Developing a Screening Tool to Predict Disability Program Participation
Honeycutt, Todd C., Brucker, Debra, The Journal of Rehabilitation
The ability to model public benefits eligibility processes can aid in program planning, resource allocation, and budgeting. Given the complexities of most public program regulations, policies, and practices, developing a simple and accurate model of eligibility for public benefits is no simple task. The success of a demonstration project currently being developed by the federal government will depend largely on the ability to construct such a model. The United States Social Security Administration (SSA) is designing a demonstration project that will promote employment among applicants for Social Security Disability Insurance (SSDI). The project, Early Intervention (EI), is one of a series of ventures that SSA is undertaking that essentially challenge the established norms and practices of the organization toward programs for persons with disabilities (Mitra & Brucker, 2004). This paper will describe one of the methodologies that will be used to select participants for El. Prior to discussing the conceptual framework for and the details of the methodology, some background information on SSDI and the disability determination process is provided.
Social Security Disability Insurance
SSDI provides cash benefits and health care coverage to persons with work-preventing disabilities and their families. As of June 2005, average monthly payments to disabled workers were $897 (SSA, 2005c). To qualify for benefits, individuals must meet stringent eligibility conditions set by SSA, the federal agency responsible for administering SSDI. Applicants must first satisfy employment history thresholds, as SSDI was intended to only provide support to persons who have had a substantial attachment to the labor force. Certain disability eligibility criteria must be satisfied as well. SSA defines disability as an inability to participate in a certain level of employment due to a medical condition that is expected to last for at least 12 months or result in death. Individuals who are blind, over the age of 55 and unable to engage in certain levels of work activity are also eligible to receive benefits. Once awarded benefits, beneficiaries can expect to receive benefits until they either medically improve, return to work at a substantial level, transition to the retirement rolls, or die. On average, beneficiaries remain on the rolls for about eleven years (Chirikos, 1995).
SSA administered SSDI to over 6.1 million disabled workers in December 2004, paying out over $71 billion in cash benefits. These figures reflect an increase of 23% in the number of beneficiaries and an increase of 44% in benefit payments over the five-year period from 2000 to 2004 (SSA, 2005a, 2005b). Given that this rate of growth has been predicted to remain fairly steady (Daub, 2002), SSA has made a concerted effort to develop return to work programs and incentives that will increase the rate at which people exit the program. Thus far, however, the return to work rate of beneficiaries has remained low, at less than 1% (SSA, 2002).
A complementary approach to encouraging program exit is to develop a method for slowing the rate of entry to SSDI. SSA is currently designing a demonstration project that would promote employment as an alternative to entering the SSDI rolls. The Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999 gives SSA the authority, for the first time, to provide return to work services and supports to applicants who meet the SSA definition of disability. The El demonstration is designed to test whether the early provision of temporary cash stipends, health care coverage, and employment services can efficiently return probable SSDI beneficiaries to work. The combination of immediate services and supports, coupled with an avoidance of the long, arduous disability determination process that is normally involved in securing SSDI benefits, may result in improved return to work rates for this population (Social Security Advisory Board, 2001a). …