A More Work Focused Disability Program? Challenges and Options

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INTRODUCTION

Over the last several decades, there has been increasing momentum among the disability community and policymakers to create laws, policies, and programs that promote the integration and inclusion of persons with disabilities into the mainstream. One key factor in attaining these goals is the expansion of employment opportunities for persons with disabilities. Passage of the Americans with Disabilities Act (ADA) in 1990 was a landmark step toward this end.

There has also been a push by policy makers to expand employment opportunities for Social Security Administration (SSA) disability participants in the Supplemental Security Income (SSI) and Disability Insurance (DI) programs. The largest of these work-focused efforts is the newly enacted Ticket to Work program, which is designed to promote work by providing SSI and DI recipients with a "ticket" to purchase rehabilitation from state VR agencies, as well as other providers that provide important employment and rehabilitation services.

Despite the Ticket to Work and other related work incentive programs for SSA disability participants, there has been continued criticism of the degree to which the current disability system focuses on promoting return-to-work opportunities for its beneficiaries. The General Accounting Office (GAO) has suggested that current return-to-work options for SSI and DI participants are limited in scope and should be significantly expanded (GAO 2002; Growick 2002). Congressional hearings on the challenges and opportunities for SSI and DI programs included a number of witnesses expressing the hope that work could become a more central focus of the programs' mission by drawing on the lessons from other public and private disability programs.

The purpose of this paper is to present options for incorporating a strong return-to-work focus in the disability eligibility requirements for the SSA disability programs, which are the same for both the SSI and DI programs. We develop these options by examining alternative concepts used in other private and public disability programs. Using the general assumption that policy makers are interested in developing a more work-focused definition, we examine alternative disability concepts that focus on an individual's residual capacity to work, rather than an inability to work. These alternative concepts move away from a static concept of disability towards a more dynamic definition that allows for changes in disability over time and different environments.

Our discussion draws on examples from a variety of private and public disability programs in the US and in Europe. We include lessons from recent testimony before the Committee on Ways and Means on possible modifications to disability definition for SSA disability programs (Committee on Ways and Means 2002) and recommendations from other research reports on how to move towards a more work-focused definition.

We take a broad view of what would necessarily be fairly sweeping changes to the disability eligibility requirements for SSA disability programs.¹ Making return-to-work central to these programs represents a major break in US disability policy and could require fundamentally transforming the focus of SSA disability (and potential retirement) programs, which have been primarily designed to provide cash benefits, as well as other disability cash transfer programs. There is currently a tension between the disability definition for SSA disability programs and efforts to provide return-to-work services to participants in these programs because the eligibility criteria require successful applicants to prove an inability to work. Contrary to arguing that not enough has been done to move toward a work-focused system within the current disability definition, we find that policy makers and SSA administrators are pursuing a number of interesting alternatives. Nonetheless, significantly more can be done if policy makers are willing to move away from the all-or-nothing benefit structure of the SSI and DI programs that focuses on a person's inability to work, and consider more fundamental changes to the purpose of disability programs. We also recognize and discuss that these changes come with serious implications.

We first examine the current disability definition for SSA disability programs, including the history of developing this definition around return-to-work options. Next, we discuss return-to-work conceptualizations for disability programs drawing on examples from other US and European public and private systems. We then use this discussion as a framework for discussing possible changes to the current definition for SSA disability programs within the confines of other disability programs, as well as for possible changes that extend beyond these programs. We conclude with a summary of our findings.

Note: This report is available in its entirety in the Portable Document Format (PDF).

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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