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Policy Options for Assisting Child SSI Recipients in Transition

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Document date: October 23, 2003
Released online: October 23, 2003

This paper was prepared for the Ticket to Work and Work Incentives Advisory Panel. The authors gratefully acknowledge the support of the Panel and its staff and also the input and editorial comments of Paul Wehman (Virginia Commonwealth University). The opinions and conclusions are solely those of the author and should not be construed as representing the opinions or policy of any agency of the Federal Government or the Urban Institute.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

Note: This report is available in its entirety in the Portable Document Format (PDF).

Executive Summary

The transition process for a child Supplemental Security Income (SSI) recipient nearing the age of 18 can be quite complicated. From a programmatic standpoint, all child SSI recipients have their eligibility redetermined under the adult SSI disability requirements at age 18. Potentially more important, many child SSI recipients are also at the age when they must prepare for life beyond secondary school. The choices made during this important transition could have long-term implications for a child's future employment prospects, particularly given the typically long durations of participation and strong work disincentives associated with SSI participation.

The purpose of our analysis is to examine concerns related to this transition process and suggest policy options for consideration by the Social Security Administration's (SSA) Ticket Advisory Panel. Our findings are based on an extensive literature review of programs that serve child SSI recipients and semi-structured interviews with experts familiar with the problems facing youth during this transition.

In previous reports, the Ticket Advisory Panel has suggested expanding eligibility for the Ticket program to child SSI recipients age 17 to 18 as one possible mechanism for improving independent living options for this population (Ticket to Work and Work Incentives Advisory Panel 2001). We build off this initial suggestion by examining other possible mechanisms for improving independent living options for "transition age" (i.e., youth nearing age 18) child SSI recipients.

The paper first provides a general overview of the programs and policies that might influence the economic decisions of child SSI recipients including SSI, Medicaid, rehabilitation programs, and education programs. We also summarize the relevant findings from our literature review.

Our program and literature review suggest a number of potential problem areas related to the transition process of child SSI recipients. We identify several specific concerns, which include:

  • Work disincentives associated with SSI and Medicaid;
  • Possible conflicts between provider and individual incentives;
  • Obstacles in accessing work preparation services;
  • Lack of coordination of services across agencies;
  • Low expectations for youth with disabilities by parents and administrators;
  • Lack of access to educational opportunities; and
  • Limited research information on transitions.

A summary of the policy options we identify for each of these concern areas is shown in the Executive Summary Table. Because of the diversity within the child SSI population and the complexity of the transition process, there is no "one size fits all" option that would universally improve this transition for all child recipients. Rather, we identify several policy options to address these multiple concerns.

It is important to note that that this summary represents a list of policy options rather than a specific set of policy recommendations. Our ability to make specific recommendations is hampered by limitations in the literature regarding the transition process. For example, we cannot make specific recommendations on, say, expanding the scope of VR for all child SSI recipients because we do not know the potential number of recipients who could take advantage of those services. Nonetheless, the concerns and policy options identified here represent an important starting point in setting a policy agenda for this population.

In assessing specific options and concerns, it is important to balance the overall objectives of the SSI program before making decisions on specific policy directions. In some cases, the options outlined above may change the purpose of the child SSI program. For example, the temporary disability option is a fundamental departure from the SSI program, which is intended to provide permanent disability cash benefits. Alternatively, it is important to balance options that are possible within the context of the current SSI program, such as balancing the need to improve work incentives with the objectives of providing cash assistance to low-income children with serious disabilities. Indeed, if policies to reduce work incentives for this group were implemented, there could be a political backlash if a large number of SSI youth, who initially became eligible because of severe disability, started entering employment.

Because of these issues, the SSA Ticket Advisory Panel will need to make important decisions about whether specific options could be incorporated into the existing child SSI program, or if substantial rethinking of the program is necessary to improve outcomes of youth with disabilities.

The Ticket Advisory Panel should also consider these concerns and options in light of upcoming legislative initiatives. While there are no major proposed legislative changes to the SSI program on the table, important reauthorizations are on the table for WIA and IDEA. Some of the policy options proposed here, especially those that fall under our general areas of concern related to vocational/work preparation services, coordination of services, and education opportunities, could have some relevance to those reauthorization decisions. Additionally, we suggest several different types of demonstration projects that could be implemented independent of a major policy initiative to gain more information on this important area.

Executive Summary Table: Summary of Concerns and Options

Concerns Options
Work Incentives
The SSI program includes several disincentives that discourage work and even participation in work preparation activities for many child SSI recipients. These disincentives are likely further complicated by the age 18 redetermination decision. — Expand the use of PASS and IRWEs for child SSI recipients.
— Remove the earnings cap covered under the SEIE.
— Exclude all child earned income in the calculation of benefits.
Child SSI recipients do not have access to a temporary source of cash benefits (or other supports). — Extend eligibility for benefits beyond age 18.
— Create a temporary disability program for some segment child SSI recipients.
The potential loss of Medicaid benefits is a strong work disincentive even for those with limited earnings. — Provide Medicaid waivers to be consistent with SSI incentives programs.
— Transitional Medicaid assistance could be guaranteed former child SSI recipients for some set period.
Provider Incentives
There is a general need to improve individual incentives for self- sufficiency in non-SSA delivery programs. — Tie funding for programs to individual outcomes.
— Develop interagency collaboration to set objectives programs (e.g.., agencies could develop joint waivers empower consumer choice and more sharply tie for providers to client outcomes within specific programs, as well as across programs).
Vocational/Work Preparation Services
Vocational Rehabilitation is the foremost public avenue for work services for people with disabilities, but access for many youth is very limited. — Make youth a priority group for VR agencies.
— Expand payment options for serving child SSI recipients.
Access to other vocational preparation activities at the state level is generally limited, particularly at One-Stop Career Centers. — Lower the age range for mandatory service at One-Stops age 16.
— Expand the Disability Program Navigator project.
Coordination of Services
There is generally no explicit facilitator, planner, or coordinator focused exclusively on the transition process and the complex mix of programs available to child SSI recipients. — SSA could develop a role for a representative to participate in the IEP process.
Educational Opportunitites
The focus on high stakes testing and integrating students with disabilities into mainstream classrooms has created incentives for many local education agencies (LEAs) to cutback Vocational Education programs. — SSA and DOE could develop demonstration projects and databases to better understand these issues.
— SSA and DOE could design options together that are consistent with broader trends in the educational system.
Low enrollment rates in post-secondary education for youth with disabilities from special education programs.
Expectations by Parents and Administrators
Unrealistically low expectations for a young person's ability to work can lead to lack of work preparation and limited options. — Parent and/or youth advocacy training can encourage parents and youths to advocate for their children or themselves.
— Expand options for vocational preparation for competitive work.
The lack of research information on transition outcomes of youth with disabilities in general, and child SSI recipients in particular, makes it difficult to identify specific policy directions in serving this population. — Researchers should be able to use upcoming data sources from SSA and DOE to examine a variety of transition issues.
— Develop an interagency research center across key government agencies, especially SSA and DOE.

Note: This report is available in its entirety in the Portable Document Format (PDF).

Topics/Tags: | Children and Youth | Education | Employment | Health/Healthcare

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