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Health Benefits for the Uninsured: Design and Early Implementation of the Accelerated Benefits Demonstration

September 1, 2008

Many Social Security Disability Insurance (SSDI) beneficiaries have serious and immediate health care needs, but, under current law, most are not eligible for Medicare until 24 months after they start receiving cash benefits. This policy brief describes a new project that is testing whether providing earlier access to health benefits, as well as other services, for new SSDI beneficiaries who have no other health insurance improves employment and health outcomes.

The Impact of Late-Career Health and Employment Shocks on Social Security and Other Wealth

December 20, 2007

About one-quarter of workers age 51 to 55 in 1992 developed health-related work limitations and about one-fifth were laid off from their jobs before age 62. Although late-career health and employment shocks often derail retirement savings plans, Social Security's disability insurance, spouse and survivor benefits, and progressive benefit formula provide important protections. In fact, health shocks increase Social Security's lifetime value, primarily because the system's disability insurance allows some disabled workers to collect benefits before age 62. However, if the system's disability insurance program did not exist, the onset of health-related work limitations would substantially reduce Social Security wealth.

How Secure Are Retirement Nest Eggs?

May 4, 2006

Life's uncertainties can upend the best-laid retirement plans. Health can fail as people grow older, or their spouses can become ill. Older people can lose their jobs, and often have trouble finding new ones. Marriages can end in widowhood or divorce. Health, employment, and marital shocks near retirement can have serious financial repercussions, raising out-of-pocket medical spending, reducing earnings, disrupting retirement saving, and forcing people to dip prematurely into their nest eggs. This brief examines different types of negative events that can strike near retirement. It reports the incidence of widowhood, divorce, job layoffs, disability, and various medical conditions over a 10-year period, and estimates their impact on household wealth. Data come from the Health and Retirement Study (HRS), a nationally representative survey of older Americans conducted by the University of Michigan for the National Institute on Aging. The survey interviewed a large sample of non-institutionalized adults ages 51 to 61 in 1992 and re-interviewed them every other year. The analysis uses data through 2002, the most recent year available. The results show that many people in their 50s and 60s experience negative shocks that threaten retirement security. Job layoffs, divorce, and the onset of work disabilities near retirement substantially erode retirement savings. The findings highlight the limitations of the safety net when things go wrong in late midlife. This Brief was written for the Center for Retirement Research based at Boston College.

Choices, Challenges, and Options: Child SSI Recipients Preparing for the Transition to Adult Life

May 23, 2005

For young people receiving Supplemental Security Income (SSI), a means-tested cash benefit for children with disabilities, the transition into young adulthood is complicated for several reasons. Health issues, service needs, and lack of access to supports can complicate planning and preparing for future schooling, work, and independent living. These issues are especially pressing at age 18 because, following legislative changes in 1996, child SSI recipients have their benefits redetermined under the adult disability criteria. Some child SSI beneficiaries lose eligibility at this redetermination because they do not meet the adult SSI disability criteria. This paper uses newly released data from the Social Security Administration (SSA), the National Survey of Children and Families (NSCF), to study this transition period for cohorts of child SSI recipients just prior to and after the age 18 redetermination. To date, information on the transition experiences of child SSI recipients has been hampered by data limitations. Our analysis addresses this gap by providing detailed information on an array of program, school, training, rehabilitation, and employment issues facing youth during this transition period.

Recommendations to the Social Security Administration on the Design of the Mental Health Treatment Study

February 28, 2005

Many beneficiaries with mental illness who have a strong desire to work nevertheless continue to seek the protection and security of disability benefits, not only because of the income such benefits provide but also for the health care coverage that comes with it. Further complicating matters is that few jobs available to people with mental illnesses have mental health care coverage, forcing individuals to choose between employment and access to care. These barriers, coupled with the limited treatment options and negative employer attitudes and even discrimination when it comes to employing people with serious metal illness, help "explain" the very rates of low labor force participation among people with psychiatric disabilities.

More Work Focused Disability Program? Challenges and Options

November 1, 2003

This paper presents options for incorporating a strong return-to-work focus in the disability eligibility requirements for the Social Security Administration's (SSA) disability programs. In developing options, we first review alternative disability concepts from other private and public disability programs that focus on an individual's residual capacity to work, rather than an inability to work. We then examine the potential implications of applying different components of these alternative conceptualizations to the current disability eligibility requirements. Our analysis illustrates that policy makers must struggle with the real costs of creating a more expansive set of disability eligibility criteria that focus on work (which will significantly increase the size of the caseload), with the other costs of having an all-or-nothing disability definition.

The Relationship between Early Disability Onset and Education and Employment

September 1, 2003

The early onset of disability (at birth through young adulthood) can affect a person's employment outcomes in myriad ways. In addition to the direct effect of disability on employment, early onset of disability likely affects the acquisition of education and job skills (human capital). This reduced "investment" in human capital in turn may reduce the individual's employment and earnings prospects throughout their lifetime. If this is the case, people with early onset of disability may be doubly disadvantaged when it comes to later employment prospects.This study analyzes how early onset of disability (onset prior to age 22) affects employment opportunities both directly and as a result of reduced investment in human capital (education) for a younger cohort (ages 22 to 35) and older cohort (ages 44 to 54). In our young cohort, we find that people with early onset of disability have a lower probability of completing high school and a lower probability of being employed than those without disabilities. Lower employment rates result from both lower levels of high school completion and a direct negative impact of disability on work. In the older cohort, we find the employment of those with disability is lower than those without disability, regardless of age of onset. However, those with early onset of disability have significantly higher employment rates than those with later onset of disability (after age 22). We hypothesize that this is a result of people with onset of disability prior to age 22 either choose careers that can be more easily accommodated than the careers people with later disability onset have, or that people with early onset of disability are more likely to be adept at seeking and using accommodations than those with later disability onset. These results suggest that policies and programs to increase employment of persons with disabilities should focus on ways to increase education levels of those with early onset of disability. They also suggest that return-to-work efforts focused on older cohorts of persons with disabilities may want to separately target programs to those with early onset of disability.