Child Supplemental Security Income Research Articles

Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income.

To analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions. Medical Expenditure Panel Study, 2000-2020 and National Survey for Children with Special Health Care Needs, 2001-2010. Leveraging variation in SSI-Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS-CSHCN. Our sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI. Automatic enrollment is associated with a statistically significant increase in insurance coverage. Expanding automatic enrollment to all states is associated with increases in Medicaid enrollment of 3% (CI 0.9%-6.7%) among all SSI children and 7% (CI 1.1%-13.9%) among children newly enrolled in SSI. We find similar decreases in uninsurance. Analysis in the NS-CSHCN replicates these findings. Medicaid automatic enrollment policies are associated with increased insurance coverage for SSI children, particularly those transitioning into the program. Medicaid policy defaults could play an important role in reducing administrative burdens to improve children's coverage and access to care.

Associations of household unmet basic needs and health outcomes among very low birth weight children.

We examined associations of past year household hardships (housing, energy, food, and healthcare hardships) with postnatal growth, developmental risk, health status, and hospitalization among children 0-36 months born with very low birth weight (VLBW) and the extent that these relationships differed by receipt of child supplemental security income (SSI). We examined cross-sectional data from 695 families. Growth was measured as weight-for-age z-score change. Developmental risk was defined as ≥1 concerns on the "Parents' Evaluation of Developmental Status" screening tool. Child health status was categorized as excellent/good vs. fair/poor. Hospitalizations excluded birth hospitalizations. Compared to children with no household hardships, odds of developmental risk were greater with 1 hardship (aOR 2.0 [1.26, 3.17]) and ≥2 hardships (aOR) 1.85 [1.18, 2.91], and odds of fair/poor child health (aOR) 1.59 [1.02, 2.49] and hospitalizations (aOR) 1.49 [1.00, 2.20] were greater among children with ≥2 hardships. In stratified analysis, associations of hardships and developmental risk were present for households with no child SSI and absent for households with child SSI. Household hardships were associated with developmental risk, fair/poor health status, and hospitalizations among VLBW children. Child SSI may be protective against developmental risk among children living in households with hardships.

What Is the Relationship Between Socioeconomic Deprivation and Child Supplemental Security Income Participation?

What Is the Relationship Between Socioeconomic Deprivation and Child Supplemental Security Income Participation?

Housing Instability Among Families With Young Children With Special Health Care Needs

Children with special health care needs (SHCNs) have significant medical and educational expenses affecting household finances. Housing instability can be detrimental to family well-being. Our objective was to evaluate housing instability in households of children with and without SHCNs. Cross-sectional surveys (2013-2017) in English and Spanish of caregivers with children <4 years old were conducted at 5 hospitals. The children with SHCN screener and caregiver report of child Supplemental Security Income (SSI) receipt were used to categorize children into the following groups: (1) no SHCNs, (2) SHCNs and no SSI, or (3) SHCNs and receiving SSI. Housing instability was determined by positive endorsement of ≥1 adverse circumstance: behind on rent or mortgage, or moving twice or more in the past year, or homelessness in the child's lifetime. Analyses used multivariable logistic regression models, adjusting for demographics and housing subsidies. Of 14 188 children, 80% had no SHCNs, 16% had SHCNs and no SSI, and 4% had SHCNs and received SSI. Compared with the no-SHCNs group, the SHCNs-no-SSI group but not the SHCN-receiving-SSI group experienced significantly greater adjusted odds of being behind on rent or mortgage (adjusted odds ratio [aOR] 1.28 [95% confidence interval (CI) 1.14-1.44]; P < .001), multiple moves (aOR 1.29 [95% CI 1.05-1.59]; P = .01), and homelessness (aOR 1.44 [95% CI 1.20-1.72]; P < .001). Families of children with SHCNs are at risk for housing instability. Child SSI receipt decreased the risk of housing instability among families of children with SHCNs. Protecting families of young children with SHCNs from housing instability is an important investment.

Supplemental Security Income and the Transition to Adulthood in the United States: State Variations in Outcomes Following the Age-18 Redetermination

AbstractPolicy makers have raised concerns about the outcomes of former child Supplemental Security Income (SSI) recipients following the redetermination of eligibility at age 18 using an adult disability definition. We use Social Security administrative data to track state-level benefit receipt and employment outcomes of all former child SSI recipients who received an age-18 redetermination from 1998 through 2006, through age 24. We find that (1) state cessation rates ranged from 20 to 47 percent, (2) ceased recipients had higher employment rates and lower rates of SSI receipt than continued recipients, and (3) continued recipients who lived in states with higher employment rates also had higher Disability Insurance benefit receipt rates than those who lived in states with lower employment rates. The findings raise questions about the state-level variation in SSI’s role in the overall safety net and the variations in options available to former child SSI recipients following the age-18 redetermination.

The Effect of Disability Payments on Household Earnings and Income: Evidence from the SSI Children's Program

Abstract I estimate the effect of removing children with disabilities from Supplemental Security Income (SSI) on parental earnings and household disability receipt. Using administrative data from the Social Security Administration (SSA), I implement regression discontinuity and differencein- differences designs based on changes in SSA's budget for child medical reviews. I find that parents fully offset the SSI loss with increased earnings, and the loss of the child's SSI payment reduces disability applications by parents and siblings but does not reduce their actual disability receipt. I examine alternative hypotheses for the large parental earnings response.

Children with Special Health Care Needs, Supplemental Security Income, and Food Insecurity.

To assess food insecurity in low-income households with young children with/without special health care needs (SHCN) and evaluate relationships between child Supplemental Security Income (SSI) receipt and food insecurity. A cross-sectional survey (2013-2015) of caregivers was conducted at 5 medical centers. Eligibility included index child age <48 months without private health insurance and a caregiver fluent in English or Spanish. Interviews included sociodemographics, 5-item Children with Special Health Care Needs Screener, 18-item US Food Security Survey Module, household public assistance program participation, and child SSI receipt. Household and child food insecurity, each, were evaluated using multivariable logistic regression models. Of 6724 index children, 81.5% screened negative for SHCN, 14.8% positive for SHCN (no SSI), and 3.7% had SHCN and received SSI. After covariate control, households, with versus without a child with SHCN, were more likely to experience household (Adjusted odds ratios [AOR] 1.24, 95% confidence intervals [CI], 1.03-1.48) and child (AOR 1.35, 95% CI, 1.11-1.63) food insecurity. Among households with children with SHCN, those with children receiving, versus not receiving SSI, were more likely to report household (AOR 1.42, 95% CI, 0.97-2.09) but not child food insecurity. Low-income households with young children having SHCN are at risk for food insecurity, regardless of child SSI receipt and household participation in other public assistance programs. Policy recommendations include reevaluation of assistance programs' income and medical deduction criteria for households with children with SHCN to decrease the food insecurity risk faced by these children and their families.

Deprivation Among U.S. Children With Disabilities Who Receive Supplemental Security Income

This study analyzes data from the 2004 and 2008 panels of the Survey of Income and Program Participation (SIPP) to examine demographic factors among low-income households with children with disabilities that were associated with greater likelihood of receiving Supplemental Security Income (SSI) program, and their rates of material hardship ( n = 444), by comparing them to low-income households with children with disabilities who did not receive child SSI ( n = 1,942) and other low-income households that did not have children with disabilities ( n = 7,533). Results showed household characteristics, such as those headed by individuals who were single women and Black people and those with less than high school education, and the presence of any working-age adult with disability to be significantly associated with greater likelihood of receiving child SSI. The study also found that controlling for selected demographic characteristics, low-income households with children with disabilities, irrespective of whether or not they received child SSI, experienced significant rates of hardships compared to low-income households without children with disabilities. The study found no evidence that receipt of SSI was associated with reduced material hardships in households with children with disabilities. Implications for policy are discussed.

English

n December 7, 2012, Nicholas Kristof, two-time Pulitzer Prize winning journalist, wrote a compelling article about people in poverty in the United States. The article, which appeared in the New York Times, describes the plight of young children who are failing in school and who are not acquiring the skills needed to move forward in their education, and tragically, in some cases, parents are allowing them to fail. It is their children’s illiteracy that enables the parents to receive Supplemental Security Income (SSI) payments from the government. These payments, meant for supporting families of children with severe functional limitations, are funds that the family uses to survive. The parents were most likely members of an educational system that failed them as well, leaving them without the academicbased life skills needed to get better paying jobs. And so a vicious cycle results with far-reaching consequences, including an abysmal education, unemployment, poorer health, and inadequate healthcare. Solutions to breaking this cycle seem impossible, but we cannot accept failure and give up. Solutions will begin with small steps, which is how every journey begins. And confidence must be drawn from what Mark Twain once said: ‘They didn’t know it was impossible, so they did it.’ Ruffing and Pavetti criticize Kristof’s article, stating that his information on SSI ‘should be rooted in facts and data, not impressions, misimpressions, and anecdotes,’ and go on to iterate, ‘This is not to say no such incidents occur, or that all families take full advantage of supplemental literacy or tutoring programs that may be available (though not always accessible) to them.’ But they would prefer commentary based on ‘actual research’ versus ‘anecdotal stories.’ Kristof, never averse to raising the specter of social problems of the minority, leaves the conducting and analyzing of research to the academics and think tanks. However, he does, in fact, cite research he believes supports his claims. A 2011 report from the Committee on Ways and Means found that four decades ago, approximately 1% of poor children had support from the SSI payment system. A 2012 report from the Social Security Administration cited that 8% of children in poverty today are enrolled in SSI. This increase in SSI support correlates with less stringent eligibility requirements for families in the program and ends up with the majority of beneficiaries transitioning into SSI in adulthood and the others being largely unprepared for life without SSI. Of significance is a finding by DeCesaro and Hemmeter. ‘The choice to return to work might be especially difficult for many child SSI recipients who have unmet health needs and fear losing future access to health benefits through Medicaid’. Save the Children is taking steps to improve literacy by striving to find answers for children whose poverty has affected their education. Save the Children is a non-profit organization dedicated to helping children both in the United States and around the world. They respond to emergency situations, where medical aid, shelter, and other relief are needed, and they also administer strategic programs to improve the education of children. They posit that ‘Education is the road that children follow to reach their full potential in life’. They have initiated education projects training teachers in the use of more effective teaching strategies, offering ways for volunteers to get children to read and do math outside of school hours, and promoting the power of artistic expression to help children heal, learn, and do better in school. In the United States, they are working in poverty-stricken areas, teaching parenting skills and providing parents with their greatest need hope. Kristof is getting the message out, believing that helping struggling children should be a national priority. He contends, ‘They’re too small to fail.’ The implications of illiteracy factor into all facets of a person’s life, including their healthcare. People require health literacy, which is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Individuals with literacy problems are unable to take full advantage of healthcare services. Weir cogently delineates the literacy spectrum and offers a reflection:

Changing circumstances: Experiences of child SSI recipients before and after their age-18 redetermination for adult benefits

This paper provides an analysis of the dynamics of the transition of child Supplemental Security Income (SSI) recipients into adulthood using linked 2001-2002 National Survey of SSI Children and Families (NSCF) survey and Social Security Administration (SSA) administrative data. We examine the interaction of impairment status, reported health needs, and other self-reported indicators of human capital on SSI program and employment outcomes after age 18. Our primary objective is to examine the differences in pre-age-18 individual characteristics across subgroups of recipients by impairment status and determine whether these differences influence post-age-18 SSI participation and employment outcomes. We find that after controlling for measures of disability severity, duration, and human capital, youth with behavioral disorders and mental disorders other than mental retardation are much less likely to receive SSI at age 19. The findings also suggest that non-health factors, particularly education, employment, and social indicators, play an important role in the probability of a child SSI recipient being on adult SSI after age 18. Our findings indicate that, while some youth appear to be making a successful transition from child SSI benefits to adult benefits or other activities (off of SSI), others appear to have limited prospects for long-term self-sufficiency. A major concern is that some youth no longer on SSI after age 18, particularly those with behavioral disorders and mental disorders other than mental retardation, may not have been sufficiently prepared for life without SSI.

Posttransition Experiences of Former Child SSI Recipients

This article uses newly released data from the National Survey of SSI Children and Families, a survey conducted by the Social Security Administration, to study the transition period for a cohort of child Supplemental Security Income (SSI) recipients following the redetermination of benefits at age 18. The work examines the differences between those who do not receive SSI benefits after age 18 as adults and those who continue to do so, focusing on the connection between pre‐age‐18 characteristics and post‐age‐18 outcomes. Comparisons show important differences in the demographic and human capital development characteristics across these two groups, indicating a possible need for transition supports for subgroups within the child SSI population. Such supports are especially needed among those who are no longer receiving benefits after age 18 and are not engaged in any schooling, employment, or training activity.

Early Transition Experiences of Transition-Age Child SSI Recipients

This article describes the challenges faced by pretransition-age (14 to 17 years) young people with disabilities receiving Supplemental Security Income (SSI) and outlines potential policy options to support their transition. The article is based on a descriptive analysis of newly released data from the 2001 National Survey of SSI Children and Families and the results of interviews with key policy experts. We find that in addition to their health status, these young people face a multidimensional set of difficulties in making a successful transition, including a high prevalence of family disadvantage, problems in school, and trouble with the police. In addition, despite the potential for losing SSI benefits and public health care coverage at age 18, they have generally low levels of participation in labor market preparation activities. The article discusses a variety of possible changes to improve the system of supports for transition-age young people with disabilities.

The impact of child SSI enrollment on household outcomes

AbstractWe use data from the Survey of Income and Program Participation (SIPP) to investigate the impact that child Supplemental Security Income (SSI) enrollment has on household outcomes, including poverty, household earnings, and health insurance coverage. The longitudinal nature of the SIPP allows us to control for unobserved, time‐invariant differences across households by measuring outcomes in the same household in the months leading up to and immediately following the first reporting of child SSI income. Our regression analyses demonstrate that for every $100 increase in household SSI income, total household income increases by roughly $72, reflecting some modest offset of other transfer income and conditional household earnings. Our analyses further demonstrate that child SSI enrollment is associated with a statistically significant and persistent reduction in the probability that a child lives in poverty of roughly 11 percentage points. Additional analyses suggest that program enrollment has virtually no impact on health insurance coverage because most new SSI recipients have health insurance from Medicaid or another source at the time of enrollment. © 2007 by the Association for Public Policy Analysis and Management

Fiscal Federalism and Welfare Policy: The Role of States in the Growth of Child SSI

The liberalization of the Supplemental Security Income (SSI) program in 1990 allowed many children receiving assistance from AFDC to enroll in SSI instead. Because of differences in the federal fun...

Does state AFDC generosity affect child SSI participation?

This article examines the extent of interactions or spillovers between the Supplemental Security Income (SSI) and Aid to Families with Dependent Children (AFDC) programs for children. In the early 1990s, the Social Security Administration substantially relaxed child eligibility criteria for SSI benefits. Since the changes, the number of U.S. children receiving cash and medical benefits through SSI tripled to nearly 1 million. The article describes a family's decision to participate in SSI and/or AFDC, and uses state-level data for three years before, and three years after, the Zebley decision to estimate the effect of state program generosity on child program participation. The expansions in child SSI eligibility increased child SSI participation and contributed to increased total program participation by children in the early 1990s. Child SSI participation increased more in states with lower AFDC payments and higher state SSI supplementation payments. These results suggest that families use SSI and AFDC as substitutes. At least 32 percent of the Zebley increase in SSI is likely attributable to the SSI–AFDC benefit gap for the median AFDC benefit state. © 2000 by the Association for Public Policy and Management.

Does state AFDC generosity affect child SSI participation?

This article examines the extent of interactions or spillovers between the Supplemental Security Income (SSI) and Aid to Families with Dependent Children (AFDC) programs for children. In the early 1990s, the Social Security Administration substantially relaxed child eligibility criteria for SSI benefits. Since the changes, the number of U.S. children receiving cash and medical benefits through SSI tripled to nearly 1 million. The article describes a family's decision to participate in SSI and/or AFDC, and uses state-level data for three years before, and three years after, the Zebley decision to estimate the effect of state program generosity on child program participation. The expansions in child SSI eligibility increased child SSI participation and contributed to increased total program participation by children in the early 1990s. Child SSI participation increased more in states with lower AFDC payments and higher state SSI supplementation payments. These results suggest that families use SSI and AFDC as substitutes. At least 32 percent of the Zebley increase in SSI is likely attributable to the SSI–AFDC benefit gap for the median AFDC benefit state. © 2000 by the Association for Public Policy and Management.