Citation
Linkins, K. W., Brya, J. J., Oelschlaeger, A., Simonson, B., Lahiri, S., McFeeters, J., Schutze, M., Jonas, J., & Mowry, M. A. (2011). Influencing the disability trajectory for workers with serious mental illness: Lessons from Minnesota’s Demonstration to Maintain Independence and Employment. Journal of Vocational Rehabilitation, 34(2), 107-118.
Highlights
- The report’s objective was to examine the impacts of the Demonstration to Maintain Independence and Employment (DMIE) in the Minnesota site. The DMIE was designed to prevent or delay people with disabilities from leaving the workforce and applying for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits.
- The study was a randomized controlled trial examining DMIE’s impacts on earnings, benefits applications, and activities of daily living (ADLs). Data sources included participant surveys and health care and employment service utilization information. Impacts were evaluated 12 months after sample members’ enrollment.
- The study found that program participants did not work more hours per month or earn more over the follow-up period than control group members, but were less likely to apply for SSDI or SSI benefits. The program also decreased the number of ADL limitations.
- The quality of causal evidence provided in this study is low. This means that we cannot be confident that the estimated effects are attributable to Minnesota’s DMIE; other factors are likely to have contributed.
Intervention Examined
Demonstration to Maintain Independence and Employment (DMIE) in Minnesota
Features of the Intervention
The DMIE, which was authorized under the 1999 Ticket to Work and Work Incentives Improvement Act and funded by the Centers for Medicare & Medicaid Services, aimed to delay or prevent reliance on Social Security disability benefits through medical assistance and other supports. Hawaii, Kansas, Minnesota, and Texas received federal funding to design and test innovative programs to obtain this objective. Each state provided health care services beyond existing health insurance coverage, as well as discounted deductibles, premiums, and copayments. DMIE participants also received employment services and a personal case manager.
This profile summarized the 12-month impacts of the Minnesota DMIE—Stay Well, Stay Working (SWSW)—which the Minnesota Department of Human Service in the Twin Cities region (Anoka, Dakota, Hennepin, and Ramsey counties) and Northeast Minnesota (Carlton, St. Louis, Pine, and Lake counties) operated from 2007 through 2009. Eligible participants had to work at least 40 hours a month, have a diagnosis of mental illness from a mental health professional, and not be receiving benefits from or be eligible to participate in any other Minnesota-sponsored public program.
Features of the Study
The study was a randomized controlled trial examining DMIE’s impact on earnings, benefits applications, and ADL limitations. The study randomly assigned 1,557 volunteer participants: 1,257 to the treatment group, which could receive SWSW services, and 300 to the control group.
Data for the analysis were drawn from multiple sources, including participant surveys administered by mail at baseline and 12 months after enrollment and health care and employment service utilization data from the Minnesota Medicaid Management Information System. Multivariate regression models estimated SWSW impacts on earnings, SSDI or SSI applications, and difficulty with an ADL.
Findings
- The study found no statistically significant differences between treatment and control group members in earnings or hours worked per month over the follow-up year.
- Among the control group, 14 percent applying for SSDI or SSI benefits during the follow-up year, compared with 7 percent of treatment group members; this difference was statistically significant.
- The number of ADL limitations was lower among treatment than control group members.
Considerations for Interpreting the Findings
Although this study was based on a randomized controlled trial, information from supplementary reports shows that the randomization process for Minnesota’s DMIE changed after May 1, 2008. Because the analysis did not account for this change in randomization process, the study could not achieve a high causal evidence rating. In addition, the racial composition of the treatment and control groups differed, and the authors did not control for race in their analyses.
Study results might not generalize to other populations, such as working-age adults diagnosed with mental illness who work fewer than 40 hours per month.
Causal Evidence Rating
The quality of causal evidence provided in this study is low. This means that we cannot be confident that the estimated effects are attributable to Minnesota’s DMIE; other factors are likely to have contributed.
Additional Sources
Linkins, K. W., Brya, J. J., McFeeters, J., Schutze, M., Oelschlaeger, A., Jonas, J. (2010). Minnesota Demonstration to Maintain Independence and Employment: Final outcome evaluation report. Falls Church, VA: The Lewin Group.