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A national profile of SSDI recipients and applicants

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A national profile of SSDI recipients and applicants
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  See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/249835742 A National Profile of SSDI Recipients andApplicantsImplications for Early Intervention  Article   in  Journal of Disability Policy Studies · December 2004 DOI: 10.1177/10442073040150030601 CITATION 1 READS 22 3 authors , including: Some of the authors of this publication are also working on these related projects: The Collaborative on Health Reform and Independent Living (CHRIL)   View projectThe Antipsychotic Atlas: Medicare Usage of Antipsychotic Medications in Washington   View projectJae KennedyWashington State University 64   PUBLICATIONS   1,283   CITATIONS   SEE PROFILE All content following this page was uploaded by Jae Kennedy on 19 September 2014. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the srcinal documentand are linked to publications on ResearchGate, letting you access and read them immediately.  A National Profile ofSSDI Recipients and Applicants Implications for Early Intervention Jae Kennedy, Washington State University at Spokane Marjorie Olney, San Diego State University  Chrisann Schiro-Geist, University ofIllinois at Urbana Less than one halfof1% ofSocial Security Disability Insurance (SSDI) beneficiaries currently returnto work.The 1999 Ticket-to-Work and Work Incentives Improvement Act (TWWIIA) charged the Social Security Administration with investigating early intervention strategies to divert some ofthe personsapplying for benefits into work support programs before they enroll in SSDI.Any early intervention programming will require greater understanding ofthe claimant population.This analysis used data from the 1994 and 1995 National Health Interview Surveys to compare the estimated 3.3 millionworking-age SSDI claimants to the estimated 3.6 million beneficiaries.These comparisons showed sub-stantial heterogeneity in both groups but found that claimants were less disabled,in better health,and more likely to be employed than beneficiaries.Both groups tended to have low incomes,and nearly  20% ofclaimants lacked health insurance.Approximately 70% ofapplicants (2.3 million) and bene- ficiaries (2.6 million) have not received vocational support services and do not believe that they need such services.These findings suggest that demand for vocational services vouchers may be low. Can a program srcinally designed as an alternative tolabor force participation be reformed to help more beneficia-ries return to work? Policymakers and advocates clearly think so—noting that most people with disabilities want to work and,with sufficient support services and adequate opportu-nities,can work (Kaye,1997;National Council on Disability,1997).The economic ramifications ofthis question are sig-nificant:Doubling the small proportion ofSSDI beneficiarieswho return to work (e.g.,from 0.5% to 1%) would return bil-lions to the Social Security trust fund over the working life of those beneficiaries (U.S.General Accounting Office,1999).Responding to these concerns,Congress passed the 1999Ticket-to-Work and Work Incentives Improvement Act(TWWIIA).Specific SSDI program changes,slated for fullimplementation in 2004,include vouchers for rehabilitationservices,maintenance ofMedicare coverage for working ben-eficiaries,and a streamlined re-enrollment process (Social Se-curity Administration,2001c).These provisions should helpsome beneficiaries,but health problems,economic constraints,inadequate skills and training,and a lack ofemployment op-portunities are likely to continue to discourage many other ben-eficiaries from reentering the workforce (National Academy of Social Insurance,1996).A complimentary strategy to these program reforms thatmay be more effective in containing caseloads and costs wouldEstablished in 1956,the Social Security Disability Income(SSDI) program provides cash benefits and health insuranceto about 6 million workers with disabilities and their families,at a total annual cost ofabout $55 billion (Social Security Ad-ministration [SSA],2001a).The program has grown rapidly in the past two decades,a trend attributed to various factors,including population growth (Marini & Reid,2001),policy changes by the SSA (Berkowitz,1997),and dislocations andtransformations ofthe U.S.labor market (Yelin,1992).Oncein the program,few beneficiaries leave:Currently,only onehalfof1% return to work (U.S.General Accounting Office,2002).Applying for SSDI is currently a lengthy and uncertainprocess.To be deemed eligible,an applicant must demonstrate“the inability to engage in any substantial gainful activity (SGA)because ofa medically determinable physical or mental im-pairment(s)”that essentially precludes workforce participa-tion (Social Security Administration,2001b).The preliminary SSA review ofapplications takes about 4 months,and morethan halfofapplications are denied.For successful applicants,there is a 5-month waiting period for cash benefits and a 2- year wait for Medicare benefits.It thus is not surprising thatafter successfully navigating this enrollment process,mostbeneficiaries appear uninterested in vocational rehabilitationservices (Sim,1999). 178 JOURNALOFDISABILITYPOLICYSTUDIESVOL .15/ NO .3/2004/ PP .178–185  at WASHINGTON STATE UNIVERSITY on September 19, 2014dps.sagepub.comDownloaded from   divert at least some individuals who are applying for benefitsinto vocational rehabilitation before they enroll (General Ac-counting Office,1998).The TWWIIA therefore directed the SSAto investigate early intervention strategies.Berkowitz (2002)described a basic two-stage applicant screening process forearly intervention.A preliminary screen would identify ap-plicants likely to be deemed eligible for SSDI (i.e.,fully andcurrently insured and working below the SGA level).A secondscreen would identify candidates potentially suitable for re-turn to work.Eligible candidates for early intervention wouldbe provided with rehabilitative services and other inducements.Targeting and timing are clearly essential to the effectiveness of this intervention.Studies have suggested that the efficacy of vocational rehabilitation depends on early and intensive in-tervention (e.g.,Marini & Reid,2001;O’Day,1999;Sim,1999).“Applicants who demonstrate an ability to succeed”wouldtherefore need to be identified quickly,on the basis ofinfor-mation available at the time ofapplication (Berkowitz,2002,p.5).As part ofa special SSA early intervention research con-tract,the Disability Research Institute conducted an analysis of the 1994 and 1995  National Health Interview Surveys (NHIS)to develop a profile ofSSDI applicants and beneficiaries,in-cluding sociodemographic characteristics,severity ofdisability,annual family income,workforce participation,health insur-ance coverage and health-care utilization,and use ofand needfor vocational services (Kennedy,Olney,Newsom,& Richer,2002).This was intended primarily as an aid for Stage 1 oftheearly intervention screening process,exploring variation be-tween and within the groups ofeligible and noneligible SSDIapplicants.In this article,we highlight the key findings fromthis analysis and discuss their implications for policy and re-search. Method Data Source  This is a secondary analysis ofthe NHIS,an ongoing house-hold survey conducted by the National Center for Health Sta-tistics (Adams & Benson,1991;Massey,Moore,Parsons,& Tadros,1989).The NHIS allows researchers to calculate na-tionally representative estimates ofkey health indicatorsamong the noninstitutionalized U.S.civilian population.Various special supplements,along with the core sur-veillance items ofthe NHIS,are administered to address spe-cific policy and population concerns.In our study,we useddata from four supplements to the 1994 and 1995 NHIS:theDisability Supplement,the Health Insurance Supplement,theAccess to Medical Care Supplement,and the Family ResourcesIncome and Assets Supplement (National Center for HealthStatistics,1998a,1998b).To increase the sample size and ac-curacy ofour estimates,we merged the data from the 1994 and1995 panels. Case Selection Criteria We used the National Center for Health Statistics’selection cri-teria for Phase 2 ofthe Disability Supplement to identify work-ing age (18–64 years) adults with disabilities.Phase 1 oftheDisability Supplement was administered to all respondents atthe same time as the 1994 and 1995 NHIS core survey.Phase2,the Disability Follow-back Survey (DFS),collected more de-tailed information on functional and activity limitations,work history,social and family support,and service utilization.TheDFS was administered 6 months to 18 months after the core sur-vey to all respondents who reported impairments,functionallimitations,chronic conditions,or receipt ofdisability benefitsin the core NHIS survey or Phase 1 ofthe Disability Supple-ment.This sample consisted of16,270 working-age adults withdisabilities (approximately 13.5% ofthe srcinal NHIS sample).We then turned to the Family Resources Income and As-sets Supplement to identify SSDI beneficiaries and claimants.Within the sample ofworking-age adults with disabilities,2,181reported currently receiving SSDI benefits,and an additional1,997 reported applying for these benefits (see Table 1).We usedNHIS population weights to determine that these cases repre-sent approximately 3.6 million SSDI beneficiaries and another3.3 million claimants.Among these 3.3 million claimants,34.2% said they had applied more than once for SSDI bene-fits.Applicants included people in the process ofapplying forbenefits,people who had been denied benefits in the past,andpeople who had terminated benefits.It was not possible to dis-tinguish among these subgroups,given the available data. Data Analysis A series ofnational prevalence estimates were calculated forboth SSDI beneficiaries and claimants.We used the SUDAANsoftware to calculate standard errors for each ofthese estimates JOURNALOFDISABILITYPOLICYSTUDIESVOL .15/ NO .3/2004 179 TABLE 1Status ofSSDI Program Recipients and Applicants in 1994 and 1995 SSDI status % of ofrecipients SampleEstimated recipients& applicants  n N  a & applicants Total numbers4,1786,833100Currently receiving SSDI2,1813,58052.4Number oftimes 1,9973,25347.6applied for SSDIOnce1,3162,14031.3Twice3776239.1Three or more times3044907.2  Note. Data are from the Disability Supplement to the 1994 and 1995  National HealthInterview Surveys (National Center for Health Statistics,1998a,1998b).SSDI = SocialSecurity Disability Insurance. a In thousands.  at WASHINGTON STATE UNIVERSITY on September 19, 2014dps.sagepub.comDownloaded from   180 JOURNALOFDISABILITYPOLICYSTUDIESVOL .15/ NO .3/2004 (Research Triangle Institute,1998).Following a protocol estab-lished by the National Center for Health Statistics,we calculatedrelative standard errors for all estimates.Population estimateswith relative standard errors ofmore than 30% should be con-sidered statistically unreliable,and they are flagged in the sum-mary tables.(Group percentages may not sum to 100,due torounding error and the omission ofmissing data.) For groupcomparisons between beneficiaries and claimants,we used theCHISQ test,which is analogous to the Pearson chi-square testfor nonsurvey data (Shah,Barnewell,& Bieler,1997). Results Table 2 compares the basic population characteristics ofSSDIbeneficiaries and claimants.We found a significant gender dis-parity:Women made up a majority ofSSDI applicants (52.6%)but constituted a minority ofbenefit recipients (40.2%),possibly attributable to gender differences in workforce par-ticipation,  χ 2 = 61.2, df  = 1,  p < .001.The racial and ethniccomposition ofclaimants and beneficiaries was similar andwas comparable to the general population ofpersons with dis-abilities,  χ 2 = 6.1, df  = 3,  p = .11.Both beneficiaries andclaimants tended to be older;two thirds ofbeneficiaries andnearly halfofclaimants were 45 or older,  χ 2 = 5.0, df  = 4,  p =0.10.Claimants had significantly higher rates ofeducationalattainment than did beneficiaries,  χ 2 = 46.3, df  = 3,  p <.001,but there was a fairly low level ofeducational attainment inboth groups:31.3% ofclaimants and 40.3% ofbeneficiariesdid not complete high school.Marital status and social support measures were mixed,perhaps due to age differences between applicants and bene-ficiaries.Beneficiaries were less likely to be married and morelikely to be widowed, χ 2 = 16.9, df  = 3,  p < .01,and to live alone, χ 2 = 6.5, df  = 1,  p = .01,but they were also more likely to haveadult children,  χ 2 = 17.1, df  = 1,  p < .001,or other family,  χ 2 = 19.1, df  = 1,  p < .001,who lived within an hour oftheir home.Activity limitation data suggested that claimants weremuch less likely to be seriously disabled than beneficiaries:al-most halfofclaimants (48.5%) said they did not have any lim-itations in activities ofdaily living (ADLs) or instrumentalactivities ofdaily living (IADLs),as opposed to only a quarterofrecipients (25.2%), χ 2 = 161.1, df  = 3,  p < .001.Fully 72.3%ofbeneficiaries reported needing assistance with ADLs and/orIADLs.Both groups tended to report fair or poor health,buthealth status was significantly worse among recipients thanamong claimants, χ 2 = 106.2, df  = 2,  p < .001.Beneficiaries hadslightly higher rates ofphysician utilization,  χ 2 = 41.1, df  = 5,  p < .001.These rates ofhealth-care utilization may be influencedby health insurance coverage,as well as health status,however.Table 3 indicates that both groups were economically disadvantaged in comparison to the general population,butbeneficiaries (24.9%) were slightly less likely than applicants(28.8%) to have family incomes below the federal poverty level, χ 2 = 18.2, df  = 1,  p < .001.SSDI recipients were much morelikely to receive public insurance,with or without private sup-plemental insurance,than applicants,  χ 2 = 450.3, df  = 3,  p <.001.Applicants relied primarily or exclusively on private in-surance,and a sizable minority (19.7%) were uninsured.Lack ofaccess to health insurance probably motivates many ofthosewho apply for SSDI.About 7.7% ofapplicants said that they had been denied health insurance and so did 4.8% ofbenefi-ciaries,  χ 2 = 11.3, df  = 1,  p < .001.More than halfofthese in-dividuals were denied coverage because ofpreexisting healthconditions.The survey data suggest that a large minority ofSSDI ap-plicants (40.7%) were employed,and an additional 4.7% of applicants were unemployed but actively seeking work (seeTable 4).As expected,these rates were much higher than thoseofbeneficiaries,  χ 2 = 292.4, df  = 2,  p < .001,but about 9.2%ofrecipients said they were working,and 1.3% were seekingwork.Among working SSDI claimants,most respondents wereworking at or near full time.About 1.3 million claimants,or76.5%,were working 30 or more hours per week.The averageweekly hours ofwork among employed SSDI applicants was39.3,and the median was 39.5.In contrast,employed recipi-ents were much more likely to work part-time.Only 37.1% wereworking 30 or more hours per week, χ 2 = 43.7, df  = 4,  p < .001.The average number ofhours worked by recipients was 29.7,and the median was 27.0.Most working recipients and applicants worked for theprivate sector, χ 2 = 4.7, df  = 2,  p = .10.Monthly earnings weremuch higher for working applicants than for working benefi-ciaries,  χ 2 = 65.7, df  = 3,  p < .001.About 56.9% ofapplicantsreported earnings ofmore than $1,000 in the preceding month,in contrast to 18.4% ofbeneficiaries.The average monthly earnings for working beneficiaries was $723 and the medianwas $500;however,approximately 19% ofsupposedly em-ployed SSDI beneficiaries reported no income in the preced-ing month.In contrast,the average monthly earnings forworking applicants was $1,693 and the median was $1,276.Most claimants and beneficiaries said they had not re-ceived and did not need vocational services (see Table 5).How-ever,14.8% ofrecipients and 14.0% ofapplicants said they needed but had not received one or more vocational services,and another 5.5% ofrecipients and 7.7% ofbeneficiaries saidthey had received vocational services but needed more assis-tance,  χ 2 = 3.8, df  = 3,  p = 0.29.The rates ofspecific serviceutilization and total number ofservices used were roughly comparable for both groups and were low overall (79.1% of beneficiaries and 80.2% ofclaimants had received no voca-tional services). Discussion Although the statistical comparisons used in this analysis tendto focus attention on between-group differences,one ofthe  at WASHINGTON STATE UNIVERSITY on September 19, 2014dps.sagepub.comDownloaded from   181 TABLE 2Population Characteristics and Health-Care Use ofSSDI Recipients and Applicants Receives SSDI Applied for SSDIRecipient/applicant characteristics  n a SE  %  n a SE  %  χ 2  p Total # ofSSDI beneficiaries 3,5801003,253100.0and claimantsGender61.20.00Male2,1399759.81,5427747.4Female1,4417040.21,7117952.6Age (yrs)5.00.1018–2486162.4180235.525–343933511.06194119.035–447384720.68895727.345–549245625.88314925.555–641,4407240.27354122.6Race/ethnicity6.10.11White2,59011972.42,24510669.0Black6384517.86114418.8Hispanic249256.9276228.5Other103162.9122183.7Education46.30.00Did not graduate from high school1,4437240.31,01857 31.3High school graduate1,2776735.71,12457 34.6Some college5563815.563142 19.4College graduate211225.937936 11.7Marital status16.90.00Married1,7528448.91,74784 53.7Widowed251227.017918 5.5Divorced or separated7374320.666944 20.6Never married8055722.55693817.5Social supportLives alone8365223.463841 19.66.50.01Adult child(ren) live nearby1,1325631.68144625.017.10.00Other family live nearby1,1086030.97864624.219.10.00Severity ofactivity limitation 161.10.00Not limited in any ADL or IADL 9015525.21,57783 48.5Limited in ADLs or IADLs 89142.58412 2.6Needs assistance with IADLs only 1,7428348.71,15860 35.6Needs assistance with ADLs only8485223.743531 13.4Self-assessed health status106.20.00Excellent or very good 4163311.68044724.7Good 8195122.98164725.1Fair or poor 2,31810664.71,6187949.7# ofphysician visits in past 12 mo.41.10.000281288.03773311.71251227.13573111.12288298.23273410.13–56854219.45603317.46–105843816.55333716.5> 101,4467440.91,0735933.3  Note. Data are from the Disability Supplement to the 1994 and 1995  National Health Interview Surveys (National Center for Health Statistics,1998a,1998b).SSDI = Social Security Disability Insurance;ADL = activities ofdaily living;IADL = instrumental activities ofdaily living.  at WASHINGTON STATE UNIVERSITY on September 19, 2014dps.sagepub.comDownloaded from 
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