Supplemental Security Income Participation Research Articles

Effects of Medicaid Expansions 2001–2015 on Supplemental Security Income Program Participation Among Childless Adults

Growing research indicates that Medicaid expansions reduce Supplemental Security Income (SSI) participation, although the magnitude of effects may vary with the presence of other health policy reforms. We examine how a series of Medicaid expansions for childless adults before and after implementation of the Patient Protection and Affordable Care Act (ACA) impact SSI participation among childless adults. We use the Medical Expenditure Panel Survey to compare the change in SSI participation in states that expanded Medicaid coverage relative to those that did not during two time periods: 2001–2013 and 2001–2015. On average, SSI participation declined by a nonstatistically significant 0.10 percentage points (95% confidence interval [CI] = [−0.54, 0.32]) from a baseline SSI participation rate of 2.2% following Medicaid expansions implemented between 2001 and 2015. When restricted to the pre-ACA era, SSI participation declined by a nonstatistically significant 0.30 percentage points (95% CI = [−0.77, 0.16]). Although the direction of the point estimates suggests that Medicaid expansions before and after implementation of the ACA may be associated with reduced SSI participation, the imprecision of the estimates due in part to the sample size precludes this conclusion. To guide states in decision-making, it is essential to understand how increased Medicaid availability impacts SSI participation under different policy environments.

Medicaid Expansions and Participation in Supplemental Security Income by Noncitizens.

Objectives. To estimate the effect of Medicaid expansion on noncitizens' and citizens' participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program.Methods. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation.Results. Medicaid expansion reduced the SSI (disability) participation of nonelderly noncitizens by 12% and of nonelderly citizens by 2%. Estimates remained robust with administrative and survey data.Conclusions. Medicaid expansion caused a substantially larger decline in the SSI participation of noncitizens, who face more restrictive SSI eligibility criteria, than of citizens. Our estimates suggest an annual savings of $619 million in the federal SSI cost because of the decline in SSI participation among noncitizens and citizens.

Contemporaneous and long-term effects of children’s public health insurance expansions on Supplemental Security Income participation

This study explores the interplay between two important public programs for vulnerable children: Medicaid and the Supplemental Security Income (SSI) program. Children’s public health insurance eligibility increased dramatically during the late 1990s with the launch of the Children’s Health Insurance Program along with concurrent Medicaid expansions. We use a measure of simulated eligibility as an exogenous source of variation in Medicaid generosity to identify the effects of the eligibility expansions on SSI outcomes. Though increases in eligibility for public health insurance did not affect contemporaneous youth SSI applications or awards on average, expansions in coverage significantly decreased both applications and awards in states where SSI recipients did not automatically receive Medicaid. We attribute the difference in findings to the higher transactions costs associated with entering Medicaid via SSI in such states. In the long-term, increased public insurance eligibility during childhood reduces young adult SSI applications to some extent, consistent with recent findings that Medicaid coverage in youth improves adult health and economic outcomes.

Early coverage expansions under the Affordable Care Act and Supplemental Security Income participation

Abstract We test whether early Affordable Care Act (ACA) Medicaid expansions in Connecticut (CT), Minnesota (MN), California (CA), and the District of Columbia (DC) affected Supplemental Security Income (SSI) receipt. We use a synthetic control approach, comparing the SSI receipt rate pre and post each early Medicaid expansion (“Early Expanders”) to the weighted receipt rate in states that expanded Medicaid in January 2014 (“Later Expanders”). In CT, the Medicaid expansion is associated with a statistically significant, 7 percent reduction in SSI beneficiaries among individuals aged 18–64. For DC, MN and CA, we do not find consistent evidence that the Medicaid expansions affected disability-related outcomes.

Medicaid Expansion And State Trends In Supplemental Security Income Program Participation.

The Affordable Care Act made low-income nonelderly adults eligible for Medicaid in 2014 without requiring them to obtain disabled status through the Supplemental Security Income (SSI) program. In states that participated in the Medicaid expansion, we found that SSI participation decreased by about 3percent after 2014.

The effect of expanding Medicaid eligibility on Supplemental Security Income program participation

Low-income adults without dependent children have historically had few paths to obtain public health insurance unless they qualified for Supplemental Security Income (SSI) cash benefits because of a disability. However, in states that expand their Medicaid programs, childless adults may obtain Medicaid without undergoing an intensive SSI disability review process and with substantially higher income and assets than the SSI program allows. This expanded availability of Medicaid coverage, independent of SSI participation, creates an opportunity to increase earnings and savings without jeopardizing health insurance coverage. In this paper, we use the natural experiments created by state decisions to expand Medicaid to nondisabled, nonelderly adults without dependent children to study the effect of decoupling Medicaid eligibility and cash assistance using a difference-in-differences study design. We collected data on the income eligibility limits, enrollment caps, and coverage characteristics of state Medicaid expansions to childless adults from 2001 to 2013. We combine these data with the nationally representative American Community Survey to estimate the effects of state expansion on SSI participation. We find relative declines in SSI participation of 0.17 percentage points on average after the introduction of Medicaid coverage for childless adults, a 7% relative decrease. This finding suggests the potential for small but important efficiency gains from separating SSI and Medicaid eligibility.

Geographies of medicalized welfare: Spatial analysis of supplemental security income in the U.S., 2000–2010

In the post-1996 welfare reform period in the U.S., disability assistance has become a significant source of government aid for low-income residents as other forms of public support have faced considerable reductions and restrictions. In order to qualify for Supplemental Security Income (SSI) – a means-tested assistance program that provides income stipends to qualified residents – working-age individuals with disabilities must have little income and resources, and procure medical documentation that confirms that they are unable to work due to a disability. The result of rising SSI enrollment in the face of cutbacks to other government programs is the increasing medicalization of welfare, whereby receipt of welfare benefits is contingent on a medical diagnosis of disability. Using county-level data from the American Community Survey and the Social Security Administration, this paper examines the changing spatial patterns of SSI participation of the working-age population in 2000 and 2010 across the U.S. in addition to the interconnections between disability, welfare, and poverty. Results from spatial analyses illustrate geographic variation in SSI prevalence, with distinctive spatial clusters of higher than average SSI participation in the southeast and Appalachian regions of the U.S. and in northern California. Multiple linear regression model results reveal that SSI participation is significantly correlated with disability, poverty, race, family type, and level of education in both 2000 and 2010. The findings suggest that spatial concentrations of disability, poverty, and underemployment persist in largely rural areas. The discussion explores the potential social and economic implications of long-term SSI clustering on localities and residents, and points to future research directions.

The Effect of Expanding Medicaid Eligibility on Supplemental Security Income Program Participation

Low-income adults without dependent children have historically had few paths to obtain public health insurance unless they qualified for Supplemental Security Income (SSI) cash benefits because of a disability. However, in states that expand their Medicaid programs, childless adults may obtain Medicaid without undergoing an intensive SSI disability review process and with substantially higher income and assets than the SSI program allows. This expanded availability of Medicaid coverage, independent of SSI participation, creates an opportunity to increase earnings and savings without jeopardizing health insurance coverage. In this paper, we use the natural experiments created by state decisions to expand Medicaid to nondisabled, nonelderly adults without dependent children to study the effect of decoupling Medicaid eligibility and cash assistance using a difference-in-differences study design. We collected data on the income eligibility limits, enrollment caps, and coverage characteristics of state Medicaid expansions to childless adults from 2001-2013. We combine these data with the nationally representative American Community Survey to estimate the effects of state expansion on SSI participation. We find relative declines in SSI participation caused by Medicaid expansions of 0.17 percentage points, a 7% relative decrease; this finding suggests the potential for small but important efficiency gains from separating SSI and Medicaid eligibility.

Economic Conditions and SSI Applications

The Supplemental Security Income (SSI) program provides federally-funded income support for individuals with disabilities, and has become one of the most important means-tested transfer programs in the United States. Previous studies have examined the effects of economic conditions on growth in disability caseloads, but most focus on the Social Security Disability Insurance (SSDI) program. Most work on SSI dates from before welfare reform, which had both direct and indirect effects on the composition of the population at risk for SSI participation. In this paper we examine the relationship between SSI application risk and economic conditions between 1996 and 2010, using data from the Survey of Income and Program Participation (SIPP) linked to the Social Security Administration’s 831 file, which includes monthly data on SSI (and SSDI) application and receipt. Results from hazard models suggest that higher state unemployment rates have a large, positive effect on the risk of SSI application among jobless individuals, and our evidence suggests that female potential applicants may be more responsive to local economic conditions than men. State-level TANF policies have no effect on SSI application risk but state fiscal distress significantly increases application risk. Given the continued growth of the SSI program, understanding these relationships is increasingly important and policy-relevant.

Long term earnings and disability program participation outcomes of the Bridges transition program

BACKGROUND: The Bridges from School to Work (Bridges) program provides job placement and supports for youth with disabilities. Operating in nine sites across the country, over 18,000 youth have received job placement services through Bridges. OBJECTIVE: The paper presents long-term outcomes of youth who participate in the study to determine if previously documented short-term outcomes continue into adulthood. METHODS: We examine the earnings of Bridges participants up to age 30. We present longitudinal statistics on the earnings and Supplemental Security Income (SSI) and Social Security Disability Insurance (DI) program participation of youth placed by Bridges into a job. A comparison with similarly aged youths receiving SSI who did not participate in Bridges is also made. RESULTS: At age 30, almost three quarters of youth placed by Bridges have earnings. We also find that SSI participation declines through age 30 and DI participation increases. Among placed youth who received SSI at the time of Bridges enrollment, half have earnings at age 30 and less than half received SSI payments; however, over one quarter receive DI benefits. CONCLUSIONS: Bridges participation potentially helps create a higher earnings capacity for participants; however, more research is necessary to establish a causal effect.

SSI Participation Among the Elderly: A Hazard Model Approach

This study revisits the historic policy concern over nonparticipation in the Supplemental Security Income (SSI) program. The most contemporary research model suggests that from a cross-sectional perspective, the elderly take-up decision is primarily determined by the financial situation of the eligible individuals. Yet extant studies have yet to establish a longitudinal model of SSI participation that explicitly takes into account the changing circumstances of the elderly. As such, this study extends the current literature by exploring the time-varying processes leading to eventual take-up of benefits among the elderly. Methodologically, the research relies on event history analysis of data from the Health and Retirement Study spanning the years 1996 to 2006 to explain the varying rates of participation over time as well as the role of life events on the take-up decision.

What is the Long-Term Impact on Zebley Kids?

In 1990, the U.S. Supreme Court decision in the Sullivan v. Zebley case fundamentally changed, albeit temporarily, the criteria under which children qualified for the Supplemental Security Income (SSI) program based on disability. Instead of a system based on medical criteria alone, 1996 enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) tied children’s eligibility for SSI, in part, to the effects of their medically determinable impairments on their ability to function day-to-day in age-appropriate activities at home, at school, and in their communities. This paper examines what happened to the Zebley cohort after the age of 18 relative to cohorts who received SSI payments under stricter criteria. This paper evaluates the long-term impact on educational attainment, earnings, SSI and Social Security Disability Insurance (SSDI) participation, and other markers of adult development for the Zebley cohort. We find that, overall, SSI receipt in childhood is associated with more positive outcomes than negative ones. The Zebley cohort has a longer attachment to the labor force and a lower likelihood of welfare receipt in adulthood, but also a higher likelihood of lacking health insurance coverage. In addition, those with health conditions most likely to be affected by the new evaluation criteria appear to substitute welfare benefits for disability benefits. These results are consistent with the hypothesis that SSI receipt at the margin improves adult outcomes.

Is participation in food and income assistance programmes associated with obesity in California adults? Results from a state-wide survey

Public assistance programmes may increase risk of obesity among adults. The current study assessed whether participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program), Supplemental Security Income (SSI) or California Work Opportunities and Responsibilities to Kids (CalWorks) was associated with obesity, independent of socio-economic status and food insecurity. A cross-sectional analysis of the 2007 Adult California Health Interview Survey. Outcome measures included BMI and obesity. Distribution of BMI and prevalence of obesity were compared by participation in each programme, using weighted linear and binomial regression models in which BMI or obesity was the outcome, respectively, and programme participation was the predictor. A population survey of various health measures. Non-institutionalized adults (n 7741) whose household income was ≤130% of the federal poverty level. The prevalence of obesity was 27.4%. After adjusting for sociodemographic characteristics, food insecurity and participation in other programmes, the prevalence of obesity was 30% higher in SNAP participants (95% CI 6%, 59%; P=0.01) than in non-participants. This association was more pronounced among men than women. SSI participation was related to an adjusted 50% higher prevalence of obesity (95% CI 27%, 77%; P<0.0001) compared with no participation. SNAP and SSI participants also reported higher soda consumption than non-participants of any programme. CalWorks participation was not associated with obesity after multivariable adjustment. Participation in SNAP or SSI was associated with obesity independent of food insecurity or socio-economic status. The suggestion that these associations may be mediated by dietary quality warrants further investigation among low-income populations.

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.

Public Health Insurance and SSI Program Participation Among the Aged

Previous researchers have noted that the 'categorical' Medicaid eligibility accompanying the welfare programs Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) often far exceeds the value of these programs' cash benefits. It may be the case that the accompanying health insurance, not the cash benefit, is often the decisive factor in welfare participation. If so, welfare participation should decrease when cash and health insurance benefits are unbundled. We present a simple model of program participation with heterogeneous valuation of health insurance and transaction costs of participation. We evaluate the following four implications of the model: 1) SSI participation declines with the expansion of alternative routes to Medicaid (i.e., non-categorical Medicaid); 2) the availability of non-categorical Medicaid increases Medicaid participation among SSI nonparticipating eligibles; 3) the average SSI benefit collected by welfare recipients is higher when non-categorical Medicaid is available; and 4) the average SSI benefit rejected by nonparticipating SSI eligibles is higher when non-categorical Medicaid is available. Overall, the findings on the model's testable implications are mixed. The estimates imply strikingly large effects of the presence of alternative routes to Medicaid on both SSI and Medicaid participation, but the results for the hypotheses about SSI benefit amounts are sensitive to controls for recipient characteristics.

The Incredible Shrinking Program

Supplemental Security Income (SSI) program features have changed little since 1974, and elderly participation has declined over time. A behavioral model of aged household SSI participation is used to simulate various policy alternatives. The failure to index asset limits has had little effect on participation, but the indexation of both asset and income disregard limits would have raised the SSI participation rate of aged households by about 30%. If, in addition, states had been required to hold the real value of their supplemental benefits constant over time, the elderly household SSI participation rate would have doubled. Finally, the model is used to estimate the impact of a recent policy change, the increase in the normal retirement age (NRA) in the regular Social Security system. When fully phased in, the increase in the NRA is predicted to raise the SSI participation of elderly households from 4.9% to 7.8%.

Transitions from Afdc to Ssi Prior to Welfare Reform - Policy Brief

The Supplemental Security Income (SSI) and Temporary Assistance for Needy Families (TANF) programs serve overlapping target groups. SSI serves adults and children with disabilities from low-income families, while TANF serves low-income families with children. Consequently, policy changes in one program can affect the other. The target group for Aid to Families with Dependent Children (AFDC), TANF's predecessor, also overlapped with SSI's target group. Many have anticipated that the replacement of AFDC with TANF in August 1996 would eventually increase SSI participation as TANF recipients with disabilities sought SSI benefits to avoid TANF work requirements and time limits.

The Effects of Changes in State SSI Supplements on Preretirement Labor Supply

Because the Supplemental Security Income (SSI) program has both income limits and asset limits, those on the margin of eligibility for the elderly component of the program face incentives to reduce labor supply prior to becoming eligible. The authors’ past research relying on cross-state variation in SSI benefits found evidence of negative labor supply effects. However, a reliance on cross-state variation implied less than ideal control samples. In contrast, this article uses CPS data covering a twenty-two-year period, which permits identifying the effects of SSI from within-state, time-series variation in SSI benefits, using a better control sample. The evidence points consistently to negative effects of more generous SSI payments on the labor supply of likely SSI participants aged sixty-two to sixty-four. For those with a high probability of SSI participation, the implied elasticities of employment and hours with respect to benefits are generally in the range of -0.2 to -0.3.

Living Arrangements and Supplemental Security Income Receipt Among the Aged

Declines in health and financial resources lead many older Americans to turn to coresidence and the Supplemental Security Income (SSI) program for support. A growing literature examines coresidence choices and SSI participation, stressing the importance of each for vulnerable aged persons. Little research, however, considers how these processes intersect. Because SSI provides Medicaid access but reduces benefits if one shares a residence, the program alters both the necessity of and the incentives for coresidence. We explore interactions between SSI participation and living arrangements by developing two joint models of the two decisions for members of the SSI-eligible population. In these models, we express the probability of SSI receipt and living with kin and joint SSI-living arrangement states as functions of individual and family attributes. We estimate model parameters using data from the 1990 to 1993 panels of the Survey of Income and Program Participation (SIPP) matched to administrative records on earnings and program participation. Our results provide tentative support for the hypothesis that these two processes should be considered jointly.

Living Arrangements and Supplemental Security Income Receipt Among the Aged

Declines in health and financial resources lead many older Americans to turn to coresidence and the Supplemental Security Income (SSI) program for support. A growing literature examines coresidence choices and SSI participation, stressing the importance of each for vulnerable aged persons. Little research, however, considers how these processes intersect. Because SSI provides Medicaid access but reduces benefits if one shares a residence, the program alters both the necessity of and the incentives for coresidence. We explore interactions between SSI participation and living arrangements by developing two joint models of the two decisions for members of the SSI-eligible population. In these models, we express the probability of SSI receipt and living with kin and joint SSI-living arrangement states as functions of individual and family attributes. We estimate model parameters using data from the 1990 to 1993 panels of the Survey of Income and Program Participation (SIPP) matched to administrative records on earnings and program participation. Our results provide tentative support for the hypothesis that these two processes should be considered jointly.