This article describes factors that will shape future demand for doctoral-trained health services researchers. Despite rapid growth in the overall health care sector and in funding for clinical research, inflation-adjusted funding for health services research has declined, implying little or no net growth in demand for people to lead these studies. Employers report being able to meet their demand for health services researchers by drawing on people trained in many disciplines, including those with formal training in health services research. Nevertheless, employers may have more difficulty hiring well-qualified researchers when faced with sharp increases in demand for health services research, which could be generated by recent economic stimulus legislation and future health reform legislation.

There is a growing divergence between demands placed on the system for assisting people with disabilities and the data required to manage this system. A new brief from our Center for Studying Disability Policy seeks to stimulate discussion about the value of establishing a national disability data system to make better use of existing data and add new data. This type of system could improve coordination of federal data collection and analysis, help agencies and others gain a better understanding of those served, and provide critical information for monitoring and improving programs.

The Medicaid Buy-In program, a state Medicaid option since the late 1990s, is designed to encourage adults with disabilities to work by allowing them to buy into Medicaid when their earnings exceed standard Medicaid eligibility limits. This article describes enrollment, expenditures, and earnings for Buy-In participants in 27 states between 2000 and 2004. Younger participants receiving no federal income support when they enroll in the Buy-In program have higher earnings, compared with older participants receiving Social Security Disability Insurance payments. The innovative process used in this study to link data from multiple agencies could be adapted for exploring other policy issues related to employment of individuals with disabilities.

The Ticket to Work and Self-Sufficiency program (TTW) was designed to enhance the market for services that help SSI and SSDI beneficiaries successfully enter the workforce. This report looks at how well the TTW market functions and the extent to which the introduction of TTW changed enrollment in employment-support services, employment, and receipt of SSDI or SSI benefits. The study found that program participation remains low but continues to grow, and survey findings indicate substantial potential for growth in participation. In addition, new payment regulations for providers may breathe new life into the market.

A special issue of the Journal of Vocational Rehabilitation, titled "Ticket to Success? Early Findings from the Ticket to Work Evaluation," summarizes the early implementation experiences and impacts of the Ticket to Work (TTW) program. The program, together with other initiatives created by the Ticket to Work and Work Incentives Improvement Act, attempts to develop a new employment services marketplace to increase the level and mix of employment support services for people who receive disability benefit payments from the Social Security Administration (SSA). Rather than setting up a single training program, TTW includes payment mechanisms designed to induce employment-service providers to increase the supply of programs and the range of approaches. Six papers in the special issue, edited by Craig Thornton, Robert Weathers, and David Wittenburg, provide an early picture of both the potential for the TTW program and the challenges involved with reaching this potential.

This paper reviews early findings for the three essential ingredients necessary for TTW success: (1) beneficiary demand for employment services that will enable them to eventually leave SSA benefits; (2) an adequate supply of employment service providers that can deliver effective employment support services; and (3) efficient support from SSA to facilitate the new market, including the provision of information to beneficiaries and providers and the management of the ticket payment system. Survey data indicate that many beneficiaries have at least a general interest in employment services that TTW could fill. The supply of new and innovative employment service providers, however, has thus far been anemic because of providers' perception that the new program is too risky and cumbersome relative to potential payments offered. SSA has made strides in implementing the program and continues to offer program changes to improve how TTW functions.

This paper presents estimates of TTW impacts on service enrollment, earnings, and benefit amounts during the first two years of program implementation. Estimates indicate that TTW had a small impact on promoting service enrollment during the first year of rollout. However, there is no compelling evidence that TTW affected beneficiary earnings and benefits during its first two years. Impact findings for all outcomes are consistent with the expectation that changes in service enrollment would occur before changes in either earnings or benefit receipt. Additionally, the relatively small size of the service enrollment impacts is consistent with the low TTW participation rate, which was less than 1 percent during the first year of the rollout.

Diabetes is a growing threat to the nation’s health that has serious and costly complications. This paper looks behind the $79.7 billion estimates for 2005 of medical and disability costs to the federal government cited in Mathematica’s main study. The estimates include $2.5 billion in disability payments associated with diabetes and $77.2 billion in increased medical costs. Nearly 80 percent of the medical costs to the federal government were incurred in the Medicare program. Without enhanced efforts to control blood glucose, reduce the risk of complications, and prevent the onset of diabetes, federal costs related to diabetes will grow in the future.

The Ticket to Work (TTW) program was designed to promote employment by enhancing the market for services that help people receiving disability benefits become economically self-sufficient. To date, the Social Security Administration has successfully begun the market enhancement process by putting the core elements of the TTW program in place across the country—mailing a Ticket to more than 11 million disability beneficiaries and inviting them to use it as a way to obtain meaningful employment; implementing new rules that allow beneficiaries to attempt to work without fear of triggering a review of their disability status; and enrolling service providers, or employment networks, that offer beneficiaries new choices for providers and service mixes. Early impacts from this report to Congress suggest that TTW slightly increased beneficiary use of employment services in 2002, the first rollout year. However, the increase did not appear to produce a corresponding increase in beneficiary earnings or a reduction in benefit payments during the first two years. The authors note that impacts for 2004 and later may be larger—participation rates continue to increase, and many nonparticipants say they plan to assign their Tickets. Nevertheless, analysis of trends in TTW payment data suggests that the program would have to induce future shifts in beneficiary behavior that are much larger than what has been observed so far in order to generate the level of exits from the program envisioned by Congress. In particular, meeting the exit goal will require TTW participation to increase substantially and a larger share of participants to earn enough so that they no longer receive cash benefits.

This appendix reviews factors and questions employers can consider in employment decisions.

The Social Security Administration established the TTW program to put disability beneficiaries on the road to economic self-sufficiency by improving access to and quality of services that will help them work. This interim report looks at the program during its first two years of operation to examine participation, beneficiary characteristics and outcomes, implementation, and other issues. It also looks at whether financial incentives are strong enough to encourage employment networks to participate, and how the program is reaching those who may need more intensive supports to succeed in the workforce. Overall, the authors note that the program has been implemented successfully, but issues such as low participation by beneficiaries and services providers need to be addressed.

Presented at the Disability Research Institute Symposium, Washington, DC.

Examines early implementation issues and findings on enrollment and participation patterns in the Social Security Administration's Ticket to Work program, which attempts to increase access to, and the quality of, rehabilitation and employment services available to Social Security disability beneficiaries. Emerging issues include low beneficiary participation, difficulty with recruitment and retention of employment networks (ENs), uncertain financial viability of ENs, and marketing challenges.

Examines early implementation issues and findings on enrollment and participation patterns in the Social Security Administration's Ticket to Work program, which attempts to increase access to, and the quality of, rehabilitation and employment services available to Social Security disability beneficiaries. Emerging issues include low beneficiary participation, difficulty with recruitment and retention of employment networks (ENs), uncertain financial viability of ENs, and marketing challenges.

The national Medicaid Buy-In program promotes employment and economic self-sufficiency for individuals with disabilities by allowing states to amend their Medicaid programs. As of December 2002, 25 states had implemented this program. Three themes emerge in this early picture of 21 states: (1) enrollment has increased substantially since 1999, (2) the majority of enrollees were already connected with public health insurance and disability-related programs, and (3) few participants had reported earnings over $800 per month, the level used to define substantial gainful employment. The report also identifies several important policy questions to be addressed.

This volume explores the prospects for success of Ticket to Work, the nation's new system for paying providers of rehabilitation and employment services for people with disabilities. Issues examined include access for the hardest to serve, potential economic and budgetary efficiencies, and the role of provider incentives in generating services with larger impact on benefits and earnings.

Describes the data processing protocol required to implement an impact evaluation of 12 state projects that the Social Security Administration funded to test new strategies for promoting employment for people with disabilities. Discusses the way in which SSA administrative data were used to 1) create longitudinal person-level files, 2) select matched comparison groups, and 3) estimate impacts.

Even after a decade of study, there are still many questions about how working-age adults with disabilities or chronic illnesses are faring in Medicaid managed care. This article draws from recent research to examine two critical issues: the need for better outcome measures specific to this population and the importance of evaluations that accurately estimate program effects, despite continued policy change, considerable differences among states, and extreme population diversity. The authors outline a research agenda that will help policymakers develop a more precise sense of how managed care practices affect different subgroups of working-age adults with disabilities and chronic illnesses and how practices could be altered to improve Medicaid's ability to meet their needs.

The issue of risk selection—which occurs when health care needs of beneficiaries in a plan differ systematically from the needs of the overall beneficiary population, and payments do not reflect these needs—is important for states that enroll blind and disabled Supplemental Security Income (SSI) beneficiaries in Medicaid managed care. SSI beneficiaries have persistent needs for care, have a wide variety of chronic conditions, and often need atypical and complex services. This article assesses the extent of risk selection in managed care plans for SSI beneficiaries during the first three years of TennCare, Tennessee's Medicaid managed care program. Using claims data on fee-for-service expenditures before enrollment in managed care, the authors find substantial evidence of persistent risk selection.