Mental Retardation Determining Eligibility for Social Security Benefits (2002) / Chapter Skim
Currently Skimming:
2. The Policy Context
2. The Policy Context
Pages 38-68
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 38... ...
and Disability Insurance (DI)
|
From page 39... ...
SSI AND Dl RECIPIENTS According to the Office of Research, Evaluation, and Statistics of the Social Security Administration, in December 2000 almost 850,000 children were receiving SSI benefits. These children represented 12.8 percent of the over 6.5 million SSI recipients.
|
From page 40... ...
People with mental retardation constituted 9 percent of all people with disabilities who received DI payments, but they received only 6.5 percent of total payments. The contrast in the prevalence of people with mental retardation in the SSI program (23 percent of program recipients)
|
From page 41... ...
Reprinted with permission. Growth in the DI and SSI programs has been extensively analyzed, and researchers have offered various reasons for this growth.
|
From page 42... ...
Benefits include income transfers, food stamps, health insurance, transportation, case management, vocational training, and support for housing and education. All of these programs are characterized by differing eligibility criteria, benefit levels, administering bodies, critical definitions (e.g., of disability)
|
From page 43... ...
Researchers have also found that public health insurance is probably a substitute for private health insurance. When eligibility for Meclicaicl was expanded to cover chilclren ancl pregnant women in the late 1980s ancl early 1990s, there was a corresponding reduction in private health insurance coverage (Garrett & Gliecl, 20001.
|
From page 44... ...
In 1997, the eligibility of hundreds of thousands of child SSI recipients was reevaluated by SSA, and 90,000 children were removed from the program (Kubik, 20001. Similarly, cost containment processes have become a hallmark of private insurance companies, which are increasingly requiring SSI determination of disability before accepting the adult child of a policyholder as an adult dependent with a lifelong health condition (Hemingson, 1998; United Health, personal communication, 19981.
|
From page 45... ...
In light of the very low competitive employment rates for adults with mental retardation, their access to private health insurance coverage is very limited. And given the reliance of state service systems on Medicaid reimbursement for community-based services for adults with mental retardation, strong incentives remain for enrollment of such adults in the SSI and, by extension, Medicaid programs.
|
From page 46... ...
People with mild mental retarclation can certainly be employocl. However, women who are also parents (usually alone)
|
From page 47... ...
47 This situation has not yet been examined systematically to determine whether it is a consequence of the labor market requiring workers with better cognitive skills or whether potential workers with mental retardation did not seek employment for fear of losing their only available health insurance: Medicaid. Indeed, considering the significant policy and societal impact of the context for persons with mild mental retardation who are affected by these changes, there is a surprising lack of research and empirical resources to describe these phenomena.
|
From page 48... ...
SSI income is considered by lenders to be a more stable source of income for purposes of purchasing a home than income from most of the jobs that people with mental retardation can hold. When accounting for the fact that these jobs also typically do not provide benefits such as health insurance, SSI becomes, again, a gateway for basic secur rutty separate trom its Income maintenance purpose.
|
From page 49... ...
Spending exclusively for residential services in 1998 totaled $16.5 billion (Braddock et al., 2000) , and represented 64 percent of total services spending for people with mental retardation or developmental disabilities in the United States (Braddock et al., 2000~.
|
From page 50... ...
If they were never identified, they are far less likely to know about SSI, or to be referred, screened, or identified after high school. However, if individuals with mild mental retardation received any services from special education during middle or high school, they should have had an individualized education program (IEP)
|
From page 51... ...
For people with mild mental retardation, like all people, basic security and quality of life are context sensitive. Their abilities to secure benefits to which they are entitled, to acquire and maintain adequate health care for themselves or their families, and to participate in job training all rely on social structures that can accommodate their disabilities.
|
From page 52... ...
Researchers have found that the risk of disability appears to be growing, and that risk is elevated in poor homes and in single-parent families (Fujiura & Yamaki, 20001. There are numerous risks associated with poverty, including poor pregnancy outcomes, child neglect and abuse, substance abuse, violence, limited access to health care, and reduced quality of life.
|
From page 53... ...
The importance of health insurance in the lives of poor children has been well established by the research community. Children who are eligible for Medicaid use significantly more medical care, particularly care provided in doctor's offices.
|
From page 54... ...
Low-income families who have children with mental retardation have two "choices" to ensure adequate health insurance coverage: to become poor or to stay poor. Over 4,000 letters have been compiled from families who report not accepting raises, overtime, or promotions in order to keep the SSI benefit that ensures health care coverage for their children with mental retardation (C.
|
From page 55... ...
The health insurance coverage offered to children under the auspices of the Medicaid program is significantly more comprehensive than the coverage typically offered by private plans. Child Medicaid beneficiaries have access to preventive care, diagnostic and evaluative treatment through the EPSDT program, and medically necessary therapies including mental health care, home health care, and office-based services (Fox et al., 19971.
|
From page 56... ...
In addition to low levels of employment, people with mental retardation have very low rates of competitive employment, as opposed to employment in sheltered workshops or supported employment positions. Estimates of the employment rate for people with mental retardation suggest that only 1215 percent of people with mental retardation are employed in jobs in the community (Mank, 20011.
|
From page 57... ...
These supports include services provided by local and state educational agencies, vocational rehabilitation agencies, mental retardation agencies, community rehabilitation agencies, and public transportation. People who have access to quality education programs and later to supportive work environments can work to an extent that would be impossible otherwise.
|
From page 58... ...
Employment outcomes include enclave or mobile crew positions and various forms of supported work and do not necessarily entail competitive employment. Thus, the number of people with mental retardation who receive vocational rehabilitation services is very small in relation to the total population of such people.
|
From page 59... ...
Fifth, SSI and DI are critical income maintenance programs for people with mental retardation and often serve as an important gateway program for other services. Given their high unemployment rates and their overall marginalized status in society (Edgerton, 1993)
|
From page 60... ...
Specifically, for those wage earners with developmental disabilities who require support services, · the monetary value of such support services should not be counted as part of the individual's income when determining eligibility for services and benefits, and · the maximum allowable income for services and benefit eligibility should be sufficiently high so as to reflect the increased cost of living borne by people who require support services and/or adaptive equipment and supplies (Illinois Planning Council on Developmental Disabilities, 1991, p.
|
From page 61... ...
. fists to secure antic ~scr~m~nat~on aegis cation In emp payment settings, which culminated in the 1990 passage of the Americans with Disabilities Act (Ticket to Work ancl Work Incentives Improvement Act of 19991.
|
From page 62... ...
Second, work is not economically feasible for people with disabilities who cannot obtain health insurance on the open market. Third, gaps in private health care coverage, including both managed care and fee-for-service plans, can be significant for people with disabilities (Mashaw & Reno, 1996~.
|
From page 63... ...
The National Academy of Social Insurance's assessment of the relationship between DI and SSI benefits, employment, and health care is telling: The [Disability] panel's basic finding is that the Social Security and SSI disability benefit programs do not pose strong incentives for Americans with disabilities to seek benefits in lieu of working.
|
From page 64... ...
Advocates have also expressed concerns that since many of the law's new provisions are optional, states will need incentives or have to be pressured to adopt the new programs. Provisions in the Ticket to Work Act that expand eligibility for Medicaid to workers with disabilities are likely to discourage growth in DI and SSI because they address the health care-employment linkage that encourages people with disabilities to maintain their SSI or DI status in order to retain health insurance benefits (Mashaw & Reno, 1996~.
|
From page 65... ...
However, return-to-work initiatives in the SSI, DI, and vocational rehabilitation programs are not equipped to address the changing nature and needs of people with disabilities. For many people with mental retardation, however, the Ticket to Work Act may offer opportunities to maintain their health care coverage and enter the workforce for the first time.
|
From page 66... ...
Counterbalanced against this realistic fear is the desire of many people with mild mental retardation to be gainfully employed, tax-paying members of society. A critical step in resolving this tension is the provision of effective support services that assist individuals to maintain employment and the provision of flexibly administered benefits that provide ongoing and predictable income and health care coverage.
|
From page 67... ...
And people with mental retardation who are gainfully employed may work in settings that do not provide employer-based health insurance or they may require employee contributions that are prohibitively costly for low-wage workers. Fear of losing health care coverage dampens the willingness of many people with mental retardation to seek gainful employment.
|
From page 68... ...
Permitting individuals with mental retardation to retain eligibility for Medicaid independent of their employment status.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.