Explore the vast range of titles available.

I estimate the effects of removing low-income youth with disabilities from Supplemental Security Income (SSI) on their earnings and income in adulthood. Using a regression discontinuity design based on a 1996 policy change in age 18 medical reviews, I find that youth who are removed from SSI at age 18 recover one-third of the lost SSI cash income in earnings. SSI youth who are removed and stay off SSI earn on average $4,400 annually, and they lose $76,000 in present discounted observed income over the 16 years following removal relative to those who do not receive a review.

The low employment rates of individuals with intellectual disability (ID) are a major concern. This study examined the effect of postsecondary education on employment atrnd earnings for individuals with ID and the effect of state variation on those outcomes. Rehabilitation Services Administration 911 (RSA-911) files for 2008–2013 were analyzed (n = 11,280 individuals with ID). Multilevel modeling techniques were used to understand state variation, such as various economic and programmatic features that influence outcomes. Postsecondary education was associated with increased employment, increased weekly earnings, decreased reliance on Supplemental Security Income (SSI) benefits. Policy implications are discussed.

This paper used Social Security Administration program data from 2005 to 2019 to examine national- and state-level changes in the number of new adult supplemental security income (SSI) awardees on the autism spectrum relative to awardees with intellectual disability and other mental health disorders. We identified three main findings: the number of autistic awards increased between 2005 and 2019 when awards for all other mental health disorders declined; roughly nine out of every 10 autistic adult awardees were between ages 18–25 years; there was variation in the growth of autistic awards across states. These findings support the need to consider geographic and age differences in SSI program participation among autistic adults and determine the underlying causes.

The article by Muchomba and Kaushal in this issue of AJPH (p. 1106) describes how states' Medicaid expansions led to a reduction in Supplemental Security Income (SSI) payments for nonelderly disabled adults, saving the federal government more than $600 million. The use of SSI fell more for noncitizen immigrants (12%) than for citizens (2%). The authors used difference-in-difference methods to compare results in Medicaid expansion versus nonexpansion states. Using two data sources, they found consistent results, providing strong evidence that Medicaid expansions reduced SSI participation more for noncitizen immigrants than for citizens. Those who get SSI are usually automatically enrolled in Medicaid. But rigid SSI income and asset eligibility criteria have meant that some disabled adults could be discouraged from working and earning more, because going over the SSI limits (and losing SSI assistance) would trigger the loss of health insurance, which is essential for those with disabilities. The Affordable Care Act allowed states to raise Medicaid income eligibility above SSI levels and eliminated asset tests, so adults with disabilities could keep their health insurance even if they earned more than SSI allows. Previous research has shown how Medicaid expansions improve work incentives and increase employment of disabled SSI recipients.

Before the Patient Protection and Affordable Care Act (ACA), many Americans with disabilities were locked into poverty to maintain eligibility for Medicaid coverage. US Medicaid expansion under the ACA allows individuals to qualify for coverage without first going through a disability determination process and declaring an inability to work to obtain Supplemental Security Income. Medicaid expansion coverage also allows for greater income and imposes no asset tests. In this article, we share updates to our previous work documenting greater employment among people with disabilities living in Medicaid expansion states. Over time (2013–2017), the trends in employment among individuals with disabilities living in Medicaid expansion states have become significant, indicating a slow but steady progression toward employment for this group post-ACA. In effect, Medicaid expansion coverage is acting as an employment incentive program for people with disabilities. These findings have broad policy implications in light of recent changes regarding imposition of work requirements for Medicaid programs.

Purpose Work incentives benefits counseling (WIBC) can be a strong facilitator contributing to improved employment outcomes for individuals with intellectual disabilities (ID) by providing information about how income may affect disability benefits eligibility. The purpose of this study is to evaluate the effect of WIBC as a VR intervention to improve on employment outcomes and earnings of transition-age youth and young adults with ID who are Supplemental Security Income benefits recipients using a propensity score matching analysis approach. Propensity score matching using logistic regression analysis and the nearest neighbour method was conducted to equalize the treatment (received WIBC) and control groups (not received WIBC) on the six prominent demographic covariates. The treatment group had higher rates of employment, higher hourly wages than the control group, while the treatment group worked less hours per week than the control group. Methods Propensity score matching using logistic regression analysis and the nearest neighbour method was conducted to equalize the treatment (received WIBC) and control groups (not received WIBC) on the six prominent demographic covariates. Results The treatment group had higher rates of employment, higher hourly wages than the control group, while the treatment group worked less hours per week than the control group. Conclusions Findings of the present study can be used by policy makers, transition specialists, rehabilitation counselors, and other disability service providers to increase employment outcomes and earnings for individuals with ID through WIBC services. Future research and practice implications are provided.

Greater attention is being paid to the transition to adulthood for youth with disabilities. We are also at a period of reckoning with the vestiges of slavery, Jim Crow, and a lack of constitutional protections for Black-identifying persons. The contemporary impact of inequitable access to opportunities, services, and supports that would improve the quality of life of racialized Black individuals has added consequences for Black youth with disabilities. A sub-population of youth with disabilities receives monthly support in the form of Supplemental Security Income (SSI), with a disproportionate number of Black-identifying youth qualifying for SSI. Such youth are impacted by the intersectionality of racism, disability, and poverty. The outcome of an SSI age-18 redetermination can be precarious and occurs in the backdrop of these intersectional forces, impacting the life course of racialized Black youth and their families on a scale that is concerning. The authors describe the time frames of pre age-18 redetermination, age-18 redetermination and post age-18 redetermination in the contexts of intersectionality and transition, and articulate what type of services and supports can reduce the experience of chronic stress in the lives of racialized Black youth facing an SSI age-18 redetermination, and thereby improve the outcomes of these youth as they transition to adulthood.

For some low-income Medicare beneficiaries, Medicaid provides financial protection against Medicare's out-of-pocket costs, but many Medicare beneficiaries who qualify for Medicaid are not continuously enrolled. We examined Medicaid disenrollment among fee-for-service Medicare beneficiaries and the relationship between disenrollment and state policies. In the period 2012-16, 18.2 percent of Medicare beneficiaries who received full or partial Medicaid disenrolled for reasons other than death. More than 50 percent of Medicare beneficiaries who remained without Medicaid one year after disenrolling continued to receive low-income subsidies for Medicare Part D coverage with eligibility requirements similar to those of Medicaid. Among Medicare beneficiaries with continuous Part D subsidies, the rate of Medicaid disenrollment was 24 percent lower in states that automatically enrolled recipients of the federal supplemental security Income program in full Medicaid, 33 percent lower in states with more generous provider payment policies, and 37 percent lower in states with less restrictive asset limits for partial Medicaid. Policies that make it easier for people to maintain Medicaid eligibility and that enhance access to care in Medicaid via higher provider reimbursements may reduce disenrollment.

As health insurance becomes available outside of the employment relationship as a result of the Affordable Care Act (ACA), the cost of applying for Social Security Disability Insurance (SSDI)—potentially going without health insurance coverage during a waiting period totaling 29 months from disability onset —will decline for many people with employer-sponsored health insurance. At the same time, the value of SSDI and Supplemental Security Income (SSI) participation will decline for individuals who otherwise lacked access to health insurance. We study the 2006 Massachusetts health insurance reform to estimate the potential effects of the ACA on SSDI and SSI applications.

The risk of losing access to crucial means-tested programs — like Medicaid, Supplemental Security Income (SSI), the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF) — poses a barrier to the enrollment of low-income Americans in clinical trials. This burden likely disproportionately affects members of racial and ethnic minority groups, people with disabilities, elderly individuals, and rural populations, and may frustrate efforts to reflect the US population in clinical trial enrollment. To help achieve representative clinical trials for myriad conditions, Congress should pass legislation excluding payments to clinical trial participants from gross income and expand the clinical trial compensation exclusions for means-tested programs established in the Ensuring Access to Clinical Trials Act of 2015.