Accelerated Benefits Demonstration


The Accelerated Benefits Demonstration tested whether making medical benefits immediately available to new Social Security Disability Insurance (SSDI) beneficiaries would improve their health and increase the likelihood they would 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) contracted with MDRC and several partners to design and evaluate the Accelerated Benefits (AB) Demonstration. The project tested whether a short-term investment in health care for certain newly entitled SSDI beneficiaries had long term pay-offs, in terms of improving beneficiaries' medical conditions and increasing the likelihood that they would return to work. After one year, the program increased health care use, reduced reported unmet medical needs, and modestly improved health and functioning. It also increased job prep and search activities but did not raise employment levels.

Agenda, Scope, and Goals

The AB Demonstration identified newly entitled SSDI beneficiaries. The demonstration project then randomly assigned some of these beneficiaries to program groups that received accelerated health care benefits — with the goal of improving their medical conditions and increasing the likelihood that they would be able to return to work and improve their self-sufficiency. In addition, the project helped SSA determine the costs and benefits associated with providing immediate medical benefits to these individuals.

MDRC was the prime contractor for the demonstration; Mathematica Policy Research, Inc., was the lead subcontractor; POMCO, CareGuide, and TransCen, Inc., were health care and employment service organizations that provided intervention services for the demonstration.

Design, Sites, and Data Sources

The sample included 2,004 SSDI beneficiaries who were likely to benefit from immediate and continued medical care. Individuals were randomly assigned into three groups: one that received accelerated benefits, another that received these benefits plus additional services, and a control group:

  • The AB group received immediate access to health care benefits.
  • The AB Plus group had immediate access to the same health care benefits and received additional supports that included medical case management, a behavioral intervention to motivate them to return to work, and employment and benefits counseling. All services were delivered telephonically.
  • The control group was subject to the existing rules governing the Medicare waiting period.

The three-group design aimed to disentangle the effects of making health care benefits available alone from the effects of a more intensive intervention. Outcomes were 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 included an impact analysis, implementation research, a benefit-cost analysis, and two policy briefs and a final report.