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Health and Disabilities
MDRC has built a portfolio of projects testing innovative strategies to enhance health care services and health outcomes for low-income people, with a particular focus on services for individuals with health- and disability-related barriers to employment. Mental and physical health problems and disabilities are among the most common obstacles to steady employment — and among the biggest contributors to increasing health care expenditures. In addition, a high proportion of the rapidly increasing expenditures for public health insurance are for a relatively small number of people suffering from multiple chronic conditions, and policymakers are looking for ways to reduce health care spending for these individuals, while not reducing the quality of the care they receive. Finally, MDRC is helping the U.S. Department of Health and Human Services develop an evaluation design and provide technical assistance for its signature home visiting initiative, which provides preventive services to families with young children to improve health and other outcomes.
MDRC researchers have developed two large-scale random assignment studies for the Social Security Administration focusing on individuals with disabilities. The Accelerated Benefits Demonstration, conducted by MDRC with Mathematica Policy Research (MPR), tested whether providing immediate health insurance coverage for individuals just approved for Social Security Disability Insurance benefits improves health outcomes and promotes employment. With MPR in the lead, MDRC is also working on the Youth Transition Demonstration, which is testing educational, employment, and other services for young people who are either receiving disability benefits or at risk of receiving them.
MDRC has launched a pilot of the Progressive Goal Attainment Program (PGAP) for returning veterans with disabilities, including post-traumatic stress disorder, to improve their employment outcomes. PGAP is the first disability program that is specifically designed to target the psychosocial risk factors of disability. Current research evidence, including from MDRC’s Accelerated Benefits Demonstration, suggests that PGAP could be an important service for veterans with disabilities.
The Rhode Island Working Towards Wellness project, a site in the Enhanced Services for the Hard-to-Employ Demonstration, tested a telephonic outreach and care management intervention for working-age adults with children who are on Medicaid and have undiagnosed depression. And, as part of the multi-site Employment Retention and Advancement project, MDRC studied two specialized welfare-to-work programs in New York City, one targeting recipients with work-limiting disabilities and another targeting recipients with substance abuse problems.
The TANF/SSI Disability Transition Project, funded by the U.S. Department of Health and Human Services and the Social Security Administration, seeks to better understand the relationship between the Temporary Assistance for Needy Families and Supplemental Security Income systems as it relates to welfare applicants and recipients with potential disabilities and to work closely with participating TANF agencies to develop and implement strong pilot tests targeted to that population.
MDRC is conducting evaluations of Coordinated Care for High-Cost Medicaid Recipients with Disabilities in Colorado and New York. The goal of both programs is to understand the variety of ways that health care and social service organizations try to coordinate the care of high-needs people with disabilities and to estimate the effects of those programs.
As part of the Opportunity NYC-Family Rewards demonstration of conditional cash transfers, MDRC is testing the effects of offering families incentives for health-based behaviors, including maintaining adequate health coverage for all children and adults in participant households, as well as age-appropriate preventive medical and dental visits for each family member.
In 2010, MDRC was awarded the Design Options for Home Visiting Evaluation (DOHVE) project from the U.S. Department of Health and Human Services. Home visiting programs provide preventive services to families with young children to prevent child maltreatment, improve maternal and child health outcomes, and increase school readiness. DOHVE will provide technical assistance to grantees of the new federal home visiting program and develop design options for conducting a national evaluation of this federal initiative.
Finally, in Using Financial Incentives to Encourage Weight Loss, MDRC staff volunteered to participate in a random assignment study of the effects of cash incentives to encourage overweight individuals to lose weight and sustain weight loss.
Key Documents on Health and Disabilities
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