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Back to Work: Recent SSA Employment Demonstrations for People with Disabilities
Back to Work: Recent SSA Employment Demonstrations for People with Disabilities
Source: Mathematica Policy Research
This issue brief summarizes short-term impacts from four large scale- demonstration projects by the Social Security Administration designed to increase the economic self-sufficiency of Supplemental Security Income recipients and Social Security Disability Insurance beneficiaries. Results from these rigorous assessments include modest improvements in employment.
How Many Disability Beneficiaries Forgo Cash Benefits Because of Work? Evidence from a New Measure
In recent years, the Social Security Administration (SSA) has placed a greater emphasis on increasing employment among people who receive federal disability benefits while also reducing their reliance on those benefits. SSA’s efforts have led to a growing interest among policymakers in exactly how many disability beneficiaries forgo cash benefits because they are working and how long they are able to remain off cash benefits. In this brief, we summarize findings from a longer report by Stapleton et al. (2010a), who used a newly developed indicator to determine how many beneficiaries receiving Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) forgo cash benefits because of work.
Do Charter Schools Improve Student Achievement? Evidence from a National Randomized Study
This paper presents findings from the first national randomized study of the impacts of charter schools on student achievement, which included 36 charter middle schools across 15 states. The paper compares students who applied and were admitted to these schools through randomized admissions lotteries with students who applied and were not admitted. It finds that, on average, charter middle schools in the study were neither more nor less successful than traditional public schools in improving student achievement. However, impacts varied significantly across schools and students, with positive impacts for more disadvantaged schools and students and negative impacts for the more advantaged.
Moving from Anecdotal to Evidence-Based: Caring for People with Disabilities
Moving from Anecdotal to Evidence-Based: Caring for People with Disabilities
Source: Mathematica Policy Research
People with disabilities make up a substantial portion of the U.S. population, and their numbers are growing over time. In 2008, 14 percent of the adult U.S. population lived with a disabling condition. These individuals have a variety of complex, and often costly, health care needs. For example, $400 billion, or nearly 27 percent of the nation’s total health care spending, went toward disability-related care in 2006. Despite the significant size of the population and cost to the nation, many health care decisions are still made based on opinion or anecdote. At the patient level, people with disabilities and their doctors need more evidence on what treatments work and those that work best. At the policy level, decision makers need better evidence to determine what programs are effective and ultimately improve quality of life for people with disabilities.
Mathematica Policy Research’s Center on Health Care Effectiveness (CHCE) recently released a number of publications and hosted a forum on how comparative effectiveness research can improve care for people with disabilities. These resources, which speak to both the challenges and promise of using comparative effectiveness research to address the wide spectrum of issues surrounding care for people with disabilities, include the following:
- Identifying Effective Health Care Services for Adults with Disabilities Choosing Wisely: Why Study Designs and Outcome Measures Matter. In this issue forum, a distinguished panel discusses study designs and outcome measures that can be used to address different comparative effectiveness research questions.
- “Choosing Wisely: Selecting Outcomes for Comparative Effectiveness Research on Services for Adults with Disabilities.”Debra Lipson, Matthew Kehn, and Eugene Rich, July 2011. This issue brief describes criteria to help researchers select and report on the outcomes that matter most to adults with disabilities and to the providers and others responsible for their care.
- “Matching Study Designs to Research Questions in Disability-Related Comparative Effectiveness Research.” Jeffrey Ballou, Eugene Rich, and Matthew Kehn, July 2011. Individuals with disabilities have complex characteristics and health service needs, which can make strong study design and implementation a challenge. Because of this complexity, randomized controlled trials, the “gold standard” of study design to evaluate evidence, may not always be necessary or even ethical. This research brief offers strategies and guidance to help decision makers assess which study designs are likely to provide the required level of evidence of comparative effectiveness to answer disability-relevant health care questions.
- “Comparative Effectiveness of Care Coordination for Adults with Disabilities.” Melanie Au, Samuel Simon, Arnold Chen, Debra Lipson, Gilbert Gimm, and Eugene Rich, June 2011. Care coordination for adults with disabilities is typically marked by costly services delivered by a variety of providers, but comparative effectiveness research can help address these challenges. This research brief presents a framework for describing the range of personal characteristics, services, outcomes, and financing issues to consider in evaluating care coordination for adults with disabilities. It also identifies key care coordination dimensions that policymakers and researchers can use in developing and researching care coordination. The brief further presents key findings from a systematic review of the recent care coordination literature, summarizes what additional information is needed, and discusses implications for future research on which care coordination strategies work best for various disabled populations.
Mathematica Examines Federal Support for Working-Age People with Disabilities
Mathematica Examines Federal Support for Working-Age People with Disabilities
Source: Mathematica Policy Research
A paper published today in Health Affairs and an accompanying issue brief—both prepared by experts at Mathematica Policy Research—show that in fiscal year 2008, the federal government spent $357 billion to assist working-age people with disabilities, representing 12 percent of all federal spending. The states provided an additional $71 billion, mostly in Medicaid payments. Despite this more than $428 billion in total spending, services provided to those with disabilities are often fragmented, confusing, and ultimately less effective than they could be. Mathematica’s brief documents how the expenditures are spread across multiple agencies that oversee more than 60 different programs to help working-age people with disabilities.
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The brief explains how, under the existing system based on programs created during the Eisenhower, Kennedy, Johnson, and Nixon administrations, the government largely serves a caretaker role. The authors point out that this model runs contrary to the current goal of “maximizing self-sufficiency” embraced by the Americans with Disabilities Act (ADA) and fails to direct funds in ways that have the most potential benefit to help those with disabilities join, remain in, or return to the U.S. workforce.
+ Policy Brief
+ Health Care Costs Are A Key Driver Of Growth In Federal And State Assistance To Working-Age People With Disabilities (Health Affairs)
Money Follows the Person: Change in Participant Experience During the First Year of Community Living
Money Follows the Person: Change in Participant Experience During the First Year of Community Living (PDF)
Source: Mathematica Policy Research
The Money Follows the Person (MFP) Demonstration, established by Congress through the Deficit Reduction Act of 2005 (DRA), provides state Medicaid programs the opportunity to help transition into the community Medicaid beneficiaries living in long-term care institutions. The MFP program provides states with enhanced federal matching rates for spending on home- and community-based services (HCBS) provided to program participants and provides funding for associated administrative costs. MFP grantees, in turn, provide enhanced community services to participants during their 365-day period of program participation. In 2007, the Centers for Medicare & Medicaid Services (CMS) awarded grants to, and has since overseen the implementation of MFP programs in 29 states and the District of Columbia.1 CMS awarded another 13 grants in February 2011; these states are currently getting the details of their programs approved and starting program operations.
The belief that many in institutional care would prefer to live in the community forms part of the basis for the MFP demonstration program. This report presents the quality-of-life experiences of 803 MFP participants who transitioned to community living between January 2008 and December 2009 and responded to grantees’ administration of pre-transition and one-year post-transition surveys. We specifically examine how reported quality of life changed after participants transitioned to community living. We find that, after one year of community living, participants reported significantly higher quality of life compared with life in institutional settings, as measured through a variety of questions. These include questions designed to assess global satisfaction with life, satisfaction with care received, and satisfaction with where participants lived. Participants reported the largest improvement in satisfaction with their living arrangements. These findings are consistent across each target population. The report concludes with a discussion of the implications of these findings for the demonstration and for other transition programs.
New Guide Offers Help on Education Evaluation for States Launching ARRA-Funded Education Reform Initiatives
New Guide Offers Help on Education Evaluation for States Launching ARRA-Funded Education Reform Initiatives
Source: Mathematica Policy Research
A new guide prepared by experts from the American Institutes for Research (AIR), Mathematica Policy Research, and Chesapeake Research Associates offers information and strategies to help states evaluate the success of education reform efforts they are conducting under funding provided by the American Recovery and Reinvestment Act (ARRA).
The guide, “Evaluating ARRA Programs and Other Educational Reforms: A Guide for States,” provides easy-to-use tools and resources— including tips and checklists—that can be used to gauge the effectiveness of reform efforts on schools, staff and students. The tips include suggesting ways to reduce the need for special data collection efforts and making it easier to combine information and build on existing data systems.
Funded by the Institute of Education Sciences of the U.S. Department of Education, the guide provides a general evaluation framework to help states maximize what they learn about their reform initiatives. It also provides examples that focus on three ARRA priority areas: increasing the effectiveness of teachers and leaders through professional development; promoting the equitable distribution of effective teachers and leaders; and turning around the lowest-performing schools.
+ Full Document (PDF)
