Supplemental Security Income Program Research Articles

Nudging Timely Wage Reporting: Field Experimental Evidence from the U.S. Supplemental Security Income Program

We study a large-scale (n = 50,000) natural field experiment implemented by the U.S. Social Security Administration aimed at increasing the timely and accurate self-reporting of wages by Supplemental Security Income (SSI) recipients. A letter reminding SSI recipients of their wage reporting responsibilities significantly increased both the likelihood of reporting any earnings and the total earnings reported. However, the specific letter content—providing social information or highlighting the salience of penalties—had no systematic effect. We develop a conservative estimate that the letters generated roughly $5.91 in savings per dollar spent, highlighting the value of such a nudge in this important context. This paper was accepted by Yan Chen, behavioral economics and decision analysis. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2022.4645 .

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.

Participant characteristics and dietary correlates of SNAP and other assistance programs among families with children from racially and ethnically diverse households

The objective of this study was to describe food purchasing behaviors and the home food environment across families simultaneously receiving SNAP (Supplemental Nutrition Assistance Program) and other cash and food assistance benefits, and assess how child dietary intake varied across three distinct categories of assistance (i.e., SNAP and other assistance programs, assistance programs other than SNAP, and not enrolled in any assistance program). This cross-sectional study was conducted with parents of children aged 5–9 years (N = 1033) from low-income and racially and ethnically diverse households, living in Minneapolis and Saint Paul, Minnesota, metropolitan areas. In an online survey, parents reported enrollment in seven assistance programs (SNAP, WIC [Special Supplemental Nutrition Program for Women, Infants and Children Program], free or reduced-cost school breakfast, free or reduced-cost school lunch, SSI [Supplemental Security Income Program], MFIP [Minnesota Family Investment Program], daycare assistance), food purchasing behaviors, the home food environment, and child dietary and fast-food intake. Descriptive statistics were computed to describe food purchasing behaviors and the home food environment. Multivariable linear regressions were used to evaluate the association between assistance categories and child dietary intake factors. Models were adjusted for child age, parent and child sex, race and ethnicity, household income, primary caregiver's educational attainment, employment status, and place of birth. Relative to families participating in assistance programs other than SNAP and not enrolled in any assistance program, families participating in SNAP and other assistance programs had less reliable modes of transportation to go food shopping (use ‘my own car or vehicle’ 57% vs. 90% and 83%, respectively), shopped less frequently during the month ('1 big trip a month and small trips in between’ 35% vs. 19% and 24%, respectively], had a somewhat higher presence of energy-dense (e.g., ‘French fries’ 60% vs. 35% and 25%, respectively) and high-sodium food items in the home (e.g., ‘canned pasta’ meals 48% vs. 35% and 20%, respectively), and some aspects of children's dietary intake that were not congruent with current dietary recommendations (e.g., consumption of ‘fried vegetables’ 3.9 times/week [95% CI 3.4, 4.4] vs. 2.9 [2.3, 3.5] and 2.8 [2.1, 3.6], respectively). Findings could inform targeted strategies to maximize the impact of simultaneous programs' benefits on improving child dietary intake and reaching eligible households not enrolled in assistance programs.

National and State Trends in autistic Adult Supplemental Security Income Awardees: 2005-2019.

This paper used Social Security Administration program data from 2005 to 2019 to examine national- and state-level changes in the number of new adult supplemental security income (SSI) awardees on the autism spectrum relative to awardees with intellectual disability and other mental health disorders. We identified three main findings: the number of autistic awards increased between 2005 and 2019 when awards for all other mental health disorders declined; roughly nine out of every 10 autistic adult awardees were between ages 18-25years; there was variation in the growth of autistic awards across states. These findings support the need to consider geographic and age differences in SSI program participation among autistic adults and determine the underlying causes.

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.

The Inequities of the Supplemental Security Income Program: The Need for Policy Change.

Farkhanda I. Farooqi, DNPc, MSN, AGPCNP-BC, FSMHNP, BSN, RN, FN-CSA, is a family psychiatric mental health nurse practitioner who provides integrative care for a multitude of dual diagnosis patients. She has experience in geriatrics, emergency trauma, mental illness crisis interventions, sexual assault trauma intervention, and extensive experience with special needs children for almost 27 years with a broad range of experience in the specialty. She is a DNP candidate at Saint Peter's University in New Jersey, the mother of four adult children, and has recently joined Fairleigh Dickenson University where she is studying family psychiatric mental health to achieve her board certification as a nurse practitioner in family psychiatry mental health in mid-2021. Address correspondence to Farkhanda I. Farooqi, DNPc, MSN, AGPCNP-BC, FSMHNP, BSN, RN, FN-CSA, 25 Deerwood Trail W, Warren, NJ 07059 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected]. If you have an idea you would like to discuss, send your contact information by e-mail and you will be contacted via your preferred method. The author reports no conflict of interest.

Trends in Supplemental Security Income Payments to Adults With Autism.

This study used Social Security Administration program data to identify population-level trends in Supplemental Security Income (SSI) program participation and payments to adult recipients with autism spectrum disorder (ASD) relative to recipients with intellectual disability and other mental disorders. The authors examined SSI program data from 2005 to 2015. Variables included caseload size, number of new adult awardees per year, total annual SSI payments per disability group, and average annual SSI payment per recipient. Adults with ASD represented a growing share of the total first-time SSI awards given to adults with mental disorders, with percentages increasing from 1.3% in 2005 to 5.0% in 2015. In 2015, 158,105 adults with ASD received SSI benefits, a 326.8% increase since 2005. Federal SSI payments to adults with ASD increased by 383.2% during the same period (totaling roughly $1.0 billion in 2015). The annual average payment for adults with ASD was $6,527.40 in 2015. The purpose of the SSI program is to reduce the extent of poverty by providing monthly payments to eligible individuals with disabilities. The authors found that a large and growing number of adults with autism receive SSI benefits. This finding underscores the importance of future research related to the economic security of adults on the autism spectrum.

Trends Over Time and Jurisdiction Variability in Supplemental Security Income and State Supplementary Payment Programs for Children With Disabilities.

Nearly 1.2 million children with disabilities received federally administered Supplemental Security Income (SSI) payments in 2017. Based on a robust review of research and evaluation evidence and microsimulations, The National Academies of Sciences, Engineering, and Medicine committee identified modifications to SSI (ie, increasing the federal SSI benefit maximum by one-third or two-thirds) as 1 of 10 strategies that could reduce the US child poverty rate, improving child health and well-being on a population level. Describing the availability and amount of SSI and State Supplementary Payment (SSP) program benefits to support families of children with disabilities may be a first step toward evaluating The National Academies of Sciences, Engineering, and Medicine-proposed modification to SSI as a potential poverty alleviation and health improvement tool for children with disabilities and their families. We used public health law research methods to characterize the laws (statutes and state agency regulations) governing the federal SSI program and SSP programs in the 50 states and District of Columbia from January 1, 1996, through November 1, 2018. The number of jurisdictions offering supplementary payments (SSP) was relatively stable between 1996 and 2018. In 2018, 23 US jurisdictions legally mandated that SSP programs were available for children. Among the states with SSP payment amounts in their codified laws, SSP monthly benefit amounts ranged from $8 to $64.35 in 1996 and $3.13 to $60.43 in 2018. Our initial exploration of SSI-related policies as a tool for improving the economic stability of children with disabilities and their families suggests that current SSPs, in combination with SSI, would not rise to the level of SSI increases proposed by The National Academies of Sciences, Engineering, and Medicine. Understanding more about how SSI and SSP reach children and work in combination with other federal and state income security programs may help identify policies and strategies that better support children with disabilities in low-income households.

When One Size Does Not Fit All: Modernizing the Supplemental Security Income Program

The federal Supplemental Security Income (SSI) program is an important part of the safety net in the United States, paying means-tested benefits to children with disabilities, nonelderly adults with disabilities, and elderly individuals. In this article, we describe the eligibility criteria for the program, how these have changed over time, and the impact of these changes on SSI enrollment. We also show that over time, SSI has grown to serve a heterogenous population, with an array of life experiences and needs. In this context, we discuss potential reforms intended to modernize the program and increase its ability to achieve its goals. These include a proposal to raise the generosity of benefits for elderly SSI recipients, increase the incentive to work among nonelderly adult SSI recipients, and harmonize disability decision-making across medical examiners and administrative law judges.

Association Of State Policies With Medicaid Disenrollment Among Low-Income Medicare Beneficiaries.

For some low-income Medicare beneficiaries, Medicaid provides financial protection against Medicare's out-of-pocket costs, but many Medicare beneficiaries who qualify for Medicaid are not continuously enrolled. We examined Medicaid disenrollment among fee-for-service Medicare beneficiaries and the relationship between disenrollment and state policies. In the period 2012-16, 18.2percent of Medicare beneficiaries who received full or partial Medicaid disenrolled for reasons other than death. More than 50percent of Medicare beneficiaries who remained without Medicaid one year after disenrolling continued to receive low-income subsidies for Medicare Part D coverage with eligibility requirements similar to those of Medicaid. Among Medicare beneficiaries with continuous Part D subsidies, the rate of Medicaid disenrollment was 24percent lower in states that automatically enrolled recipients of the federal Supplemental Security Income program in full Medicaid, 33percent lower in states with more generous provider payment policies, and 37percent lower in states with less restrictive asset limits for partial Medicaid. Policies that make it easier for people to maintain Medicaid eligibility and that enhance access to care in Medicaid via higher provider reimbursements may reduce disenrollment.

Supplemental Security Income enrollment and health care and social assistance employment and wages.

We examine the relationship between disabled working-age Supplemental Security Income (SSI) enrollment and health care and social assistance employment and wages. County-level data are gathered from government and other publicly available sources for 3144 US counties (2012 to 2015). Population-weighted linear regression analyses examine associations between each health care and social assistance employment and wage measure and SSI enrollment, controlling for factors associated with health care and social assistance employment and wages. Results show positive associations between county-level percent of the population enrolled in the SSI program and health care and social assistance employment and wages with strong associations identified for social assistance employment. A one standard deviation increase in SSI enrollment is associated with a 5.6% increase in the health care and social assistance sector employment percent compared with the mean and 9.7% and 7.3% increases in health care and social assistance sector employment and wage shares, respectively, when compared with the means. We find working-age adult SSI enrollment is positively associated with employment outcomes, primarily in the social assistance organization subsector and in lower wage paying jobs. Evolving federal disability policy may influence existing and future SSI enrollment, which has implications for health care workforce employment and composition.

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.

A Review of U.S. Federal and State Means-Tested Programs

This report presents a review of the major U.S. federal and state means-tested programs, including a review of how they operate, common features, and rules governing eligibility. The review covers the nature of the target recipient population, the nature of the benefits (cash or in-kind), whether the program is an entitlement, as well as financial and nonfinancial eligibility rules and benefit determination. Each of the features is compared to that of the Supplemental Security Income (SSI) program. The review reveals that SSI has many common features with other transfer programs, and that many other differences follow naturally from its particular goals and aims. However, large differences between SSI and other programs exist in financial eligibility rules. The current upper income limits for SSI are in the approximate range of 75 to 80 percent of the poverty line for single and married-couple recipients, respectively, below the 100- to 130-percent of the poverty line income limits for Supplemental Nutrition Assistance Program (SNAP), the 130- to 185-percent limits for school food programs, the 185 percent limits for Women, Infants, and Children (WIC), the 138-percent limits for Medicaid, and the 100-percent limits for Workforce Innovation and Opportunity Act (WIOA). Another significant difference is in resource and asset tests in SSI, which have been held constant in nominal dollars since 1989 and hence have been becoming more restrictive in real terms over time. Most other transfer programs have been moving in the opposite direction, reducing the restrictiveness of their asset tests, exempting additional items from countable assets, and in many cases eliminating asset tests entirely.

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.

Supplemental Security Income's 'Dedicated Account': A Debunked Urban Legend and Twenty Years of Waste

This article explains the “dedicated account” provision of the Supplemental Security Income program (SSI) for children with disabilities. The children’s SSI program has always been highly contentious, and is a regular target of media criticism, most of it claiming that the program’s beneficiaries aren’t actually disabled. Responding to an onslaught of such claims in the mid-1990’s, Congress created the dedicated account as part of PRWORA, the statute that “ended welfare as we know it.” The dedicated account rule requires any payment of past-due benefits that covers a period of six months or more to be deposited in a restricted bank account. Funds in this account cannot be used for food, shelter, clothing, transportation or most of the things a poor family with a disabled child might need. In an effort to shield the child from what the media portrays as scheming parents, Congress placed so many restrictions on the account that for many parents it is unusable. The article, which is based on the stories of a number of clients of Greater Boston Legal Services Children’s Disability Project, calculates that the Social Security Administration spends over $7 million each year administering dedicated accounts. Three successive Social Security Commissioners have asked Congress to abolish the account. This article attempts to show why they are right.

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.

Means Testing Social Security: Modeling and Policy Analysis

Means testing can balance the need to provide adequate retirement incomes with the requirement that such provision is fiscally sustainable and economically efficient. Critics of the policy suggest that to reduce benefits as a retiree’s income and/or wealth increase is to discourage work and savings. Yet such distortions are small compared to those resulting from large earnings related pensions that, due to demographic change, require greater levels of financing via payroll taxes. Some form of means testing exists in most countries, usually involving small, safety-net schemes that target the poorest retirees (e.g., the Supplemental Security Income program in the U.S.). But an appropriately designed means-testing instrument can also be used to reduce the liability of large, publicly financed social security promises by excluding the affluent. This paper summarises means-testing design and implementation in a number of OECD countries as well as tackling key criticisms of means testing. In doing so, we discuss a number of recent, cutting-edge modelling approaches and empirical insights that examine economic impacts of means testing in the Australian and U.S. contexts.

Supplemental Security Income Benefits for Mental Disorders.

The Supplemental Security Income Program (SSI) provides financial support to low-income households with children and youth with severe disabilities. The program included children when it began in the early 1970s. The numbers of children receiving SSI benefits increased substantially in the early 1990s, in part through an expansion of the listings of mental health conditions with which children could become eligible. Over the past 20 years, larger numbers of children have received SSI benefits for mental disorders, and these increases have led to questions from the press and Congress regarding these numbers. Do they indicate more of an increase in mental disorders among SSI children than in the general population? The National Academy of Medicine (NAM; formerly the Institute of Medicine) convened a study panel to examine what is known about mental disorders among the child SSI population and how that compares with evidence about mental disorders in children in general. The NAM report provides detailed information about how SSI works, about the changing numbers of children receiving SSI for mental disorders, and some comparisons with other evidence about rising rates of mental disorders in the general population and especially among children living in poverty. The report indicates that increasing numbers of children with mental disorders in SSI mirror similar increases in the population in general. This article summarizes key evidence from the NAM report and suggests the implications for pediatricians.

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.

Medicaid Expansion Effects on SSI: Evidence from the First Two Years

The Affordable Care Act (ACA) of 2010 expanded eligibility for public health insurance, Medicaid, to nearly all adults ages 18-64 with household incomes below 138% of the federal poverty line and living in states that opted to participate in the Medicaid expansion. The ACA Medicaid expansion can potentially decrease reliance of disabled adults on the Supplemental Security Income program which provides Medicaid coverage as well as cash assistance to low-income individuals with disabilities. In the paper we estimate the effects of Medicaid expansion on the entry into the Supplemental Security Income in the first two years following the expansion launch in January 2014. We use data from the Social Security Administration and identify causal effects by exploiting cross state variation in Medicaid eligibility resulting from states’ decisions about whether to participate in the Medicaid expansion.