Disability Publications: 2012 and Earlier
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Reports | Journal Articles | Issue Briefs
"MAX and NCHS Survey Linkage, 1999-2009." Julie Sykes and Kerianne Hourihan, December 2012. This report describes the linkage of National Center for Health Statistics (NCHS) survey data to Medicaid Analytic eXtract (MAX) files. It describes the data sources, linkage algorithm, linkage results, and offers advice to researchers interested in using the linked NCHS-MAX 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.
"Medicaid Substance Abuse Treatment Spending: Findings Report." Ellen Bouchery, Rick Harwood, Rosalie Malsberger, Emily Caffery, Jessica Nysenbaum, and Kerianne Hourihan, September 2012. This study used Medicaid Analytic eXtract (MAX) files to develop national estimates of Medicaid substance abuse (SA) treatment spending, as well as estimates of state spending in 18 states with predominantly fee-for-service coverage of SA treatment. Nationally, medical expenditures to treat SA disorders were $3.4 billion in 2008. About 1.1 million people received services, slightly less than 1 percent of Medicaid enrollees, averaging $3,000 per service user per year. There was extreme variation across states in the average amount spent on SA treatment services per Medicaid enrolled month among individuals age 12 and older, with treatment spending ranging from less than $3 per enrolled month to over $26.
"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.
"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.
"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.
“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.
"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.
*"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.