A Health Conscious Safety Net: An Overview of Emerging Disability Policy Issues

1
A Health Conscious Safety Net? An Overview of
Emerging Disability Policy Issues

• David Wittenburg

2
Motivation

• Disability onset
• Program spending
• Hundreds of billions on cash and in-kind benefits
• Major issue at the state and federal level
• Looming deficits
• SSA Disability Programs
• Medicaid
• Medicare
• State financed systems (state mental health
  systems)

3
Purpose

• Examine incidence of disability prevalence in
  low-income population
• Discuss programs available to low-income adults.
• Motivate broader discussion of trends within the
  population
  with disabilities

4
Methodology

• Select population with disabilities
• Work limitation definition
• Captures subpopulation of people with
  disabilities
• Other definitions available
• Examine cross-sectional trends in low-income
  population
• National Survey of Americas Families
• Discussion of major issues

5
High Prevalence of Disability Among Low-Income
Adults
6
Overview of Cash Program Options

• Supplemental Security Income (SSI) and Disability
  Insurance (DI)
• SSI targeted to low-income adults
• DI targeted to adults with work history
• SSI and DI use the same disability definition
• Other disability programs
• Targeted generally to workers/those injured on
  job
• Workers Compensation
• Private Disability Insurance
• Other Welfare programs
• TANF/GA

7
In-kind Programs

• Medicaid
• SSI recipients
• Certain populations with disabilities
• Other low-income groups (e.g., TANF)
• Medicare
• DI eligibles after two year waiting period
• Other
• Food Stamps, housing

8
Low Employment/High Program Participation Rates
Among Low Income Adults with Disabilities
9
Work/Program Participation Trade Off
Full Time Job (40 hrs/wk) Earnings 10/hr 1,600
Monthly SSI Benefit 552 Avg. Monthly Medicaid
Spending 1,000 Other Benefits (State
supplements, Food Stamps) 200 Total Value
1,700
Part-Time Job (20 hrs/wk) Earnings 20/hr 1,600
10
Dynamics of SSA Disability Application Process

• All or nothing application process
• You are in or out
• Average processing time takes at 120 days
• Most applicants (60) are rejected at initial
  application
• Complicated appeals process
• One-third of new awards are based on appeals

11
Program Participation Dynamics for SSI/DI

• Few recipients ever leave the rolls
• Long application process
• Disability characteristics
• Health characteristics

12
The Dilemma

• Lifetime of program benefits vs. employment
• Tradeoffs are especially sharp for those with
  limited work histories/incomes
• What message do policy makers send to people with
  disabilities?
• Americans with Disabilities Act (ADA)
• Social Security disability programs

13
Higher Rates of Financial Difficulties
14
Discussion

• Does the current safety net of programs meet the
  needs of people with disabilities?
• Are there alternatives?

15
Gaps in the Current Safety Net

• Is the policy message consistent?
• Does one size fit all?
• Population with disabilities is
• diverse
• Growing
• Need for temporary benefits?

16
Trends in Employment and Program Participation

• Trends from Houtenville and Weathers
  presentations underscore the importance of
  rethinking policies