Citation
Chambless, C., Julnes, G., McCormick, S., & Reither, A. (2011). Supporting work effort of SSDI beneficiaries: Implementation of Benefit Offset Pilot Demonstration. Journal of Disability Policy Studies, 22(3), 179-188.
Highlights
- This report presented an implementation and impact analysis of the Utah Benefits Offset Pilot Demonstration Project (BOPD). The study examined pilot procedures and potential challenges for national implementation of the Benefit Offset National Demonstration (BOND), which intended to reduce barriers confronting SSDI recipients wishing to increase their earnings by offering a benefit offset.
- The study focused on how to effectively implement and administer the benefit offset and whether work incentives counseling and other employment supports would encourage beneficiaries to take advantage of the offset program. The authors used administrative data about recruitment and service use, focus groups, and surveys.
- The study found that recruitment for the demonstration was challenging because of perceived threats to benefits status from participating. Effective communication through multiple modes was crucial to successful recruitment. In addition, staff found the start and end dates of benefits changes difficult to communicate to participants, and so developed tools, including time lines, to do so.
- Due to limitations in the study’s discussions of its research methods, it is unclear whether findings are potentially applicable to other projects for SSDI beneficiaries.
Intervention Examined
The Utah Benefits Offset Pilot Demonstration Project
Features of the Intervention
Administered by the Social Security Administration (SSA), the BOPD was a pilot test of the later BOND. The primary intervention was a benefit offset that replaced the so-called cash cliff that SSDI recipients who work eventually experience. The cash cliff refers to the fact that Social Security Disability Insurance (SSDI) recipients who have completed a nine-month trial work period (TWP) followed by a three-month grace period have all their SSDI benefits suspended or terminated if they earn more than a threshold amount known as substantial gainful activity (SGA). The benefit offset replaces the complete loss of all benefits for working SSDI recipients, instead gradually withdrawing the SSDI benefit by $1 for every $2 earned above the SGA amount. SSA discontinued benefit offset eligibility for BOPD treatment subjects who had not completed a TWP by December 31, 2008, which was two years earlier than BOPD treatment subjects had initially been told their benefit offset eligibility would expire.
BOPD was implemented in four states: Connecticut, Utah, Vermont, and Wisconsin. Apart from recruiting SSDI recipients who received benefits solely based on their own earnings records, had completed a TWP within the past 72 months, and were not concurrently receiving SSI benefits, the states were free to select their own program eligibility criteria. Utah recruited potential participants statewide from the disability Medicaid program, the SSA benefits counseling program, the vocational rehabilitation program, and two community mental health programs. Of the 11,350 Utah residents contacted to participate in the BOPD, 1,495 responded to the initial solicitation. Ultimately, 503 were found eligible, consented to participate, and were enrolled in the pilot.
Features of the Study
The implementation portion of the study sought to evaluate procedures in obtaining participants’ consent and retaining participants, and assess challenges in providing employment supports to participants. The study described major aspects of inputs, resources, collaboration between partners, recruitment and enrollment processes, and service delivery. The study drew on administrative data on recruitment and service use, surveys, and focus group data. The pilot began in August 2005 and study participants enrolled from August 22, 2005, to October 31, 2006. This profile focuses on the implementation of BOPD in Utah; implementation results were not presented for the other states.
Findings
The Utah BOPD was implemented by the public vocational rehabilitation agency, the Medicaid agency, the state workforce agency, and two community mental health agencies (one in a rural area and one in an urban area). The agencies identified and recruited SSDI beneficiaries from their program rolls, provided services that would support work efforts, and collected administrative service data. SSA did not make lists of SSDI beneficiaries’ names available, and this lack of data on SSDI status resulted in an inefficient enrollment process.
Demonstration staff enrolled participants into the study and provided benefits counseling. They also made referrals for other supports such as vocational rehabilitation services, Medicaid, and mental health providers. Vocational rehabilitation services included creating an individualized plan based on an employment goal, completing a vocational assessment, career counseling, education and job training, medical rehabilitation, and job placement. If a participant appeared to be eligible for Medicaid, a referral was made to the state’s Medicaid Buy-In program, which allowed disabled people whose incomes exceeded the usual eligibility limit to pay a monthly premium to access Medicaid. In doing so, the program aimed to remove the disincentive for low-income beneficiaries to work. Mental health providers offered case management, job coaching, and work opportunities for individuals diagnosed as having serious, persistent mental illness.
Lessons learned from the pilot demonstration included the following:
- The pilot study found that beneficiaries and their families were anxious when approached about going to work or participating in a program that they perceived could jeopardize their benefits status; because beneficiaries had previously affirmed their inability to work when applying for SSDI, they might have been wary to then participate in a program that encouraged them to work (although the demonstration did not show this). To address this concern, demonstration staff modified their recruitment strategy halfway through the recruitment period to offer a more personal approach from counselors or others who already had relationships with the people being recruited. This approach was successful at increasing enrollment.
- The demonstration staff initially faced challenges explaining the demonstration to potential participants, obtaining informed consent, and providing services. To address these challenges, staff developed a variety of communication techniques, including one-on-one meetings, brochures, slide presentations, and diagrams, to better explain the demonstration. They also developed plain language materials and modified resources for use with participants who had visual or hearing/speech impairments.
- It was difficult to plan or know with certainty when participants would begin to receive benefit offsets. To determine whether beneficiaries had used up their TWP, SSA conducted a continuing disability review to verify employment status, wages, and subsidies. The time to complete this process varied, and because of this uncertain timing, beneficiaries could not know in advance when they would be eligible for the offset. To address this uncertainty, demonstration staff stayed in close contact with the participants to alert them to milestones and provided them with a time line to help monitor receipt of the offset.
Considerations for Interpreting the Findings
The study clearly identified the research questions and stated that it used service use data to explore these topics. However, it did not explain how it used survey and focus group data, despite including descriptive information on how the pilot was implemented, such as challenges and modifications during implementation. The study did a good job presenting enrollment data, but did not include participation data. The study would have benefited from a more thorough description of its sources, data collection techniques, analysis methods, and data quality control techniques, especially regarding survey and focus group data collection. Without this information, it is unclear whether findings are potentially applicable to other projects for SSDI beneficiaries.