One in seven working age adults identifies as having a disability in OECD countries. Many of them are excluded from meaningful work and have low levels of income and social engagement. Governments can help create an environment that supports social and labour market integration for people with disability. This report reviews the effectiveness of the social protection system for people with disability in Italy and summarises the results of a pilot carried out in four regions testing an alternative disability assessment. The current assessment process can sometimes deny services to people in need of support while being generous to people with significant health problems but who are not experiencing severe disability. A disability assessment that takes medical and functional aspects into account helps to direct services and resources to those most in need and to harmonise access to disability support across the country. Implementing disability reform has proved to be difficult in Italy in the past decade. This report provides evidence that reform can improve outcomes for people with disability.