Comparing beneficiaries of the Medicare savings programs with eligible nonparticipants

This note focuses on participation in two entitlement programs that help reduce out-of-pocket expenses for low-income Medicare beneficiaries: the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program. As of 1999, about 2.75 million eligible, noninstitutionalized individuals were not enrolled in these Medicare savings programs. The eligible nonparticipants differed substantially from the QMB and SLMB participants in that they were less likely to be Supplemental Security Income beneficiaries and more likely to be elderly, nonblack, and in relatively good health. These findings, which could help target future outreach efforts, are based on Survey of Income and Program Participation data matched with administrative records from the Social Security Administration.     

Industry, occupation, and disability insurance beneficiary work return.

This article uses the New Beneficiary Data System to describe the first job held after award of Disability Insurance benefits, in terms of occupation and industry. It examines work activity within sectors of employment, and looks at the issues of whether work return in certain industries and occupations varies according to the demographic characteristics of the beneficiaries. The article also presents data on sector-specific employer accommodations that can aid in sustained work return. Postentitlement work was fairly evenly distributed across occupational and industrial sectors. Persons with higher levels of educational attainment were found to be in white-collar employment sectors. There were noticeable differences in the availability of employer accommodations across postentitlement occupations and industries.     

Administrative Failure and the International NGO Response to Hurricane Katrina

The devastation caused by Hurricane Katrina and the subsequent failure of government agencies and public administrators elicited an unprecedented response by international nongovernmental organizations (INGOs) to a disaster in the United States. This paper focuses on why so many INGOs were compelled to provide humanitarian assistance and relief in the United States for the first time and the administrative barriers they faced while doing so. What does such a response reveal about administrative failures in the wake of Katrina, and what might the implications be for reconceptualizing roles for nonprofit and nongovernmental organizations in disaster relief? The authors answer these questions using data from interviews with INGO representatives, organizational press releases and Web sites, news articles, and official reports and documentation.     

Health status of new retired-worker beneficiaries: findings from the New Beneficiary Survey

In general, individuals who first received social security retired-worker benefits in June 1980-May 1981 viewed themselves as being in good health. They reported this view in response to questions in the 1982 New Beneficiary Survey conducted by the Social Security Administration. Two-thirds of the respondents in the retired-worker sample reported having no health-related work limitations and no moderate or severe functional activity limitations. However, more than half of those who did report such limitations indicated that the limitations were severe enough to keep them from any work for pay. Beneficiaries whose first monthly benefits were claimed at age 62 were more likely to report themselves in poor health than those receiving a first benefit at age 63 or older, but even among the 62-year-olds, more than three-fifths reported no work-limiting conditions.     

Social Security disability beneficiaries with work-related goals and expectations

This study examines working-age Social Security Disability Insurance and Supplemental Security Income beneficiaries who report having work goals or expectations, referring to these individuals as "work-oriented." The study uses data from the 2004 National Beneficiary Survey matched to administrative data spanning 2004-2007 to identify work-oriented beneficiaries and to analyze their sociodemographic, health, and employment characteristics, as well as their earnings-related benefit suspensions and terminations. Relative to other disability beneficiaries, the 40 percent classified as work-oriented were younger and more educated, had been on the disability rolls a shorter time, had lower income from public assistance, and were healthier. Just over half had recently engaged in work or in work preparation activities at interview, about half had earnings at some point during 2004-2007, and 10 percent left the disability rolls because of earnings for at least 1 month during that period. The findings show that a large share of beneficiaries have work goals, most are attempting to work, and many experience some success.     

Disability beneficiaries who work and their experience under program work incentives.

This research examines the return to work by Disability Insurance beneficiaries who were first entitled to benefits in 1980-81 and who were originally selected to be interviewed in the New Beneficiary Survey. To facilitate an examination of actual labor-force participation by beneficiaries, information on work and participation in program work incentives was collected from their claims folders. The analysis shows that approximately 10 percent of disability beneficiaries work during their initial period of benefit entitlement. About 80 percent are granted a trial work period, and over 70 percent of those granted trial work successfully complete it. More than half of them, however, were not successful in leaving the rolls through their work effort. In fact, benefit terminations due to work occurred for fewer than 3 percent of all beneficiaries in the cohort; approximately one-third of them had returned to the rolls by the end of the period under study. Beneficiaries most likely to make a work attempt were young and had a high level of education. Those with a high Social Security benefit amount were less likely to make a work attempt.     

Jobs of persons working after receiving retired-worker benefits

This article describes the jobs of new Social Security retired-worker beneficiaries about 2 years after they received their first benefit payment and compares the characteristics of these jobs with those of jobs they were in before they received a benefit. The data are from the Social Security Administration's 1982 New Beneficiary Survey (NBS). The NBS data show that more than one-fifth of the new retired-worker beneficiaries were working 18-30 months after receipt of their first benefit payment. Most of the respondents usually worked less than full time at modest hourly wages rates--often for fewer hours and at lower wages than on the jobs they were in before benefit receipt. Thus, their annual earnings generally also were modest. The working NBS respondents were employed in all categories of occupations, but the majority were in white-collar jobs, often in the same major occupational or industrial category that they had been in before benefit receipt. When job changes had occurred, the tendency was to move into work in the service industries. Those individuals who were working were only slightly more likely to be self-employed in the postbenefit period than they had been in the prebenefit period.     

Policy roles: an analysis of policy formulators and policy implementors

This paper presents an empirical analysis of individuals in policy formulating and policy implementing roles. Data for the comparison are from interviews with a random sample of 119 New Zealand middle-level public administrators from 27 government departments.The individuals in the policy formulating roles were slightly younger; however, those in the formulating and implementing roles varied little from each other in terms of social background, educational attainment and career patterns. Few differences were evident in regard to job satisfaction, decisional authority, and hierarchical relations. Significant differences between policy formulators and policy implementors were discovered in terms of work load, career aspirations, and awareness of political influences in governmental policymaking.From the evidence of this study, the New Zealand administrative system does not allocate policy formulating roles to individuals different from those who implement policies. Differences between formulators and implementors in the New Zealand system appear to stem from the nature of the work of the two policy roles.     

Mr. Justice Brandeis and the Creation of the Federal Register

The creation of the Federal Register in 1935 was crucial in enhancing transparency in American national government and its accountability under law. This historic action during the troubled New Deal era established a core institutional framework that endures as the nation begins a new century and as public administration struggles with an era of new institutionalism. Drawing on archival records and interviews, this article examines the political, administrative, and legal factors that led to the Register's creation. In particular, it sheds light on the little known but pivotal role played by Justice Brandeis in an extrajudicial capacity in this process. Brandeis's actions derive, in part, from his lifelong concern for fostering government openness and ensuring accountability under law from government bureaucracy. Without his intervention, it is unlikely the Federal Register Act would have been enacted at the time and in its important institutional form.     

The implications of differences between employer and worker employment/earnings reports for policy evaluation

Differences in administrative (UI) and survey (S) records on employment and earnings have substantial implications for assessing the impact of a variety of public interventions, such as welfare‐to‐work and employment training programs, and especially the state‐oriented welfare reform legislation of 1996. We use data from the 1998 and 1999 waves of the Child Support Demonstration Evaluation (CSDE) Resident Parent Surveys to explore individual differences between survey and UI employment and earnings reports for a Wisconsin sample of current and former welfare recipients. After exploring the potential causes of misreports from both sources, we document the degree of discrepancy between survey and UI earnings and employment measures and assess the difference between the two earnings measures in estimates of simple human capital (earnings) functions. Last, we evaluate the correspondence of the two measures with “hardship” indicators of economic well‐being.     

Reported reasons retired workers left their last job: findings from the New Beneficiary Survey

About a third of all new retired-worker beneficiaries who had stopped work reported that the main reason they left their last job was a desire to retire. The existence of health problems was the next most frequently given reason, and it was reported by about a fourth of the group. These responses were made to questions in the 1982 New Beneficiary Survey, conducted by the Social Security Administration (SSA) in October-December 1982. Recently retired workers not only said they wished to retire, but more of them began receiving benefits at age 62 than at older ages; by age 65 most were beneficiaries. Forty-five percent of the men and almost 54 percent of the women had already left their last job at the time they received their first benefit. Married women in particular had not only stopped work but frequently had left their last job more than 3 years before they received their first benefit check.     

“It’s Great When People Don’t Even Have Their Welfare Cases Opened”: TANF Diversion as Process and Lesson

The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) encouraged states to reduce welfare caseloads. Caseload reduction can be accomplished by promoting exit for work, marriage, or other private means of support and by diverting new applicants. Most research on caseload decline has focused on welfare‐to‐work outcomes; less is known about processes of diversion. This study employs administrative records and ethnographic data to examine diversion in West County, New York, from 1999 to 2003. Findings demonstrate a high level of diversion and suggest that application is an ongoing and at times remedial process rather than an event. Diversion occurs at all points of the expanded TANF (Temporary Assistance to Needy Families) intake process and is associated with one‐time lump sum payments as well as the hassle factor engendered by new eligibility requirements. The encumbered lives of applicants and TANF staff discretion are also implicated as factors contributing to diversion. We conclude with an analysis of the implications of TANF diversion for access to benefits.     

Measuring Government in the Early Twentieth Century

This article discusses the early history of performance and productivity measurement. It finds sophisticated development of these tools beginning in the first decade of the twentieth century, primarily at the New York Bureau of Municipal Research. These practices grew out of accounting, the social survey, work records, and municipal statistics. The bureau built government's capacity to measure. They advocated such basic empirical practices as making observations at all, doing so systematically and routinely, and recording data at the time of observation. By 1912, performance measurement exhibited many of the features associated with the modern practice: measuring of input, output, and results; attempting to make government more productive; making reports comparable among communities; and focusing on allocation and accountability. Performance measurement was developed in the context of shifting power between the elected executive and the legislature.     

Child protective intervention in the context of welfare reform: The effects of work and welfare on maltreatment reports

Recent changes in welfare policy have produced changes in parental work and welfare receipt. These factors are assessed in relation to investigated reports of child abuse and neglect using survey data on 1998 welfare recipients in nine Illinois counties, in conjunction with longitudinal administrative data on cash welfare benefits, employment, and child abuse and neglect reports. Trend analyses show that rates of child maltreatment reports among welfare recipients have risen since the passage of PRWORA in 1996. Findings from multivariate analyses indicate that parental employment has a protective effect on reports to child protection systems (CPS), that this effect is greatest when combined with welfare receipt, and that this effect becomes stronger over time. Those who receive welfare in the absence of employment face a significantly greater risk of CPS involvement, even compared with those who neither work nor receive welfare. © 2003 by the Association for Public Policy Analysis and Management     

Physically demanding occupations, health, and work after retirement: findings from the New Beneficiary Survey

This article uses data on a recent cohort of Social Security retired-worker beneficiaries to examine the predictors of work after initial receipt of benefits. It focuses on two factors: an analysis of the effects of ill health and of employment in a physically demanding occupation in the year preceding receipt of benefits. Based on responses received during the Social Security Administration's New Beneficiary Survey, the employment of men in a physically demanding occupation is associated with a lower probability of work in retirement; the existence of a work-limiting health condition also lowers their probability of work. Full-time, full-year workers in 1979 who had changed jobs in the years just preceding the receipt of Social Security benefits were more likely to work after they became beneficiaries. It may be that workers anticipate constraints on their ability to continue working on a job and reduce the effect of those constraints through earlier job changes. The finding that the work effort of women beneficiaries is not affected by previous employment in occupations identified as physically demanding may signify the failure of customary physical demand indices to measure stress on those jobs in which women are most likely to be employed.     

Distribution of income sources of recent retirees: findings from the New Beneficiary Survey

Using data from the New Beneficiary Survey, this article examines income received by the newly retired from assets, employer-provided pensions, and social security. Today's retirees commonly possess pension or asset income to supplement social security. The proportions with asset income were 83 percent for married men and their wives and 69 percent for the unmarried. The proportions with pension income were 56 percent for the married couples and 42 percent for the unmarried. The article finds that up through the middle of the income distribution, social security remains the main income component. In addition to these traditional income sources of the retired, the data also highlight the important role of earnings among many of the new beneficiaries--44 percent of the married couples and 27 percent of the unmarried had current earnings.     

ADMINISTRATIVE REFORM IN NEW SOUTH WALES UNDER GOVERNOR DARLING

As a governor, Ralph Darling is remembered more for his authoritarian behaviour and harsh rule than for his administrative achievements. Only recently have historians shown much awareness of the important reforms which he made in the machinery of government. Yet, although attention has been drawn to this aspect of his work it has not been adequately examined. The tendency is still to concentrate on the colourful and controversial features of his regime, pushing to one side its more mundane developments. Admittedly, there are exceptions. J. W. Cell included an interesting section on Darling in British Colonial Administration in the Mid-Nineteenth Century , as did J. J. Eddy in Britain and the Australian Colonies. The first of these treatments is too brief, however, and the second concentrates on those aspects affected by the attempts of the British Treasury to exert more influence over colonial administration. Despite these books, the valuable thesis on the Colonial Secretary's Office by G. D. Richardson and the helpful prefaces that appear in the various guides to the records of government departments, prepared by the State Archives of New South Wales, much remains to be done. Most of the departments that existed under Darling still await detailed treatment both in themselves and in relation to the overall changes that were made between 1825 and 1831. As matters stand, there is a gap not only in what was a vital era in the administrative history of New South Wales, but also in Darling's own record. The present paper attempts to repair this omission.     

Eligibility for the Medicare buy-in programs, based on a survey of income and program participation simulation.

Medicare buy-in programs are designed to reduce out-of-pocket expenses of beneficiaries with modest income and assets. This article provides estimates of the size of the Medicare beneficiary population eligible for the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the Qualified Individual-1 (QI-1) program. The buy-in programs use the same resource limits (twice those used in the Supplemental Security Income (SSI) program) but different thresholds for determining income eligibility. The QMB program uses 100 percent of the poverty line as the cutoff, QI-1 covers persons above 120 percent but at or below 135 percent of the poverty line, and the SLMB program is in between. Making informed judgments about the rate of participation in the buy-in programs and the need for outreach requires an accurate estimate of the size of the eligible population. If that population is underestimated, policymakers might come to unduly optimistic conclusions about current buy-in participation. In contrast, an overestimate may make current participation seem too low. If policymakers react to an upwardly biased estimate of the eligible population by increasing outreach, they are bound to be disappointed by the results of that effort. Estimates of the eligible population from past studies of the QMB and SLMB programs range from 5.1 million to 9.1 million. In the absence of new information, it is difficult to judge the accuracy of those estimates because the methodologies had substantial shortcomings that might bias the results. The most common shortcomings include the lack of high-quality, monthly income data and the lack of information on assets from the same data file that was used to estimate participation and income eligibility for Medicare. The current study uses the most recently available (as of August 2000) Survey of Income and Program Participation (SIPP) file that is matched to the Social Security Administration's (SSA's) administrative records. The data file covers 1995 information. Estimates were also obtained using 1991 data to assess the sensitivity of eligibility estimates to the year chosen. The SIPP has several major advantages over other data sources because it contains relevant, high-quality information on both income and assets for establishing financial eligibility for the buy-in programs. First, the SIPP collects detailed and conceptually appropriate information on monthly, rather than annual, income and therefore has more complete information about income than do other surveys. As a result, SIPP-based estimates of poverty are substantially lower than estimates based on the Current Population Survey. Second, the SIPP also collects information on assets at the individual level. Thus, the survey provides enough detail to measure the major income and asset exclusions directly. Finally, the SIPP data are matched to SSA administrative records: Medicare eligibility can therefore be accurately measured, and self-reported data on Social Security and SSI benefits can be replaced with more accurate monthly information. Our 1995 simulation estimates that approximately 4.8 million persons in the U.S. noninstitutionalized population were eligible for the QMB program and an additional 1.6 million for the SLMB program. The total--roughly 6.5 million--is within the range of estimates from past studies but is closer to the lower end, suggesting that the eligible population is smaller than was previously believed. When the estimated QI-1 eligible population of 0.9 million is added, the total for the three buy-in programs is 7.4 million. Because the QI-1 program did not exist in 1995, only the estimated 6.5 million QMBs and SLMBs would actually have been eligible to receive benefits. The 7.4 million figure represents the 1995 Medicare beneficiaries who would be eligible for buy-in under program rules for 2000. Adjusting that number to account for increases in the Medicare population between 1995 and 1999 yields an estimated eligible population of 7.8 million in 1999. Compared with other elderly Medicare recipients, eligible elderly QMBs and SLMBs have poorer health, more functional limitations, and higher rates of health care use. Thus, not only are their income resources relatively limited, but their need for potentially expensive medical care is also greater. Similar differences were not found in health, functional limitations, and health care use among disabled participants in the QMB and SLMB programs. Our estimates imply that about 2.5 million noninstitutionalized individuals were eligible for but not enrolled in the QMB and SLMB programs in 1999. That finding suggests that fewer eligibles may be available for targeting by outreach efforts than was previously believed. Outreach may be more difficult than it would be with a larger eligible population. (ABSTRACT TRUNCATED)     

Longitudinal outcomes of an early cohort of Ticket to Work participants

Using 2004-2006 National Beneficiary Survey data matched to Social Security administrative data, we follow a cohort of disability beneficiaries participating in the Ticket to Work (TTW) program for several years to assess changes in their service use, health status, employment, and income. About 20 percent of TTW participants achieved employment at levels that would significantly reduce their disability benefits. Another 40 percent achieved some employment success, but the remaining 40 percent reported no earnings during 2003-2005. Use of TTW support services during 2003-2005 was modest. Many participants experienced significant changes in their health status across survey rounds, which might have affected their ability to actively participate in TTW and to become employed. Many also experienced significant employment and income instability. The findings suggest that employment among TTW participants was associated with reduced poverty.