In most states, when the low-income families of a child with a disability receive cash payments from the federal Supplemental Security Income (SSI) program, the child is automatically eligible for Medicaid health insurance.
In reality, up to 480,000 children on Medicaid who might also be eligible for SSI are not receiving it, according to a new study by researchers at Colgate University, Westat, and Mathematica. This means that only about seven out of 10 of the children likely to be eligible for SSI are currently enrolled.
These are children whose disabilities typically require intensive medical care and could potentially benefit from the extra $943 a month to help their families pay for their care.
The estimate of many more eligible children comes after a decade of declining SSI enrollment. When the program was created in 1974, enrollment rose virtually unabated until 2013. Since then, it has dropped sharply, a trend that accelerated during the pandemic when applications declined as families isolated from COVID and Social Security’s field offices closed.
The researchers examined 32 states to identify areas with the most potential for expanding SSI’s rolls nationwide. Using sophisticated statistical tools, they analyzed health care use among Medicaid-enrolled children who are potential SSI candidates, comparing them to current recipients, more than half of whom have mental or developmental disabilities.
There is large potential for boosting SSI enrollment around the country, from New York, Maryland and Ohio to Arizona, California and Washington State. In these states, less than 70 percent of the children who are potentially eligible are enrolled. The take-up rates in a handful of other large states including Florida, Pennsylvania, and Texas are between 70 percent and 72.4 percent.
County-level findings in this study illustrate the variation in SSI enrollment from one state to the next. In a majority of Arkansas counties, for example, less than 70 percent of potentially eligible children are receiving SSI. But enrollment exceeds 75 percent in much of Colorado.
The researchers’ estimate of about 480,000 more potential SSI recipients considers those with at least a modest 5 percent probability of being eligible.
Though this 5 percent probability sounds low, even children with a fairly low probability of SSI eligibility make intensive use of their Medicaid coverage in ways that are very similar to – and sometimes exceed – the usage by children who already receive SSI and Medicaid. In one example from their analysis, the potentially eligible children use ADHD medications at higher rates than children who are receiving SSI.
The estimate also adjusts for the range of probabilities. It assumes that only five out of the 100 children with a 5 percent probability of eligibility would actually be eligible, whereas 40 out of 100 children with a 40 percent chance – whose health care usage is that much more intensive – would be eligible.
Medicaid is jointly funded by the federal and state governments, but the states are responsible for their outreach and enrollment practices and how they manage their programs. The researchers suggest that states could adopt similar modeling techniques to identify more Medicaid-enrolled children who may qualify for SSI.
“Children with similar conditions have notably different probabilities of SSI receipt depending on the state they live in,” they concluded.
To read this study by Michael Levere and David Wittenburg, see “How Many Medicaid Recipients Might be Eligible for SSI?”
The research reported herein was performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium. The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA or any agency of the Federal Government. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.
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