Accelerated Benefits Demonstration (ABD)

Objective

Many Social Security Disability Insurance (SSDI) beneficiaries have serious health care needs, but under current law, most are not eligible for federally funded health care benefits through Medicare for a period of 24 months after they are entitled to cash benefits. During this “waiting period,” most beneficiaries have poor health and limited functioning, and their demand for health care is high. According to data from the 1994-1996 National Health Interview Survey, the average SSDI beneficiary makes 22 doctor visits and spends seven days hospitalized in the year after they begin receiving SSDI benefits. Despite the need for health care, more than one in five new beneficiaries lack health insurance during this waiting period, and their health might suffer as a consequence.

In 1999, Congress provided the Social Security Administration (SSA) the authority to examine the effect of changing the waiting period. The result was the Accelerated Benefits Demonstration (ABD), a five-year study of whether a short-term investment in health care and related services for newly entitled SSDI beneficiaries leads to improved health, increased employment, and reduced reliance on SSDI benefits.

Status

The demonstration ended in February 2011 with the issuance of a final project report.

In January 2006, SSA awarded a contract to MDRC to implement and evaluate the ABD.  Participants were newly entitled SSDI beneficiaries, under age 55, with at least 18 months before entitlement to Medicare. Random assignment began in October 2007 with a pilot phase (Phase I) where beneficiaries were recruited from four metropolitan areas: Houston, Minneapolis, New York, and Phoenix. Recruitment for full rollout (Phase II) began in March 2008 and was completed in January 2009 with a total sample of 1,997 beneficiaries drawn from 53 metropolitan areas with the largest number of new SSDI beneficiaries.  These beneficiaries were randomly assigned to one of three research groups: (1) a treatment group that received health benefits which were designed to be accessible and affordable and which covered a broad range of health care services; (2) another treatment group that received these same health benefits but were also offered voluntary services delivered by telephone to facilitate a return to work and to improve access to needed health care, including a behavioral motivation program, employment and benefits counseling, and medical case management; and (3) a control group that could not receive the health benefits offered through the ABD but could obtain health insurance on their own. We continued to provide services to participants until they transitioned to Medicare upon completion of the two-year waiting period.  In February 2011, MDRC issued a report examining the impacts and costs of the ABD one year following recruitment into the study.

Analysis of the ABD results indicated that:

Participants made extensive use of program services. Almost all treatment group members used ABD health benefits during the first year, most commonly for doctor visits, diagnostic testing, and prescription medications.
ABD health care benefits increased health care use and reduced reported unmet medical needs. In addition, treatment group members reported spending less of their own money on health care.
There were no statistically significant impacts on current employment or employment during the year after random assignment. Overall, employment was very low for all research groups, which is consistent with the serious health problems and low employment rates observed at baseline.

Policy Brief/Early Findings
Policy Brief/Six-Month Survey Results
Social Security Bulletin Article on Accelerated Benefits Demonstration
AB Final Report
AB Final Report – Appendixes

Not applicable.