Kalman Rupp

A life-cycle perspective on the transition to adulthood among children receiving Supplemental Security Income payments

Youth who receive cash benefits from the Supplemental Security Income (SSI) program, the largest federal program that provides cash payments to low-income youth with severe disabilities and their families, face several challenges in transitioning into adulthood. From a human capital development perspective, the disabilities and health problems during childhood and early adulthood as well as the family environment form important inputs that will likely influence long-term adult outcomes. This paper provides a review of some of the challenges these youth face in transitioning into adulthood using a life-cycle framework and presents descriptive statistics on their challenges and outcomes into early adulthood. Our summary illustrates the challenges that SSI youth face as they make the transition to adulthood and shows how the long-term employment and program outcomes of this population have changed over time. The findings provide a broader framework for the remaining five papers in this issue and underscore the need for rigorous testing of promising interventions and a carefully balanced mix of statistical and econometric analyses based on longitudinal data sources with a long time horizon.

Family caregiving and employment among parents of children with disabilities on SSI

Parental and family inputs are particularly important for children with disabilities receiving benefits from the Sup- plemental Security Income (SSI) program. These children often need disability or health-related care, and nonfamily sources provide only limited access. This is the first study to analyze family and nonfamily caregiving for these children with disabilities based on nationally representative quantitative data from the National Survey of SSI Children and Families (NSCF), a survey focusing on SSI recipient children with disabilities. The data suggests substantial variability in the need for caregiving among children on SSI. We find that there is also substantial variation in family inputs related to parental education, living arrangements, the presence of other children of preschool age and other factors that affect the quality and quantity of caregiving. Our analysis confirms that family caregiving is much more substantial for these children than nonfamily caregiving, and that caregiving from both sources is associated with various indicators of the nature and extent of disabilities. We find some - but weaker - evidence of an association between the childs disabilities and parental employment. Overall, while there is some substitution between parental employment and caregiving there appears to be a substantial net burden on the family arising from the childs needs for caregiving. We also find that there are significant predictors of family caregiving and parental employment that are unrelated to the childs disabilities. Most of these show opposite relationships to caregiving and parental employment - negative for one, positive for the other or vice versa. However, better parental education substantially increases the odds of both caregiving and parental employment. Parental disability sharply reduces the odds of parental employment and somewhat increases the odds of reported family caregiving. Overall, the challenges are especially substantial for single mothers who cannot share the extra burden of raising a child with severe disabilities with a spouse.

A LONG-TERM VIEW OF HEALTH STATUS, DISABILITIES, MORTALITY, AND PARTICIPATION IN THE DI AND SSI DISABILITY PROGRAMS

Using data from the Survey of Income and Program Participation (SIPP) matched to administrative records, we examine mortality risk and participation in the Disability Insurance (DI) and Supplemental Security Income (SSI) disability programs from a long-term perspective. Over a period of 14 years, we analyze the effect of self-reported health and disability on the probability of death and disability program entry among individuals aged 18–48 in 1984. We also assess DI and SSI programs from a life-cycle perspective. Self-reported poor health and severe disability at baseline are strongly correlated with death over the 14-year follow-up period. These variables also are strong predictors of disability program participation over the follow-up period among non-participants at baseline or before, with increasing marginal probabilities in the out-years. Our cross-sectional models are consistent with recent studies that find that the work-prevented measure is useful in modeling DI entry. However, once self-reported health and functional limitations are accounted for, the longitudinal entry models provide conflicting DI results for the work-prevented measure, suggesting that, contrary to claims based on cross-sectional or short-time horizon application models, the work-prevented measure is an unreliable indicator of severity. The risk of SSI and DI participation is significantly greater for individuals who die, suggesting that future mortality captures the effect of case severity and deterioration of health during the follow-up period. From a life-cycle perspective, a substantially greater proportion of individuals participate in SSI or DI at some point in their lives compared to typical cross-sectional estimates of participation, especially among minorities, people with less than a high school education, and those with early onset of poor health and/or disabilities. Cross-sectional estimates for the Social Security area population indicate SSI and DI participation rates of no more than 5% combined in 2000. In contrast, for individuals aged 43–48 in 1984, we observe a cumulative lifetime SSI and/or DI participation rate of 14%. The corresponding figure is 32% for individuals in that age group who did not graduate from high school, suggesting the need for human capital investments and/or improved work incentives.

Accounting for the Process of Disablement and Longitudinal Outcomes Among the Near Elderly and Elderly

Using a new disability measure applicable to both the near elderly and elderly population, we track respondents aged 51–61 in 1992 from the Health and Retirement Study and account for their status over 20 years. We demonstrate that to screen in as disabled and to screen out as nondisabled require different analytic strategies and use multiple indicators to establish three groups: disabled, nondisabled, and a residual category with ambiguous status. We use work-disability and Supplemental Security Income/Disability Insurance (SSI/DI) receipt for testing distributional outcomes and assessing face validity of our disability measure. Selective attrition due to death and institutionalization is substantial over 20 years. Persistent disability is the dominant adverse outcome of initial disability shock. Overtime exits due to death become progressively more important; 44% disabled at baseline are dead by Wave 11 compared to 21% for nondisabled. Disability status at baseline is associated with financial insecurity persisting to Wave 11 among survivors.