Non SSA Program Interactions

Healthcare Utilization and Interest in Employment Services Among Patients in Behavioral Health Homes

Social Security Administration Payments to Vocational Rehabilitation Agencies

Department of Defense, Veterans Administration, and Social Security Benefits: Early Intervention Initiatives and Program Interactions

Transitions from State Disability Insurance to Social Security Disability Insurance: Predictive Characteristics and Options for Early Intervention

Comparison of Department of Defense, Veterans Affairs, and Social Security Administration Disability Determination Processes

Outcomes of Youth and Young Adults Seeking VR Services

Access to Post-Secondary Education for Transition-Age Youth with and Without Severe Mental Illness Receiving Vocational Rehabilitation (VR) Services

Impact of the Affordable Care Act Medicaid Expansions on Applications for Federal Disability Benefits

Behavioral Risk Factor Surveillance System (BRFSS) Employment-Related Health Insurance Follow-Up

Using Person-Level, Local-Area-Level, and State-Level Factors to Examine State Variation in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) Participation

Contemporaneous and Longer-Term Effects of CHIP Eligibility Expansions on SSI Enrollment

The Impact of Vocational Rehabilitation on the Employment and Benefit Receipt of People with Less Significant Disabilities

What Happens When Employees Exhaust Their Short-Term Disability Insurance Benefits?

The Impact of a Workers’ Compensation Health Quality Initiative in Washington on Entry into SSA’s Disability Programs

The Relationship of Multiple Program Benefits and Employment to SSI/SSDI Enrollment and Reliance

The Experiences of Low-Income Children with Disabilities as They Enter Early Adulthood

How do the Customers of a Prominent Intermediary that Helps People Apply for SSDI/SSI Compare to all SSDI/SSI Applicants and Awardees?

Assessing the Consequences of a Child’s Disability on Parental Labor Supply, Earnings, and Household Benefit Receipt

Evaluating Job Corps for Youth with Medical Limitations: Long-Run Impacts on Earnings and Benefit Receipt

Impacts of the 2010 VA PTSD Rule Change on Veterans’ Disability Compensation and Reported Cognitive Disability

Healthcare Utilization and Interest in Employment Services Among Patients in Behavioral Health Homes
Investigators: Judith Cook, Jane Burke-Miller, and Lisa Razzano (University of Illinois-Chicago)

Abstract

For this study, we will use data gathered from Medicaid-funded behavioral health homes to inform the Social Security Administration’s early intervention efforts. A behavioral health home (BHH) is an organization that serves as a health home for individuals with mental health and substance use disorders; the BHH delivers primary medical care, prevention, and wellness activities in a behavioral health care setting. The focus of the study will be the extent to which a BHH supports or has the capacity to support patients’ employment and reduce their reliance on disability benefits.

For the study, we will use administrative and survey data from patients at BHHs in Chicago, Illinois, that serve over 1,400 clients with mental health disorders. We will analyze the physical and behavioral health status of patients who are and are not currently employed, their current and past labor force participation, the types and amounts of medical and mental health services they use, their SSI/SSDI beneficiary status, their intentions, if any, to apply for those benefits, and their participation in state and local programs that support work and economic self-sufficiency. The results will be used to identify the types of assistance that help patients achieve emotional stability and physical health, thereby diverting them from applying for SSI/SSDI benefits. We will also seek to identify the career-related services and supports that help keep these individuals in the labor force. Special emphasis will be on service coordination between BHH staff and staff in state vocational rehabilitation agencies and other programs that enable patients to stay employed and leave, or avoid entering, the SSI/SSDI rolls.

Social Security Administration Payments to Vocational Rehabilitation Agencies
Investigators: Jody Schimmel (Mathematica Policy Research) and Paul O’Leary (SSA, OPDR)

Abstract

Social Security disability beneficiaries often have a desire to work and reduce their dependence on benefits, but need services and supports to help them achieve their goals. The federal/state vocational rehabilitation (VR) serves this role for individuals with significant disabilities, including though not limited to, federal disability beneficiaries. The Social Security Administration (SSA) recognizes the important role of the VR program in assisting beneficiaries and provides mechanisms for compensating VR agencies for successful returns-to-work among disability beneficiaries. The main purpose of these payments is to promote earnings outcomes for beneficiaries that are sufficiently high and long-term that beneficiaries forgo their cash disability benefits, thereby reducing SSA program costs. The extent of these savings, however, is not fully known.

The Social Security Administration (SSA) provides reimbursement to vocational rehabilitation (VR) agencies in two primary ways for services provided to disability beneficiaries. The first and most commonly used, known as the SSA/VR Reimbursement Program, or “traditional” payment system, provides payment to VR agencies, up to a limit, for costs incurred in providing services to beneficiaries whose VR cases are successfully closed. The second system, established through the Ticket to Work (TTW) program in 2002, offers milestone and outcome payments to VR agencies operating as Employment Networks once beneficiaries achieve certain employment targets. A third system, also under TTW but with only outcome payments, was also established in 2002, but has rarely been used.

The purpose of this project is to explore the employment success of Social Security disability beneficiaries who use VR services, as measured by a monthly indicator of cash benefits forgone because of work and the dollar value of benefits forgone. This information will then be compared to data collected on the payments made by SSA to VR on behalf of beneficiaries who successfully returned to employment to ascertain whether VR services resulted in cost savings to SSA via forgone benefits. In addition, the investigators will assess the extent to which VR agencies might have been eligible for additional payments for SSDI beneficiaries, had the agencies submitted claims to SSA. The project will also include an estimate of the effect of delays in VR service delivery to SSDI beneficiary clients on SSA payments to VR agencies and benefits forgone for work, exploring how these estimates vary by state and with beneficiary characteristics. Using this information, the authors will assess the implications of the findings in the context of existing pay-for-performance literature and results of the TTW evaluation for potential improvements to the payment systems that SSA uses to reimburse VR agencies.  

Department of Defense, Veterans Administration, and Social Security Benefits: Early Intervention Initiatives and Program Interactions
Investigators: John Kregel, David Cifu, and Susan O'Mara (Virginia Commonwealth University)

Abstract

Many veterans with disabilities are eligible for Social Security Administration (SSA) disability benefits, and the number receiving benefits from more than one program has increased over the past decade. The financial benefit programs administered by the Department of Defense (DoD), the Veterans Administration (VA), and Social Security vary significantly in their definitions of disability, application processes, eligibility requirements, benefits, and earnings rules. Program interactions and employment disincentives inherent in the DoD and VA programs have created two major challenges for veterans attempting to pursue employment and economic self-sufficiency. First, program complexity makes it difficult for veterans receiving Social Security benefits to take advantage of Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) work incentives designed to support their employment efforts. Second, available evidence indicates that these powerful disincentives limit the effectiveness of DoD and VA rehabilitation and return-to-work programs.

This project will address both these challenges and identify opportunities for administrative or program modifications that will promote employment. First, we will assess the programmatic interactions among the DoD, VA, and SSA disability benefit programs to identify ways in which their existing administrative procedures and earnings rules can be implemented to encourage veterans with disabilities to work rather than enter SSDI, SSI, Medicare, Medicaid, or other civilian support programs. Second, we will conduct a systematic review of DoD and VA early intervention and employment services, including DoD's cognitive rehabilitation and Wounded Warrior programs, and VA's Vocational Rehabilitation and Employment vocational training and job placement, Compensated Work Therapy, and supported employment programs. The combined results of these activities will be used to establish future research goals promoting employment for veterans who receive SSA benefits and reducing their dependence on SSA and other federal benefits.

"Disability Benefits for Veterans: Interactions Among Department of Defense, Department of Veterans Affairs, and Social Security Administration Programs," (brief) John Kregel and Lucy Miller, June 2016. (PDF)

"Federal Financial Benefits and Health Care Coverage for Veterans with Disabilities," (working paper) Lucy Miller and John Kregel, December 2015. (PDF)  

"Employment Services and Supports Available to Veterans with Disabilities Through the U.S. Department of Veterans Affairs and Other Federal Agencies," Michael West and John Kregel, March 2014. (PDF)

Transitions from State Disability Insurance to Social Security Disability Insurance: Predictive Characteristics and Options for Early Intervention
Investigators: David Stapleton and Yonatan Ben-Shalom (Mathematica Policy Research); Frank Neuhauser (University of California at Berkeley)

Abstract

California is the largest of the five states that provide mandatory short-term disability benefits to eligible workers soon after they first experience a work-limiting disability. About 500,000 California State Disability Insurance (SDI) claims are paid each year for non-occupational injuries and other health conditions lasting more than seven days. This payout is in addition to more than 500,000 Workers’ Compensation (WC) claims paid to workers injured on the job. Furthermore, more than 80,000 California residents began receiving Social Security Disability Insurance (SSDI) benefits as disabled workers in 2011—more than 8 percent of all SSDI awards that year and more than any other state. It is very likely that a substantial share of SSDI allowances each year are made to workers who have a claim in California’s SDI and WC programs.

The goal of this project is to use California’s experience with its SDI and WC programs to inform the Social Security Administration (SSA) on the potential for early intervention among workers who experience disability onset and become potential SSDI applicants with high likelihood of an allowance. We will use administrative data on California’s SDI and WC benefit claimants to identify the characteristics and medical conditions associated with SSDI allowances made to current or recent SDI and WC claimants. We will also meet with state agency administrators to obtain a better understanding of the nature of California’s SDI, WC, and vocational rehabilitation programs; the extent to which these programs or others already offer employment services to SDI and WC claimants and their employers; and the potential for expanding such services to those most likely to enter SSDI. 

"Early Identification of Potential SSDI Entrants in California: The Predictive Value of State Disability Insurance and Workers' Compensation Claims," Journal of Occupational Rehabilitation, Frank Neuhauser, Yonatan Ben-Shalom, and David Stapleton, June 2018. 

"A First Step to Helping California Workers Keep Their Jobs: Identifying Likely SSDI Entrants Using State Disability Claims," Yonatan Ben-Shalom, Frank Neuhauser, and David Stapleton, February 2017. (PDF)

Comparison of Department of Defense, Veterans Affairs, and Social Security Administration Disability Determination Processes
Investigators: David Cifu and John Kregel (Virginia Commonwealth University)

Abstract

Prior to October 2011, the steps of the disability evaluation system utilized by the various military branches within the U.S. Department of Defense (DoD) differed to some extent. Moreover, the disability evaluation system used by the U.S. Department of Veterans Affairs (VA) differed significantly from that which was used by the DoD. With the implementation of the Integrated Disability Evaluation System (IDES) in October 2011, a single set of medical examinations began to be used by all branches of the U.S. military and by the VA to determine both fitness and disability. Under the new IDES, only one set of medical exams, performed to VA standards, provides all the information needed by both departments. The IDES is intended—by standardizing the DoD and VA evaluation process—to provide a more seamless and faster transition. The effect of the recent changes to the DoD and VA disability determination process on the award of VA benefits is unknown, as is the extent to which this affects subsequent Social Security Administration (SSA) applications. With this study, we will examine the similarities and differences in the DoD/VA and SSA disability determination processes.

During the first phase of the study, we will collect background documentation on the DoD/VA IDES and analyze the process along multiple dimensions: the purpose of the disability evaluation, assessment of degree of injury or illness, assessment of the veteran's ability to perform military/employment duties, components of the medical and physical evaluation, and role of the treating and consulting physicians. We will also examine two key VA data sets (Chapter 31 Master Record and CWINRS) to identify the data elements and database structures that can be compared with similar SSA data. During the final phase of the study, we will convene a focus group consisting of representatives from the three collaborating agencies to review the revised working document and help achieve consensus on the similarities and differences of the two processes. The results of this activity will form the basis for a summary manuscript describing the results of all study activities. 

Outcomes of Youth and Young Adults Seeking VR Services
Investigators: Todd Honeycutt and Allison Thompkins (Mathematica Policy Research)

Abstract

State vocational rehabilitation (VR) agencies serve a critical role in helping youth with disabilities make the transition from high school to employment, often by offering them additional training and higher education. In principle, effective VR services can help young adults avoid seeking disability benefits or help those with benefits become more self-sufficient—outcomes that are of compelling interest to the Social Security Administration (SSA). This project explored state-level variations in VR use among young adults with disabilities and their employment and benefit outcomes. This information could be important for SSA and others interested in improving outcomes for this population in two ways. First, VR agencies that serve more transition-age youth may have practices whose adoption in other areas could improve outreach and enrollment in services. Second, those with better outcomes in diverting such youth from disability benefits or assisting them to leave benefits may provide important lessons for the operation of other agencies and existing or future programs.

This project documented the variation in the extent to which state VR agencies served transition-age youth and examined their SSA disability benefit outcomes. Its findings are presented in three research products: a working paper summarizing state VR agency statistics on VR participation among transition-age youth with disabilities; a working paper (forthcoming) with the results of agency staff interviews on potential best practices in serving youth—information that could be applied by other VR agencies or incorporated into current and alternative programs for youth with disabilities; and a working paper (forthcoming) on the outcomes of youth with and without SSA disability benefits who seek VR services.

"Bridging the Gap: A Comparative Assessment of Vocational Rehabilitation Agency Practices with Transition-Age Youth," Journal of Vocational Rehabilitation, Todd Honeycutt, Maura Bardos, and Stephanie McLeod, October 2015.

"State Differences in the Vocational Rehabilitation Experiences of Transition-Age Youth with Disabilities," Journal of Vocational Rehabilitation, Todd Honeycutt, Allison Thompkins, Maura Bardos, and Steven Stern, January 2015. 

"Youth with Disabilities at the Transition Crossroads: Employment and SSA Outcomes After Seeking VR Services," Todd Honeycutt, Maura Bardos, and Allison Thompkins, July 2014. (PDF)

"Youth with Disabilities at the Crossroads: The Intersection of Vocational Rehabilitation and Disability Benefits for Youth with Disabilities," Todd Honeycutt, Allison Thompkins, Maura Bardos, and Steven Stern, July 2014. (PDF)

"Bridging the Gap: A Comparative Assessment of Vocational Rehabilitation Agency Practices with Transition-Age Youth," Todd Honeycutt, Maura Bardos, and Stephanie McLeod, April 2014. (PDF)

"State Differences in the Vocational Rehabilitation Experiences of Transition-Age Youth with Disabilities," Todd Honeycutt, Allison Thompkins, Maura Bardos, and  Steven Stern, October 2013. (PDF)

Access to Post-Secondary Education for Transition-Age Youth with and Without Severe Mental Illness Receiving Vocational Rehabilitation (VR) Services
Investigators: Todd Honeycutt and David Mann (Mathematica Policy Research), Steven Stern (University of Virginia), John Pepper (University of Virginia), and Robert Schmidt (University of Richmond)

Abstract

State VR agencies represent an important resource for youth with disabilities in their transition from school to work, particularly in terms of providing them with access to post-secondary education and training services. For youth with severe mental illness (SMI), these supports may be especially critical, given these youth’s already poor education and employment outcomes. We will examine the extent to which VR agencies provide post-secondary education supports to youth with and without SMI and document the outcomes for those who receive such supports. Our findings will not only highlight the role VR agencies play in facilitating access to post-secondary services for youth with SMI but also enable us to suggest how optimizing such access could lead to better transition outcomes.

We will analyze Rehabilitation Services Administration case service records matched to the Disability Analysis File and Master Earnings File to provide information about how state VR agencies provide post-secondary education services to transition-age youth with disabilities with and without SMI. We will also use these records to examine the VR, Social Security disability program, and earnings outcomes of youth who receive these services. In the first stage of the analysis, we will conduct descriptive analyses of the extent to which state VR agencies provide post-secondary education services to their transition-age clients both with and without SMI. In the second analytical stage, we will use Social Security Administration administrative data to track long-term Social Security disability program and earnings outcomes for those who do and do not receive post-secondary education services to determine the returns on the receipt of such services.

"Public Provision of Postsecondary Education for Transition-Age Youth with Mental Health Conditions," Psychiatric Rehabilitation Journal, Todd C. Honeycutt, Priyanka Anand, Max Rubinstein, and Steven N. Stern, June 2017.

Impact of the Affordable Care Act Medicaid Expansions on Applications for Federal Disability Benefits
Investigators: Jody Schimmel Hyde, Priyanka Anand, and Margaret Colby (Mathematica Policy Research)

Abstract

The Patient Protection and Affordable Care Act allows states to expand Medicaid coverage to all low-income adults with household incomes up to 138 percent of the federal poverty line starting in 2014. As of September 2014, 28 states (including DC) have decided to expand Medicaid coverage under this option. For many low-income individuals with disabilities, this expanded coverage offers an avenue to Medicaid enrollment previously available only through Supplemental Security Income (SSI) receipt.

Using the Social Security Administration’s Electronic Disability Claiming System, we will estimate the impact of Medicaid expansions on applications to SSI and Social Security Disability Insurance (SSDI). To isolate the causal effect of the Medicaid expansion, we will use a difference-in-difference regression estimation approach, comparing SSI/SSDI applications before and after the Medicaid expansion in states that expanded Medicaid to applications in the same period for states that did not expand Medicaid. To ensure comparability between the treatment and control groups, we will use a synthetic control group method, which creates a weighted comparison group whose characteristics closely match those of the population in expansion states. We will also consider a triple difference approach, comparing changes in SSI/SSDI applications among groups unlikely to be affected by the expansion to a within-state comparison of changes among groups likely to be affected. Our findings will provide important insight into whether the new availability of health insurance coverage changes incentives for individuals with disabilities to apply for SSI and SSDI benefits.

Behavioral Risk Factor Surveillance System (BRFSS) Employment-Related Health Insurance Follow-Up
Investigators: Alexis Henry and Jack Gettens (University of Massachusetts Medical School)

Abstract 

Many people with disabilities will become newly insured with the implementation of health care reform, but the new coverage is unlikely to fully meet their need for employment-related health insurance. Rather than requiring that the health care reform plans include employment-related services for people with disabilities, an alternative and potentially more viable policy solution for people with disabilities is for a new type of subsidized coverage to wrap around health care reform coverage to provide the services and cost protections necessary for employment.

In the first two years of the DRC, investigators conducted studies to inform the design of such wraparound coverage. In the first year, investigators conducted a focus group study that described the wraparound needs of people with disabilities. Last year, investigators designed and conducted a follow-up survey (Employment Needs Survey) to the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) Survey. The Employment Needs Survey supplements the BRFSS core survey with questions on employment, use, and unmet needs for health care services, health care costs, and service delivery. This study will follow up the survey by analyzing the combined data from the Employment Needs Survey and the core BRFSS. We will quantify the employment-related health insurance needs among people with disabilities. We will examine the importance of specific health care services to people’s employment, whether people have cost-related problems obtaining care, how unmet health care needs affect employment, the reasons for unmet needs, and how health care service delivery affects employment.

Using Person-Level, Local-Area-Level, and State-Level Factors to Examine State Variation in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) Participation
Investigators: Alexis Henry and Jack Gettens (University of Massachusetts Medical School)

Abstract

There is wide variation across states in SSI and SSDI participation rates. The reasons for the variation likely exist at the person, state, and local-area levels. Person-level factors include state-to-state variation in the within-state distributions of age, health status, disability prevalence, or country of origin. State-level factors include variation in state welfare policies, administration of disability determinations, or access to health insurance. Prior research has examined the variation in SSI or SSDI participation as it related to person-level and state-level factors. However, there is a lack of research on the role of local-area factors. It is likely that variation in the local-area characteristics will account for a substantial portion of the variation in SSI and SSDI participation across states, beyond what can be explained by state-level factors alone.  

In this study, we will use data from the 2010–2012 American Community Survey to examine the factors that influence the variation across states in SSI and SSDI participation rates among working-age adults. The study will examine person-level, local-area-level, and state-level factors. Local areas will be defined by Public Use Micro Areas, which are geographically contiguous within-state areas of populations of at least 100,000 people made up of geographic building blocks—for example, counties and census tracts. Regression techniques, including multi-level analysis, will be used to identify the factors associated with SSI and SSDI participation among persons with disabilities. Investigators will conduct separate regression analysis for SSI participants, SSDI participants, and participants in both programs.

"Accounting for Geographic Variation in Social Security Disability Program Participation," Social Security BulletinJack Gettens, Pei-Pei Lei, and Alexis Henry, May 2018.

"Accounting for Geographic Variation in DI and SSI Participation," Jack Gettens, Pei-Pei Lei, and Alexis Henry, March 2016. (PDF)

Contemporaneous and Longer-Term Effects of CHIP Eligibility Expansions on SSI Enrollment
Investigators: Sean Orzol, Michael Levere, and Lindsey Leininger (Mathematica Policy Research), Nancy Early (Social Security Administration)

Abstract

This study will explore the interplay between two important public programs for vulnerable children: the Supplemental Security Income (SSI) Program and the Children’s Health Insurance Program (CHIP). Specifically, we will estimate how the initial creation and continued expansion of CHIP in the late 1990s and early 2000s affected SSI applications and awards among children and young adults. We hypothesize that the newly available CHIP coverage—noteworthy for the relative ease of its application process compared with other public programs—was an attractive, potential substitute for SSI, especially among families that may have valued SSI primarily for the associated Medicaid benefit.

The key data sources for the study will include the Current Population Survey and Social Security Administrative data, such as the 831 file. The former will be used to construct measures that reflect the generosity of CHIP eligibility criteria and sociodemographic controls. The latter will be used to construct SSI application and award counts. We will we use a generalized difference-in-differences design that takes advantage of the expansion of CHIP in steps within states, to isolate plausibly causal impacts of CHIP eligibility on SSI outcomes. Moreover, we will explore both the contemporaneous and longer-term effects of CHIP eligibility on SSI enrollment, identifying whether and how early exposure to CHIP eligibility changes the trajectory of SSI attachment throughout the course of childhood and early adulthood. We expect our estimates to contribute to the broader literature that examines how the availability of public health insurance options outside of SSI affect SSI enrollment.

"How Did Expansions of Children's Public Health Insurance Affect Participation in the Supplemental Security Income Program?" (DRC Brief Number: 2019-03), Michael Levere, Sean Orzol, Lindsey Leininger, and Nancy Early, June 2019. 

"Contemporaneous and Long-Term Effects of Children's Public Health Insurance Expansions on Supplemental Security Income Participation," Journal of Health Economics, Michael Levere, Sean Orzol, Lindsey Leininger, and Nancy Early, March 2019.

"Contemporaneous and Long-Term Effects of Children's Public Health Insurance Expansions on Supplemental Security Income Participation," (DRC Working Paper 2018-03), Michael Levere, Sean Orzol, Lindsey Leininger, and Nancy Early, May 2018. 

The Impact of Vocational Rehabilitation on the Employment and Benefit Receipt of People with Less Significant Disabilities
Investigators: David R. Mann and Heinrich Hock (Mathematica Policy Research), Kai Filion (Social Security Administration)

Abstract

The federal-state Vocational Rehabilitation (VR) Program provides services and supports to people with disabilities who want to either start working or return to work. VR seems to be in a good position to help applicants find a job or remain employed and therefore to avoid becoming reliant on Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits. However, there is limited evidence on the impacts of VR services because it is difficult to determine what client outcomes would have been absent the application for VR services.

This study will use recent changes in order of selection (OOS) status at a few state VR agencies to estimate the causal effect of VR services on SSDI, SSI, and employment outcomes. When funding for services is limited, state VR agencies may impose OOS, under which they give priority to applicants whose disabilities are considered the most significant. When OOS is imposed, applicants with relatively less significant disabilities are typically placed on a waitlist for services. These sudden changes in OOS status provide opportunities to estimate program impacts for those affected by changes in OOS status. The data sources for the study will be administrative data from both the Rehabilitation Services Administration and the Social Security Administration. A regression discontinuity design will be used for the analysis.

What Happens When Employees Exhaust Their Short-Term Disability Insurance Benefits?
Investigators: Kara Contreary and Yonatan Ben-Shalom (Mathematica Policy Research)

Abstract

Private short-term disability (STD) insurance policies replace part of the wages of employees who are temporarily unable to work because of illness or injury, usually for a maximum six months to a year. Because policies pay only partial wages, claimants have an incentive to return to work as soon as they recover enough to resume their duties. However, STD claimants who do not fully recover before their benefits expire run a high risk of losing their job, receiving long-term disability (LTD) insurance benefits (if insured), and entering the Social Security Disability Insurance (SSDI) program. Furthermore, many employees who have LTD insurance are at high risk of entering into SSDI based on the severity of their disabilities and the prevalent practice of LTD insurers requiring that their claimants apply for SSDI.

We will examine the individual, employer, and plan characteristics associated with the receipt of private STD benefits. Our analysis will focus on two main outcomes: (1) the frequency with which claimants remain on leave until their STD benefits expire and (2) the frequency of the transition to LTD benefits. We will identify the predictors of exhausting STD benefits and/or of transitioning to LTD by using the Integrated Benefits Institute (IBI) Health and Productivity Benchmarking data, which include 4.6 million STD claims from 12 disability insurance carriers and third-party leave administrators from 2011 to 2014. Our work will shed light on two important issues: (1) factors that lend themselves to policy change and affect beneficiaries’ propensity to return to work and (2) individual characteristics that identify STD claimants who are good candidates for early intervention stay-at-work efforts.

"Worth the Wait? Improving Predictions of Prolonged Work Disability," (DRC Brief 2018-02), Kara Contreary, Yonatan Ben-Shalom, and Brian Gifford, July 2018.

The Impact of a Workers’ Compensation Health Quality Initiative in Washington on Entry into SSA’s Disability Programs
Investigators: Yonatan Ben-Shalom (Mathematica Policy Research); Gary Franklin, Deborah Fulton-Kehoe, and Jeanne Sears (University of Washington); Thomas Wickizer (Ohio State University)

Abstract

Washington State’s Department of Labor & Industries (L&I) Centers for Occupational Health and Education (COHE) program works with providers, employers, and injured workers to improve medical and return-to-work outcomes. The COHE model was first implemented as a pilot in western Washington, and in response to the pilot’s success, the program was introduced to the entire state. A preliminary analysis showed that there was an approximate 25 percent reduction in the number of claimants who entered Social Security Disability Insurance (SSDI) in the eight years after the COHE pilot. This finding is based on the Social Security Administration’s inquiries related to the enforcement of the 80 percent cap on the wage replacement rate for the combined workers’ compensation and SSDI/Supplemental Security Income benefits.

We will examine the impact of COHE on the outcomes of long-term disability programs, including SSDI and Supplemental Security Income applications and awards, and on workers’ compensation awards for total permanent disability. The data source will be SSA data matched to L&I data on all workers filing workers’ compensation claims from 2002 to 2013. We will first construct rates (outcome per 10,000 claimants) for the three outcome measures and examine temporal patterns for the different claimant cohorts and for different claimant subgroups. We will then focus on the sample of claims used for the evaluation of the COHE pilot and use time-to-event models to examine the relationship between various factors and the outcomes of interest. Finally, we will use the estimated model for each event to calculate the impact of COHE on the frequency with which an event occurs in a specified period (for example, the percentage of claimants awarded SSDI within eight years of filing a workers’ compensation claim).

The Relationship of Multiple Program Benefits and Employment to SSI/SSDI Enrollment and Reliance
Investigators: Judith Cook and Jane Burke-Miller (University of Illinois at Chicago)

Abstract

A significant component of the Disability Research Consortium’s mission supports research that will build a better understanding of how federal programs for people with disabilities interact with each other and with other benefit programs. In addition to the Social Security Administration’s (SSA’s) Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs, the Department of Veterans Affairs, the Department of Labor, the Department of Education, the Department of Health and Human Services, and state and local agencies administer programs for people with disabilities. This project will describe (1) how SSA’s programs for people with psychiatric disabilities interact with other benefit programs and (2) how program participation changes in relation to part- or full-time employment. The project will also address the question of what level of self-sufficiency is achieved by people with psychiatric disabilities who receive supported employment.

A complex descriptive analysis will quantify sources of income among people with serious mental illness, their reliance on public and private sources of income and other benefits, and how these features change over time relative to SSI/SSDI benefit status and employment. The data source for the study is the multisite Employment Intervention Demonstration Program, which includes detailed information on sources of income and benefits in a sizeable population of SSDI and SSI beneficiaries, and among individuals who are not beneficiaries but who have been diagnosed with serious mental illness. It is noteworthy that the longitudinal nature of the data provides an opportunity to study the dynamics of program interactions, which cannot be accomplished in studies that must rely on cross-sectional data.

"The Relationship of Multiple Program Benefits and Employment to SSI/DI Enrollment and Reliance Among Working-Age Adults with Serious Mental Illness," (DRC Working Paper 2017-03), Judith A. Cook and Jane K. Burke-Miller, October 2017. (PDF)

The Experiences of Low-Income Children with Disabilities as They Enter Early Adulthood
Investigators: Denise Hoffman (Mathematica Policy Research), Jeffrey Hemmeter and Michelle Bailey (SSA)

Abstract

The years leading up to adulthood are particularly significant in the lives of low-income children with disabilities. During this time, youth make decisions and prepare for the trajectory they want their adult lives to take. Some may receive vocational training and rehabilitation to get ready for the transition from education to employment. Others may receive Supplemental Security Income (SSI) benefits now and may expect to receive disability benefits as adults.

For this study, we will estimate the association between the characteristics of former child SSI recipients, the services and benefits they receive, and their outcomes in early adulthood. Outcomes will include receipt of federal disability benefits; employment and earnings; and mortality. We will focus on children who were ages 14 to 17 in the year 2001, using data from the National Survey of SSI Children and Families linked to 2013 administrative data. This analysis will help the Social Security Administration identify areas to consider in designing future innovations to reduce individuals’ reliance on benefits and improve long-term outcomes for low-income children with disabilities.

"The Relationship Between Youth Services and Adult Outcomes among Former Child SSI Recipients," Journal of Vocational Rehabilitation, Denise Hoffman, Jeffrey Hemmeter, and Michelle Stegman Bailey, March 2018.

"Vocational Rehabilitation: A Bridge to Self-Sufficiency for Youth Who Receive Supplemental Security Income?" (DRC Brief Number 2017-03), Denise Hoffman, Jeffrey Hemmeter, and Michelle Stegman Bailey, April 2017. (PDF)

How do the Customers of a Prominent Intermediary that Helps People Apply for SSDI/SSI Compare to all SSDI/SSI Applicants and Awardees?  
Investigators: Yonatan Ben-Shalom and Dara Lee Luca (Mathematica Policy Research)

Abstract

Intermediary organizations that help people apply for and receive Social Security Administration (SSA) disability benefits are a prominent but understudied part of the disability landscape. There is limited public information about the size, composition, and source of these intermediaries’ customer base, or the role these organizations play in the SSA disability program’s eligibility process. On the one hand, if intermediaries help applicants give SSA objective, complete information about their conditions, and dissuade those who do not meet SSA’s medical eligibility criteria from filing an application or pursuing an appeal after an initial denial, the burden on SSA of collecting documentation and making an accurate decision would presumably be lower than if the client applied without representation. On the other hand, if intermediaries encourage applications from those who are ineligible, or help applicants give SSA information that is biased toward allowances because it is subjective or incomplete, SSA will either have to do more work to reach correct decisions or risk allowing cases incorrectly. A better understanding of these intermediaries and their clients can help inform policies about their activities that can presumably influence the extent to which their activities support or hinder disability determination processes. 

To develop a better understanding of the extent to which customers of disability intermediaries represent federal disability applicants and awardees, this study will develop descriptive statistics about the customers of one prominent intermediary and compare them to statistics on Social Security Disability Insurance and Supplemental Security Income (SSDI/SSI) applicants and awardees. The findings will provide new information about the overlap between the intermediary and SSA’s populations, including a descriptive comparison of how the populations compare on several demographic characteristics and on types of impairment. The study is a first step in gaining a better understanding of how these intermediaries affect the disability determination process and SSA’s ability to make correct award decisions. 

Assessing the Consequences of a Child’s Disability on Parental Labor Supply, Earnings, and Household Benefit Receipt
Investigators: Dara Lee Luca and Purvi Sevak (Mathematica Policy Research)

Abstract

Despite the potentially significant impacts that a child’s disability can have on the parents’ working hours and earnings and the household’s program participation, these impacts are not well understood. A child with a disability may require more financial resources and parental time than a child without a disability, given that appropriate child care may be expensive or unavailable. A potential consequence is that one or both parents may have to withdraw from the labor force to care for the child, leading to income loss and later benefit receipt. On the other hand, parents could increase their working hours or the number of jobs they hold if they have to pay more for the child’s medical and other care. Understanding whether children’s health problems lead to reduced parental earnings and participation in the labor market is critical to formulating effective child disability policies because most welfare programs are means-tested.

The goal of this study is to shed light on how the onset of a child’s disability may affect parental labor market outcomes and household benefit receipt. Using longitudinal data from the Fragile Families & Child Wellbeing Study, a rich data set based on a cohort of about 5,000 children born between 1998 and 2000 and their parents who were followed for over 10 years, we will examine the dynamic nature of the timing of disability onset, parents’ working habits, household income, and participation in safety net programs. The results of this study will help SSA in its efforts to understand the experiences of families that have children with disabilities and to understand how to strengthen supports for this especially vulnerable population.

Evaluating Job Corps for Youth with Medical Limitations: Long-Run Impacts on Earnings and Benefit Receipt
Investigators: Heinrich Hock and Dara Lee Luca (Mathematica Policy Research), and Jeffrey Hemmeter (Social Security Administration)

Abstract

This study will assess the long-run impacts of Job Corps for transition-age youth who enrolled in the National Job Corps Study (NJCS), an experimental evaluation conducted during the 1990s. A U.S. Department of Labor program, Job Corps provides intensive, comprehensive, and integrated education and training to over 50,000 economically disadvantaged youth each year. A recent analysis of NJCS survey data on youth who self-identified medical limitations upon entering the study found that Job Corps participation increased their earnings by an estimated 30 percent over a four-year period. The estimates also indicated large reductions over a four-year period in the amounts of SSA disability benefits that were received, for both participants with baseline medical limitations (52 percent) and for other youth (26 percent)—or a projected total four-year reduction of over $15 million (in 2016 dollars) per annual Job Corps cohort.

This study will estimate program impacts over a period of up to 20 years after the youth enrolled in the NJCS. Estimates will be based on SSA administrative data for both youth with baseline medical limitations and other youth. We will establish whether earnings and the impact on disability programs are reflected in the administrative data, which may be more reliable than survey data, and whether they persisted over the longer run. We will also assess whether Job Corps participation reduced or delayed new SSA disability benefit awards after the original four-year study period. The findings may help establish whether Job Corps is a promising option for improving the long-term employment and disability program outcomes of youth with disabilities.

Impacts of the 2010 VA PTSD Rule Change on Veterans’ Disability Compensation and Reported Cognitive Disability 
Investigators: Kara Contreary and Yonatan Ben-Shalom (Mathematica Policy Research); Jennifer Tennant (Ithaca College)

Abstract

In July 2010, the U.S. Department of Veterans Affairs (VA) introduced a new rule on post-traumatic stress disorder (PTSD). The new rule applies to all veterans, including those who served before 9/11, and simplifies the process for obtaining disability compensation for veterans with PTSD. The new regulation states that VA will grant disability compensation to those with PTSD if they can prove that they served in a war zone and in a job consistent with the PTSD-causing event or events. Before the new rule, noncombat veterans had to prove that a specific “hostile military activity” caused their PTSD in order to receive disability compensation. Many veterans did not serve in combat roles but had traumatic experiences during their tours of duty. Easing the eligibility rule likely led to an increase in disability compensation among veterans who served in a war zone but not in a combat role. The change may also have led to reduced stigma among veterans with regard to reporting serious difficulties concentrating, remembering, or making decisions (hereafter, “cognitive disability”).

This project will answer two research questions: (1) Did the change in the VA PTSD rule lead to an increase in self-reported cognitive disability and an increase in VA disability compensation for veterans who served in combat zones? (2) Did the change in the VA PTSD rule have a spillover effect on Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs—that is, does the evidence show that veterans with PTSD turned to SSDI and/or SSI instead of VA disability compensation before the policy change? Such evidence would suggest that the Social Security Administration’s (SSA’s) disability benefits might be a substitute for VA disability compensation. In contrast, evidence of a relative increase in SSDI or SSI receipt after the PTSD rule change would suggest that SSA disability benefits are a complement to VA disability compensation.

"Impacts of the 2010 VA PTSD Rule Change on Veterans' Disability Compensation and Reported Cognitive Disability," Journal of Disability Policy Studies, Kara Contreary, Jennifer Tennant, and Yonatan Ben-Shalom, December 2017.