Disability Topics

• Center for Studying Disability Policy
• Children and Youth with Disabilities
• Working-Age Adults
• Adults of All Ages
• Collecting and Improving Disability Data
• Clients

The Demonstration to Maintain Independence and Employment

Can a program of health benefits and employment supports postpone, if not prevent, the loss of employment and independence due to a potentially disabling condition? Will these benefits improve participants’ health and functional status and access to care?       

The Demonstration to Maintain Independence and Employment (DMIE), authorized under the Ticket to Work and Work Incentives Improvement Act of 1999, awards funds to states to develop, implement, and evaluate interventions for workers with potentially disabling health conditions, such as diabetes, HIV, and mental illness. Many of these adults do not have access to the comprehensive health insurance coverage and employment supports that could prevent their condition from becoming a severe disability and help to maintain their employment, health status, and independence from public assistance programs.

Under the DMIE, states may provide health insurance coverage that is equivalent to their standard Medicaid benefit package or “wrap-around” coverage, which supplements public or employer-sponsored coverage. States may also offer employment support and case management services. In 2006 and 2007, the Centers for Medicare & Medicaid Services (CMS) approved demonstrations in four states—Hawaii, Kansas, Minnesota, and Texas—which are using a rigorous evaluation design with random assignment. The demonstrations ended in September 2009.   

Mathematica’s national evaluation is compiling data from the four states into a uniform data set to compare findings across sites. The evaluation is using federal administrative data on earnings and disability program participation to examine whether the DMIE results in sustained employment and independence from disability programs. The evaluation is also using CMS's Medicaid Analytic eXtract data files to examine Medicaid service utilization and expenditures.

Mathematica is conducting site visits to each state project and will combine this information with data collected through quarterly reports and phone interviews. The final report is expected in September 2010.

Publications

"Demonstration to Maintain Independence and Employment (DMIE): Final Report" (June 2011, revised February 2012)
"The Demonstration to Maintain Independence and Employment: Implications for National Health Care Reform," Working with Disability, Work and Insurance In Brief #10 (December 2009)
"Interim Report on the Demonstration to Maintain Independence and Employment" Full Report Executive Summary (April 2009)
“What Is the Demonstration to Maintain Independence and Employment (DMIE) and Who Is Participating?" Working with Disability, Work and Insurance In Brief #6 (August 2007)