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Health and Disabilities
Mental and physical health problems and disabilities are among the most common obstacles to steady employment — and among the biggest contributors to increasing health care expenditures. In addition, health care needs are often much greater for low-income families and for individuals with disabilities. MDRC is currently building a portfolio of projects testing innovative strategies to enhance health care services for individuals facing health- and disability-related barriers and to improve their employment and health outcomes.
These projects are motivated by two trends. First, despite 20 years of advocacy and legislation designed to expand employment opportunities for people with disabilities, the proportion who work has remained persistently low, and many have become increasingly dependent on income assistance programs, such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Policymakers and advocates are searching for strategies that can bring more people with disabilities into the economic mainstream. Second, a high proportion of the rapidly increasing expenditures for public health insurance are for a relatively small number of people suffering from multiple chronic conditions, and policymakers are looking for ways to reduce health care spending for these individuals, while not reducing the quality of the care they receive.
MDRC researchers have initiated two large-scale random assignment studies for the Social Security Administration focusing on individuals with disabilities. The Accelerated Benefits Demonstration, being conducted by MDRC with Mathematica Policy Research (MPR), is testing whether providing immediate health insurance coverage promotes employment and reduces benefit receipt for individuals just approved for SSDI benefits. MDRC is also working with MPR on the Youth Transition Demonstration, which is testing educational, employment, and other services for young people who are either receiving disability benefits or at risk of receiving them.
The Rhode Island Working Towards Wellness project, a site in the Enhanced Services for the Hard-to-Employ Demonstration, is testing a telephonic outreach and care management intervention for working-age adults with children who are on Medicaid and have undiagnosed depression.
As part of the multi-site Employment Retention and Advancement project, MDRC is testing two specialized welfare-to-work programs in New York City, one targeting recipients with work-limiting disabilities and another targeting recipients with substance abuse problems.
The TANF/SSI Disability Transition Project, funded by the U.S. Department of Health and Human Services and the Social Security Administration, seeks to better understand the relationship between the Temporary Assistance for Needy Families and Supplemental Security Income systems as it relates to welfare applicants and recipients with potential disabilities and to work closely with participating TANF agencies to develop and implement strong pilot tests targeted to that population.
Finally, MDRC is condacting evaluations of Coordinated Care for High-Cost Medicaid Recipients with Disabilities in Colorado and New York. The goal of both programs is to understand the variety of ways that health care and social service organizations try to coordinate the care of high-needs people with disabilities and to estimate the effects of those programs.
Key Documents on Health and Disabilities
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