Impact of a case management program to reduce dependence on federal benefits for low-income working adults with potential disabilities

This study evaluates whether a coordinated program of health and employment supports can help working people with potentially disabling physical and/or behavioral conditions avoid dependence on federal disability benefits. The Texas Working Well study enrolled 1,616 adult outpatients from a large public health system who were at risk of disability because of serious mental illness or another behavioral disorder+serious physical diagnosis. All participants were employed at least 40 hours a month at study entry. Participants were randomized to the intervention (n=904) or control (n=712) groups; the intervention group received coordinated case management (health navigation, vocational supports), expedited appointments, free medications and no copays for medical visits. Health, employment, quality of life and receipt of disability (SSI/SSDI) outcomes at 18 months post-enrollment were compared between intervention and control participants. Data come from annual participant surveys, medical records, and state employment and disability data. Participants were predominantly female (77%) and of minority race/ethnicity (77%). About 11% had a diagnosis of serious mental illness. Some 70% had a high school degree or higher. Average family income was under $20,000. The 18 months results showed significant benefits (especially related to health care access, utilization and medication adherence) for the intervention group. For the primary study endpoint, the intervention group was less likely (6%) than the control group (8%) [p<.05] to be receiving disability. Early intervention programs targeting working adults with mental health conditions can improve their health status and reduce their likelihood of receiving federal disability benefits.