The proposal would test early-interventions for workers with mental illness under 50 targeted to two sub-groups: those receiving services from a state vocational rehabilitation agency who are not DI or SSI disability beneficiaries; and those who have recently applied for disability benefits and were denied. Participants would receive an intensive set of behavioral health and related services to help them remain in or return to the labor market rather than seek SSA disability benefits.
Respondent: Steve Bell, Vice President, Social & Economic Policy, Abt Associates
The Integrated Employment Support and Eligibility Determination proposal would integrate timely employment support systems after the onset or worsening of a medical condition, along with an improved disability determination process so as to improve economic outcomes for workers and reduce entry into SSDI.
The proposal would extend private disability insurance coverage so as to support workers for up to 2.25 years following onset of disability. It would provide partial income replacement and supports geared toward helping individuals maximize work readiness and self-sufficiency. After receiving private insurance benefits for twenty-four months, individuals who are unable to engage in substantial gainful employment would transition into the SSDI system.
Respondent: Dave Wittenberg, Senior Researcher, Mathematica Policy Research
The proposal is based on a comprehensive 2004 Netherlands reform requiring employers to cover wages during a two year waiting period before DI entitlement; the inclusion of effective gatekeeper protocol; required employer and employee active measures for health and continued work as a condition of enrollment after two years; and adoption of a competitive market for employer provided sickness and disability insurance as between government and private carriers for the first two years. Post- reform disability inflow in Holland is 20 – 40% of pre-reform 2001 base year.
Respondents: Ted McCann, Staff Director, Ways and Means Social Security Committee; and Jon Baron, President, Coalition for Evidence-Based Policy
The proposal would adapt to DI and SSI a 13 year old NYC large-scale program for TANF recipients who claim health as reasons for inability to seek or obtain jobs. The intervention uses an independent vendor under a performance contract to maximize employment rather than push recipients to SSI. Vendor comprehensive medical health assessment is followed by vocational and job search efforts where practical. Fewer than 20% are referred to SSI, the balance to health and vocational activities followed by work.
Respondent: Mike Wiseman, Research Professor of Public Policy, Public Administration, and Economics, George Washington University
The proposal is based on UK reforms which include an independent medical and functional assessment from a government contracted service provider; a fixed term disability period followed by reassessment; a “Fit for Work Service” provided by a vendor which includes a telephone and internet service to offer advice to businesses for their workers who have experienced a health shock; engagement of MD general practitioners to understand the health benefits of work over disability; and a triage of disability applicants into three categories - - permanently disabled, work capable with accommodations, and ready to work. Post-reform new disability intakes in the UK are no longer rising.
Eloise Anderson, Secretary, WI Department Children and Families
Respondent: Matt Weidinger, Staff Director, Ways and Means Human Services Committee
The proposal would change SSI children benefits from cash payments going to adult family heads with its undesirable dependency effects, and substitute the same fund contributions for services to covered child using a flexible spending account. The service objective is to help overcome a child’s disability, do better in school and transition to adult employment.
Respondent: Yoni Ben-Shalom, Senior Researcher, Mathematica Policy Research
The proposal would adapt to DI a quality improvement intervention currently implemented within Washington State’s workers’ compensation system. The program provides WC financial incentives to health providers for using best practices, coupled with support and care management. Patients treated by providers who more often adopted occupational health best practices have on average 57% fewer WC disability days. The program is now being adopted statewide.