Program Participation Patterns Among Persons with Disabilities - Executive Summary

Pat Doyle, Esther Miller and Jim Sears

Mathematica Policy Research, Inc.

This report was prepared under contract #HHS-88-0047 between the U.S. Department of Health and Human Services (HHS) Office of Social Services Policy (now DALTCP) and Mathematica Policy Research, Inc. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Michele Adler.

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.

This report relies on data from the Survey of Income and Program Participation (SIPP) to explore the extent to which persons with disabilities participate in federally subsidized cash and in-kind programs and the adequacy of total benefits from the combination of programs in alleviating poverty among this group. The report establishes the existence of disabilities according to three broad definitions: limitations in functioning (defined differently for adults and children), limitations in work, and the receipt of disability benefits. A six-level scale of limitations in functioning and a four-level scale of limitations in work are used to account for a broad range of limitations--from the most severely disabled persons to those who report no limitations. In addition, we use the term 'substantial functional limitations' to denote persons whose level of limitation in functioning is more severe than experiencing difficulty with just one function.

This study is part of a series of four reports prepared for the Department of Health and Human Services to other information on the population of persons with disabilities. Other reports in the series include the following:

• A profile of persons with disabilities that provides the motivation for the different definitions and classifications of disability used in this study and which details both the prevalence of disabilities and the characteristics of the population with and without disabilities
• A profile of the rules and benefit structures of the federal programs which serve the disabled
• A profile of persons with disabilities who are in the labor market

The program participation patterns of the population of disabled persons and the adequacy of federal assistance in alleviating poverty among this group are summarized below.

FINDINGS

Programs designed to provide financial assistance to the disabled working-age population (Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Medic-are) are well targeted, in that:

• Two-thirds or more of participants have substantial functional limitations or are prevented from working.

• The likelihood of participation increases with the presence and severity of a limitation in functioning or a limitation in work.

Furthermore, while the Aid to Families with Dependent Children (AFDC), Food Stamp, and Medicaid programs are not targeted specifically to the disabled, a significant proportion of working-age program participants report substantial functional limitations. In addition, nonelderly individuals with disabilities are more likely to participate in the AFDC, Food Stamp, Social Security (other than SSDI), and smaller programs than is the total population of nonelderly persons.

Although not targeted to the disabled elderly population, most programs which provide benefits conditional on reaching age 65 serve a substantial portion of those with disabilities. Three-fourths of the participants in need-tested programs targeted to the low-income elderly population and slightly less than half of the participants in Social Security and Medicare have substantial functional limitations. While it is true that most elderly individuals are covered under the Social Security program and participation does not appear to be influenced by the severity of the limitation in functioning, participation rates in the other programs are affected by disability status. Participation in the SSI program increases with the severity of the limitation in functioning, and participation in federal assistance programs other than Social Security is higher among persons with substantial functional limitations than among those without.

Federal assistance programs in combination are more successful at reaching most of the low-income population with disabilities than at reaching the low-income population in general. However, a significant portion of the nonelderly low-income population with disabilities receive no assistance from the federal government--one-fourth of low-income working-age adults with substantial functional limitations, 16 percent of low-income working-age adults who are prevented from working, and one-fifth of low-income children with disabilities.

A substantial portion of persons with disabilities have health insurance, due in large part to the link between public health insurance and the receipt of federal assistance. Nonetheless, nearly one-fifth of the low-income nonelderly population lack insurance coverage from both public and private sources. The rate and nature of health insurance coverage vary by participation in federal assistance programs, disability status, and age.

The proportion of disabled individuals who participate in the SSI program appears to be low relative to the number who are apparently eligible:

• The overall participation rate for eligible working-age adults is estimated to be 38 percent, and the overall rate among eligible elderly individuals is estimated to be 50 percent.

• Participation rates among the working-age population do not increase with the severity of the limitation in functioning, while participation rates among the elderly do.

Income support programs combined with food stamps are successful at moving many persons with disabilities out of poverty. However, a substantial portion of nonelderly disabled individuals and a small but significant portion of elderly disabled individuals remain poor even after their receipt of food stamp benefits is taken into account:

• Among the working-age adult population, Social Security benefits are very effective at reducing poverty, and are more effective for persons with disabilities than the total population. Cash assistance programs combined with food stamps are successful at increasing the economic status of persons in very poor households (defined as households whose pre-transfer household income is below half the poverty line). Nonetheless, one-third of very poor persons with disabilities and one-fourth of the total of the total population of the very poor are still in poverty even after the receipt of these benefits.

• Social Security benefits are very successful at alleviating poverty among the elderly population. However, proportionately more disabled elderly persons remain in poverty after the receipt of federal cash assistance and food stamps than is true of the total population of elderly persons.

• Small sample sizes preclude drawing specific statements about the impact of federal assistance programs on the poverty status of disabled children. However, over four-fifths; of children whose pre-transfer household income is below half the poverty line and almost one-third of children in other pre-transfer poor households remain poor after federal cash assistance and food stamps are taken into account.