U.S. Department of Health and Human Services

An Estimate of the Number of Persons with Developmental Disabilities Receiving Supplemental Security Income Benefits and Their Characteristics

Brian O. Burwell

SysteMetrics/McGraw-Hill

July 1990

PDF Version: http://aspe.hhs.gov/daltcp/reports/ssiestes.pdf (32 PDF pages)

This report was prepared under contract #HHS-100-88-0035 between the U.S. Department of Health and Human Services (HHS), Office of Social Services Policy (now the Office of Disability, Aging and Long-Term Care Policy) and SysteMetrics/McGraw-Hill. For additional information, you may visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the Office of Disability, Aging and Long-Term Care Policy at HHS/ASPE/DALTCP, Room 424E, H.H Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.

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.

TABLE OF CONTENTS

PREFACE

1.0 OVERVIEW

2.0 DATA SOURCE

3.0 ESTIMATE OF SSI DISABLED RECIPIENTS WITH DEVELOPMENTAL DISABILITIES

4.0 CHARACTERISTICS OF PERSONS WITH DEVELOPMENTAL DISABILITIES RECEIVING SSI BENEFITS

By SSI Group Classification

By Age

By Race

By Sex

By Marital Status

By Living Arrangement

By Recipient of State Supplementation Payments

By SSI/SSP Payment Amounts

By Receipt of Unearned Income

5.0 STATE-LEVEL ESTIMATES OF PERSONS WITH DEVELOPMENTAL DISABILITIES RECEIVING SSI BENEFITS

ATTACHMENT A

NOTES

LIST OF TABLES

TABLE 1. Primary Disabling Conditions of SSI Recipients Under Age 22: December 1997

TABLE 2. SSI Disabled Recipients Over Age 21 with Diagnoses Indicating a Developmental Disability

TABLE 3. Adult SSI Recipients Who Applied for SSI Prior to Age 22

TABLE 4. Adult SSI Recipients with Missing or Non-DD Diagnoses, Who Applied for SSI After Age 21, And Who Receive SSDI Adult Disabled Children (ADC) Benefits

TABLE 5. Estimate of SSI Disabled Adults Over Age 22 with Valid Diagnoses Who Have Developmental Disabilities

TABLE 6. Estimate of SSI Recipients with Developmental Disabilities: December 1987 and March 1989

TABLE 7. DD Analytical Group by SSI Group Classification

TABLE 8. DD Analytical Group by Age

TABLE 9. DD Analytical Group by Race

TABLE 10. Analytical Groups by Sex

TABLE 11. Analytical Groups by Marital Status

TABLE 12. DD Analytical Group by Living Arrangement

TABLE 13. Analytical Groups by Receipt of State Supplementation Payments

TABLE 14. Analytical Groups by Average SSI/SSP Payment Amounts

TABLE 15. Analytical Groups by Receipt of Unearned Income

TABLE 16

PREFACE

This study was prepared under Contract No. HHS-100-88-0035 with the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services. The overall purpose of the contract, The Project to Design a Survey of Persons with Developmental Disabilities, was to develop a national survey design that would provide data on a nationally representative sample of persons with developmental disabilities, and which could be used to develop more effective program policies for providing assistance to such persons. The Final Report of the Project to Design a Survey of Persons with Developmental Disabilities: Survey Goals, Justification, and Design, may be obtained upon request from the Office of the Assistant Secretary for Planning and Evaluation (ASPE).

This study, An Estimate of the Number of Persons with Developmental Disabilities Receiving Supplemental Security Incomes Benefits and Their Characteristics, was one of a series of analyses of various national data sets which included persons with developmental disabilities that were used to help guide the national survey design project. The study was conducted by SysteMetrics/McGraw-Hill under subcontract to Mathematica Policy Research, which was the prime contractor. The Federal project officer was Robert Clark of ASPE, and the project director at Mathematica Policy Research was Craig Thornton. The author would like to thank both of them for their guidance and assistance on this study. Additional thanks are extended to Michael Staren and Satya Kochhar of the Office of Supplemental Security Income, Social Security Administration, for their generous assistance, and to Elizabeth Boggs for her very helpful comments on a previous draft of this paper.

1.0 OVERVIEW

Many children and adults with developmental disabilities receive financial assistance from the Supplemental Security Income (SSI) program. To qualify for SSI benefits, disabled persons under the age of 65 must meet two basic eligibility requirements: (1) they must be certified as disabled by the Social Security Administration; and (2) their income and assets must fall below SSI financial eligibility limits.¹ In 1990, a single disabled individual living independently was required to have "countable' income below $386 per month and countable assets of less than $2,000 in order to qualify for Federal SSI benefits.²

Although it is well known that many persons with developmental disabilities receive SSI benefits, specific estimates of the number of developmentally disabled SSI recipients have not been developed. Such estimates are important for projecting the costs of proposed changes in Federal assistance to persons with developmental disabilities, including changes in the Medicaid progam, since Medicaid eligibility is closely linked to eligibility for SSI benefits. This paper provides an estimate of the number of persons with developmental disabilities receiving SSI benefits, based on SSI administrative records, and also presents data on certain characteristics of the developmentally disabled (DD) SSI population.

2.0 DATA SOURCE

The data source for the study was the "10-percent disability sample file" of SSI recipients extracted from the Supplemental Security Record (SSR), which is the main SSI computerized administrative file. The SSI 10-percent file is constructed periodically by the Office of Research and Statistics of the Social Security Administration in order to provide cross-sectional estimates of the SSI caseload as well as data on the SSI program experience for a given group of recipients. The 10-percent file is an outgrowth of the SSI 1-percent file, which was orginally begun in 1981. The Office of Research and Statistics' reason for constructing a 10-percent file in addition to a 1percent file was to enhance the analytical opportunities for describing the SSI caseload along a variety of dimensions, including the development of cross-State comparisons.

This paper was conducted under a contract by the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services with Mathematica Policy Research, Inc., in which SysteMetrics/McGraw-Hill is participating as a subcontractor, to develop a National Survey of Mentally Retarded and Developmentally Disabled Persons in Community Settings. In this project, analyses are being conducted of various national data sets which include persons with developmental disabilities to help develop national estimates of the developmentally disabled population and to help guide the survey design effort.

For the study, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) requested and received from the Social Security Administration a copy of the December 1987 10-percent disability sample file. The December 1987 file was the most recent 10-percent file constructed at the time of the request (spring 1989). The file contained 551,156 records of disabled individuals on the SSR administrative file. Of these, only a subset were actually receiving Federally-administered SSI payments in December 1987. The remaining records were either of persons who were still in the application process, persons who had applied for benefits but did not meet the eligibility criteria, persons whose SSI payments were on hold or temporarily suspended, or persons whose benefits were recently terminated. There were 288,054 records of recipients in "active payment status," approximately 9.8% of the 2,929,612 persons receiving Federally-administered SSI benefits on the basis of blindness or disability in December 1987.³

Attachment A presents a Record Description of the 10-percent disability sample file. Of greatest interest to this study was the Current Diagnostic Code, which indicated the primary disabling condition of the SSI beneficiary. As will be discussed later on, this variable was used to identify recipients whose primary diagnosis indicated a developmental condition. However, there were a number of problems with this data item which may limit the quality of the information presented in this study. For one, in many records on the file, the Current Diagnostic Code was missing altogether. Of the 288,054 records of recipients in active payment status, 111,466 (38.7%) had missing Current Diagnostic Codes. It is also known that persons with missing diagnostic codes are more likely to be persons who have been receiving SSI payments for longer periods of time (i.e. codes are more likely to be present for recipients with more recent eligibility dates). Thus, a description of the SSI disabled caseload based on records of persons with non-missing Current Diagnostic Codes may not represent a true picture of the SSI caseload.

Second, among those records with Current Diagnostic Codes, data quality problems may exist. One problem relates to the fact that for a few years in the mid-1980s, SSA switched from using the International Classification of Diseases (ICD) four-digit coding system to a newly devised system of three-digit impairment codes. After a few years of experimenting with the impairment code system, however, SSA decided to switch back to the ICD-9 system. Although attempts have been made by SSA to recode the three-digit impairment codes for persons on the 10-percent file to ICD-9 codes, this recoding, effort may have introducted inaccuracies into the data set. A second problem relates to the more generic process of assigning diagnostic classifications to SSI recipients by SSA staff. These classifications are made from a review of the medical documentation submitted to the Social Security Administration as part of the disability determination process, and inevitably some misclassification of diagnoses and conditions must occur during this process. Consequently, the estimates of persons with developmental disabilities receiving SSI benefits presented in this paper must be interpreted with caution.

3.0 ESTIMATE OF SSI DISABLED RECIPIENTS WITH DEVELOPMENTAL DISABILITIES

Who are persons with developmental disabilities? The most common definition is that used in the Developmental Disabilities Assistance and Bill of Rights Act Amendments of 1987, which specifies that a developmental disability is:

A severe, chronic disability of a person which:

1. is attributable to a mental or physical impairment or a combination of mental or physical impairments;

2. is manifested before the person attains age twenty-two;

3. is likely to continue indefinitely;

4. results in substantial functional limitations in three or more of the following areas of major life activity:

   • self care
   • receptive and expressive language
   • learning
   • mobility
   • self-direction
   • capacity for independent living and

   • economic self-sufficiency; and

5. reflects the person's need for a combination and sequence of special, interdisciplinary, or generic care, treatment or other services which are of lifelong or extended duration and are individually planned or coordinated.

In this study, an estimate of SSI recipients with developmental disabilities was developed through a sequential, iterative process. First, we assumed that all persons under the age of 22 in December 1987 who were receiving SSI payments were developmentally disabled. It is self-evident that all SSI recipients under age 22 have a disability with an age of onset prior to age 22. The main question is whether all children who qualify as disabled for SSI purposes also meet the "severity" and "permanency" criteria of the DD Act definition.

For children applying for SSI benefits, "the disability standard is a medically determinable physical or mental impairment of comparable severity to one that prevents an adult from engaging in substantial gainful employment."⁴ As for adults, the disability must have lasted, or be expected to last, at least 12 months or be expected to result in death. However, the criteria used to determine disability among SSI child applicants, since they are based on the same criteria used in determining whether an adult applicant is capable of gainful employment, have been criticized as not adequately reflecting age-appropriate disability limitations in children and which therefore result in inequities in the determination of disability among children. At the same time, there may be some children who qualify for SSI benefits who would not meet the DD Act's criteria for functional limitations in three or more areas of life activity. For example, a child who is blind, or who has a severe hearing loss, or who has a malignant neoplasm, may be functionally limited in less than three areas of life activity, but nonetheless qualify as disabled for SSI purposes.

Nonetheless, we made the simple assumption that all SSI recipients under age 22 could be classified as developmentally disabled. Of the SSI disabled population on the file, 14.9% were under age 22. Not all of these persons were receiving SSI benefits as "disabled children," since persons aged 18 and over may receive SSI benefits as a separate adult unit. Table 1 presents the distribution of the SSI disabled population under age 22 by primary disabling condition. Children with a diagnosis of mental retardation are clearly the dominant category, comprising 42.2% of the entire population, and 47.7% of all children with a valid diagnosis on the file. The next most common disabling conditions among SSI children were infantile cerebral palsy, hearing loss, congenital anomalies, and schizophrenic disorders. No other condition occurred in more than 2 percent of the population. Note, however, that if one combined all mental disorders (schizophrenic disorders, psychoses with origin in childhood, neurotic disorders, other organic psychotic conditions, and affective psychoses) into a single diagnostic classification, these children would total 22,130 individuals, about 5.2% of the SSI child population, becoming the third most prevalent diagnostic condition. Persons with mental disorders are often excluded from discussions of the developmentally disabled population, since most persons with severe mental disorders initially become symptomatic in adulthood, not childhood.

For adults, an iterative process was used to estimate the number of SSI recipients with developmental disabilities. Among adults, more records on the file were missing diagnoses. As shown in Table 2, 43.4% of SSI adults on the 10-percent file were missing Current Diagnostic Codes, while 56.6% had valid diagnosis codes. Our first step was to identify a number of specific diagnostic conditions which are universally accepted as indicative of a developmental condition. These diagnoses were:

Persons with these diagnostic conditions comprised 21.2% of all SSI adults on the file with valid diagnosis codes (Table 2). Persons with mental retardation comprised 90% of all persons with these diagnoses.

We knew that many other SSI adults with diagnoses other than those listed above were developmentally disabled, but could not be classified as such on the basis of diagnosis alone. For example, as discussed above, SSI adults with mental disorders may have had an age of onset prior to age 22 or subsequent to age 22. The same is true for persons with epilepsy, multiple sclerosis, neoplasms, traumatic brain injuries, and so on. Although the SSI Record Description includes an Age of Onset field, we were informed by SSA that data in this field did not accurately represent the true date of disability onset for most recipients. In most cases, the Age of Onset is the date on which the applicant was determined disabled for SSI purposes (i.e. the date on which documentation of disability was accepted), and often corresponds or post-dates the actual date of application for benefits. Thus, for this study, we assumed that any SSI recipient who originally applied for benefits prior to age 22 was likely to have a developmental disability.

Table 3 shows the percentage of SSI adults on the 10-percent file who originally applied for SSI benefits prior to age 22. Of those with one of the DD diagnoses discussed above, 37.2% had originally applied for benefits prior to age 22. However, it is interesting to note that the majority of adult SSI recipients with these diagnoses did not apply for benefits until their adult 'years (although many were undoubtedly already adults when the SSI program was enacted in 1974). Of SSI adults who did not have one of the DD diagnoses previously discussed, 5.9% had originally applied for SSI benefits prior to age 22. We added these recipients to our estimate of SSI adults with non-missing diagnoses who could be classified as having a developmental disability.

To this point, we have identified SSI adults as being developmentally disabled if either (1) they were indicated to have a specific DD diagnosis; or (2) they applied for SSI benefits prior to age 22. To this group, we added a final group: SSI adults who were receiving Title II (Social Security Disability) benefits as Adult Disabled Children (ADC). Persons receiving Adult Disabled Children benefits are persons who were disabled prior to age 22, and are the children of retired, disabled, or deceased Social Security beneficiaries. Table 4 shows that of those SSI adults with non-missing diagnoses not previously classified as developmentally disabled, another 0.9% were ADC recipients.

Table 5 summarizes our estimate of the percentage of SSI disabled adults who are developmentally disabled with this methodological approach. Among persons on the 10-percent file over the age of 21, 26.6% of adults were classified as developmentally disabled under one or more of the three criteria employed.

Table 6 summarizes our overall estimate of the number and percentage of all disabled SSI recipients who are developmentally disabled. For this estimate, we used SSA data on the actual number of persons receiving SSI benefits in December 1987, applying the percent of beneficiaries classified as developmentally disabled on the 10-percent file (100% of recipients under age 22 and 26.6% of disabled recipients age 22 and over). Using this approach, we estimate that there were approximately 1,066,370 developmentally disabled persons receiving Federally-administered SSI benefits in December 1987, 36.4% of all SSI disabled beneficiaries.^5,6 Within this total population, we estimate that approximately 63% were persons with a diagnosis of mental retardation (72% of adults and 48% of children) and 37% were persons with a developmental disability other than mental retardation.

This estimate of course assumes that the percentage of persons with missing diagnoses on the 10 percent file who are developmentally disabled is the same as those with valid diagnoses. We believe that this is a reasonably valid assumption. Note that if we apply only two of the three criteria which were used to identify developmentally disabled adults with valid diagnoses (the two criteria being; (1) applied for SSI benefits prior to age 22; and (2) were receiving Title II benefits as Adult Disabled Children), 24.4% of those with missing diagnoses would be classified as developmentally disabled on these two criteria alone (see Table 3 and Table 4). We believe that if it was possible to apply the third criterion to this group (a specific DD diagnosis), this percentage would increase somewhat, but would probably not be far different from the 26.6% estimate derived for SSI-disabled adults with valid diagnoses.

4.0 CHARACTERISTICS OF PERSONS WITH DEVELOPMENTAL DISABILITIES RECEIVING SSI BENEFITS

This section presents a descriptive analysis of persons with developmental disabilities receiving Federally-administered SSI benefits, based upon information available on the SSI 10-percent disability sample file. In this analysis, adult SSI recipients with missing diagnoses who meet the criteria of either (1) applying for SSI prior to age 22; or (2) also receiving Adult Disabled Children benefits under Title II, are classified as developmentally disabled and other persons with missing diagnoses are classified as "non-DD adults."

By SSI Group Classification

Table 7 presents the SSI group classification of SSI children, DD adults, and non-DD adults (hereafter referred to as the "analytical groups"). of interest is the fact that 32% of SSI children under age 22 are classified as disabled individuals rather than disabled children. In the SSI program, once a child reaches the age of 18, parents are no longer considered to be financially responsible for the care of their children, and parental income is no longer deemed available to the SSI recipient. Also, parental income is not deemed available when children are placed in out-of-home settings, such as Intermediate Care Facilities for the Mentally Retarded (ICFs-MR). Thus, it appears that approximately one-third of SSI children under age 22 are either between the ages of 18 and 21, or are living in out-of-home settings.

By Age

SSI recipients with developmental disabilities are considerably younger than other disabled SSI recipients, as shown in Table 8. However, SSI recipients under age 22, all of whom we defined as developmentally disabled, are older than the general child population. For example, while almost 19 percent of all children in the general population are under age 4, children under the age of 4 comprised less than 10 percent of all SSI disabled children. In contrast, children between 18 and 21 comprised over 36 percent of SSI disabled children, but only 19 percent of all children. In terms of prevalence rates, there were 2.7 SSI disabled children per 1,000 children in the general population in 1987; 4.2 per thousand between the ages of 4 and 10; 5.3 per thousand between the ages of 11 and 17; and 10.4 per 1,000 between the ages of 18 and 21.

The increase in prevalence rates with increasing age is due to two major factors: (1) it has often been difficult for very young children with disabilities to pass the Social Security disability test;⁷ and (2) some children with developmental disabilities do not develop their disabilities into later in childhood (e.g. accident victims, adolescents with mental illness). The large increase in prevalence rates among children between the ages of 18 and 21 is also due to the fact that parental income and assets are no longer taken into account in determining the financial eligibility of SSI applicants once a child reaches the age of 18.

Almost 50 percent of all SSI adults persons identified as developmentally disabled on the SSI 10% file were between the ages of 22 and 30, and over 97 percent were under the age of 65. In contrast, only about 6 percent of non-DD adults were between the ages of 22 and 30 and over one-fourth were over the age of 65. Developmentally disabled adults comprised almost 75 percent of all SSI disabled recipients in the 22-30 age group, but less than 4 percent of SSI disabled recipients over age 65. This difference is largely due to the fact that non-DD adults usually enter the SSI program as a-result of a disabling condition which began later in life. However, the data also suggest that persons with developmental disabilities will comprise an increasing proportion of the SSI disabled population in future years.

By Race

A significant percentage of developmentally disabled recipients on SSI are not white, although this is less true for DD recipients than non-DD recipients, as shown in Table 9. The fact that a higher percentage of DD adults are white than children is probably attributable to the fact that many white developmentally disabled children living in middle or upper income families are not eligible for SSI as children (due to deeming of parental income) but then become eligible for SSI on their own right once they turn 18 years of age.

By Sex

The developmentally disabled population on SSI differs significantly from the non-DD population on SSI with regard to gender. About 58% of SSI children, and about 52% of DD adults, are male, as shown in Table 10. This is partly attributable to the fact that there is a higher incidence of mental retardation among males than among females. In contrast, about two-thirds of the non-DD adult population is female.

By Marital Status

As shown in Table 11, about 91 percent of DD adults on SSI are not married, while about 9 percent are married. Developmentally disabled adults on SSI are about half as likely to be married as non-DD adults on SSI.

By Living Arrangement

According to SSA data, less than half of all SSI recipients under age 22 live in their parents' household, as shown in Table 12. About 13 percent live in "another's household" which, in SSI terms, means that the recipient lives in a household which provides in-kind support (generally room and board) to the recipient.⁸ In these cases, the SSI payment level is reduced by one-third. About 36 percent of recipients under age 22 live in their "own household," which, however, can include a group home or foster care placement in which the household is not contributing in-kind support to the recipient. About 5 percent of SSI recipients under age 22 live in Medicaid certified institutions, which can include ICFs-MR, pediatric nursing homes, or hospitals.

Approximately 10 percent of DD adults are classified by SSA as living in another's household. This may give some indication of the percentage of developmentally disabled adults who still live with their parents. However, it is probably an underestimate since it only includes those adults who receive reduced SSI benefits because they do not contribute to their own room and board. About 6 percent of developmentally disabled adults on SSI live in Medicaid-certified facilities.⁹

By Receipt of State Supplementation Payments

Developmentally disabled adults on SSI are somewhat less likely than other SSI disabled recipients to receive State Supplementation Payments (SSP), as shown in Table 13. Among DD adults, 37.4% received SSP, compared to 44.1% of non-DD adults. Two possible reasons for this difference are: (1) non-DD adults are more likely to fall into special eligibility groups which qualify for SSP;¹⁰ and/or (2) developmentally disabled SSI recipients may disapproportionately reside in States which do not have State Supplementation programs (see Section 5.0).¹¹

By SSI/SSP Payment Amounts

As shown in Table 14, DD adults received an average Federal SSI payment amount of $220.86 in December 1987, compared to $234.85 for non-DD adults. This difference may also be due to the facts that DD adults are more likely to receive a reduced Federal SSI benefit because they live in "another's household, or because they live in a Medicaid-certified institution, and only receive the SSI personal needs allowance of $25 per month (see Table 12).

By Receipt of Unearned Income

About 60% of DD adults on SSI receive income from sources other than the SSI program; for the remaining 40%, Federal and State SSI/SSP payments are their sole source of income, as shown in Table 15.¹² The most common source of outside income received by DD adults is Social Security benefits received under Title II. These benefits encompass all types of Social Security benefits, including childhood survivor benefits, disability insurance benefits, Adult Disabled Children benefits, and retirement benefits (for persons over age 65). About the same percentage of DD adults on SSI also receive Title II benefits as non-DD adults on SSI.

5.0 STATE-LEVEL ESTIMATES OF PERSONS WITH DEVELOPMENTAL DISABILITIES RECEIVING SSI BENEFITS

One objective of conducting an analysis of the SSI 10-percent disability file was to investigate the extent to which SSI data may suggest cross-State differences in the prevalence of developmental disabilities. These data are important to the Federal policy development process in that the Federal allocation of resources for services to persons with developmental disabilities should reflect differences in need across States. If the prevalence of developmental disabilities is higher in some States than in others, then the allocation of Federal resources should reflect such differences.

However, the SSI 10-percent disability file is an imperfect data source for examining cross-State differences in the prevalence of developmental disabilities, for the following reasons:

• The likelihood of a developmentally disabled person receiving SSI/SSP benefits is to some extent related to the benefit level established by States under their State supplementation programs. However, as shown in Table 14, only about 4.8% of developmentally disabled adults receive only State supplementation payments (because their countable incomes fall "above the Federal benefit level but below the State supplementation level).¹³

• Among disabled children, eligibility for SSI benefits will also vary across States depending upon overall rates of poverty in a State. Only disabled children under age 18 in relatively poor families qualify for SSI benefits due to the deeming of parental income and assets. Thus, in poorer States, one would expect to see a higher rate of SSI child recipients than in wealthier States.

• Among all persons with developmental disabilities who are potentially eligible for SSI benefits (persons who would be eligible if they applied), participation rates may vary considerably across States. Differences in participation rates across States may be due to differences in public awareness about the program, differences among State agencies (e.g. State Mental Retardation and Mental Health agencies) in helping persons apply for SSI benefits, differences in administrative practices among local SSA offices and Disability Determination Services (DDS) offices, differences in access to points of application (e.g. urban/rural differences), and so on. Among elderly persons who are potentially eligible for SSI benefits, there is some evidence that only about 50% actually participate in the program. No similar research has been conducted with regard to rates of SSI program participation among potentially eligible disabled persons.

• Since the SSI 10-percent file is a sample of all disabled persons in each State, differences in the estimated number of developmentally disabled SSI recipients may be attributable to sampling error and/or differences in data quality across States (e.g. number of disabled recipients on the file with missing diagnosis codes). In this regard, the percentage of disabled SSI recipients on the file with missing diagnoses ranged from 19.3 percent in Nevada to 48.1 percent in New York. The number of individual cases on the 10-percent file ranged from 185 in Wyoming to 45,895 in California. In all States, the number of cases on the file was between 9 and 11 percent of the reported total number of blind and disabled SSI beneficiaries in December 1987.

Table 16 presents State-level data on the estimated percent of disabled SSI SSI recipients who are developmentally disabled, and the rate of DD SSI recipients per 1,000 State population. The percent of all disabled SSI recipients classified as developmentally disabled ranged from 26.4 percent in California to 52.7 percent in Nebraska. The rate of DD SSI recipients per 1,000 State population also varied considerably across States, from a low of 1.7 recipients per thousand in Wyoming to a high of 9.5 recipients per thousand in Mississippi, more than a five-fold difference. The highest rates occurred in the southeastern States, with the exception of Florida. The lowest rates occurred in Nevada, Utah, Wyoming, Minnesota, New Hampshire, Connecticut and Alaska.

ATTACHMENT A

NOTES

1. Once an individual turns age 65, an applicant for SSI benefits no longer has to meet the disability requirement, only the financial eligibility requirements.

2. SSI applicants can have gross income considerably above this level and still qualify for SSI benefits, since various income exclusions are allowed in determining "countable income," (including more than one-half of earned income). Also, in States which supplement Federal SSI benefits, higher income thresholds may apply.

3. Social Security Administration, Office of Research and Statistics. Social Security Bulletin, Annual Statistical Supplement. 1988. Table 9.Al.

4. Fox, H.B. and Greaney, A. A Preliminary Assessment of Disabled Children's Access to Supplemental Security Income and Medicaid Benefits. Fox Health Policy Consultants, 1988.

5. This estimate only includes SSI disabled beneficiaries who receive Federally-administered SSI/SSP payments. A small number of persons receive State supplementation payments only in States which have elected to administer their own State supplementation programs. According SSA data, there were approximately 48,457 blind and disabled persons receiving State supplementation payments only in these States in October 1989, about half of whom were in the State of Illinois, which has a very idiosyncratic State supplementation program. If we assume that 36.4% of these persons were also developmentally disabled, it would increase our total estimate of developmentally disabled persons receiving SSI and/or State supplementation payments in January 1990 by about 1.5%, or by about 17,600 persons.

6. It is also possible that some proportion of persons receiving SSI payments on the basis of age (over age 65), not disability, are also developmentally disabled. In March 1989, there were 1,427,045 aged SSI recipients, compared to 3,056,843 blind and disabled recipients. It is important to note, however, that when a disabled SSI beneficiary turns age 65, he or she is not re-classified as an aged beneficiary. Thus, aged SSI recipients are by and large persons who originally applied for SSI benefits after their 65th birthday. It is reasonable to expect that few persons with developmental disabilities would wait until their 65th birthday to apply for benefits, although if a disabled beneficiary for some reason lost their SSI benefits (e.g. by failing to appear at their annual re-determination) and then re-applied for benefits after turning 65, then it is likely they would be classified as "aged" rather than "disabled."

7. The recent ruling of the United States Supreme Court in the case of Sullivan v. Zebley (110, S. Ct. 885 [1990]) may substantially increase the number of younger children who qualify for SSI benefits.

8. It is possible that many children classified as living in "another's household" are children eighteen years of age or over living with their parents. In these cases, parental income is not deemed, but the SSI payment may be reduced by one-third due to the provision of in-kind support by the parents.

9. Note that developmentally disabled persons living in institutions such as ICFs-MR are not eligible for SSI payments if they have countable income in excess of $30 per month ($25 per month in 1987). According to data collected by the Health Care Financing Administration, about 61% of ICF-MR recipients receive SSI payments, and 39% do not.

10. In their State Supplementation programs, States often establish special eligibility groups (e.g. residents of licensed board and care facilities) which qualify for supplementation payments.

11. Note also that these data only represent those persons who reside in States in which State Supplementation Payments are Federally administered. Although in December 1987, there were 25 States which administered their own State Supplementation programs, persons in States with Federally-administered State supplementation accounted for 89% of all blind and disabled persons receiving State supplementation. Source: Social Security Bulletin, Annual Statistical Supplement, 1988, Table 9.A5.

12. Sources of unearned income, as recorded on the 10-percent file, however, includes in-kind support from living in another's household and deemed income from parents or spouses.

13. Disabled persons in California account for almost two-thirds of all disabled persons who only receive State supplementation payments. California has by far the highest SSI supplementation level of any State. In 1987, the State supplementation level in California for a disabled individual living independently was $627 per month, almost twice the 1987 Federal SSI benefit level of $340 per month.