The ‘Olympic Hurdles’ of Obtaining Federal Benefits for Inmates with Disabilities: A Study of Two Massachusetts County Jails

Sixty-four percent of US jail inmates are reported to suffer from mental health issues, compared to just 18.9% of the general population. This disparity becomes greater when considering a broader definition of disability, and individuals with disabilities are overrepresented in correctional facilities. They are often left without the ability to find employment at reentry, with Supplementary Security Income (SSI) and Social Security Disability Insurance (SSDI) providing pathways to housing and improved living conditions. However, complicated application procedures often result in the formerly jailed returning to prior lifestyles and rearrests. This study explores SSI/SSDI systems at two Massachusetts county jails.

Social Welfare History in the Age of Diversity

This policy perspective discusses three important social welfare programs—Social Security Disability Insurance, Medicare, and Temporary Aid to Needy Families—and offers an explanation of how they have expanded over time.

Well-Being of Ambulatory Adults With Cerebral Palsy: Education, Employment, and Physical Function of a Cohort Who Received Specialized Pediatric Care

Introduction: The transition from pediatric health care and school systems presents enormous challenges for young adults with cerebral palsy (CP). The lack of strong societal support during this seminal life event is well-documented and leads many adults with CP to struggle with independence, higher education, and employment. Despite the relatively high prevalence of CP, information about the experiences and function of adults with CP in our society continues to be limited. The purpose of this project was to describe well-being by assessing education, employment, physical function, walking activity, and utilization of health care in an ambulatory adult cohort with CP who received specialized pediatric care at our center.Method: In this Institutional Review Board-approved prospective study, we invited former patients from our tertiary care pediatric CP center to complete a set of patient-reported outcomes including (1) the Patient-Reported Outcomes Measurement Information System domains of physical function and pain interference, (2) the Satisfaction with Life Scale, and a project-specific demographic questionnaire about education, employment, income, independence, pain, and health care utilization. Participants also wore a pedometer for 8 days to monitor community walking activity. Chi-squared pairwise or t-tests were used as appropriate to compare survey responses and walking activity data between three groups: participants who self-reported, those who reported by proxy, and published normative data from age-matched typically developing adult (TDA) samples.Results: One hundred twenty-six adults with CP consented to participate; 85 self-reported [age 29.7 ± 4.3 years; Gross Motor Function Classification System: I (28%), II (47%), and III, (25%)] and 41 reported by proxy [age 29.7 ± 4.1 years; Gross Motor Function Classification System: I (10%), II (68%), and III (22%)]. For the group who self-reported, high school graduation rate (99%) was similar to TDA (92%; p = 0.0173) but bachelor's degree achievement rate (55%) was higher than TDA (37%; p < 0.001). Despite more advanced education, the unemployment rate in this group was higher than national levels at 33% and was associated with high utilization of Social Security Disability Insurance (33%). Within the self-reporting group, 13% required a caregiver. For the group who reported by proxy, educational levels (73% high school graduates, 0 bachelor's degree) were lower than the general population (p < 0.001) and unemployment was higher than the national level, at 64%. Unemployment in this group was associated with high utilization of Social Security Disability Insurance (85%). Within the proxy-reporting group, 71% required a caregiver. The full cohort demonstrated lower levels of physical function according to the Patient-Reported Outcomes Measurement Information System and less community walking activity compared with TDA references (p < 0.001). This cohort of adults with CP reported significantly higher frequency of chronic pain (48 vs. 12% for TDA; p < 0.001), but less pain interference with daily activities than TDA based on Patient-Reported Outcomes Measurement Information System results (p < 0.001). This cohort reported good to excellent overall health (93%) and high utilization of primary care (98%), but limited utilization of specialty care, specifically orthopedic care (21%) and physical therapy (15%).Discussion: This cohort of adults with CP had similar levels of education as the general population, but had relatively high rates of unemployment, caretaker need, and Social Security Disability Insurance utilization. Although chronic pain was frequent, the impact of pain on work and independent living did not exceed reports from a typically developing reference. Better targeted societal resources for adults with physical disabilities are urgently needed to allow equitable access to employment, promote opportunities for independence, and enable full participation in community life.

Overestimation by misspecification: revisiting the relation between the unemployment rate and disability insurance claims in the USA

PurposeDespite numerous studies, our understanding of the determinants of disability insurance (DI) claim rates in the USA is clouded. When the unemployment (UE) rate soars during an economic downturn such as the spread of COVID-19, assuming a linear positive relationship between the two variables, as the prior literature has suggested, forewarns a large spike in DI claim rates. Yet, if the model is misspecified, it can lead to misinformed decisions such as reducing DI awards during an economic downturn when such awards are needed the most. This study aims to improve the accuracy of the DI claims' prediction.Design/methodology/approachThis study suggests that the relationship between the UE rate and DI claim rate is nonlinear and examines this hypothesis using a panel dataset of 866 state-year observations from 2002–2018.FindingsThe results provided compelling evidence in support of the proposed quadratic relationship between the UE rate and DI claim rate and revealed that compared to a quadratic model, the linear model overestimated the DI claim rate by approximately 18 percent or 172,000 claims per year.Practical implicationsGiven that DI awards represent hundreds of thousands of dollars in present value terms, the impact of increase in DI claims on the Social Security Disability Fund during an economic downturn might not be as high as some model might forecast.Originality/valueTo our knowledge, no other studies have examined a quadratic relationship between the UE rate and the DI claim rate. This study is especially relevant during the coronavirus (COVID-19) pandemic and its aftermath. In April 2020, the UE rate spiked to nearly 15 percent nationwide, with Nevada and Michigan at 28 percent and 22.7 percent, respectively. The nonlinear model used in this study suggests that, as the UE increases, DI claims increase, albeit at a decreasing rate. On the contrary, a linear relationship between the UE rate and DI claim rates implies that the increase in the DI claim rate would be constant regardless of the UE rate. This misspecification can result in misinformed decisions, such as the reduction of DI awards because of the overestimation of claims during economic downturns. This can lead to lower award rates during economic turmoil when this assistance is most needed.

Employment Patterns of SSI-First Awardees Who Enter SSDI After Achieving Disability-Insured Status

This article uses administrative data from the Social Security Administration to explore the employment patterns and characteristics of individuals awarded Supplemental Security Income (SSI) benefits between 2001 and 2009 who later became disability insured and qualified for Social Security Disability Insurance (SSDI). While these individuals are a small portion of all SSI and SSDI beneficiaries, they are particularly interesting because they demonstrate a desire and ability to work despite the health conditions that make them eligible for disability benefits. On average, 2.3% of SSI-first awardees enter SSDI after they become disability insured within 5 years of their SSI award. These SSI awardees are younger than other SSI awardees and are more likely to achieve work-related milestones during the 5 years after SSI award. Although awardees in this group show signs of an ability to work, they gradually start dropping out of the labor force starting 5 months before SSDI benefits begin and drop out in greater numbers through the first year of SSDI benefits. This suggests that some of them may work enough to achieve disability-insured status but stop when they enter SSDI.

Disability Insurance in the Great Recession: Ease of Access, Program Enrollment, and Local Hysteresis

We examine the interaction between Social Security Disability Insurance (SSDI) access and economic shocks during the Great Recession by exploiting exogenous variation in SSDI appeals processing time–a measure of hassle or access–between neighboring zip codes assigned to different hearing offices. During the Great Recession, longer processing times led to lower SSDI enrollment in places that experienced more severe labor market downturns. In the full sample, processing time has no clear effect on the pace of employment recovery. However, among severely shocked places with high baseline SSDI enrollment, those with longer processing times saw faster recovery in employment rates.

Using behavioral outreach to counteract administrative burden and encourage take-up of simplified disability payment rules

Take-up of employment programs among people with disabilities can be limited by the administrative burdens of decision-making, which must factor in the complexities of how work affects disability cash assistance payments. This study presents evidence on using outreach motivated by behavioral research to encourage enrollment in a pilot initiative with the Social Security Administration that simplified Social Security Disability Insurance payment rules. Because enrolling would leave some beneficiaries worse off, informed enrollment decisions required understanding both the complexities of current rules and potential effects of the new demonstration rules. We sought to counteract bottlenecks stemming from decision-making burdens through increased outreach with tailored messaging. A randomized controlled trial was used to test two features of a reminder postcard. First, we compared fold-over postcards containing information about the demonstration to open postcards with more generic information, finding that fold-over postcards increased enrollment by around 25 percent (or 0.12 percentage points). Second, we compared an urgent message framing with no stated enrollment end-date to a deadline framing with an explicit enrollment cutoff date. Although the final enrollment rate was similar across timeline framing options, the urgent framing appears to have resulted in faster enrollment.