The National Health Interview Survey (NHIS) provides the most comprehensive nationally representative data on health and disability that also allows identification of TANF recipients and reports on employment. The NHIS interviews roughly 45,000 families a year, but declining TANF caseloads (and reporting of TANF benefits) limit the sample size of TANF recipients. This study pools 2005 and 2006 together to yield a larger unweighted sample size of 654 families with a TANF recipient in the prior calendar year. This sample provides an accurate baseline of disability prevalence before final implementation of DRA related changes. The NHIS is a complex survey sample; in this report, all results are appropriately weighted and the calculation of standard error accounts for the survey design.
The multi-dimensional nature of disability and health limitations argues for the use of multiple measures to capture disability. The findings in this report are for a number of different measures of disability for adults and children.(1) We report the most commonly used measures in the literature (see Altman and Bernstein 2008 and Harris, Hendershot, Stapleton 2005) as well as information that is generally not available in other surveys. For adults, the commonly used measures include limitations in a set of individual activities including whether they need help with self-care (bathing/showering, dressing, eating, getting in and out of bed or chairs, using the toilet, and getting around the home); help with routine activities (everyday household chores, unnecessary business, shopping, or getting around for other purposes); and whether a person is limited in the kind or amount of work they can do or unable to perform work due to physical, emotional, or mental limitations or conditions. In addition, we include other measures of disability: limitations in movement (difficulties with specific physical activities); mental or emotional problems; sensory limitations in seeing or hearing; cognitive limitations in remembering; limitations in ability to carry out social activities; and excessive alcohol use. We report results for measures separately, but also present several composite measures of disability created from these individual measures.
We also present findings on disability among other family members (adults and children) of the TANF recipient, since these can impact a recipient’s ability to work and these members may receive services from the TANF agency. The measures we use are: (1) another adult in the family has self-care or routine needs limitations; or (2) a child has a self-care limitation or is limited in their ability to play or conduct activities similar to other children their age. In addition to these measures, we also include for adults and children information about receipt of government disability benefits, including Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), and Railroad Retirement income received as a result of disability. While these benefits have nondisability requirements on income and work history, eligibles have met a fairly severe definition of disability that is difficult to duplicate in secondary data. We also include receipt of private disability benefits, which are usually available through an employer.
Using all of the above measures of disability we report on the prevalence of disability among TANF recipients. To put these results in context, we also compare results for TANF recipients to all adults (N=35,789), food stamp recipients (N=2,677), and low-income single mothers (N=4,293).(2) The first provides context for the extent to which TANF recipients have greater rates of disability than the general population. The second and third provide a comparison of disability relative to groups that are similar in terms of income and family structure, but are not necessarily receiving TANF. Because we are primarily concerned with promoting work, all of these groups are limited to adults ages 21 to 55. We want each group to be representative of the relevant subpopulation, so we do not require the groups be mutually exclusive. This means that almost all TANF recipients will also be in the Food Stamp recipient group and many will be in the low-income single mothers group.
Since some disability questions in the NHIS are asked only for a randomly chosen adult in the family, we limit our analysis sample to this set of adults. Our unweighted sample sizes are still large enough to support our analysis. We use appropriate weights so that the presented findings are representative of the US non-institutionalized population.(3)
When comparing these results to findings from other data, the reader should be aware of the timing of this survey information. The NHIS income data are for the previous calendar year. Therefore, our measures of TANF receipt (as well as Food Stamp and public disability receipt and low-income status) are for the prior calendar year. Since the measures of disability are current (at the time of the interview) there may be some difference when comparing to data that measure disability and benefit receipt at the same time. In addition, current employment is measured at the time of the survey, so results on employment of TANF recipients may differ from surveys where the two are measured contemporaneously.