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Policy Framework
The Accelerated Benefits Demonstration is testing whether making medical benefits immediately available to new Social Security Disability Insurance (SSDI) beneficiaries will improve their health and increase the likelihood they will return to work. SSDI pays cash benefits to eligible workers who are disabled. Financed by Social Security taxes paid by workers, employers, and self-employed persons, SSDI pays monthly benefits based on the Social Security earnings record of the insured worker. In addition, SSDI beneficiaries become eligible for Medicare coverage.
However, access to health insurance is an important concern for the 700,000 new Social Security Disability Insurance (SSDI) beneficiaries each year who must wait up to 29 months to become eligible for Medicare. Under current program rules, new beneficiaries receive cash benefits five months after receiving their disability determination and become eligible for Medicare coverage an additional 24 months after the start of cash benefits. During this period, a beneficiary’s health condition may deteriorate because of the natural progression of the condition, lack of medical access and medical care, and physical inactivity from not working.
The U.S. Social Security Administration (SSA) has contracted with MDRC and several partners to design and evaluate the Accelerated Benefits (AB) Demonstration. The project will test whether a short-term investment in health care for certain newly entitled SSDI beneficiaries has long term pay-offs, in terms of improving beneficaries' medical conditions and increasing the likelihood that they will return to work.
Agenda, Scope, and Goals
The AB Demonstration will identify newly entitled SSDI beneficiaries. The demonstration project will then randomly assign some of these beneficiaries to program groups that receive accelerated health care benefits — with the goal of improving their medical conditions and increasing the likelihood that they will be able to return to work and improve their self-sufficiency. In addition, the project will help SSA determine the costs and benefits associated with providing immediate medical benefits to these individuals.
MDRC is the prime contractor for the demonstration; Mathematica Policy Research, Inc., is the lead subcontractor; POMCO, CareGuide, and TransCen, Inc., are health care and employment service organizations and will provide intervention services for the demonstration.
Design, Sites, and Data Sources
The sample will include 2,000 SSDI beneficiaries who are likely to benefit from immediate and continued medical care. They will be randomly assigned into three groups: one receiving accelerated benefits, another receiving these benefits plus additional services, and a control group:
- The AB group will receive immediate access to health care benefits.
- The AB Plus group will have immediate access to health care benefits and receive additional supports that include care management, a behavioral intervention to motivate them to return to work, and employment and benefits counseling. Care management and employment counseling will be delivered telephonically.
- The control group will be subject to the existing rules governing the Medicare waiting period.
The three-group design will disentangle the effects of making health care benefits available alone from the effects of a more intensive intervention. Outcomes will be assessed through 6- and 12-month follow-up surveys, administrative records on employment and disability benefit receipt, and Management Information System (MIS) data on the services provided to AB and AB Plus treatment group participants. The study includes an impact analysis, implementation research, a benefit-cost analysis, and two major reports.
What's Next
The evaluation, which began in January 2006, will be conducted over five years, until 2011. During the first year of the project, the evaluation team developed the intervention. Enrollment began in October 2007.
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