Effective Jan. 1, 1997, the Contract with America Advancement Act (PL 104-121) terminated the Social Security Administration's Disability Insurance (DI) and Supplemental Security Income (SSI) benefits for persons diagnosed with drug or alcohol addiction, also known as DA and A recipients. The law ended Medicaid eligibility as well, leading to many chronic substance abuse patients losing Medicaid reimbursement for addiction treatment and general health care needs. The legislation raised two sets of interrelated concerns. The first was for the well-being of the substance abusers who lost their mandate for treatment, insurance for treatment, insurance for general health care, monthly income, and their relationships with their representative payees. The second was for the larger effects on others in society. Several studies have been conducted or are currently in progress that address the issue of how the benefits termination affected recipients. However, no rigorous evaluation of the net impact of the law using actual resource utilization and labor force participation data has yet been attempted. The proposed study fills that gap with a quasi-experimental evaluation of the economic impact of the policy change in Washington State. Using records extracted and recombined from existing datasets, the analytic methodology combines an enhanced interrupted time series analysis with 1) recent developments in the multilevel random regression modeling of longitudinal outcome data, and 2) contemporary economic valuation methods for resource utilization and productivity.
Specific aims are: 1. Estimate the net impact of the law on service utilization and labor force participation among the DA and A population as a whole and its component subgroups. Service utilization data will include mental health services, general medical services, substance abuse services, use of the criminal justice system, and cash benefits. Subgroups will include former benefit classification (SSI, DI, or both), urban v. rural, age, gender, education, ethnicity, criminal justice background, previous employment history, substance abuse diagnosis, substance abuse treatment history, psychiatric comorbidity, medical comorbidity, and SSI/DI requalification status. 2. Based on the findings from Aim 1, estimate the economic impact of the benefits termination on federal, state and local government resources, for the population as a whole and subgroups. This will be accomplished through the use of cost data from Washington State and current economic valuation models that assign unit cost estimates to each of the resource utilization and productivity activities that were modeled in Aim 1.
