The impact of rehabilitation and counseling services on the labor market activity of Social Security Disability Insurance (SSDI) beneficiaries.

We use data from a social experiment to estimate the impact of a rehabilitation and counseling program on the labor market activity of newly entitled Social Security Disability Insurance (SSDI) beneficiaries. Our results indicate that the program led to a 4.6 percentage point increase in the receipt of employment services within the first year following random assignment and a 5.1 percentage point increase in participation in the Social Security Administration's Ticket to Work program within the first three years following random assignment. The program led to a 5.3 percentage point increase, or almost 50 percent increase, in employment, and an $831 increase in annual earnings in the second calendar year after the calendar year of random assignment. The employment and earnings impacts are smaller and not statistically significant in the third calendar year following random assignment, and we describe SSDI rules that are consistent with this finding. Our findings indicate that disability reform proposals focusing on restoring the work capacity of people with disabilities can increase the disability employment rate.

The effect of expanding access to health insurance on the health and mortality of Social Security Disability Insurance beneficiaries.

We use a social experiment to estimate the impact of expanding health insurance coverage on the health and mortality of newly entitled SSDI beneficiaries who lacked health insurance. Our intent-to-treat estimates show that expanding health insurance has significant effects on self-reported health at one year following health insurance enrollment, positive effects on mental health and physical health at one year following health insurance enrollment, and no significant effects on mortality within our observation period. About 30% of control group members obtained health insurance coverage within one year following enrollment. We use two-stage least square models to estimate the impact on those who would not have obtained health insurance coverage without the demonstration project and find larger effects on self-reported health and mental health among these SSDI beneficiaries. Finally, we examine distributional impacts to show that mean impacts miss meaningful effects.

Effect of postsecondary education on the economic status of persons who are deaf or hard of hearing.

This article examines the effect that postsecondary education has on earnings and the duration of time spent in the Social Security disability programs for young persons who are deaf or hard of hearing. Our hypothesis is that investments in postsecondary training increase the likelihood of employment for persons who are deaf or hard of hearing and thus reduce dependency on disability-related income support programs. A longitudinal data set based upon records from the National Technical Institute for the Deaf and Social Security administrative records is used for this analysis. We find that those who graduate, even those who graduate with vocational degrees, experience significant earnings benefits and reductions in the duration of time spent on federal disability programs when compared with those who do not graduate with a degree. This finding suggests that reductions in the duration of time spent on Social Security programs are not limited to those with the highest level of scholastic aptitude and that investments in post-secondary education can benefit a broad group of deaf and hard-of-hearing persons. In addition, the data show that individuals who attend college, but withdraw before graduation, fair no better economically than individuals who never attended college.

Expanding access to health care for Social Security Disability Insurance beneficiaries: early findings from the accelerated benefits demonstration.

Most Social Security Disability Insurance (DI) beneficiaries must complete a 5-month waiting period before they become entitled to DI cash benefits and an additional 24-month waiting period before Medicare benefits begin. The Accelerated Benefits (AB) demonstration is a randomized experiment designed to test the effects of providing newly entitled DI beneficiaries who do not have health insurance with a generous health benefits package during the Medicare waiting period. This article presents early findings on the prevalence of health insurance coverage among newly entitled beneficiaries and the characteristics of those without health insurance. It also examines the effects of AB on health care utilization, the extent to which AB reduces unmet medical needs, and the costs of providing the AB health benefits package.

How postsecondary education improves adult outcomes for Supplemental Security Income children with severe hearing impairments.

The rapid growth in the number of children participating in the Supplemental Security Income (SSI) program before the age of 18 has led policymakers to consider new methods of assisting children with disabilities in their transition from school to work. Postsecondary education represents one path that SSI children may take to acquire the skills necessary to enter employment and reduce dependency on the SSI disability program as adults. Yet little is known about SSI children's experience with postsecondary education, let alone their ability to increase their labor market earnings and reduce their time on SSI as adults in the long term. This lack of information on long-term outcomes is due in part to a lack of longitudinal data. This article uses a unique longitudinal data set to conduct a case study of SSI children who applied for postsecondary education at the National Technical Institute for the Deaf (NTID) within the Rochester Institute of Technology. The data set was created by merging NTID administrative data on the characteristics and experiences of its applicants to Social Security Administration (SSA) longitudinal data on earnings and program participation. We used this data file to estimate the likelihood that an SSI child will graduate from NTID relative to other hearing-impaired NTID applicants, and we estimated the influence of graduation from NTID on participation in the SSI adult program and later success in the labor market. The results of our analysis show that the percentage of NTID applicants who were SSI children increased over time, from a low of 10 percent in 1982 to more than 41 percent in 2000. However, the differences in the probability of graduation from NTID between deaf SSI children and deaf applicants who were not SSI children did not change accordingly. The probability of graduation for SSI children who applied to NTID was 13.5 percentage points lower than for those who were not SSI children. The estimated disparity indicates that targeting college retention programs toward SSI children may be an effective way to improve overall graduation rates. Our results also show that SSI children who graduated from NTID spent less time in the SSI adult program and had higher earnings than SSI children who did not gradu- ate. Compared with SSI children who were accepted to NTID but chose not to attend, SSI children who graduated from NTID left the SSI program 19 months earlier, were less likely to reenter the program, and at age 30 had increased their earnings by an estimated 49 percent. Our findings demonstrate that SSI children need not be relegated to a lifetime of SSI participation as adults, despite the poor overall labor market experience of this population since the creation of the SSI program in 1974.

Participation in programs designed to improve employment outcomes for persons with psychiatric disabilities: evidence from the New York WORKS demonstration project.

The New York WORKS demonstration project was designed to improve employment outcomes for persons with psychiatric disabilities receiving Supplemental Security Income (SSI) disability payments. This article shows how the individual characteristics of participants were related to outcomes at each stage of the multistage recruitment process used in the project and how those characteristics contributed to enrollment. The findings are important to program administrators who are interested in ensuring that SSI recipients receive equal access to employment-related services and who want to improve recruitment strategies for future demonstration projects. The New York WORKS recruitment process used administrative records from the Social Security Administration (SSA) to identify the population of over 68,000 SSI recipients with a diagnosis of a psychiatric disability in Erie County and New York City. Staff involved in the project documented the results of each stage of the recruitment process. The New York WORKS project included four stages: (1) the provision of information (sending a letter and information packet); (2) demonstrated awareness of the project (response to a letter containing an overview of the project); (3) expression of interest (indication of interest in the project, using a postmarked form returned to New York WORKS project staff); and (4) participation (actual enrollment in the program). The project staff members were also able to identify data from administrative records that described the characteristics of the population, including age, sex, type of psychiatric diagnosis, the number of months that the person collected benefits before the recruitment process, employment experience before the recruitment process, and annual earnings in the year before the recruitment process. The data on outcomes at each stage of the recruitment process and the characteristics of SSI recipients were analyzed using an empirical method recently suggested by Heckman and Smith. The analysis identified the relationship between the characteristics of SSI recipients and the outcomes at each stage of the recruitment process and demonstrated how those characteristics contributed to the overall likelihood of enrollment. Demographic characteristics, information about diagnosis, and characteristics related to work history had different effects on outcomes at different stages of the recruitment process. For example, younger SSI recipients were less likely to reply to the information letter but more likely to express an interest in the project and more likely to enroll, given that interest. This result suggests that there may be an information barrier for the younger group of SSI recipients during the early recruitment stages. There were also interesting differences by psychiatric diagnosis and by recent employment experience at each stage of the process. Most notably, persons with anxiety disorders were less likely to express an interest in the project and less likely to enroll in the project if they expressed an interest. This finding suggests that project administrators may need to examine more effective methods to accommodate persons with an anxiety disorder at the enrollment stage of the recruitment process. Persons with relatively low earnings in the year before the project were more likely to respond, to express interest in the project, and to enroll than were those with no earnings and those with relatively high earnings. This finding suggests that the recruitment strategy used by the New York WORKS project is more effective at enrolling a subset of the population that has some demonstrated work capacity and that, of those with a demonstrated work capacity, New York WORKS is enrolling those who are likely to have the most to gain from the project. This finding has implications for the development of sample designs for other demonstration projects, in particular the SSA-proposed mental health treatment study. A number of strategies may lead to improvements in future evaluations of participation in SSA projects and programs. For example, the New York WORKS data did not contain information for all SSI recipients on race, education, or literacy. These factors have been shown to be important in the Job Training Partnership Act literature and are likely to play a role in participation. The inclusion of these data in future evaluations may provide important information on participation in SSA projects. Another useful strategy for future evaluations includes the identification of random samples of those who choose not to enroll at different stages in the process and the collection of information on the reason for the decision. These additional data may help project administrators to gain a clearer description of the reasons for differences in outcome that occur at each stage of the process, assess the overall performance of the recruitment process, and improve the recruitment processes used in future projects.