Federal program expenditures for working-age people with disabilities: Research Report

Public assistance programs are important sources of support for working-age people with disabilities in the United States. Using a variety of information sources, the authors estimate that the federal government spent $226 billion in 2002 on working-age people with disabilities, including both cash and in-kind benefits. These expenditures account for about 2.2 percent of the nation’s gross domestic product (GDP) and 11.3 percent of all federal outlays. States contributed an additional$50 billion under federal-state programs. The bulk of these expenditures provided income support and health care to working-age people with disabilities who were not employed or had very low earnings. The authors provide a detailed accounting of the expenditures and question whether the distribution of expenditures is properly aligned with the evolving disability paradigm

A Review of Recent Evaluation Efforts Associated with Programs and Policies Designed to Promote the Employment of Adults with Disabilities

The purpose of this report is to provide a review of the recent evaluation activities being conducted for a number of state and federal programs, policies, and initiatives designed to promote the employment of people with disabilities. The review is intended to provide a single source for information on the nature of the initiatives and the evaluation efforts that have been recently completed or are currently under way and the findings to date related to the effectiveness of these initiatives. This broad review is also intended to provide some evidence of the progress we are making. The report also suggests avenues where further efforts and progress might be warranted. We identified 27 initiatives or programs and their associated evaluations that represent a federally sponsored program, policy, or initiative designed specifically to improve employment of the working-age adult population with disabilities. Because of resource constraints, we did not review initiatives designed to improve the adult employment outcomes of youth with disabilities, such as the Social Security Administration (SSA) sponsored Youth Transition Demonstrations. We also did not review small-scale studies evaluating the effectiveness of specific clinical, supported employment, or vocational rehabilitation (VR) approaches. We only looked at information related to the major federal programs serving people with disabilities, general legislation and policies, and initiatives that were fairly large-scale in nature

The Health Care Financing Maze for Working-Age People with Disabilities

Much of the research on health care financing for people with disabilities has focused on the Medicaid and Medicare programs. The findings of this research often highlight the inadequacies of those programs in providing appropriate services to address the special needs of people with disabilities. A focus on these large programs, however, obscures the role of other public and private insurers, as well as the role of programs that provide many additional services to this population – all of which add complexity to the system. The purpose of this paper is to describe the health care financing system as a whole, including the large public programs, other public and private insurers, and the many other programs that provide additional services. The description of the system highlights structural problems that need to be addressed in order to substantially improve the delivery of health and related services to people with disabilities. In the next section, we describe each source of health care financing for working-age people with disabilities and highlight its implications for service delivery and quality of life. In the concluding section, we describe the key structural shortcomings of the current financing system, assess the extent to which current reform efforts are addressing these shortcomings, and discuss the implications for broader efforts to reform health care financing system

Program Expenditures for Working-age People with Disabilities in a Time of Fiscal Restraint

Public expenditures in federal and federal-state programs for working-age people with disabilities totaled an estimated $276 billion in 2002. The federal share of these expenditures,$226 billion, was 11.3 percent of all federal outlays; states contributed an additional $50 billion . These expenditures accounted for about 2.7 percent of the nation’s gross domestic product (GDP) and are growing much faster than GDP and all federal outlays. Most expenditures were for income support and health care to people with disabilities who were not employed or who had very low earnings. The fact that the relative economic well-being of working-age people with disabilities is falling has prompted increased scrutiny of how money is spent and whether there are any significant policy reforms that should be pursued (Stapleton and Burkhauser, 2003). This scrutiny will become more intense if the federal deficit rises, as it is projected to do, and the prevalence of disability grows as the baby boom generation ages. These circumstances make it an opportune time to re-evaluate the structure of federal disability programs and whether they are properly aligned with the evolving disability paradigm—a paradigm that stresses helping people with disabilities help themselves to be full members of the economic and social lives of their communities, rather than objects of charity (Stapleton et. al, 2005).Fed_Expend_Brief_Final.pdf: 664 downloads, before Oct. 1, 2020.0-Federal_Expenditures_Final_Brief.txt: 99 downloads, before Oct. 1, 2020

Estimating Households’ Expenditures on Disability in Africa: The Uses and Limitations of the Standard of Living Method

People with disabilities face extra costs of living to participate in the social and economic lives of their communities on an equal basis with people without disabilities. If these extra costs are not accounted for, then their economic wellbeing will be overestimated. The Standard of Living (SOL) method is a way of generating these estimates and is thus useful for determining the economic impact of those costs in the current environment. However, previous studies have used different indicators for disability and different measures of the standard of living, so it is hard to compare estimates across different countries. This study applies a consistent set of indicators across seven African countries to produce comparable estimates. Our estimates of the extra costs of living in these lower-income countries are much lower than the results produced for higher-income countries in prior work. We argue that this finding highlights the limitations of the SOL method as a useful source of information for developing inclusive systems of social protection in lower-income countries because it captures what households spend but not what the person with a disability needs to fully participate in the social and economic lives of their community. In lower-income countries, people with disabilities are likely to have fewer opportunities to spend on needed items thus resulting in substantial unmet need for disability-related goods and services. Failing to account for these unmet needs can lead to inadequate systems of social protection if they are based solely on SOL estimates