Health Status and Health Insurance
State Medicaid Eligibility and Enrollment Policies and Rates of Medicaid Participation among Disabled Supplemental Security Income Recipients
In addition to providing income-maintenance payments to eligible participants, the Supplemental Security Income (SSI) program provides automatic Medicaid enrollment for applicants upon SSI award in most states. Other states require applicants to file a separate Medicaid application. Some use the SSI eligibility criteria for both programs; others use Medicaid eligibility rules that are more restrictive. The authors use matched monthly longitudinal administrative records to test whether automatic enrollment has a positive effect on Medicaid coverage. Using logistic regression with a combination of repeated cross-section and regression discontinuity approaches, they find positive effects of automatic enrollment on Medicaid coverage relative to other policies. The differences are attributable to a discontinuous increase in Medicaid coverage shortly after the final disability determination decision. The time lag arising from the often-lengthy disability determination process reduces the effectiveness of automatic enrollment, which depends critically on timeliness of the final award decision.
The Supplemental Poverty Measure (SPM) and Children: How and Why the SPM and Official Poverty Estimates Differ
In 2011, the Census Bureau released its first report on the Supplemental Poverty Measure (SPM). The SPM addresses many criticisms of the official poverty measure, and its intent is to provide an improved statistical picture of poverty. This article examines the extent of poverty identified by the two measures. The authors present a detailed examination of poverty among children (aged 0–17). For a more comprehensive view of poverty and comparison purposes, some findings are presented for two older segments of the U.S. population.
The Supplemental Poverty Measure (SPM) and Nonaged Adults: How and Why the SPM and Official Poverty Estimates Differ
In 2011, the Census Bureau released its first report on the Supplemental Poverty Measure (SPM). The SPM addresses many criticisms of the official poverty measure, and its intent is to provide an improved statistical picture of poverty. This article examines the extent of poverty identified by the two measures. The authors present a detailed examination of poverty among nonaged adults (those aged 18–64). For a more comprehensive view of poverty and comparison purposes, some findings are presented for younger and older segments of the population.
Recruitment in the Mental Health Treatment Study: A Behavioral Health/Employment Intervention for Social Security Disabled-Worker Beneficiaries
The recent development of evidence-based behavioral health and vocational rehabilitation interventions for persons with serious psychiatric impairments created the impetus for exploring the efficacy of those interventions if they were widely available to Social Security Disability Insurance beneficiaries. As a first step in this endeavor—a multisite randomized trial for providing interventions to beneficiaries with psychiatric impairments—the Mental Health Treatment Study was implemented. The authors report on the subject recruitment patterns for the study, including assessment of take-up rates, and on the statistical analysis of the relationships between beneficiaries' characteristics and the probability of enrollment. Results indicated that take-up rates among potential MHTS subjects with confirmed telephone contacts met or exceeded rates for previous Social Security Administration randomized trials, and beneficiaries with administrative records of recent vocational or labor-market activity were most likely to enroll. The authors discuss implications of their analyses on recruitment in similar interventions in the future.
The Supplemental Poverty Measure (SPM) and the Aged: How and Why the SPM and Official Poverty Estimates Differ
In November 2011, the Census Bureau released its first report on the Supplemental Poverty Measure. The SPM addresses many criticisms of the official poverty measure and is intended to provide an improved statistical picture of poverty. This article examines the extent of poverty identified by the two measures. First, we look at how the SPM and official estimates differ for various aged and nonaged groups. Then, we look at why the SPM poverty rate for the aged is much higher than the official rate.
Outcome Variation in the Social Security Disability Insurance Program: The Role of Primary Diagnoses
This article investigates the role that primary impairments play in explaining heterogeneity in disability decisions. Using claimant-level data within a hierarchical framework, the author explores variation in outcomes along three dimensions: state of origin, adjudicative stage, and primary diagnosis. The findings indicate that the impairments account for a substantial portion of claimant-level variation in initial allowances. Furthermore, the author finds that the predictions of an initial and a final allowance are highly correlated when applicants are grouped by impairment. In other words, diagnoses that are more likely to result in an initial allowance also tend to be more likely to receive a final allowance.
The rising cost of employer contributions for employee health insurance reduces the percentage of compensation subject to Social Security payroll taxes. This article uses the Medical Expenditure Panel Survey to analyze trends in the cost of employer health insurance contributions relative to money wages and total compensation. The analysis shows how increasing employer health insurance premium costs from 1996 to 2008 reduced the percentage of compensation subject to payroll taxes, and it predicts the effects of health insurance reform on taxable compensation.
Factors Affecting Initial Disability Allowance Rates for the Disability Insurance and Supplemental Security Income Programs: The Role of the Demographic and Diagnostic Composition of Applicants and Local Labor Market Conditions
Various factors outside the control of decision makers may affect the rate at which disability applications are allowed or denied during the initial step of eligibility determination in the Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) programs. This article, using individual-level data on applications, focuses on the role of three important factors—the demographic characteristics of applicants, the diagnostic mix of applicants, and the local unemployment rate—in affecting the probability of an initial allowance and state allowance rates. A random sample of initial determination administrative records for the 1993–2008 period is used for the analysis in a fixed-effects multiple regression framework. The empirical results show that the demographic and diagnostic characteristics of applicants and the local unemployment rate substantially affect the initial allowance rate. An increase in the local unemployment rate tends to be associated with a decrease in the initial allowance rate. This negative relationship holds for adult applicants in both the DI and SSI programs and for SSI childhood applicants.
Profile of Social Security Disabled Workers and Dependents Who Have a Connection to Workers' Compensation or Public Disability Benefits
This note provides a comprehensive profile of the characteristics of disability beneficiaries with a connection to workers' compensation or public disability benefits (PDBs). The 8.3 percent of disabled workers who have this connection tend to be economically better off, more frequently middle aged, male, afflicted with a musculoskeletal and connective tissue disorder, and tend to wait longer to apply for social security disability benefits after onset than the general disabled-worker population. In our analysis, we have included a special focus on California, as this state represents a large portion of the PDB workload, and its experience has a substantial effect on the national picture.
This article analyzes the effect of longitudinal interactions between the Disability Insurance (DI) and Supplemental Security Income (SSI) programs in providing access to Medicare and Medicaid, using a sample of administrative records spanning 84 months. Our study is the first effort to link and analyze record data on participation in all four of these major, and highly interrelated, public benefit programs in the United States. We find that SSI facilitates high levels of Medicaid coverage for SSI awardees overall and provides access to Medicaid for many DI awardees during the 24-month Medicare waiting period. Many people who exit SSI retain their Medicaid coverage, but the gap in coverage between continuing SSI participants and those who leave the program increases over time. After Medicare kicks in, public health insurance coverage is virtually complete among awardees with some DI involvement, including dual Medicaid and Medicare coverage for some.
Workplace injuries and illnesses are an important cause of disability. States have designed their workers' compensation programs to provide cash and medical-care benefits for those injuries and illnesses, but people who become disabled at work may also be eligible for Social Security Disability Insurance (DI) and related Medicare benefits. This article uses matched state workers' compensation and Social Security data to estimate whether workplace injuries and illnesses increase the probability of receiving DI benefits and whether people who become DI beneficiaries receive benefits at younger ages.
Expanding Access to Health Care for Social Security Disability Insurance Beneficiaries: Early Findings from the Accelerated Benefits Demonstration
The Accelerated Benefits (AB) demonstration project provides health benefits to Social Security Disability Insurance beneficiaries who have no health insurance during the 24-month period most beneficiaries are required to wait before Medicare benefits begin. This article describes the project and presents baseline survey results on health insurance coverage among newly entitled beneficiaries and the characteristics of those without coverage. A 6-month follow-up survey provides information on the effects of the AB health benefits package on health care utilization and on reducing unmet medical needs. The article also reports the costs of providing the health benefits package during the 24-month Medicare waiting period.
This article uses different sources of United States data to focus on the retirement resources of women aged 55–64 in 2004, 1994, and 1984. Notable changes have occurred with women's pathways into retirement resulting from increased education and lifetime work experience. There appear marked cohort differences in potential retirement outcomes.
It is widely known that about three-fourths of the working-age population is insured for Disability Insurance (DI), but the substantial role played by the Supplemental Security Income (SSI) program in providing disability benefit coverage is not well understood. Using data from the 1996 panel of the Survey of Income and Program Participation (SIPP) we find that over one-third (36 percent) of the working-age population is covered by SSI in the event of a severe disability. Three important implications follow: (1) SSI increases the overall coverage of the working-age population; (2) SSI enhances the bundle of cash benefits available to disabled individuals; and (3) interactions with other public programs—most notably the SSI path to Medicaid coverage—also enhance the safety net. Ignoring these implications could lead to inaccurate inferences in analytic studies.
During the first three decades of the Supplemental Security Income (SSI) program, the number of children receiving SSI because of a disability increased from 70,000 in 1974 to about 1 million at the end of 2005. With over 8,500 interviews completed between July 2001 and June 2002, the National Survey of SSI Children and Families (NSCF) is the first nationally representative survey since 1978 of noninstitutionalized children and young adults who were receiving SSI during the survey period or had formerly received SSI. The article discusses the objectives of the survey, its methodology and implementation, content of the questionnaire, a randomized response-incentive experiment, and related products including the release of a public-use data file.
A Profile of Children with Disabilities Receiving SSI: Highlights from the National Survey of SSI Children and Families
This article, based on interviews from the National Survey of SSI Children and Families conducted between July 2001 and June 2002, presents a profile of children under the age of 18 who were receiving support from the Supplemental Security Income program. The topics highlighted provide information of SSI children with disabilities and their families not available from administrative records, including demographic characteristics, income and assets, perceived health and disabilities, and health care utilization. While virtually every child in the SSI program is covered by some form of health insurance, primarily Medicaid, the data indicate substantial heterogeneity on other variables. This is true on many different dimensions, such as the perceived severity of the child's disabling conditions, health care utilization and service needs, the presence of other family members with disabilities, family demographics, and access to non-SSI sources of incomes.
Policies that would reduce or eliminate Social Security benefits for early retirees could have adverse consequences for older workers in poor health. This article documents the health and financial circumstances of beneficiaries aged 62–64. It examines the extent to which poor health limits work among early retirees and assesses the extent to which curtailment of early retirement benefits might lead to increases in the Disability Insurance program rolls.
The Erosion of Retiree Health Benefits and Retirement Behavior: Implications for the Disability Insurance Program
The number of companies offering health benefits to early retirees is declining, although reductions in the percentage of early retirees covered by health insurance have been only slight to date. In general, workers who will be covered by health insurance are more likely than other workers to retire before the age of 65, when they become eligible for Medicare. What effect that will have on claims under the Disability Insurance program is not yet clear.
The economic well-being of subgroups of the population usually is measured by comparing resources and needs. The measure of resources often includes noncash income. Equivalence scales are used to adjust for differential needs. Little attention, however, has been paid to the desirability of consistency between the specifications of the resources and the equivalence scales in these comparisons. This exploratory paper suggests that a lack of consistency between the definitions used on the income and the needs sides can be important for the assessment of the economic well-being of subgroups when some types of noncash income are included in the definition of income. The measured economic status of the aged in the United States when Medicare noncash income is included in the definition of income is used as an example of this consistency problem. Some previous estimates have used equivalence scales that probably understated the relative needs of the aged by omitting needs associated with Medicare. The measured economic well-being of the aged relative to that of other age groups could be overestimated substantially as a result of this consistency problem. The basic problem is not confined to the treatment of Medicare or to the United States, but is much broader in nature.
The Hazard of Mortality Among Aging Retired- and Disabled-Worker Men: A Comparative Sociodemographic and Health Status Analysis
Income, Assets, and Health Insurance: Economic Resources for Meeting Acute Health Care Needs of the Aged
Health Insurance Coverage Among Recently Entitled Disability Insurance Beneficiaries: Findings From the New Beneficiary Survey
Statistical Methods for the Estimation of Costs in the Medicare Waiting Period for Social Security Disabled Worker Beneficiaries
This paper presents the statistical methods used to estimate Medicare costs in the waiting period that were presented in text tables 2–3 of Bye and Riley (1989). The first part describes the development of Medicare utilization equations for each Social Security Disability Insurance (DI) program status group. The second part describes how these equations were used to predict expected costs per month and how the monthly estimates were aggregated to yield estimates of costs in the full 2-year waiting period and in the second year only. Finally, there is a brief discussion of the accuracy of the predictions.