The Eligibility Definition Used in the Social Security Administration’s Disability Programs Needs to be Changed

In its October 2003 report on the definition of disability used by the Social Security Administration’s (SSA’s) disability programs [i.e., Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) for people with disabilities], the Social Security Advisory Board raises the issue of whether this definition is at odds with the concept of disability embodied in the Americans with Disabilities Act (ADA) and, more importantly, with the aspirations of people with disabilities to be full participants in mainstream social activities and lead fulfilling, productive lives. The Board declares that “the Nation must face up to the contradictions created by the existing definition of disability.” I wholeheartedly agree. Further, I have concluded that we have to make fundamental, conceptual changes to both how we define eligibility for economic security benefits, and how we provide those benefits, if we are ever to fulfill the promise of the ADA. To convince you of that proposition, I will begin by relating a number of facts that paint a very bleak picture – a picture of deterioration in the economic security of the population that the disability programs are intended to serve; a picture of programs that purport to provide economic security, but are themselves financially insecure and subject to cycles of expansion and cuts that undermine their purpose; a picture of programs that are facing their biggest expenditure crisis ever; and a picture of an eligibility determination process that is inefficient and inequitable -- one that rations benefits by imposing high application costs on applicants in an arbitrary fashion. I will then argue that the fundamental reason for this bleak picture is the conceptual definition of eligibility that these programs use – one rooted in a disability paradigm that social scientists, people with disabilities, and, to a substantial extent, the public have rejected as being flawed, most emphatically through the passage of the ADA. Current law requires eligibility rules to be based on the premise that disability is medically determinable. That’s wrong because, as the ADA recognizes, a person’s environment matters. I will further argue that programs relying on this eligibility definition must inevitably: reward people if they do not try to help themselves, but not if they do; push the people they serve out of society’s mainstream, fostering a culture of isolation and dependency; relegate many to a lifetime of poverty; and undermine their promise of economic security because of the periodic “reforms” that are necessary to maintain taxpayer support. I conclude by pointing out that to change the conceptual definition for program eligibility, we also must change our whole approach to providing for the economic security of people with disabilities. We need to replace our current “caretaker” approach with one that emphasizes helping people with disabilities help themselves. I will briefly describe features that such a program might require, and point out the most significant challenges we would face in making the transition

Transforming Disability Policy: Testimony to the Senate Committee on FInance

Briefing paper prepared for the U.S. Senate Committee on Finance Hearing, Barriers to Work for Individuals Receiving Social Security Benefits, June 21, 2007. Personal views on transformation of disability policy

Characteristics or Incentives: Why Do Employment Outcomes for the SSA Beneficiary Clients of VR Agencies Differ, on Average, from Those of Other Clients?

This report uses data from the Longitudinal Study of Vocational Rehabilitation Services Programs to compare employment outcomes of state vocational rehabilitation (VR) agency clients who receive Social Security Disability Insurance (DI) or Supplemental Security Income (SSI) -- “beneficiary clients” -- to those of non-beneficiary clients, before and after controlling for detailed information on disability and other characteristics that are likely to affect outcomes. Differences are substantial. Characteristics do explain a substantial share of the differences, but substantial differences remain. For instance, we estimate that only 23 percent of beneficiaries who received services achieved earnings above $500 per month for at least 9 months out of a 15-month period, compared to 54 percent of non-beneficiaries – a 30 percentage point difference. After controlling for other characteristics, the difference is 17 percentage points. One likely explanation for a substantial portion of the remaining difference is work disincentives faced by beneficiary clients. During this period, SSI recipients lost 50 cents in benefits for every dollar earned above certain disregards, and SSDI beneficiaries lost all benefits if they earned more than$500 per month, again net of certain disregards, for more than nine months

Federal program expenditures for working-age people with disabilities: Research Report

Public assistance programs are important sources of support for working-age people with disabilities in the United States. Using a variety of information sources, the authors estimate that the federal government spent $226 billion in 2002 on working-age people with disabilities, including both cash and in-kind benefits. These expenditures account for about 2.2 percent of the nation’s gross domestic product (GDP) and 11.3 percent of all federal outlays. States contributed an additional$50 billion under federal-state programs. The bulk of these expenditures provided income support and health care to working-age people with disabilities who were not employed or had very low earnings. The authors provide a detailed accounting of the expenditures and question whether the distribution of expenditures is properly aligned with the evolving disability paradigm

Summary Review of Data Sources for School to Work Transitions by Youth with Disabilities - Policy Brief

This brief summarizes our findings from a review of potential data sources to examine school-to-work transitions by youth with disabilities (Wittenburg and Stapleton, 2000). Our objective was to identify data sources for future school-to-work analyses that contain longitudinal information on youth with disabilities. We conclude that the following data sources are most promising based on our selection criteria: Survey of Income and Program Participation (SIPP); National Longitudinal Study of Adolescent Health (Add Health); Rehabilitation Services Administration (RSA) 911 Database and RSA’s Longitudinal Study of Vocational Rehabilitation (VR); state administrative data (multiple states); National Educational Longitudinal Study of 1988 (NELS:88); National Longitudinal Transition Study of Special Education Students (NLTS); National Longitudinal Transition Study of Special Education Students-2 (NLTS-2); and National Longitudinal Survey of Youth: 1997 (NLSY:97)

An Inventory of Disability Information for the Population Living in Institutions

The population living in institutions is excluded from most major national surveys. We evaluate the implications of this exclusion for disability statistics and research by compiling and examining existing disability information for the population living in institutions, with an emphasis on working-age people. The population living in institutions is a very small share of the entire population, but increased considerably from 1990 to 2000, especially for those ages 18-64. Working-age people accounted for a much larger proportion of the population living in institutions in 2000 (56 percent) than in 1990 (45 percent). As of 2000, 86 percent of the institutionalized working-age population resided in correctional institutions, and the remaining 14 percent were approximately evenly split between nursing homes and other institutions, many of which specialize in care for people with disabilities. When disability is defined as having at least one of the four disabilities in the 2000 Census—self-care, mental, physical, or sensory disabilities—the vast majority of the population with disabilities lives in household units; 8.7 percent live in group quarters (GQs), 6.4 percent live in institutional GQs, and 2.3 percent in non-institutional GQs. For working-age people with disabilities, the share of males living in institutional GQs is much larger than the share of females (7.7 percent versus 1.7 percent), in part reflecting the fact that more than nine out of ten inmates in correctional institutions are male. Working-age people with disabilities residing in institutional GQs are also disproportionately African American (38.6 percent of those ages 18-49 and 22.4 percent of those ages 50-64). Increased incarceration rates and the relatively high prevalence of disability in the incarcerated population suggest that growth in incarceration could have a substantial impact on disability prevalence in the household population, and on the characteristics of the household population with disabilities, most notably for young male African Americans. The nursing home residence rate declined for all age groups, but for those under 65 the decline is very small relative to the size of all persons in that age group, and thus seems unlikely to have much impact on disability statistics for the household population. We found no surveys covering the population living in institutions other than correctional institutions and nursing homes. The lack of information on this population may present a substantial problem for disability statistics and research

Will Expanding Health Care Coverage for People with Disabilities Increase their Employment and Earnings? Evidence from an Analysis of the SSI Work Incentive Program

Reports findings from study that examines the effect that increases in the income threshold under the Supplemental Security Income (SSI) work incentive program have on the employment, earnings, and program participation patterns of SSI recipients. Under Section 1619 of the Social Security Act, SSI recipients may maintain Medicaid eligibility, even if their income is above the level that makes them ineligible for SSI payments. If earnings increase beyond the threshold, however, the person loses their SSI and Medicaid eligibility. Findings indicate that many SSI recipients restrain their earnings to stay below the threshold, supporting the hypothesis that lack of access to health insurance is an important work disincentive for people with disabilities

Review of Data Sources for School to Work Transitions by Youth with Disabilities

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The decline in the employment rate for people with disabilities: Bad data, bad health, or bad policy?

A major debate has begun over reports of an unprecedented decline in the employment of working age people with disabilities over the 1990s business cycle. Here we review the literature on what can and cannot be said with current data on this subject and conclude that this decline is not an artifact of the data. We then review the various explanations and evidence for this decline and conclude that it was caused by changes in social policy rather than increases in the severity of the underlying health conditions and impairments of this population. The implication is that significant changes in public policy are needed to more effectively integrate working age people with disabilities into employment. We identify and discuss the most promising directions for public policy in this area

Contrasting the Employment of Single Mothers and People with Disabilities

The transition of single women with children off the welfare rolls and into employment (see Figures 1 and 2) in the 1990s has been described as “stunning” by leading policy researchers (see, for instance, Blank 2002). The authors in The Decline in Employment of People with Disabilities: A Policy Puzzle (Stapleton and Burkhauser 2003) document and analyze an equally stunning transition of working-age people with disabilities out of the workforce and onto disability income support programs (see Figures 1 and 2), despite the upsurge in government rhetoric proclaiming increased employment and economic independence as a primary policy goal. Employment and program participation trends for both populations departed sharply from trends in the prior decade