Supplemental Security Income Receipt Research Articles

The effect of disability insurance receipt on mortality

This paper estimates the effect of Disability Insurance and Supplemental Security Income receipt on mortality for individuals on the margin of being allowed versus denied benefits. Exploiting the random assignment of administrative law judges to disability insurance cases, we find that benefit allowance increases 10-year mortality rates by 2.8 percentage points for marginal beneficiaries. However, using a Marginal Treatment Effects approach, we find evidence that benefit receipt reduces mortality for inframarginal beneficiaries, who are typically less healthy than marginal beneficiaries. Furthermore, we find suggestive evidence that allowance reduces mortality among those with expensive health conditions such as cancer.

Does Welfare Prevent Crime? the Criminal Justice Outcomes of Youth Removed from Ssi

Abstract We estimate the effect of losing Supplemental Security Income (SSI) benefits at age 18 on criminal justice and employment outcomes over the next two decades. To estimate this effect, we use a regression discontinuity design in the likelihood of being reviewed for SSI eligibility at age 18 created by the 1996 welfare reform law. We evaluate this natural experiment with Social Security Administration data linked to records from the Criminal Justice Administrative Records System. We find that SSI removal increases the number of criminal charges by a statistically significant 20% over the next two decades. The increase in charges is concentrated in offenses for which income generation is a primary motivation (60% increase), especially theft, burglary, fraud/forgery, and prostitution. The effect of SSI removal on criminal justice involvement persists more than two decades later, even as the effect of removal on contemporaneous SSI receipt diminishes. In response to SSI removal, youth are twice as likely to be charged with an illicit income-generating offense than they are to maintain steady employment at ${\$}$15,000/year in the labor market. As a result of these charges, the annual likelihood of incarceration increases by a statistically significant 60% in the two decades following SSI removal. The costs to taxpayers of enforcement and incarceration from SSI removal are so high that they nearly eliminate the savings to taxpayers from reduced SSI benefits.

The Labor Market Consequences of Receiving Disability Benefits during Childhood

I estimate the labor market effects of gaining eligibility for Supplemental Security Income (SSI) disability benefits during childhood. A Supreme Court decision eased the criteria to be considered disabled, disproportionately affecting child applicants with mental disorders. For individuals with mental disorders, each additional year of exposure to eased standards during childhood increased their SSI receipt by 0.3 years. The additional benefit receipt reduced cumulative labor market earnings through age 30 by $1,600 for each additional year of exposure for those with mental disorders. Importantly, this does not address the full range of outcomes that may be affected by receiving benefits.

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

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

Food insecurity patterns before and after initial receipt of Supplemental Security Income - CORRIGENDUM.

Food insecurity patterns before and after initial receipt of Supplemental Security Income - CORRIGENDUM.

Association of Health Status With Receipt of Supplemental Security Income Among Individuals With Severe Disabilities and Very Low Income and Assets

Association of Health Status With Receipt of Supplemental Security Income Among Individuals With Severe Disabilities and Very Low Income and Assets

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.

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

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

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

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

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

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

Impact of mental health problems on self-perceived oral health needs in a Medicaid population.

The purpose of this study was to examine the prevalence of self-perceived oral health needs among Medicaid-enrolled adults with and without mental health problems and to identify factors predictive of enrollees' perceived oral health needs. The study involved a secondary analysis of 1,721 respondents to the Florida Health Services Survey. Contrary to the previous research, the findings from this study indicated that respondents with mental health problems (52.9%) did not differ significantly in their dental needs compared to those who did not have mental health problems (49.3%). The results from a logistic regression suggested that after controlling for demographic characteristics, substance abuse problems and functional needs increased the likelihood of self-reported oral health needs, whereas the receipt of Supplemental Security Income (SSI) was associated with decreased dental needs. The prevalence of unmet dental needs among these respondents (i.e., 23%) supported the conclusion that a significant gap exists in the accessibility of oral health services among this population.

Community-level characteristics associated with variation in rates of homelessness among families and single adults.

We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations.

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.

Patterns of healthcare use and employment among people with disabilities

BackgroundEmployment rates among people with disabilities are low. Poor health is often cited as a barrier to work. Disability or a lack of disability-related resources may interfere with the ability to secure and maintain work. ObjectiveThis paper presents an exploratory examination of the association between variation in service use and employment. MethodsThe paper uses data from North Carolina Medicaid recipients age 18–64 who were eligible in fiscal year 2007 due to receipt of Supplemental Security Income (n = 60,190). Logistic regression was used to model employment as a function of variation in healthcare use, with conditional models stratifying by days of service use and unconditional models run by quantile of service use. ResultsPeople with the least service use (<12 days) had the highest employment rate (over 20%); those with the most service use (≥54 days) had the lowest employment rate (7.8%). Those in between displayed remarkably little variation in employment rate by level of service use. The amount of week-to-week variation in service use was positively associated with the probability of employment. ConclusionsAmong Medicaid enrollees with disabilities who use outpatient services, amount of service use is negatively associated with employment and variation in use is positively associated with employment. Future research involving more extensive administrative data, primary data collection, and the use of mixed methods would improve understanding of these findings.

Modeling the indirect economic implications of musculoskeletal disorders and treatment

BackgroundMusculoskeletal disorders impose a substantial economic burden on American society, but few studies have examined the economic benefits associated with treating such disorders. The purpose of this research is to estimate the indirect economic implications of activity limitations associated with musculoskeletal disorders and to quantifying the potential economic gains from elective surgery to treat arthritis of the knee and hip.MethodsUsing regression analysis with the National Health Interview Survey (2004-2010 data, n=185,829 adults) we quantify the relationship between severity of activity limitations (walking, sitting, standing, etc.) and employment, household income, missed work days, and receipt of supplemental security income for disability. Activity limitations are combined to create an index similar to the Functional Ability Index from the Short Form 36 Health Questionnaire (SF-36) often used in clinical trials to measure patient functional mobility. This index is included in the regression analyses. We use data from published, prospective clinical trials to establish the improvement in patient functional ability following surgery to treat arthritis of the knee and hip.ResultsImproved physical function is associated with higher likelihood of employment, higher household income and fewer missed work days for those who are employed, and reduced likelihood of receiving supplemental security income for disability. The magnitude of the impact and statistical significance vary by activity limitation and severity. Each percentage point increase in the index value is associated with a 2-percentage-point increase in the odds of being employed, a 3-percentage-point-day decline in work days missed and an additional $180 in annual household income if employed, and a 2-percentage-point decline in the odds of receiving supplemental security income for disability. All estimates are statistically significant at the 0.05 level.ConclusionsUsing a large, representative sample of non-institutionalized adults in the U.S., we find that physical activity limitations are associated with worse economic outcomes across multiple economic metrics. Combined with estimates of improved functional ability following knee and hip surgery, we quantify some of the economic benefits of surgery for arthritis of the knee and hip. This information helps improve understanding of the societal benefits of medical treatment for musculoskeletal conditions.

The Extended TANF Application Period and Applicant Outcomes: Evidence from Wisconsin

This article examines the characteristics and income patterns associated with welfare entry and nonentry in the context of an extended application period for a sample of 1,664 women who applied for Temporary Assistance for Needy Families services in Wisconsin in the fall of 2006. The study uses data derived from the systematic review of caseworker notes as well as administrative data on welfare participation, earnings, child support, the Supplemental Nutrition Assistance Program, Earned Income Tax Credit estimates, and Supplemental Security Income receipt. It finds that about one-half of those who applied for services did not enter the welfare program within a 60-day time frame. Results indicate that those with consistent employment prior to applying for services, those with very young children, and pregnant applicants are less likely to drop out. In examining differences in economic well-being in the year following an application, the study finds that those who applied for and entered welfare (participants) and those who applied for but did not enter (dropouts) generally had similarly high levels of poverty. However, dropouts had higher rates of deep poverty, with some subgroups--such as those who had declined services--fating better than others. KEY WORDS: poverty; TANF; welfare; welfare application ********** The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-110) ushered in a new era of work-based welfare. Benefits are time limited and are no longer an entitlement; work activities are generally mandatory in exchange for cash assistance. These components of postreform Temporary Assistance for Needy Families (TANF) programs were designed to move low-income families off the welfare rolls and into the labor market, reducing caseloads and reliance on welfare. An expansive literature on welfare leavers has documented the dramatic decline in TANF caseloads and increased employment among single mothers, although findings point to poverty-level earnings and future spells of welfare receipt for many (for a review of welfare leaver outcomes, see Acs & Loprest, 2004; Cancian, Haveman, Meyer, & Wolfe, 2002; Cancian & Meyer, 2004; Danziger, Heflin, Corcoran, Oltmans, & Wang, 2002; Grogger & Karoly, 2005; Wu, Cancian, & Meyer, 2008). Although scholars continue to debate the impact of welfare reform policies relative to the economy on postreform caseload decline (see Danielson & Klerman, 2008), the strong work-first approach of modern welfare programs, which generally offer lower cash benefits than those earned through unsubsidized employment, shares some credit for the sharp reduction in caseloads and the increase in low-income women's employment (Blank & Schmidt, 2001; Grogger & Karoly, 2005; Moffit, 2002). There is another contributor to reduced welfare caseloads: TANF policies that redirect applicants before they enroll, often referred to as (Besharov & Germanis, 2007; Danielson & Klerman, 2008; Meyers & Lurie, 2005; Ridzi & London, 2006). Two popular diversion tools are (1) one-time cash payments offered in lieu of TANF participation and (2) extended application periods during which applicants participate in mandatory job-search activities over a prescribed number of days prior to eligibility determination. Diversion procedures are intended to attach unemployed applicants to the labor market or maintain employment for the working poor prior to TANF enrollment, thereby promoting self-sufficiency among target groups. There are, however, concerns regarding the effectiveness of diversion tools in moving applicants into employment and targeting the appropriate groups. For example, scholarship on lump-sum cash payments suggests that those who are both the best and least equipped for the labor market are targeted, and a substantial number of recipients cycle onto TANF soon after receipt of the payment (Hetling, Ovwigho, & Born, 2007; Helting, Tracy, & Born, 2006; London, 2003). …

Quality of Life and Life Skill Baseline Measures of Urban Adolescents with Disabilities

Many gaps exist in the understanding of how adolescents with disabilities successfully transition to adulthood and the services contributing to this success. This study attempts to fill one gap by establishing quality of life baseline measures for low-income urban adolescents. We compared baseline data for a representative sample of adolescents with disabilities in the District of Columbia to national norms using three instruments—the Pediatric Quality of Life Inventory 4.0, the Ansell-Casey Life Skills Assessment, and the Career Maturity Inventory-Attitude Scale. The sample for this study was primarily African American and had a higher level of disability as measured by receipt of Supplemental Security Income (SSI). The baseline scores of the adolescents in DC may be lower than the normed scores of their peers with disabilities in the U.S. because of socioeconomic and racial inequities and because the population has to contend with greater levels of disabilities.

Transition-Age Youths with Visual Impairments in Vocational Rehabilitation: A New Look at Competitive Outcomes and Services

Introduction Given the low rate of closure of cases for employment, the study presented here analyzed the characteristics of consumers and services that predict competitive employment for youths with visual impairments who are making the transition from secondary education to employment in the vocation rehabilitation program. Methods Using data from the Rehabilitation Services Administration on 2,282 consumers aged 22 or younger whose cases were closed after they received services, we conducted descriptive and logistic regression analyses to determine which client and service factors predicted competitive employment. Results Gender; race; education; disability; the severity of visual impairment, receipt of Supplemental Security Income, earnings at the time of application, which are indicative of early work experiences; and four of five service clusters were significantly related to employment outcomes. Discussion This research provided new knowledge regarding influences, “risk factors,” and predictors of competitive employment—what works—for youths with visual impairments. Implications for practitioners We make recommendations for the provision of vocational rehabilitation services, transition programs, policy regarding groups “at-risk” for poor employment outcomes, and future research.

Characteristics of Early Work Experiences and Their Association with Future Employment

Introduction Early work experiences are a key predictor of future employment for transition-age youths with visual impairments. We investigated how specific characteristics of early work experiences influence future employment and whether the receipt of Supplemental Security Income (SSI) benefits is associated with early work experiences among this population. Method Secondary data analyses were conducted using four waves of data from the second National Longitudinal Transition Study, which included a nationally representative sample of high school students with visual impairments who were receiving special education services. Results Future employment outcomes were positively associated with the characteristics of early work experiences, including finding a job independently, holding multiple jobs, and holding jobs for longer periods of time. Participating in school-sponsored work was not associated with future employment. Youths who received SSI benefits were significantly less likely to engage in productive activities, including employment, in Wave 3 than were those who did not receive benefits; however, this was not the case for youths who received SSI benefits in Wave 2. Discussion Not all early work experiences were found to be equally predictive of future employment for youths with visual impairments. The results indicate that it may not be sufficient for youths simply to be employed during high school without consideration of the types of work, how the jobs were obtained, or how long the jobs lasted. These characteristics of early work experiences are important to future employment and should be considered when helping youths prepare for the transition from school to work. Implications for Practitioners Professionals and parents should emphasize the benefits of early employment to youths with visual impairments. Youths should be encouraged to obtain multiple work experiences during high school while keeping in mind that longer job tenure is also positively associated with future employment. Professionals should particularly encourage youths who receive SSI benefits to obtain early work experiences and should inform them and their families about incentives that allow them to retain benefits while working.

Antisocial behavioral syndromes and 3‐year quality‐of‐life outcomes in United States adults

To examine 3-year quality-of-life (QOL) outcomes among United States adults with Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) antisocial personality disorder (ASPD), syndromal adult antisocial behavior without conduct disorder (CD) before age 15 [adulthood antisocial behavioral syndrome (AABS), not a DSM-IV diagnosis], or no antisocial behavioral syndrome at baseline. Face-to-face interviews (n = 34 653). Psychiatric disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV Version. Health-related QOL was assessed using the Short-Form 12-Item Health Survey, version 2 (SF-12v2). Other outcomes included past-year Perceived Stress Scale-4 (PSS-4) scores, employment, receipt of Supplemental Security Income (SSI), welfare, and food stamps, and participation in social relationships. Antisocial personality disorder and AABS predicted poorer employment, financial dependency, social relationship, and physical health outcomes. Relationships of antisociality to SSI and food stamp receipt and physical health scales were modified by baseline age. Both antisocial syndromes predicted higher PSS-4, AABS predicted lower SF-12v2 Vitality, and ASPD predicted lower SF-12v2 Social Functioning scores in women. Similar prediction of QOL by ASPD and AABS suggests limited utility of requiring CD before age 15 to diagnose ASPD. Findings underscore the need to improve prevention and treatment of antisocial syndromes.