Federal Disability Programs Research Articles

The effects of expanding access to mental health services on SS(D)I applications and awards

The growing number of individuals suffering from a serious mental illness underscores the important role of interventions such as treatment, policies, and programs to support those in need. Such support efforts often interact in unanticipated ways. This paper considers the degree to which access to mental health treatment services affects participation in federal disability programs including the Supplemental Security Income and the Social Security Disability Insurance (SS(D)I) programs. Our main approach uses an identification strategy that leverages county-level variation in the number of mental health treatment establishments to estimate changes in access to mental health treatment on SS(D)I program participation—measured by applications and awards. We also explore a series of event studies and heterogeneity analyses. Our results show that an increase in mental health facilities increases participation in SS(D)I programs. A 10 percent increase in a county’s number of office-based mental health establishments increases the SSI application rate by 1.2 percent and the SSDI application rate by 0.7 percent. While the overall sample suggests that this does not translate to an increase in SS(D)I awards, we do find increases in awards in counties that have a higher proportion of residents below the poverty line. This suggests that increasing access to mental health resources can be a pathway through which people suffering from severe mental illness can be diagnosed and access social safety nets.

Experiences with Work and Participation in Public Programs by Low-Income Medicaid Enrollees Using Qualitative Interviews.

Centers for Medicare & Medicaid Services (CMS) began encouraging governors to implement work requirements for Medicaid enrollees using section 1115 waivers in 2018. Significant controversy surrounds such attempts, but we know little about the perceptions and experiences of enrollees. To characterize experiences of work and its relationship to participation in Medicaid and other public programs among potential targets of Medicaid work requirements. In-depth, semi-structured, one-time qualitative interviews. 35 very low-income, non-disabled Medicaid expansion enrollees participating in a county-sponsored Medicaid managed care plan as a part of a larger study. We used a biographical narrative interpretive method during interviews including questions about the use of employment and income support and other public programs including from state and federal disability programs. Our team iteratively coded verbatim transcripts allowing for emergent themes. Interview data revealed high motivation for, and broad participation in, formal and informal paid work. Eight themes emerged: (1) critical poverty (for example, "I'm not content, but what choices do I have?"); (2) behavioral and physical health barriers to work; (3) social barriers: unstable housing, low education, criminal justice involvement; (4) work, pride, and shame; (5)inflexible, unstable work (for example, "Can I have a job that will accommodate my doctor appointments?…Will my therapy have to suffer? You know? So it's a double edged sword."); (6) Medicaid supports the ability to work; (7) lack of transparency and misalignment of program eligibility (for example, "It's not like I don't want to work because I would like to work. It's just that I don't want to be homeless again, right?"); and (8) barriers, confusion, and contradictions about federal disability. We conclude that bipartisan solutions prioritizing the availability of well-paying jobs and planful transitions off of public programs would best serve very low-income, work-capable Medicaid enrollees.

The Impact of Affordable Care Act Medicaid Expansions on Applications to Federal Disability Programs.

In this paper, we estimate the impact of Medicaid expansions via the Patient Protection and Affordable Care Act (ACA) on applications to federal disability programs in 14 states that expanded Medicaid in January 2014. We use a difference-in-differences regression model to compare disability application rates in geographic areas within states that expanded Medicaid to rates in areas of non-expansion states that were carefully selected using a matching approach that accounts for state Medicaid policies pre-ACA as well as demographic and socioeconomic characteristics that might influence disability application rates. We find a slower decrease in Supplemental Security Income (SSI) application rates after Medicaid expansions in expansion states relative to non-expansion states, with application rates declining in both state groups from 2014 through 2016. Our analysis of the impact of the Medicaid expansions on Social Security Disability Insurance (SSDI) application rates was inconclusive for reasons we discuss in the paper.

Characteristics of adults with psychiatric disabilities participating in the federal disability programs.

We use nationally representative data on working-age recipients of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) to profile beneficiaries with psychiatric disabilities and compare them with beneficiaries eligible for SSDI and SSI on the basis of other health conditions. Using data from 4 National Beneficiary Survey rounds, we conducted descriptive analyses of the personal and health characteristics and employment experiences of beneficiaries with and without psychiatric disabilities. Our sample includes 16,190 SSDI and SSI beneficiaries, of whom 6,447 have psychiatric disabilities. We conducted statistical tests of significance (χ2 and t statistics) to assess the difference between beneficiaries with and without psychiatric disabilities. Beneficiaries with psychiatric disabilities differ in many ways from other beneficiaries. They are significantly more likely to be younger than 55 years of age, female, have children, be unmarried, live alone, and be in poverty. Although a greater share report a desire to work, they are also more likely than their counterparts with other disabilities to report various employment barriers, including being discouraged by previous work attempts, the perception that others do not think they can work, a lack of transportation, and not wanting to lose cash or health insurance benefits. The findings suggest that beneficiaries with psychiatric disabilities face numerous significant employment obstacles that would need to be addressed for supported employment or similar approaches to be successful. (PsycINFO Database Record

Annals for Educators - 15 November 2016

Annals for Educators - 15 November 2016

Return to work: A critical aspect of care coordination for younger dual eligibles

BackgroundAnnual health care costs for dual eligibles now top $300 billion. Many dual eligibles are under age 65 and their needs differ significantly from retired elderly dual eligibles. For younger dual eligibles, successful return to work is an important objective for coordinated care. ObjectivesTo assess relative rates of dual eligibility by age group and program enrollment (SSDI or OASI), and to identify the prevalence among these subgroups of factors associated with return to work. MethodsPopulation estimates and logistic regression analysis of the 2010 Medicare Current Beneficiary Survey (MCBS). ResultsAlthough they make up only 16% of the total Medicare beneficiary population, disabled workers under age 65 constitute 42% of all dual eligibles. SSDI beneficiaries under age 45 have 20 times greater odds of receiving Medicaid benefits compared to retirees (AOR = 19.8, 95% CI = 16.2–24.2). The youngest dual eligible adults are more likely to work, have fewer chronic conditions, and report better health status than other dual eligibles. However, they are more likely to report problems with obtaining health care and be dissatisfied with the quality of the care they receive. ConclusionsDual eligible workers with disabilities are an important target population for coordinated services because of their high lifetime program costs – many will receive SSDI, SSI, Medicare, and Medicaid benefits for decades. Return to work and continued employment are important policy objectives for younger dual eligibles and should provide the greatest return in terms of reduced dependence on federal disability programs.

Health Care Access Affects Attitudes About Health Outcomes and Decisions to Apply for Social Security Disability Benefits

This article reports on qualitative findings from a mixed methods study that explored the efficacy of providing enhanced health benefits and services to people with chronic health conditions to reduce their application rates to federal disability programs. Comparing an intervention and control group, the study found that those who received enhanced benefits had reduced health decline. To explore reasons for this reduction, authors conducted focus groups with a sample of participants from both groups. Four themes emerged: (a) Due to the effects of their conditions, most participants believed their health would worsen over time; (b) Intervention group members said their health deterioration would be slowed or prevented, while control group members worried about more rapid decline and the future; (c) Intervention group members related their beliefs about continued health to their ability to access care; (d) Control group members were more likely than intervention group members to indicate they applied or were interested in applying for social security disability benefits. These themes suggest that people who believe they have access to quality health care feel their health can and will improve over time. If health care reform leads to the availability of more comprehensive coverage for people with potentially disabling conditions, growth in federal disability programs may slow.

Understanding the Growth in Federal Disability Programs: Who are the Marginal Beneficiaries and How Much Do They Cost?

SSI and SSDI, the two work disability programs administered by the Social Security Administration (SSA), have been marked by concerns about target efficiency since their inception. This study uses SSA administrative data linked with National Health Interview Survey data (NHIS) to examine health status, labor force participation at time of NHIS interview, and linked mortality data to examine mortality during the period following NHIS interview. The self-reported health status data present two strong and consistent patterns: denied applicants report being in considerably worse health than non-applicants, and beneficiaries appear to be sicker yet. In logit models among disability beneficiaries, women are significantly less likely to report excellent/very good health, but race has no significant effect. While being female decreased the probability of good health, it has no significant effect on the probability of reporting no work limitation at time of interview among beneficiaries. Although race was not significant in the model of self-reported health, both Hispanics and non-Hispanic blacks are significantly more likely to report no work limitation at time of interview. This study has important limitations. NHIS respondents who link to the SSA administrative data may not be representative of all individuals with disability application histories. In addition, individuals must live long enough after disability determination to be drawn into an NHIS sample, and these results reflect the experience of that subsample of disability applicants who do not die during the determination process or soon thereafter.

Rosa's Law and the Language of Disability: Implications for Rehabilitation Counseling

National campaigns promoting the use of the term intellectual disability (ID) have culminated in the recent U.S. congressional passing of Rosa's Law. Rosa's Law changes how ID is referred to in federal disability programs by removing all references to the term, “mental retardation” (U.S Government Printing Office, October, 2010). Little is known about how the change in language will affect rehabilitation counseling practice and education. Accordingly, this article addresses the following: (a) history of the descriptors of ID, (b) the stigmatizing effects of terminology, (c) eliminating the use of the r-word through Rosa's Law, and (d) implications for the rehabilitation counseling profession.

Effect of Postsecondary Education on the Economic Status of Persons Who Are Deaf or Hard of Hearing

This article examines the effect that postsecondary education has on earnings and the duration of time spent in the Social Security disability programs for young persons who are deaf or hard of hearing. Our hypothesis is that investments in postsecondary training increase the likelihood of employment for persons who are deaf or hard of hearing and thus reduce dependency on disability-related income support programs. A longitudinal data set based upon records from the National Technical Institute for the Deaf and Social Security administrative records is used for this analysis. We find that those who graduate, even those who graduate with vocational degrees, experience significant earnings benefits and reductions in the duration of time spent on federal disability programs when compared with those who do not graduate with a degree. This finding suggests that reductions in the duration of time spent on Social Security programs are not limited to those with the highest level of scholastic aptitude and that investments in post-secondary education can benefit a broad group of deaf and hard-of-hearing persons. In addition, the data show that individuals who attend college, but withdraw before graduation, fair no better economically than individuals who never attended college.

Impact of early intervention programs for working adults with potentially disabling conditions: Evidence from the national DMIE evaluation

This article presents initial findings from the national DMIE evaluation, which used random assignment to test whether a program of enhanced health and employment supports for working adults with potentially disabling conditions can reduce the likelihood of applying for federal disability benefits and improve employment retention. Analyses are based on a total of 4,054 participants in demonstrations from four states (Hawaii, Kansas, Minnesota, and Texas). The demonstration was effective in reducing applications to federal disability programs 12 months after enrollment using combined data from the two largest state demonstrations (4.8 percent in the treatment group versus 6.9 percent in the control group). Evidence of short-term impacts on monthly hours worked was mixed across the states. Although these initial findings suggest modest positive effects of an early intervention program, longer term effects should be examined in future studies.

The Renaming ofMental Retardation: Understanding the Change to the TermIntellectual Disability

There is considerable and intense discussion in the field of intellectual disability/mental retardation about the construct of disability, how intellectual disability fits within the general construct of disability, and the use of the term intellectual disability (Glidden, 2006; Greenspan, 2006; MacMillan, Siperstein, & Leffert, 2006; Schalock & Luckasson, 2004; Switzky & Greenspan, 2006b). This discussion is occurring within the context of competing world views of the philosophical and epistemological underpinnings of the conceptions of intellectual disability/mental retardation (Switzky & Greenspan, 2006a). Increasingly, the term intellectual disability is being used instead of mental retardation. This transition in terminology is exemplified by organization names (e.g., the American Association on Intellectual and Developmental Disabilities—AAIDD, International Association for the Scientific Study of Intellectual Disabilities, President’s Committee for People With Intellectual Disabilities), journal titles, and published research (Parmenter, 2004; Schroeder, Gertz, & Velazquez, 2002). A number of questions have emerged with the increased use of the term intellectual disability:

Program Expenditures for Working-age People with Disabilities in a Time of Fiscal Restraint

Public expenditures in federal and federal-state programs for working-age people with disabilities totaled an estimated $276 billion in 2002. The federal share of these expenditures, $226 billion, was 11.3 percent of all federal outlays; states contributed an additional $50 billion. These expenditures accounted for about 2.7 percent of the nation's gross domestic product (GDP) and are growing much faster than GDP and all federal outlays. Most expenditures were for income support and health care to people with disabilities who were not employed or who had very low earnings. The fact that the relative economic well-being of working-age people with disabilities is falling has prompted increased scrutiny of how money is spent and whether there are any significant policy reforms that should be pursued (Stapleton and Burkhauser, 2003). This scrutiny will become more intense if the federal deficit rises, as it is projected to do, and the prevalence of disability grows as the baby boom generation ages. These circumstances make it an opportune time to re-evaluate the structure of federal disability programs and whether they are properly aligned with the evolving disability paradigm - a paradigm that stresses helping people with disabilities help themselves to be full members of the economic and social lives of their communities, rather than objects of charity (Stapleton et. al, 2005).

Street-level Bureaucrats, Administrative Power and the Manipulation of Federal Social Security Disability Programs

AbstractThe implementation of federal programs provides an opportunity for state officials to impose their own interests on the policy process. The federal government delegates administrative power to the states to implement federal programs. Because elected state officials serve as one of the principals to street-level bureaucrats, these officials should be able to influence these street-level agents to implement policy to further state needs. However, very little research has examined whether street-level bureaucrats act strategically to benefit state interests as they implement policy. In this article, I use Seemingly Unrelated Regression analysis to examine variation in award rates across the 50 states in two federal disability programs, SSI and SSDI. My findings reveal that program incentives lead state street-level bureaucrats to act strategically in implementing these programs. State bureaucrats reduce access to federal programs when state governments incur costs associated with those programs, especially under conditions of fiscal stress.

The Future of SIPP for Analyzing Disability and Health1

The paper describes SIPP data elements pertaining to health and disability, examines broad policy needs for health and disability issues from the perspective of the Department of Health and Human Services, and contains recommendations for future SIPP design. Specific health and disability items described include health insurance, health care utilization, participation in Federal disability programs, functional disability (i.e. ADLs and IADLs), work disability, and children's disability. The paper contains recommendations to more consistently collect health and disability data in SIPP. Although the goals of SIPP are to study the dynamics of Federal program participation and describe the income distribution of the population, since program participation and income are so closely influenced by health and disability, SIPP' s goals cannot be fully met until health and disability data are collected more consistently.

The Effect of Changes in the Federal Disability Programs on State and Local General Assistance Programs

Since early 1981, there has been a large-scale removal of persons from the SSI and Social Security disability programs as a result of the Social Security Disability Amendments of 1980. This article reports on the findings of a national survey designed to determine whether the removal of persons from the federal disability programs had an impact on state and local General Assistance programs and the extent to which older recipients of General Assistance are in need of long-term income assistance for health and other reasons.

The Effect of Changes in the Federal Disability Programs on State and Local General Assistance Programs

The Effect of Changes in the Federal Disability Programs on State and Local General Assistance Programs