Demonstration to Maintain Independence and Employment in Texas: Long-Term Follow-Up of Health Services Utilization and Employment Outcomes

The Demonstration to Maintain Independence and Employment (DMIE) was authorized under the Ticket to Work and Work Incentives Improvement Act of 1999 and awarded funds to states to develop, implement, and evaluate interventions for workers with potentially disabling health conditions. These interventions were designed to prevent participants’ conditions from becoming severely disabling, and to maintain their employment, health status, and independence from public assistance programs. From 2007 through 2009, Texas implemented a multi-component intervention aimed at providing comprehensive health insurance coverage, expedited access to services, healthcare navigators, and vocational supports for working adults with serious mental illness or co-occurring behavioral and physical health disorders. Compared to control participants in a randomized trial, intervention participants reported greater access to and utilization of health and mental health services, and were significantly less likely to be receiving SSI/DI than controls after one year of service delivery (6% vs. 8%, respectively) although there was no difference in employment retention. In this brief, we report on the long-term effects of these early-intervention services by evaluating health services use, Medicaid disability enrollment, and employment among DMIE participants from 2010-2014, the 5 years following the program.