Demonstration to Maintain Independence and Employment (DMIE)

Prepared for
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services
woman in a wheelchair working with male colleague

Can a program of health benefits and employment supports postpone, if not prevent, the loss of employment and independence due to a potentially disabling condition? Will these benefits improve participants’ health and functional status and access to care?

The Demonstration to Maintain Independence and Employment (DMIE), authorized under the Ticket to Work and Work Incentives Improvement Act of 1999, awards funds to states to develop, implement, and evaluate interventions for workers with potentially disabling health conditions, such as diabetes, HIV, and mental illness. Many of these adults do not have access to the comprehensive health insurance coverage and employment supports that could prevent their condition from becoming a severe disability and help to maintain their employment, health status, and independence from public assistance programs.

Under the DMIE, states may provide health insurance coverage that is equivalent to their standard Medicaid benefit package or “wrap-around” coverage, which supplements public or employer-sponsored coverage. States may also offer employment support and case management services. In 2006 and 2007, the Centers for Medicare & Medicaid Services approved demonstrations in Hawaii, Kansas, Minnesota, and Texas, which are using a rigorous evaluation design with random assignment. The demonstrations ended in September 2009.

Mathematica’s national evaluation of the DMIE examined impacts on three key outcomes: health and functional status, employment outcomes, and reliance on federal disability benefits. The interventions were found to have a positive impact on participants’ functional status in Hawaii and Minnesota and led to a decline of SSA benefit receipt in a combined sample of participants in Minnesota and Texas. The intervention did not, however, have a statistically significant impact on earnings in any of the four sites. Overall, the results suggest that early interventions such as the DMIE can have positive impacts, although the effects are likely to vary based on the target population and available services.