Citation
Weathers, R., & Bailey, M. (2014). The impact of rehabilitation and counseling services on the labor market activity of Social Security Disability (SSDI) beneficiaries. Journal of Policy Analysis & Management, 33(3), 623-648.
Highlights
- The study’s objective was to examine up to 36 month employment and earnings impacts 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 eligible people were randomly assigned to participate in the ABD. Evaluation data sources included a baseline telephone interview, a 12-month follow-up survey, the Master Beneficiary Record data file, the Summary Earnings Record data file, and Ticket to Work SSA administrative records. The authors estimated the impacts on earnings and employment outcomes for each of three years following enrollment.
- The study found positive impacts on employment and earnings for those receiving ABD telephonic services.
- The quality of causal evidence presented in this study is high because it is a well-implemented randomized controlled trial. This means that we are confident that the estimated effects are attributable to the intervention and not to other factors.
Intervention Examined
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
Data were collected from a wide range of sources, including a baseline telephone interview, a 12-month follow-up survey, the Master Beneficiary Record data file, the Summary Earnings Record data file, and Ticket to Work SSA administrative records. The authors estimated the impacts of AB Plus compared with the control group; AB Plus compared with AB only; and AB only compared with the control group. Outcomes of interest included any employment and average annual earnings in each of the first three years following random assignment.
Findings
- Compared with the control group, AB Plus resulted in a 5.3 percentage point increase in those with any earnings two years after random assignment. In addition, it resulted in a $576 increase in average annual earnings one year after random assignment and $831 two years after random assignment, though these differences were no longer statistically significant by the third year after random assignment.
- Compared with the AB-only group, AB Plus resulted in a 5.6 percentage point increase in those with any earnings two years after random assignment. In addition, it resulted in an increase in average annual earnings of $736 in the first year and $1,024 in the second year after random assignment, though these differences were no longer statistically significant by the third year after random assignment.
- There were no statistically significant differences in employment or earnings over any follow-up period between the AB-only and control groups.
Considerations for Interpreting the Findings
Because the ABD was targeted to SSDI recipients most likely to benefit from accelerated benefits and services, the findings are generalizable only to the subset of SSDI recipients eligible to participate: those ages 18 to 54 without health insurance. In addition, provisions of the Affordable Care Act, which was passed after the ABD concluded, might have decreased the proportion of SSDI recipients who were uninsured during the Medicare waiting period. This would further limit the study’s generalizability.
The study authors estimated multiple related impacts on employment and earnings. Performing multiple statistical tests on related outcomes makes it more likely that some impacts will be found statistically significant purely by chance and not because they reflect program effectiveness. The authors did not perform statistical adjustments to account for the multiple tests, so the number of statistically significant findings from the study is likely to be overstated.
Causal Evidence Rating
This quality of causal evidence presented in this study is high because it is a well-implemented randomized controlled trial. This means that we are confident that the estimated effects are attributable to the intervention and not to other factors.