Date: 2026-08-11. Extends Phase 0 anchors 7 and 9; adjudicates H4. Programs: SSI 1619(b) and SSDI cash-cliff / extended Medicare are separate rule stacks. Ticket take-up is cited only as a participation denominator for H4’s usability leg; population employment effects live in §5.
Search log (PRISMA-lite)
| Field | Record |
|---|---|
| Date | 2026-08-11 |
| Strings | SSA Red Book TWP EPE SGA 1619(b); SSI ASR 1619(b) Table 40 43; BOND Final Evaluation Report Gubits 2018; Medicaid Buy-In workers with disabilities Gettens; Mathematica three E’s Medicaid Buy-In enrollment earnings |
| Sources searched | SSA Red Book (SSDI/SSI employment supports; 2024 parameter page); SSI ASR 2023 §7 (1619); Abt/Mathematica BOND FER Vol. 1 + Abt 2019 brief; Washington MBI evaluation (Gettens et al. 2012); Mathematica MBI “three E’s” / Liu & Weathers earnings notes; BPC 2022 MBI data-gap brief; KFF buy-in state count |
| Inclusion | Agency primary rules and published take-up tables; SSA-commissioned RCT/demo evaluations; peer-reviewed or Mathematica state/national MBI outcome studies with transparent comparison design |
| Exclusion | Vendor “how to keep benefits” marketing; equating Ticket counseling with cliff redesign; treating BOND null as proof beneficiaries “don’t want to work” |
1. Rule stack that binds (Red Book)
SSDI cash path (Title II):
| Stage | Rule (construct) | 2024 parameters (Red Book) |
|---|---|---|
| Trial Work Period (TWP) | 9 service months in a rolling 60-month window; full cash benefits continue regardless of earnings if disability continues | Service-month threshold $1,110/mo |
| Extended Period of Eligibility (EPE) | 36-month re-entitlement: cash paid when earnings < SGA; suspended when ≥ SGA (plus 3-month grace at first SGA month) | Non-blind SGA 1, 550 * */mo; blind * *2,590 |
| After EPE | Cash terminates on a month of SGA; Expedited Reinstatement (EXR) is the safety net within 5 years | — |
| Extended Medicare | Premium-free Part A continues ≥93 months after TWP ends if disability continues | Separate from cash |
The cash cliff is the step from full monthly DI benefit to zero once SGA persists past TWP/grace — not a gradual phase-down. Beneficiaries rationally treat SGA as a hard stop even when extended Medicare softens the health cliff for a time.
SSI path (Title XVI):
- Permanent 1 − for−2 earned-income exclusion after small disregards (no SSDI-style TWP/EPE cliff for cash).
- 1619(a): special SSI cash while earnings exceed SGA but countable income stays below the break-even point.
- 1619(b): Medicaid continuance after cash zeros out, subject to state earnings thresholds and need-for-Medicaid-to-work tests.
Medicaid Buy-In (state option): working people with disabilities pay premiums to keep Medicaid when earnings exceed ordinary ABD limits. KFF (2025/2026 surveys): 47 states offer a buy-in. National enrollment is stale: BPC (2022) cites ~193,000 enrollees across 35 states in 2011 as the last comprehensive public figure — a data gap for O4 scoring, not a claim that buy-ins are unused.
Confidence: strong on Red Book rule logic and 2024 parameters; strong on 1619(b) counts; moderate on current buy-in headcount (2011 last national).
2. Take-up (H4 first leg; KC3)
December 2023 (SSI ASR; Phase 0 lock):
| Construct | Count / share |
|---|---|
| 1619(b) participants aged 18–64 | 108,825 |
| Blind/disabled SSI recipients 18–64 | 4,148,143 |
| 1619(b) share | 2.6% |
| Working blind/disabled (incl. 1619) | 5.1% of blind/disabled |
Ticket assignment rates in the Mathematica evaluation series and later GSA/OES summaries sit in the low single digits of the eligible pool (historical Phase-1 peaks ~1–1.4%; later program-wide summaries often ≤**~5%**). That is a usability signal for H4, not an employment effect size (those are §5).
KC3 remains unfired for 1619(b): denominators are published.
Confidence: strong.
3. BOND as cliff evidence (anchor 9)
Abt/Mathematica BOND Final Evaluation Report (Gubits et al., Oct 2018) and the Abt 2019 synthesis brief lock the following:
| Result | Stage 1 (national sample) | Stage 2 (volunteers) |
|---|---|---|
| Average earnings impact of 1 − for−2 offset | Null (not statistically significant) | Null |
| Average SSDI benefits due | +$143/year (~+1%) over 5 years | +450–500/year (~+4%) over 4 years |
| Share with earnings above BYA (annualized SGA) | +7% relative to control | +23% relative |
| Enhanced work-incentives counseling (EWIC) vs standard WIC | — | Virtually no incremental earnings/benefit impacts |
| Benefit-cost (Stage 1) | Net social cost for full caseload | Offset+WIC net benefit in volunteer subpopulation; EWIC net loss |
Reading for the cliff wager: replacing the cash step-function with a 1 − for−2 ramp did not raise average earnings in the nationally representative sample; it raised average benefits paid (windfall to those already at SGA under current law dominated induced above-BYA entry). Information intensification alone fails in the same experiment (EWIC ≈ WIC). Anchor 9 holds: BOND found limited (null average) earnings response to the offset.
That null constrains architecture #3 (cliff redesign scored against BOND): a pure DI cash offset is not a free fiscal lunch and may not move mean earnings. It does not rescue motivational programs; counseling enhancements also failed.
Confidence: strong — primary SSA-commissioned RCT/demo.
4. Coverage-cliff instruments vs information-only (≥2 evaluations)
H4’s second leg needs cliff/offset or coverage-separation designs that move earnings more than information-only interventions:
- Washington Medicaid Buy-In (Healthcare for Workers with Disabilities) — Gettens et al., Journal of Disability Policy Studies (2012): matched comparison of recent conventional-Medicaid enrollees who entered MBI vs matched stayers. Findings: MBI associated with more work, higher earnings, and lower food-stamp reliance while preserving medical coverage. This is a health-coverage cliff redesign, not a Ticket mailer.
- National / multi-state MBI outcome series (Mathematica) — Gimm, Davis, Andrews, Ireys & Liu (“three E’s,” 2008) and related Liu & Weathers earnings notes: among MBI participants with wages, on the order of ~40% increased earnings after enrollment (median real increase on the order of ~$2,600 in the national synthesis cited in secondary reviews). Design is pre/post among enrollees, weaker than the WA match, but directionally consistent and independent of Ticket counseling.
Contrast set (information / service vouchers): BOND EWIC null (§4.3); Ticket ITT employment/exit nulls (§5). Coverage continuity instruments show earnings movement where counseling- and voucher-intensity do not.
Band: Pure DI cash offset (BOND) did not move average earnings. The binding “cliff” in the supported reading is therefore health-coverage loss and rule complexity, not merely the existence of any phase-down schedule — and not work aversion cured by motivational messaging.
Confidence: moderate-to-strong on the WA matched study; moderate on national MBI descriptive earnings gains.
5. H4 adjudication
H4 — The cliff, not work aversion, binds return to work.
| Criterion | Result |
|---|---|
| 1619(b)/Ticket take-up low relative to working-age rolls | Met. 1619(b) 2.6%; Ticket assignment low-single-digit % of eligibles. |
| ≥2 evaluations find cliff or offset / coverage-separation designs move earnings more than information-only | Met via WA MBI matched evaluation + Mathematica MBI earnings series, contrasted with BOND EWIC and Ticket info/service nulls. Pure DI cash offset (BOND) itself is null on mean earnings — logged as architecture constraint, not a veto of the take-up leg. |
Verdict: SUPPORTED, with the BOND null carried into scorecard O4 cells for cash-offset architectures.
Refutation path closed: take-up is not high, so “high take-up + offset non-response” does not fire even though BOND earnings non-response is real.
Confidence: strong on take-up; moderate-to-strong on the comparative evaluation leg once cash-offset vs coverage-cliff are distinguished.
Implications
- Architecture #3 (cliff redesign) must be scored against BOND’s null mean earnings / higher benefits paid, not against a folk theory that any ramp automatically pays for itself.
- Architecture #4 (Medicaid buy-in expansion) is the cleaner O4 instrument on present evidence: it attacks the coverage cliff Ticket counseling does not.
- Low 1619(b) take-up is a usability finding under existing statute — simplifying automatic continuance / threshold communication remains live even before new offsets.