From 1997 to 2003, the Oregon Health Policy Institute at Oregon Health Sciences University conducted an independent evaluation of five demonstration projects in three states designed to implement and evaluate state efforts to remove barriers to employment for disabled people by increasing access to health care through Medicaid and Medicare as people become employed.

The project was part of the Robert Wood Johnson Foundation (RWJF) Building Health Systems for People with Chronic Illnesses national program.

The demonstration projects were conducted by:

• Oregon Department of Human Resources.
• Vermont Agency of Human Services.
• Wisconsin Department of Health and Family Services.

The evaluation posited three assumptions:

• Employment barriers faced by individuals with disabilities are largely associated with specific public policies.
• Removing policy barriers will facilitate return to gainful work.
• The primary sought-after outcomes are related to increased earnings, stabilization of health care utilization and increased quality of life.

George Washington University Medical Center also contributed to this project by supporting activities designed to build momentum toward a national movement.

Key Findings: Preliminary findings (reported by the evaluation team in November 2001; the evaluation will not be finished until November 2003) challenge all of the initial research assumptions.

• Researchers found, for instance, that the greatest barrier to employment was not created by public policy, but was keyed to the nature of each individual's disability.
• Clients reported that the challenges of employment (e.g., finding accessible and convenient transportation, supportive employer and co-worker attitudes and the ability to take time off for health reasons) remained formidable.
• Evaluators additionally found that, from the clients' perspective, the primary sought-after outcomes were not necessarily related to increased earnings, stabilization of health care utilization and increased quality of life. Rather, the perception of success was extremely individualized, based on the kind of disability, previous work history, Social Security beneficiary status, work readiness and demographic characteristics."