United Kingdom's Income Support Program for People With Disabilities: Redesign, Reform, and Policy Lessons for the United States

We reviewed the operational aspects of Employment and Support Allowance (ESA)-the income support program for people with disabilities in the United Kingdom-and its potential policy lessons for the United States' Social Security Disability Insurance (SSDI) program. ESA has a five-step eligibility determination process, and eligible beneficiaries receive either an unconditional cash benefit or payments conditional on participating in return-to-work activities. The United Kingdom has reformed ESA to better meet policy objectives. Both ESA and SSDI collect medical documentation, but ESA also requires face-to-face eligibility assessments for almost all claimants. ESA eligibility is based on functional limitations exclusively, whereas SSDI assesses the ability to perform substantial work. With its focus on helping some beneficiaries return to work, ESA differs from SSDI, which requires no return-to-work efforts to receive benefits. ESA might offer policy lessons for SSDI with regard to pilot testing, program reform, and accurate decision making.