Social Security Disability Insurance Research Articles

Modernizing the Ssdi Eligibility Criteria: A Reform Proposal that Eliminates the Outdated Medical-Vocational Grid

The Social Security Disability Insurance (SSDI) program, designed to assist individuals unable to work because of permanent disability, has grown substantially over the past 10 years. We document this growth, adjusting for the changing demographics of the US population, and find that the program is covering a higher percentage of the workforce over time despite the fact that actual disability rates are falling. We explain that the medical-vocational grid guidelines that are used to determine whether someone is disabled are an important part of the explanation for increased disability awards. The grid applies much looser standards for applicants as young as 45 and 50. We propose that age be eliminated as a deciding criterion, as well as language ability and education level. We also note that the guideline's list of impairments is outdated and needs to reflect a modern workforce that has access to remedying medical technologies.

Pathways Taken by New Social Security Disability Insurance and Supplemental Security Income Awardees

We use administrative data to examine the various milestones achieved and pathways followed by new Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) awardees. Our findings show that 80% of DI-first awardees and 53% of SSI-first awardees either achieved none of the milestones we tracked in the 10 years after their initial award or their only milestone was death or attainment of full retirement age. Furthermore, many DI and SSI awardees who achieved work- or program-related milestones during the analysis period did not make additional progress toward exiting the program. For example, one third of DI-first and one fifth of SSI-first awardees who enrolled in employment services had no other milestones and one quarter of DI-first awardees who completed a trial work period either had no other milestones or their only additional milestone was enrolling in employment services. We also found that approximately one quarter of SSI-beneficiaries who later received DI had their SSI benefits suspended and terminated due to excess income that included DI payments as the only additional milestones. Finally, our analysis reveals great diversity in the paths taken to achieve work- and program-related milestones, which policy makers should consider when designing interventions to help awardees return to work.

Social Security and Disability Due to Mental Impairment in Adults.

The Social Security Administration (SSA) oversees two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Adults with mental impairments represent a very large component of the programs. Policy makers and SSA are concerned about the accuracy of disability determination and also about low levels of labor force participation among individuals with disabilities. Adults with mental impairments are challenging to assess for work-related functional limitations. They are also a challenge to return to labor force participation. SSA has sponsored several demonstration research programs focusing on improving the accuracy of disability determination and on interventions in supported employment to return individuals with mental impairments to competitive employment. This article reviews the demonstration research focused on both entry into the disability system (at the "front door") and potential exit from it (through the "back door"). All of the research holds promise to "right-size" the SSA disability program.

The Effect of the Disability Insurance Application Decision on the Employment of Denied Applicants

Social Security Disability Insurance (SSDI) affects the labor supply of applicants through its work discouragement and through human capital deterioration regardless of the ultimate acceptance or denial of the claim. In this paper, I provide an estimate of the causal effect of SSDI application on denied applicants using non-applicants as a comparison group. Exploiting instrumental variable approach, I find that the SSDI causes a 36 percentage point reduction in employment of the denied applicants of ages 50 to 58 in the short run. The loss of potential employment of the denied SSDI applicants is a welfare loss to the society.

Work incentives in the Social Security Disability benefit formula

AbstractWe examine the connection between taxes paid and benefits accrued under the Social Security Disability Insurance (SSDI) program on both the intensive and extensive margins. We perform these calculations for stylized workers given the existing benefit structure and disability hazard rates. On the intensive margin, we examine the effect of an additional dollar of earnings on the marginal payroll taxes contributed and future benefits earned. We find that the present discounted value of disability benefits received from an additional dollar of earnings, net of the SSDI payroll tax, generally declines with age, becoming negative around age 40 and reaching almost zero at age 63. On the extensive margin, we determine the effect of working an additional year on the additional payroll taxes and future benefits as a percentage of income. The return to working an additional year at an income level just large enough to earn Social Security credits for the year is large and positive through age 60. However, the return to working an additional full year is substantially smaller and becomes negative at approximately age 57. Thus, older workers face strong incentives to earn enough to obtain creditable coverage through age 60, but they face disincentives for additional earnings. In addition, workers aged 61 and older face work disincentives at any level of earnings. We repeat this analysis for stylized workers at different levels of earnings and find that, while the program transfers resources from high earners to low earners, the workers experience similar patterns in the returns to working.

The Decline in the U.S. Labor Force Participation Rate

After peaking around the year 2000, the Labor Force Participation Rate (LFPR) of Americans declined substantially, falling faster after the financial crisis of 2007. Since 2015, the LFPR has remained at its lowest in four decades. In this paper, we produce a comprehensive review of the literature investigating the causes of the recent decline in LFPR. We include works from the academic literature as well as the gray literature from research institutes and labor market experts, and published and unpublished studies. The literature reviewed signals multiple causes behind this decline. The research on the extent to which the Great Recession had caused the decline establishes that most of it cannot be attributed to cyclical factors. Additionally, the literature examines the relative importance of trend factors, such as long-running demographic patterns, which explain at least part of the decline. The review includes articles that aim to quantify the impact of one or more factors through statistical or econometric analysis or economic modeling. Demographic trends, like the aging of the Baby Boom Generation, explain a large portion of the decline. The rest of the decline can be attributed to factors that affect the participation rates of specific subpopulations, such as technological innovations and trade, as well as to changes in social programs, such as Social Security Disability Insurance. Some subpopulation trends are clear, but their ultimate causes are not fully understood, as is the case for female and youth LFPRs. We list these factors and point to important areas for future research.

Layering, Kludgeocracy and Disability Rights: The Limited Influence of the Social Model in American Disability Policy

The United States has been a leader in the creation of disability rights law, providing a policy template for other nations. Yet the social model, the animating philosophy behind the disability rights movement, has had little effect on the wide range of welfare programs that serve people with disabilities. These programs, whose creation preceded the modern disability rights movement, reflect a medical model of disability that is at odds with the social model. Analysing the Americans with Disabilities Act (which embodies the social model) and Social Security Disability Insurance (the largest welfare program for people with disabilities), we explore how and why this layering of contradictory disability rights and welfare programs developed and how it has been maintained. We argue that the tension between these policies engendered a series of patches, or ‘kludges’, that allow the policies to coexist without meaningful synthesis. We contend that the United States is particularly prone to this layering of ‘tense policies’, but that it is likely characteristic of disability policy in many nations. Finally we argue that accurate benchmarking of disability rights regimes across nations requires analysts to dig through all the layers of disability policy.

Predicting Receipt of Social Security Administration Disability Benefits Using Biomarkers and Other Physiological Measures: Evidence From the Health and Retirement Study.

The objective of this study was to assess how well physiological measures, including biomarkers and genetic indicators, predict receipt of Social Security Administration (SSA) disability benefits among U.S. adults aged 51 to 65 years. We used data from the 2006 to 2012 waves of the Health and Retirement Study (HRS), linked to SSA administrative data. Using logistic regression, we predicted benefit receipt (either Social Security Disability Insurance or Supplemental Security Income) using 19 distinct physiological markers, adjusting for age, sex, race, and select medication use. We then calculated the propensity (i.e., predicted probability) that each HRS respondent received benefits and assessed how well propensity score-based classifications could identify beneficiaries and nonbeneficiaries. Thirteen percent of respondents received benefits. Using the propensity score cut point that maximized the sum of sensitivity and specificity, the model correctly predicted 75.9% of beneficiaries and 73.5% of nonbeneficiaries. Physiological measures have moderate power to predict SSA disability benefit receipt.

Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults

Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown. To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures. This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS). Self-reported SNAP participation in 2011. Total health care expenditures (all paid claims and out-of-pocket costs) in the 2012-2013 period. To test whether SNAP participation was associated with lower subsequent health care expenditures, we used generalized linear modeling (gamma distribution, log link, with survey design information), adjusting for demographics (age, gender, race/ethnicity), socioeconomic factors (income, education, Social Security Disability Insurance disability, urban/rural), census region, health insurance, and self-reported medical conditions. We also conducted sensitivity analyses as a robustness check for these modeling assumptions. A total of 4447 participants (2567 women and 1880 men) were enrolled in the study, mean (SE) age, 42.7 (0.5) years; 1889 were SNAP participants, and 2558 were not. Compared with other low-income adults, SNAP participants were younger (mean [SE] age, 40.3 [0.6] vs 44.1 [0.7] years), more likely to have public insurance or be uninsured (84.9% vs 67.7%), and more likely to be disabled (24.2% vs 10.6%) (P < .001 for all). In age- and gender-adjusted models, health care expenditures between those who did and did not participate in SNAP were similar (difference, $34; 95% CI, -$1097 to $1165). In fully adjusted models, SNAP was associated with lower estimated annual health care expenditures (-$1409; 95% CI, -$2694 to -$125). Sensitivity analyses were consistent with these results, also indicating that SNAP participation was associated with significantly lower estimated expenditures. SNAP enrollment is associated with reduced health care spending among low-income American adults, a finding consistent across several analytic approaches. Encouraging SNAP enrollment among eligible adults may help reduce health care costs in the United States.

Social Security Disability Insurance Enrollment and Health Care Employment.

To examine the relationship between Social Security Disability Insurance (SSDI) enrollment and health care employment. State-year level data from government and other publicly available sources for all states (2000-2014). Population-weighted linear regression analyses model associations between each health care employment measure and each SSDI enrollment measure (i.e., SSDI overall, physical, or mental health enrollment rates), controlling for factors associated with health care employment, state fixed effects, and secular time trends. Data are gathered from publicly available sources. A one standard deviation increase in SSDI enrollment per 100,000 population is associated with a statistically significant 2.6 and 4.5 percent increase in the mean employment rate per 100,000 population for health care practitioner and technical occupations and health care support occupations, respectively. The size of this relationship varies by the type of disabling condition for SSDI enrollment (physical versus mental health). Social Security Disability Insurance enrollment is significantly associated with health care employment at the state level. Quantifying the magnitude of this relationship is important given high SSDI enrollment rates as well as evolving policy and demographic shifts related to the SSDI program.

Firm-Level Early Intervention Incentives: Which Recent Employers of Disability Program Entrants Would Pay More?

The declining economic status of people with disabilities and the predicted 2016 depletion of the Social Security Disability Insurance (DI) Trust Fund have generated considerable interest in propos...

Cognitive Predictors of Work Among Social Security Disability Insurance Beneficiaries With Psychiatric Disorders Enrolled in IPS Supported Employment.

Impaired cognitive functioning is a significant predictor of work dysfunction in schizophrenia. Less is known, however about relationships of cognition and work in people with less severe disorders with relatively normal cognitive functioning. This secondary analysis evaluated cognitive predictors of work in Social Security Disability Insurance (SSDI) beneficiaries with a recent work history who were randomized to receive mental health services, supported employment, and freedom from work disincentives over a 2-year study period in the Mental Health Treatment Study. Of the 1045 participants randomized to the treatment package, 945 (90.4%) received a cognitive assessment at study entry. Competitive work activity was evaluated using a computer-assisted timeline follow-back calendar at baseline and quarterly for 24 months. Mood disorders were the most common psychiatric diagnoses (64.9%), followed by schizophrenia or schizoaffective disorder (35.1%). Tobit regression analyses predicting the average number of hours worked per week, controlling for demographic characteristics, diagnosis, and work history indicated that the cognitive composite score (P < .01) and verbal learning subscale scores (P < .001) were associated with fewer hours of weekly work over the study period. Cognitive functioning predicted work over 2 years in SSDI beneficiaries with mood or schizophrenia-spectrum disorders who were receiving supported employment and mental health interventions, despite a relative absence of cognitive impairment in the study participants. The findings suggest cognitive functioning contributes to competitive work outcomes in persons with psychiatric disorders who have relatively unimpaired cognitive abilities, even under optimal conditions of treatment and vocational support.

Son of Sam, Service-Connected Entitlements, and Disabled Veteran Prisoners

American veterans have been over-represented in the United States carceral system since at least the Vietnam War era. Prior to 1980, veterans who were wounded in the line of duty were entitled to hard-earned, service-connected disability benefits regardless of post-service involvement in the civilian criminal justice system. In 1979, the American media began running sensationalized stories detailing alleged abuse of the Social Security Disability Insurance (SSDI) program by notorious prisoners, including New York “Son of Sam” mass murderer, David Berkowitz. In response to the outcry over these well-publicized accounts of prisoner SSDI abuse, Congress enacted a law, 38 U.S.C. § 5313, that stripped certain veteran prisoners of their service-connected disability benefits. This Article argues that the federal law that strips disabled, justice-involved veterans of their service-connected benefits as the result of non-service-connected misconduct should be repealed. Section 5313 is unjust, unwarranted, and unproductive, for at least five reasons. First, Congress enacted the statute to realize federal cost savings at the expense of a politically and socially vulnerable population: disabled, justice-involved veterans. Second, the statute is grounded in faulty logic and a fundamental misunderstanding of the nature and purpose of the Department of Veterans Affairs (VA) disability compensation program. Third, Congress stripped disabled, justice-involved veterans of their service-connected disability benefits largely as a result of its erroneous conflation of VA disability compensation and SSDI benefits. Fourth, Section 5313 fails to take into account the evidence-based nexus between military service trauma and post-service mental health issues and related criminal behavior. Finally, revoking service-connected disability benefits impedes justice-involved veteran rehabilitation, reentry, and readjustment.

Patterns of psychiatric emergency department utilization among community-dwelling Medicare beneficiaries under 65.

This study estimated patterns and trends in all-cause (any reason, including psychiatry related) and psychiatric emergency department (ED) utilization among Medicare beneficiaries under 65 who were residing in community settings (i.e., noninstitutionalized or in their own homes). Medicare beneficiaries under the age of 65 enrolled in Medicare for Social Security Disability Insurance (SSDI) due to permanent physical or mental disabilities are a population with poor health conditions and high utilization of health services; however, this vulnerable population has received limited attention from researchers and policymakers compared to the Medicare beneficiaries 65 years and older. Data from the 2002-2009 Medicare Current Beneficiary Survey (MCBS) with linked Medicare administrative claims data were used to select a total of 4,864 Medicare beneficiaries under the age of 65 with a total of 10,384 person-years (weighted n = 30,086,846 person-years). We found that trends in all-cause and psychiatric ED utilization among the young and disabled Medicare beneficiaries remained stable, but trends in the proportion of all-cause ED visits that were psychiatric related increased, and trends in the proportion of psychiatric ED visits resulting in a psychiatric inpatient stay decreased over time. Factors associated with a higher likelihood of psychiatric ED utilization included younger age, residence in the Northeast region, lower education level, Medicare-Medicaid dual eligibility, use of psychotropic medication, and greater number of chronic and psychiatric conditions. These findings highlight the need for policies, programs, and system interventions designed to reduce future psychiatric ED events and improve the access and quality of community mental health services for the community-dwelling, young, and disabled Medicare population. (PsycINFO Database Record

SSI/SSDI Outreach, Access, and Recovery (SOAR): Disability Application Outcomes Among Homeless Adults.

The SSI/SSDI Outreach, Access, and Recovery (SOAR) program has been shown to increase access to Supplemental Security Income and Social Security Disability Insurance benefits among homeless adults. However, little empirical data exist on how or for whom SOAR achieves successful application outcomes. This study investigated applicant and application characteristics associated with disability application outcomes among homeless adults. Secondary data on 6,361 SOAR-assisted applications were obtained. Multilevel models investigated between-applicant differences in application processing time and decision as a function of applicant and application characteristics. Older age and living in an institution were associated with greater odds of application approval. Female gender and receipt of public assistance were associated with longer processing time and lower odds of approval. Except for quality review, SOAR critical components were associated with greater odds of approval. Women and adults receiving public assistance appear disadvantaged in the SOAR application process. SOAR critical components promote successful disability application outcomes.

Characteristics and Employment of Applicants for Social Security Disability Insurance over the Business Cycle

Abstract We investigate the relationship between the unemployment rate and characteristics of applicants for Social Security Disability Insurance using administrative records of the universe of applicants between 1991 and 2008. As the unemployment rate rises, applications shift to those with higher work capacity who are rejected early in the eligibility determination process and have higher pre-application earnings and employment. However, post-application earnings and employment of denied applicants are slightly negatively related to the unemployment rate, suggesting that both compositional changes toward applications with higher work capacity and adverse economic conditions affect their employment and earnings.

Effects of Medicare Coverage for the Chronically Ill on Health Insurance, Utilization, and Mortality

I study the effect of the 1973 expansion of Medicare coverage to individuals with End-Stage Renal Disease (ESRD) on insurance coverage, health care utilization, and mortality. Between the ESRD expansion and a simultaneous expansion of Medicare coverage to long-term Social Security Disability Insurance (SSDI) recipients, insurance coverage increased by 4.4 to 8.3 percentage points and the bulk of the increase in insurance coverage was due to an increase in Medicare coverage. The expansion was also associated with an increase in physician visits and a seven log point reduction in mortality from kidney disease, which I replicate in cross-country comparisons. Lastly, I provide evidence for two mechanisms that affected mortality: 1) an increase in access to and use of treatment, which is plausibly driven by changes in insurance coverage; and 2) an increase, by 1975, in entry of dialysis clinics in areas with a greater burden of kidney disease in 1971. Based on changes in the ages at which people died form kidney disease and all other causes, the ESRD program cost between $29000 and $245000 per life year saved, which includes a range of welfare improving values.

The Decentralization of Social Assistance and the Rise of Disability Insurance Enrolment

Fiscal decentralization, the decentralization of government expenditures to local governments, may enhance public sector efficiency. Vertical externalities, i.e. spillovers between local and central government, could however undo part of this advantage. In this paper we estimate spillovers from Social Assistance (SA), administered by municipalities, towards central government’s Social Security Disability Insurance (SSDI) scheme in The Netherlands. The latter scheme saw rapidly rising enrolment rates after financial responsibility for Social Assistance was transferred from central to local government. We find that the correlation between local SSDI enrolment and the local stock of SA benefits recipients has increased significantly in the years after decentralization. We show that an increased caseload shifting from Social Assistance to Disability Insurance is the only plausible explanation for this change. Our analysis shows that, following the decentralization of Social Assistance, at least one third of the SSDI inflow was diverted from SA. This caseload shifting increased more rapidly in municipalities experiencing deficits on their SA budgets than in municipalities running a surplus.

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

The Connection Between Social Security Disability Insurance and High Unemployment

Even as national unemployment has fallen, counties with persistently high unemployment also have more disability.