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Early Intervention Seeks to Help Workers with Potentially Disabling Conditions Maintain Independence and Employment

New Issue Brief Describes Implications for National Health Care Reform

Contact: Cheryl Pedersen, (609) 275-2258

WASHINGTON, D.C. (December 15, 2009)—Individuals with potentially disabling conditions who are employed have distinct health care needs that, if neglected, can lead to the onset of a disability, loss of work, and subsequent dependence on federal disability benefits. In addition, many of these individuals are at risk of being underinsured because of their complex health care needs. A new issue brief from Mathematica Policy Research describes how four states are helping workers with disabilities to stay employed by providing them with expanded access to medical services and employment supports. The state initiatives are part of the Demonstration to Maintain Independence and Employment (DMIE), authorized by Congress and administered by the Centers for Medicare & Medicaid Services for the purpose of decreasing enrollment into federal disability programs by supporting the continued employment of workers with potentially disabling conditions. Mathematica is conducting a national evaluation of the DMIE.

Hawaii, Kansas, Minnesota, and Texas designed their DMIE programs to have comprehensive models of coverage because workers with disabilities tend to be in poorer health, are more likely to have a lower household income, and are less likely to work than the general population. Many need a comprehensive package of services as well as help navigating the system to get the care they need and remain healthy and employed. The state interventions, which include working adults with different types of potentially disabling conditions, share two main components: (1) enhanced access to medical services, or “wrap-around” coverage, and (2) employment supports, such as case management and vocational rehabilitation services.

Some states increase access to medical services by broadening medical benefits. For example, they offer dental and vision coverage or services such as durable medical equipment or chemical dependency treatment. All four reduce financial barriers to care by paying for part or all of participants’ premiums, copayments, or deductibles. Lack of affordability is a key issue because this group has high needs and is at high risk of being underinsured.

Employment supports help workers remain employed and independent. These supports include vocational rehabilitation as well as system "navigators" who work one on one with participants to assess their health and employment needs, develop a plan for meeting these needs, and identify steps to make use of available services and supports. Some also help build interview skills and identify job leads. They also help workers navigate the health care system effectively and ensure that care is adequate, appropriate, and coordinated.

“Preliminary results suggest that DMIE might reduce or delay entrance onto federal disability rolls,” said Noelle Denny-Brown, the report’s lead author and a research analyst at Mathematica. “This type of early intervention may save federal dollars and could be a way to provide early intervention services to address the needs of workers with disabilities. As national health reform proposals continue to evolve, results from the DMIE evaluation could also inform future policies and programs that address the needs of underinsured workers who have potentially disabling conditions.”

“The Demonstration to Maintain Independence and Employment: Implications for National Health Care Reform,” the tenth issue brief in Mathematica’s series on Working with Disability, was written by Denny-Brown, Boyd Gilman, Gilbert Gimm, Henry Ireys, and Sarah Croake. To learn more about Mathematica’s national evaluation of the DMIE program, which will be completed in 2011, click here.

Mathematica Policy Research, a nonpartisan research firm, provides a full range of research and data collection services, including program evaluation and policy research, survey design and data collection, research assessment and interpretation, and  program performance/data management, to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Ann Arbor, Mich., Cambridge, Mass., Chicago, Ill., Oakland, Calif., and Washington, D.C., has conducted some of the most important studies of health care, education, family support, employment, nutrition, and early childhood policies and programs.