reports

Working well – the Texas demonstration to maintain independence and employment: 18-month outcomes

Journal of Vocational Rehabilitation 34:97-106.

Addiction Research Institute, Center for Social Work Research, University of Texas at Austin, Austin, TX, USA

Uninsured working adults with chronic mental, behavioral and physical health conditions may have greater difficulty in accessing needed health care due to health care costs and crowded public health systems. Untreated medical conditions can lead to poorer health, which is linked to loss of employment and eventual applications for and receipt of federal benefits such as Supplemental Security Income and Social Security Disability Insurance (SSI/SSDI). The Working Well study was designed to determine whether a coordinated set of health benefits and employment supports could help low-income working adults maintain their employment and remain independent of publicly funded disability assistance. Patients from the Harris County Hospital District, a large public health system providing indigent care in the Houston metroplex, were recruited and randomized to the intervention (N=904) and control (N=712) groups. The Working Well case management intervention included health navigation, employment/vocational supports, expedited appointments, free medications, and no co-pays for medical visits. Participant outcomes were measured through surveys, health claims data, and state agency employment data. Intervention group participants reported greater access to care, greater likelihood of outpatient medical visits and less likelihood of receiving SSI/SSDI benefits. These findings suggest that public health care systems can provide disability prevention programs, improve access to care and reduce reliance on publicly funded disability assistance.