Note: The study operated from April 30, 2007 through Sept. 30, 2009. Data collection and evaluation activities continued through 2013.

Preventing Disability

Federal disability programs provide financial and medical assistance to workers who become disabled, however there are no federal programs designed to prevent workers with significant health problems from becoming disabled and dependent on federal assistance. In Texas, where one third of workers are uninsured, many workers with significant health conditions become disabled and rely on public programs for assistance.

Working Well, the Texas Demonstration to Maintain Independence and Employment was a ground-breaking study designed to help keep people well and working. Working Well tested whether providing health coverage and employment supports would keep working people with mental and physical disabilities off federal benefits, such as Medicaid, Supplemental Security Income or Social Security Disability Insurance. The study included over 1,600 participants in the Harris County Hospital District (Houston), making it one of the largest federally funded scientific studies of its kind in the nation. The study compared participants receiving interventions to a control group of similar people who did not get the interventions. Working Well interventions included:

  • Case management, including individualized planning, advocacy, navigation
  • Job training and employment services
  • Expedited clinic appointments
  • Substance abuse services
  • Dental benefits
  • Vision benefits
  • Eliminating co-payments for health services or prescriptions

The results of Working Well suggest these interventions improve outcomes for workers with serious health conditions and, while available, can contribute to lower rates of application for disability. Longer-term positive impacts on specific populations, such as people with serious mental illness, were also observed after interventions ended.

Learn more about the program and its participants by reading Demonstration to Maintain Independence and Employment reports, publications and participant stories.

About the Project

Demonstration to Maintain Independence and Employment grants were authorized by the Ticket to Work and Work Incentives Improvement Act of 1999 and administered by the Center for Medicare and Medicaid Services. Project oversight was conducted by the Texas Department of State Health Services, and Texas project evaluation by the University of Texas Addiction Research Institute in Austin. The Harris County Hospital District (Harris Health System) provided the interventions.