perspective on the Transition to Adulthood Among Children Receiving Supplemental Security Income Payments," Paul S. Davies, Kalman Rupp, and David Wittenburg.
"Family Caregiving and Employment Among Parents of Children with Disabilities on SSI," Kalman Rupp and Steve Ressler.
"Unmet Health Care Needs and Medical Out-of-Pocket Expenses of SSI Children," Anne DeCesaro and Jeffrey Hemmeter.
"Changing Circumstances: Experiences of Child SSI Recipients Before and After Their Age-18 Redetermination for Adult Benefits," Jeffrey Hemmeter, Jacqueline Kauff, and David Wittenburg.
"The Social Security Administration's Youth Transition Demonstration Projects," Thomas Fraker and Anu Rangarajan.
"Providing Supports to Youth with Disabilities Transitioning to Adulthood: Case Descriptions from the Youth Transition Demonstration," Richard G. Luecking and David Wittenburg.
"Intimate Partner Violence, Health Status, and Health Care Access Among Women with Disabilities." Kirsten A. Barrett, Bonnie O'Day, Allison Roche, and Barbara Lepidus Carlson. Women's Health Issues, vol. 19, issue 2, March-April 2009 (subscription required). Evidence suggests that intimate partner violence (IPV) is more pervasive among women with disabilities than among women without disabilities. However, little is known about the relationship between intimate partner violence, health status, and access to care. This article describes the prevalence of IPV among women with disabilities and compares it to prevalence among women without disabilities. For both groups, the authors examine health status and health care access and the association between IPV, health status, and health care access. Women with disabilities are significantly more likely to experience IPV (33.2 and 21.2 percent, respectively). In addition, women with disabilities who have experienced IPV are 35 percent less likely to report their health as good to excellent and are 58 percent more likely to report an unmet health care need owing to cost.
"Income Security for Workers: A Stressed Support System in Need of Innovation." David C. Stapleton, Richard V. Burkhauser, Peiyun She, Robert R. Weathers, and Gina A. Livermore. Journal of Disability Policy Studies, vol. 19, no. 4, March 2009 (subscription required). The current mix of public and private programs to support workers after they experience disability onset provides benefits to millions of workers and former workers. Yet, despite the large and growing costs of these programs, the inflation-adjusted household incomes of workers with disabilities have been falling for more than two decades, both absolutely and, especially, relative to the incomes of those without disabilities. The aging of the baby boom generation is likely to make matters worse, and the government's fiscal circumstance will make sustaining existing public programs increasingly difficult. Current policy initiatives might eventually improve the disability support system, but they are not likely to ward off adverse consequences of the pending crisis. Policy changes that leverage existing private-sector practices and capabilities might achieve greater success but have received little attention and are far from proven.
"Long-Term Poverty and Disability Among Working-Age Adults."Peiyun She and Gina A. Livermore. Journal of Disability Policy Studies, vol. 19, no. 4, March 2009 (subscription required). The authors use longitudinal data from the Survey of Income and Program Participation spanning 1996 to 1999 to estimate the prevalence of short- and long-term poverty among working-age people with and without disabilities. Depending on the disability measure used, annual poverty rates are two to five times higher among people with disabilities, compared to those without disabilities. Relative long-term poverty rates among those with disabilities are much higher than relative short-term poverty rates. People with disabilities represented 47 percent of those in poverty in 1997 according to an annual measure of poverty, and 65 percent of those in poverty according to a long-term measure. Disability may receive little attention in the poverty literature because most statistics are based on short-term measures, which partially mask the strong relationship between long-term poverty and long-term disability, as well as outdated perceptions of the relationship between disability and the ability to work.
*"What Determines Progress in State MFP Transition Programs?" The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #8. Debra J. Lipson, Christal Stone Valenzano, and Susan R. Williams, October 2011. This report, the eighth in Mathematica's Money Follows the Person series, identifies key factors that have contributed to and hindered state efforts to transition Medicaid enrollees to community living and rebalance their long-term care systems. Three crucial program elements are (1) effective transition coordinators, (2) ability to cover one-time moving expenses, and (3) extra support from transition coordinators or extra home and community-based services beyond what regular Medicaid programs typically cover. The report cites lack of affordable, accessible housing as the single greatest barrier to transitions. The report also identifies strategies states use to transition and maintain participants successfully in the community.
*"The Youth Transition Demonstration: Interim Findings and Lessons for Program Implementation." Thomas Fraker, October 2011. This issue brief presents findings from a random assignment evaluation of the Social Security Administration’s Youth Transition Demonstration, which is analyzing the implementation of six demonstration projects and their impacts on helping youth with disabilities find jobs and reduce their dependency on federal disability benefits. One of the initial three projects achieved statistically significant impacts on the proportion of youth employed during the year following random assignment. However, demonstration refinements based on the implementation experiences of the early projects may result in stronger interventions among the final three projects and, thus, in stronger results.
*"Costs, Cuts, and Consequences: Charting a New Course for Working-Age People with Disabilities."Issue Brief #11-03. David Stapleton and Gina Livermore, September 2011. This brief looks at our nation's spending on programs for working-age people with disabilities, a population that seeks greater independence but is commonly misperceived as unemployable. In 2008, an estimated $357 billion (nearly 12 percent of all federal spending) went to support these individuals.
*"A First Look at How MFP Participants Fare After Returning to the Community" The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #7, John Schurrer and Audra Wenzlow, July 2011.
*"The SSDI Trust Fund: New Solutions to an Old Problem." Issue Brief #11-02, David Stapleton and David Wittenburg, June 2011. Social Security Disability Insurance (SSDI) provides cash assistance to workers with disabilities. SSDI has a near-term financing problem and has encountered similar problems in the past. This brief discusses an approach to a long-term solution using a work support policy that could reduce entry into the program and improve the economic outlook for workers with disabilities.
*"Money Follows the Person: Change in Participant Experience During the First Year of Community Living." The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #6, Samuel E. Simon and Matthew R. Hodges, May 2011. This report presents the quality-of-life experiences of 803 MFP participants who transitioned to community living between January 2008 and December 2009 and responded to grantees’ administration of pre-transition and one-year post-transition surveys. The authors specifically examine how reported quality of life changed after participants transitioned to community living. After one year of community living, participants reported significantly higher quality of life compared with life in institutional settings.
*"Bending the Employment, Income, and Cost Curves for People with Disabilities." Issue Brief #11-01. David C. Stapleton, April 2011. This issue brief proposes a two-pronged approach for increasing the employment rate for people with disabilities, reducing their reliance on federal support, and increasing their household incomes, while preserving benefits for those who are unable to work. This approach includes introducing an experience-rating system for the disability portion of the payroll tax and expanding the Earned Income Tax Credit for workers in all low-income households, funded by higher taxes on high-income households.
*"Money Follows the Person Demonstration Program: A Profile of Participants." The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #5. Debra J. Lipson and Susan R. Williams, January 2011. This report profiles participants who transitioned from institutions to qualified home or community-based residences from the start of the program through June 2010.
*"How Are the Experiences of Individuals with Severe Mental Illness Different from Those of Other Medicaid Buy-In Participants?" Working with Disability, Work and Insurance In Brief #11. Su Liu and Sarah Croake, August 2010. This issue brief presents the health and employment experiences of Medicaid Buy-In participants with severe mental illness in comparison to those of other Medicaid Buy-In participants. These descriptive statistics of medical expenditures, earnings, and earnings growth show that Buy-In participants with severe mental illness had lower medical expenditures and were more likely to be employed and to increase their earnings over time, at least in the short to medium term.
*"The Starting Point: The Balance of State Long-Term Care Systems Before the Implementation of the Money Follows the Person Demonstration." Reports from the Field #4. Carol Irvin and Jeffrey Ballou, May 2010. The fourth report of the Money Follows the Person (MFP) Demonstration provides an early assessment of the balance of home and community-based care services (HCBS) and institutional long-term care systems in states before MFP was implemented. By looking at the status of these long-term systems state-by-state, the assessment helps to develop a baseline to measure the program’s impacts on long-term care systems.
"Phone or Face-to-Face? Comparing Data from Surveys of People with Disabilities." Trends in Data Collection Methods Issue Brief #4. Matt Sloan, Debra Wright, and Kirsten Barrett, May 2010. This issue brief compares the quality of data collected for the National Beneficiary Survey (NBS), a survey of people with mental and physical impairments, via computer-assisted telephone interviewing (CATI) and computer assisted personal interviewing (CAPI).
"Providing Health Benefits and Work-Related Services to Social Security Disability Insurance Beneficiaries: Six-Month Results from the Accelerated Benefits Demonstration.” Policy Brief. David Wittenburg, Anne Warren, Deborah Peikes, and Stephen Freedman, April 2010. This brief, the second in a series, evaluates the impacts of the Accelerated Benefits Demonstration, which provides earlier access to health coverage and related services to uninsured beneficiaries. Early findings indicate that the demonstration increased the use of health care services and reduced reported unmet health care needs for these individuals during the first six months following random assignment.
"Quality’s New Frontier: Reducing Hospitalizations and Improving Transitions in Long-Term Care." Trends in Health Care Quality Issue Brief #7. Debra J. Lipson and Samuel Simon, March 2010. Hospitals and post-acute care providers have developed quality measures to evaluate their effectiveness in preventing readmissions, but these measures are lacking in long-term care. This issue brief discusses the need for similar measures to assess the quality of long-term care for people in nursing homes and other home- and community-based service settings. It also identifies evidence-based care models and interventions for reducing potentially avoidable hospitalizations and highlights the need to develop financial incentives for providers to measure and improve performance.
"Successfully Implementing SOAR: Lessons Learned from Six States." ASPE Research Brief. Jacqueline Kauff and Jonathan Brown, February 2010. This brief details factors that help states and communities successfully implement the SSI/SSDI Outreach, Access, and Recovery (SOAR) initiative, a program to improve access to disability benefits for people who are homeless.
*“Project SEARCH: Opening Doors to Employment for Young People with Disabilities.” Disability Policy Research Brief #09-06. Bonnie O’Day, December 2009. In the mid-1990s, the Cincinnati Children’s Hospital implemented Project SEARCH, a school-to-work program for developmentally and physically disabled high school students transitioning to employment. This approach requires successful collaboration between a sponsoring employer, a school system, a community rehabilitation provider, and the state vocational rehabilitation agency and/or the state or local developmental disabilities agency. Project SEARCH is unique in its total immersion of students in the workplace. Each Project SEARCH site generally enrolls 10 to 12 students per year, who spend the entire school day at the workplace. During the second month, students progress to the first of three individualized worksite rotations or internships that simulate real-world employment lasting 10 weeks. The student is often placed in one of the departments in the organization where he or she served as an intern. While this school-to-work model has been implemented in 140 additional sites in the United States and the United Kingdom, a national evaluation has not been conducted. A cost/benefit analysis should be implemented to determine if the high costs of the program—$233,280 per site which serves approximately 10 to 12 students per year—merit its implementation on a wider level.
*"Work-Oriented Social Security Disability Beneficiaries: Characteristics and Employment-Related Activities.” Disability Policy Research Brief #09-05. Gina A. Livermore, December 2009. This brief discusses the characteristics of working-age individuals receiving Social Security disability benefits with work goals and describes their employment success. The findings suggest that beneficiaries fall into three broad groups based on their work-related efforts and expectations. For 60 percent, gainful employment seems to be neither a plan nor an option. Of the 40 percent who are interested in working, about half are actively pursuing and achieving this goal.
*“Early Implementation Experiences of State MFP Programs.” National Evaluation of the Money Follows the Person Demonstration Grant Program: Reports from the Field #3. Noelle Denny-Brown and Debra J. Lipson, November 2009. The Money Follows the Person (MFP) demonstration is the most ambitious program to date aimed at helping Medicaid enrollees transition from long-term care institutions to the community. This report, the third in a series presenting findings from Mathematica’s evaluation of the MFP program, describes states’ early implementation experiences and state transition activity as of December 2008. It also discusses the challenges that states have encountered in trying to launch the program, and implications for making fundamental changes in the long-term care system.
*"Will Health Care Reform Increase the Employment of People with Disabilities?” Disability Policy Research Brief #09-04. David Stapleton and Su Liu, November 2009. Leading health care financing reforms might mitigate, or even eliminate, challenges that the current system creates for people with disabilities who work, or want to work, but there is no guarantee. This brief summarizes the challenges posed by the current system and considers how features of leading reform proposals would, or would not, address these challenges.
*"What Happens to Medicaid Buy-In Participants After They Leave the Program?" Working with Disability, Work, and Insurance In Brief #9. Su Liu and Silvie Colman, September 2009. This brief explores the paths of people with disabilities who leave the Medicaid Buy-In program, finding that their earnings and employment rates decline after disenrollment. The program helps adults with disabilities work while still retaining Medicaid coverage. At the end of 2008, 37 states reported covering 92,446 people in the program.
*"Implications of State Program Features for Attaining MFP Transition Goals."The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #2. Debra J. Lipson and Susan R. Williams, June 2009. In 2007, the federal government funded programs in 30 states and the District of Columbia under the Money Follows the Person demonstration to support the transition of Medicaid beneficiaries in long-term institutional care to home and community-based settings. This report describes variation in the design of state transition programs and discusses how differences in key features affect the pace and degree of implementation, as well as the likelihood of meeting transition goals. While some states are on track to meet their goals, others have been slow to start programs because of delays in finalizing operational plans or Medicaid home and community-based program changes, problems finding or contracting with transition agencies, and other setbacks.
*"Is It Time to Establish a National Disability Data System?"Disability Policy Research Brief #09-03. David Stapleton and Craig Thornton, May 2009. There is a growing divergence between demands placed on the system for assisting people with disabilities and the data required to manage this system. A new brief from our Center for Studying Disability Policy seeks to stimulate discussion about the value of establishing a national disability data system to make better use of existing data and add new data. This type of system could improve coordination of federal data collection and analysis, help agencies and others gain a better understanding of those served, and provide critical information for monitoring and improving programs.
*"Transforming Disability Policy for Youth and Young Adults with Disabilities."Disability Policy Research Brief, #09-01. Bonnie O'Day and David Stapleton, March 2009. The transition to adulthood can be difficult for young people with disabilities, and changes in public policy are needed to give them the support they need to find meaningful work, stay employed, and reduce their dependency on federal and state disability benefits. This brief highlights the importance of improving transition policy for youth with disabilities, reviews lessons from recent research, and considers transformative policy changes and why and how such changes might be tested. It also discusses an example of a transformative policy with potential to improve transitions for youth with disabilities—the Transition to Economic Self-Sufficiency (TESS) program.
*"Costs and Benefits of Eliminating the Medicare Waiting Period for SSDI Beneficiaries." Disability Policy Research Brief, #09-02. Gina Livermore, David Stapleton, and Henry Claypool, March 2009. The Social Security Disability Insurance (SSDI) program provides a safety net for individuals who must stop working because of a disability. Although Medicare coverage is available to people with disabilities, they must wait for that coverage until 24 months after they become eligible for SSDI. This brief discusses the costs and benefits associated with eliminating the Medicare waiting period for new SSDI beneficiaries. The authors estimate that doing so would increase annual Medicare costs by approximately $14 billion, provided that all beneficiaries are enrolled throughout the 24-month period. This represents about three percent of total Medicare expenditures in 2006. Even though costs would be substantial, potential benefits would also accrue: fewer beneficiaries delaying needed health care; reduced financial hardships for those who must pay high out-of-pocket costs for medical care due to lack of insurance; and reduced Medicaid expenditures for states. In addition, better coverage and access to health care during the waiting period might lead to improved health and increased or earlier return to work.
*"Transitioning Medicaid Enrollees from Institutions to the Community: Number of People Eligible and Number of Transitions Targeted Under Money Follows the Person (MFP)."The National Evaluation of the Money Follows the Person Demonstration Grant Program, Reports from the Field #1. Audra T. Wenzlow and Debra J. Lipson, January 2009. The MFP demonstration is the most ambitious program to date aimed at helping Medicaid enrollees transition from long-term care institutions to the community. This report, the first in a new series, assesses the scope of the program—profiling the Medicaid population in long-term institutional care eligible for MFP, rates of transition to the community before MFP began, and potential change in transition rates if states reach their program goals. State MFP programs seek to transition about 36,000 individuals over the course of the demonstration, or less than 1 percent of the approximately one million people who could be eligible annually.
*"How Do Employment Outcomes of Medicaid Buy-In Participants Vary Based on Prior Medicaid Coverage? An Example from Massachusetts." Working with Disability Work and Insurance In Brief #8. Marsha Langer Ellison, Mihail Samnaliev, Alexis D. Henry, Jody Schimmel Beauchamp, Annette Shea, and Jay Himmelstein, October 2008. The Medicaid Buy-In program is a key component of the federal effort to help people with disabilities work without fear of losing health coverage. The program enables participants to "buy into" Medicaid even if their income is too high for other Medicaid eligibility categories. A new brief, the eighth in a series on working with disability, looks at the employment outcomes of participants in Massachusetts's Buy-In program, known as CommonHealth Working (CHW). The brief examines differences in post-enrollment employment rates; monthly hours worked and earnings; and private health insurance coverage between new CHW enrollees previously covered by MassHealth, Massachusetts's Medicaid program, and those without prior MassHealth coverage. The brief also compares outcomes for a year before and after CHW enrollment for a subset of participants with prior MassHealth coverage who had been enrolled in CHW continuously for at least 12 months. The average employment rate among these participants rose sharply after CHW enrollment—from 36 percent in the 12 months prior to enrollment to 86 percent in the 12 months after enrollment. As a result, average monthly earnings increased 140 percent, average hours worked rose by 150 percent, and more were covered by private health insurance.
"Health Benefits for the Uninsured: Design and Early Implementation of the Accelerated Benefits Demonstration." David Wittenburg, Peter Baird, Lisa Schwartz, and David Butler, September 2008. The goal of the Accelerated Benefits Demonstration is to assess the efficacy of providing newly awarded SSDI beneficiaries who have no health coverage with immediate access to health benefits. With earlier access, beneficiaries may experience better health outcomes, increase their likelihood of returning to work, and reduce long-term dependence on SSDI benefits. This brief provides an overview of the project, describes findings from the initial phase of enrollment from October and November 2007, and reviews plans for full implementation.