Michalopoulos, C., Wittenburg, D., Israel, D., Schore, J., Warren, A., Zutshi, A., Freedman, S., & Schwartz, L. (2011). The Accelerated Benefits Demonstration and Evaluation Project: Impacts on health and employment at twelve months. New York: MDRC.
- This is the 12-month survey impact report of the Accelerated Benefits Demonstration (ABD), an effort to provide immediate health insurance and employment and benefits counseling to new, uninsured Social Security Disability Insurance (SSDI) recipients during the 24 month Medicare eligibility waiting period.
- About 2,000 volunteers were randomly assigned as part of the demonstration; this report focuses on approximately 1,500 of them. Study data sources included Social Security Administration (SSA) administrative records, a baseline telephone survey, a follow-up 12-month survey, health claims data, and a case management information system.
- ABD health insurance increased health care utilization, reduced unmet medical care needs, and improved self-reported health. However, ABD employment supports did not increase employment in the first 12 months of follow-up.
- The quality of the causal evidence presented in this report is high because the study is a well-implemented randomized controlled trial. This means we can be confident that the outcome differences between research groups are attributable to ABD, and not other factors.
Accelerated Benefits Demonstration
Features of the Intervention
Almost all new SSDI recipients must wait 24 months after their SSDI eligibility date to be eligible for Medicare benefits. Some SSDI recipients have no health insurance during this Medicare waiting period. The ABD provided health insurance to new, uninsured SSDI recipients (that is, no concurrent SSI/SSDI recipients), ages 18 to 54, who had at least 18 months to wait before Medicare eligibility.
For the demonstration, 1,997 volunteers living in 53 qualifying U.S. metropolitan areas were randomly assigned to receive either accelerated benefits (AB), AB Plus, or no additional services (that is, control). Both AB and AB Plus members received immediate health insurance with greater benefit coverage, lower copayments, and a more comprehensive provider network than Medicare. AB Plus members were also eligible for three voluntary services delivered by telephone: a behavioral health motivation program, employment and public assistance benefits counseling, and medical case management. The report’s analysis sample includes 1,531 people randomly assigned to one of the three experimental groups on or before November 6, 2008, because after that date random assignment into AB Plus was ended due to budgetary pressures.
Features of the Study
The study’s data sources include SSA administrative records, a baseline telephone survey, a follow-up 12-month survey, health claims data for members of each of the two program groups (AB and AB plus), and a case management information system.
The impact of accelerated health insurance coverage was estimated as the difference between the AB group and the control group, whereas the impact of accelerated health insurance coverage plus supportive services was estimated as the difference between the AB Plus group and the control group. The incremental impact of the supportive services was estimated as the difference between the AB Plus group and the AB group. All impacts were regression-adjusted to account for differences in baseline characteristics across groups.
- Accelerated health care benefits improved self-reported health across a variety of measures, including a 10 percentage point increase in those rating their health as good, very good, or excellent in the AB group and a 7 percentage point increase in the same measure for the AB Plus group. Both AB and AB Plus also increased health care utilization.
- Relative to those who just received AB, the supportive services available to the AB Plus group did not increase employment in the first 12 months.
Considerations for Interpreting the Findings
The study period coincided with the 2007–2009 U.S. recession, which might have dampened any short-term employment impacts. This report is limited to 12-month impacts, but the overall effectiveness of the program might depend upon employment impacts and health impacts that are not expected to materialize until approximately five years after random assignment.
Causal Evidence Rating
The quality of the causal evidence presented in this report is high because the study is a well-implemented randomized controlled trial. This means we can be confident that the outcome differences between research groups are attributable to ABD, and not other factors.