This issue brief presents longitudinal employment and exit for work statistics for SSDI beneficiaries followed for 10 years from when they first received their award.

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.

Leading health care financing reforms might mitigate, or even eliminate, challenges that the current system creates for people with disabilities who work, or want to work, but there is no guarantee. This brief summarizes the challenges posed by the current system and considers how features of leading reform proposals would, or would not, address these challenges.

This report uses National Health Interview Survey (NHIS) data linked to data from the Social Security Disability Insurance (SSDI) and Medicare programs to create profiles of SSDI beneficiaries during the three years before and after SSDI entry to illustrate changes in insurance status, health care access, and utilization. SSDI beneficiaries were less likely to be insured, even three years prior to SSDI entry, and utilization and access problems peaked right before and after entry. At the time their SSDI applications were approved, 11 percent had completed the entire 24-month Medicare waiting period and about one-third had completed 12 months or more. Eliminating the Medicare waiting period could help many beneficiaries who lack health insurance. However, this policy alone would not help those who are uninsured before entry and approved a long time after SSDI entitlement.

There is a growing divergence between demands placed on the system for assisting people with disabilities and the data required to manage this system. A new brief from our Center for Studying Disability Policy seeks to stimulate discussion about the value of establishing a national disability data system to make better use of existing data and add new data. This type of system could improve coordination of federal data collection and analysis, help agencies and others gain a better understanding of those served, and provide critical information for monitoring and improving programs.

Helping people with disabilities find and keep jobs is a key component to reducing dependency on Social Security disability benefits. The Ticket to Work program aims to do that by offering people with disabilities greater choice in service providers and access to more employment options. The latest report from Mathematica’s Ticket to Work program evaluation presents results from the National Beneficiary Survey, administered each year from 2004 through 2006. The findings indicate that many beneficiaries of Social Security disability insurance were working and engaging in work-preparation activities, and many more saw themselves working in the future. However, a host of common experiences among beneficiaries stood between them and employment including poor health, inaccessible workplaces, low levels of education that may limit their employment opportunities, and fear of jeopardizing their benefits by earning above the Substantial Gainful Activity limit. The Ticket to Work program has the potential to address some of these issues by providing greater economic incentives for employment and reducing the varied employment-related obstacles many beneficiaries face.

The transition to adulthood can be difficult for young people with disabilities, and changes in public policy are needed to give them the support they need to find meaningful work, stay employed, and reduce their dependency on federal and state disability benefits. This brief highlights the importance of improving transition policy for youth with disabilities, reviews lessons from recent research, and considers transformative policy changes and why and how such changes might be tested. It also discusses an example of a transformative policy with potential to improve transitions for youth with disabilities—the Transition to Economic Self-Sufficiency (TESS) program.

The Social Security Disability Insurance (SSDI) program provides a safety net for individuals who must stop working because of a disability. Although Medicare coverage is available to people with disabilities, they must wait for that coverage until 24 months after they become eligible for SSDI. This brief discusses the costs and benefits associated with eliminating the Medicare waiting period for new SSDI beneficiaries. The authors estimate that doing so would increase annual Medicare costs by approximately $14 billion, provided that all beneficiaries are enrolled throughout the 24-month period. This represents about three percent of total Medicare expenditures in 2006. Even though costs would be substantial, potential benefits would also accrue: fewer beneficiaries delaying needed health care; reduced financial hardships for those who must pay high out-of-pocket costs for medical care due to lack of insurance; and reduced Medicaid expenditures for states. In addition, better coverage and access to health care during the waiting period might lead to improved health and increased or earlier return to work.

The idea of people with disabilities working is becoming the expectation and goal of public policy in the U.S. as well as in many other countries. This research brief from Mathematica’s Center for Studying Disability Policy profiles the U.K.’s Pathways to Work program which offers employment support and services to applicants for Incapacity Benefits (IB), the country’s largest disability program. Its key elements are a series of compulsory work-focused interviews, as well as a range of optional services and financial supports known as the Choices Package. The brief notes that after 18 months, employment increased substantially, and there was a small reduction in caseload size. Pathways increased the probability of being in paid work by 7 percent—a 25 percent increase over the comparison group. The program also reduced the IB caseload by an estimated 2 percent. In addition, it reduced by 11 percent the likelihood that claimants report a health condition significantly limiting their ability to carry out daily activities.

The Ticket to Work and Self-Sufficiency program (TTW) was designed to enhance the market for services that help SSI and SSDI beneficiaries successfully enter the workforce. This report looks at how well the TTW market functions and the extent to which the introduction of TTW changed enrollment in employment-support services, employment, and receipt of SSDI or SSI benefits. The study found that program participation remains low but continues to grow, and survey findings indicate substantial potential for growth in participation. In addition, new payment regulations for providers may breathe new life into the market.

Allowance programs are a conceptually appealing way to help people with disabilities and their families pay for goods and services that such individuals often need. The programs provide recipients with financial resources that they can use in a flexible and efficient manner to improve their standard of living. Current disability allowance programs in the United Kingdom have been strained by the sustained growth in the number of people obtaining benefits. This report examines how the international literature on the extra costs of disability could contribute to an assessment of the United Kingdom’s Disability Living Allowance (DLA) and Attendance Allowance (AA) programs.

The authors examine the participation of SSA disability beneficiaries in the TTW program through December 2004. On an absolute scale, participation is very low, and perhaps much lower than many had hoped. Participation is not low relative to the historical rate for program exits due to work, however, and certain groups of beneficiaries participate at higher rates than others. A large majority of participants assign their Tickets to state vocational rehabilitation agencies (SVRAs), predominantly under the traditional, cost-reimbursement payment system. Most SVRA administrators indicate that they have not made major changes to the way they serve their beneficiary clients as a result of TTW. These findings suggest that, through December 2004, TTW does not represent a significant departure from the past. Participants with Tickets assigned to Employment Networks (ENs) are substantially more likely than those with Tickets assigned to SVRAs to earn at a level that will lead to program exit. This finding likely reflects the strong incentives that ENs have to serve only those with a high likelihood of exiting the rolls, but might also reflect greater focus on achievement of high earnings.

This paper presents estimates of TTW impacts on service enrollment, earnings, and benefit amounts during the first two years of program implementation. Estimates indicate that TTW had a small impact on promoting service enrollment during the first year of rollout. However, there is no compelling evidence that TTW affected beneficiary earnings and benefits during its first two years. Impact findings for all outcomes are consistent with the expectation that changes in service enrollment would occur before changes in either earnings or benefit receipt. Additionally, the relatively small size of the service enrollment impacts is consistent with the low TTW participation rate, which was less than 1 percent during the first year of the rollout.

The Ticket to Work (TTW) program was designed to promote employment by enhancing the market for services that help people receiving disability benefits become economically self-sufficient. To date, the Social Security Administration has successfully begun the market enhancement process by putting the core elements of the TTW program in place across the country—mailing a Ticket to more than 11 million disability beneficiaries and inviting them to use it as a way to obtain meaningful employment; implementing new rules that allow beneficiaries to attempt to work without fear of triggering a review of their disability status; and enrolling service providers, or employment networks, that offer beneficiaries new choices for providers and service mixes. Early impacts from this report to Congress suggest that TTW slightly increased beneficiary use of employment services in 2002, the first rollout year. However, the increase did not appear to produce a corresponding increase in beneficiary earnings or a reduction in benefit payments during the first two years. The authors note that impacts for 2004 and later may be larger—participation rates continue to increase, and many nonparticipants say they plan to assign their Tickets. Nevertheless, analysis of trends in TTW payment data suggests that the program would have to induce future shifts in beneficiary behavior that are much larger than what has been observed so far in order to generate the level of exits from the program envisioned by Congress. In particular, meeting the exit goal will require TTW participation to increase substantially and a larger share of participants to earn enough so that they no longer receive cash benefits.

The Social Security Administration established the TTW program to put disability beneficiaries on the road to economic self-sufficiency by improving access to and quality of services that will help them work. This interim report looks at the program during its first two years of operation to examine participation, beneficiary characteristics and outcomes, implementation, and other issues. It also looks at whether financial incentives are strong enough to encourage employment networks to participate, and how the program is reaching those who may need more intensive supports to succeed in the workforce. Overall, the authors note that the program has been implemented successfully, but issues such as low participation by beneficiaries and services providers need to be addressed.

Examines early implementation issues and findings on enrollment and participation patterns in the Social Security Administration's Ticket to Work program, which attempts to increase access to, and the quality of, rehabilitation and employment services available to Social Security disability beneficiaries. Emerging issues include low beneficiary participation, difficulty with recruitment and retention of employment networks (ENs), uncertain financial viability of ENs, and marketing challenges.