G. Research on Related Topics

The legislative mandate for this report requires inclusion of information about relevant research on the Supplemental Security Income (SSI) program by the Social Security Administration (SSA) and others. Section 1 of this appendix describes SSA’s major ongoing projects. Section 2 presents a bibliography of studies regarding SSI payment levels, recipients, and reform proposals published in the past 10 years by both public and private entities.

Using Survey of Income and Program Participation (SIPP) data matched to administrative records, SSA researchers have developed a model of financial eligibility for SSI to estimate the rate of participation among the eligible elderly and the effects of various options to modify the SSI program (see Davies et al. 2001/2002). The model suggests that the rate of participation among the eligible elderly was about 62 percent in 1991. Estimates for 1996 and 2004 are also near this level; however, when measurement error is reduced by using administrative measures of OASDI income rather than the amounts self-reported in the SIPP, participation rates are over 72 percent (see Strand et al. 2009). An updated version of the model uses the 2008 SIPP matched to administrative records.

We used the model to simulate the potential effects of several approaches to expand the SSI program to fight poverty among the elderly. Approaches focusing on incremental changes in the Federal benefit rate, the general income exclusion, and the resources test appear roughly equally effective in reducing the poverty gap among the elderly on a cost-equivalent basis, while two approaches focusing on relaxing the earned income exclusion are less effective (Davies, Rupp, and Strand 2004). We expanded the model to address SSI participation and financial eligibility among the working-age disabled and to assess SSI benefit restructuring options for the entire SSI population. The working-age model allows for the identification of working-age persons by their SSI financial eligibility status, Social Security Disability Insurance (SSDI) insured status, and participation in both programs. We used the expanded model to assess SSI’s role in complementing SSDI and enhancing the safety net for the working-age population (Rupp, Davies, and Strand 2008). We simulated the effects of several approaches to changing in-kind support and maintenance rules and options for altering the calculation of the Federal benefit rate for certain living arrangement categories (Balkus et al. 2009). We also studied eligibility for Medicare buy-in programs with the financial eligibility model (see Rupp and Sears 2000; Sears 2001/2002). In unpublished internal research, we used the model to estimate the size of the population potentially eligible for the Medicare Part D low income subsidy.

The National Survey of SSI Children and Families (NSCF) addressed a number of agency policy and program objectives. One objective was to address issues specifically pertaining to the effects of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (welfare reform). However, the survey as designed is useful for the study of a broader range of issues of current interest to policy makers. Most importantly, it allows for the analysis of a nationally representative cross-section of SSI recipient children aged 0-17 and young adults aged 18-23. Among the questions the survey answers are the following:

The NSCF data collection began July 2001 and concluded June 2002. The NSCF sample size was considerably larger for SSI children and young adults than the sample size available in other surveys. Altogether, the NSCF includes 8,535 completed interviews with 5,006 individuals who received SSI benefits in December 2000 and 5,033 who received SSI benefits in December 1996. The NSCF public-use data file and documentation is available on our website at www.ssa.gov/disabilityresearch/nscf.htm. Davies and Rupp (2005/2006) provides an overview of the survey and describes some key features. We discuss other analyses using these data in section d, Analytic Studies, below. Although it was a cross-sectional data collection effort, we continue to update the match between NSCF and SSI administrative records with longitudinal data on SSI program participation.

This year ends the current series of cooperative agreements with the Disability Research Consortium (DRC) and Retirement Research Consortium (RRC). DRC and RRC consists of cooperatively funded research centers: Mathematica Policy Research's Center for Studying Disability Policy, the National Bureau of Economic Research's Disability Research Center and Retirement Research Center, Center for Retirement Research at Boston College, and the University of Michigan Retirement Research Center.

At the close of FY 2018, SSA anticipates to consolidate the RRC and DRC into a single program (RDRC) with a scope equivalent to the two current programs.

Recent research conducted through the DRC focused on young SSI recipients. Orzol, Leininger, and Early (2017) examine Children's Health Insurance Program (CHIP) eligibility expansions and SSI applications and awards, while Hoffman, Hemmeter, and Bailey (2017) studies adulthood outcomes for child SSI recipients. Other DRC work focuses on vulnerable groups. Cook and Burke-Miller (2017) explore the relationship between SSI recipients with psychiatric disabilities and their enrollment in other federal, state, and local program.

SSA researchers have conducted a number of studies that provide a better understanding of the SSI program, the elderly and disabled target populations, program interactions, and the role of the SSI program in the United States social safety net. Nicholas (2013) as well as Koenig and Rupp (2003/2004) estimate the prevalence, characteristics, and poverty status of SSI recipients living with others on SSI (who are not an eligible spouse) in the context of their individual, family and household units. In 2003 and again in 2005, SSA provided funding for interviewing supplemental samples of SSI and SSDI beneficiaries to increase the SIPP sample size available for analyses of these target groups. DeCesaro and Hemmeter (2008) examines the characteristics of SSDI and SSI program participants using the 2003 supplemental sample combined with the 2001 SIPP, both matched to administrative records. Bailey and Hemmeter (2014, 2015) updated this research note using the 2008 SIPP matched to SSA administrative records to examine the characteristics of SSDI and SSI program participants. Rupp and Davies (2004) tracks survey respondents from the 1984 SIPP for 14 years using administrative records on SSI and SSDI participation and death events to assess the relationship between self-reported health status, disabilities, mortality, and participation in the SSI and SSDI programs. Weathers et al. (2007) uses a unique longitudinal dataset based on administrative data from the National Technical Institute for the Deaf (NTID) linked to our administrative records to conduct a case study of SSI children who applied for postsecondary education at NTID. Hemmeter, Donovan, Cobb and Asbury (2015) compare the outcomes of participants in the Marriott Foundation for People with Disabilities Bridges from School to Work program with non-participating SSI recipients. Another study uses our administrative records from August 2005 through August 2007 to analyze SSI recipients who lived in counties and parishes affected by Hurricanes Katrina and Rita (Davies and Hemmeter 2010). Hemmeter (2009) examines the occupational distribution of SSI disability recipients aged 18-61 who work. Hemmeter and Gilby (2009) analyzes age-18 redetermination outcomes for SSI youth, including appeals of initial cessations and subsequent reapplications for benefits after a period of ineligibility, while Hemmeter (2012) looks at changes in diagnostic codes following the age-18 redetermination. Hemmeter (2015) looks at the entry of youth onto the SSI program at age 18. Another series of research studies examine the subsequent participation in the SSDI and SSI programs by individuals whose eligibility for those programs ceased through a continuing disability review because of medical improvements (Hemmeter and Stegman 2013, Hemmeter and Bailey 2015). Hemmeter, Mann, and Wittenburg (2017) look at state variation in post-age-18 redetermination outcomes. Rupp (2012) analyzes factors affecting initial disability allowance rates for the SSDI and SSI programs and finds that demographic and diagnostic characteristics of applicants and the local unemployment rate substantially affect the initial allowance rate. Rupp, Hemmeter, and Davies (2015) built off the work by Davies, Rupp, and Wittenburg (2009) to explore the longitudinal patterns of DI and SSI participation and mortality of child SSI awardees.

Using data from the Current Population Survey matched to our administrative records, Nicholas and Wiseman (2009 and 2010) assess the impact of using administrative records on poverty estimation among elderly SSI recipients using the official and alternative definitions of poverty. Wiseman and Ycas (2008) compares the Canadian social assistance program for the elderly with the SSI program, looking at program structure, cost, and consequences for elderly poverty rates. Kemp (2010) conducts a descriptive analysis of the SSI student earned income exclusion. One ongoing study is examining the growth in SSI applications and awards among children. Rupp, Hemmeter, and Davies (2015) looked at SSI children by year and age at award and analyzed transitions (e.g., onto SSDI, off SSDI and SSI, mortality) as they age into adulthood. Parent, Sayman and Kulzer (2012) provides a comprehensive profile of the characteristics of disability beneficiaries with a connection to workers’ compensation or public disability benefits. Parent et al. (2012) found that 8.3 percent of disabled workers who have this connection tend to be economically better off, more frequently middle-aged, male, afflicted with a musculoskeletal and connective tissue disorder, and tend to wait longer to apply for SSDI benefits after onset than the general disabled-worker population.

Several studies focus on the distributional effects of the SSI program through its interactions with other Federal and State programs. Dushi and Rupp (2013) uses longitudinal data from the Health and Retirement Study to assess the role of SSI and related social safety net programs in providing a buffer against the potentially adverse effects of disability shocks in the near-elderly population on financial well-being. Rupp et al. (2007) provides an empirical analysis of the SSI Federal benefit rate for assessing benefit adequacy among elderly Social Security beneficiaries and the effectiveness of the SSI benefit eligibility screens for targeting economically vulnerable elderly beneficiaries. Balkus et al. (2009) examines the distributional effects of replacing current policies on living arrangements and in-kind support with a simpler, cost neutral alternative. Strand and Rupp (2007) highlights the distributional implications of Social Security reform scenarios involving a potential shift from wage indexing to price indexing or longevity indexing in the establishment of initial benefits. Strand (2010) uses matched SIPP records to examine potential eligibility for three major means-tested programs (SSI, Medicaid, and SNAP) among near retirees aged 55-64 and eventual SSI participation upon reaching age 65. Rupp, Davies, and Strand (2008) find that over one-third of the working-age population is covered by SSI in the event of a severe disability, which provides disability benefit coverage to many who are not SSDI-insured and enhances the potential bundle of disability cash benefits among a substantial segment of those who are SSDI-insured.

Rupp and Riley recently published papers that are based on a linkage of individual-level administrative data from SSA and the Centers for Medicare & Medicaid Services. First, Rupp and Riley (2011) analyzes longitudinal patterns of interaction between SSDI and SSI and finds that one quarter of the year 2000 cohort of first-ever, working-age disability awardees received benefits from both programs over a 60-month period. A second paper (Rupp and Riley 2012) analyzes the effect of longitudinal interactions between the SSDI and SSI programs in providing access to Medicare and Medicaid, and finds that SSI facilitates high levels of Medicaid coverage for SSI awardees overall and provides access to Medicaid for many SSDI awardees during the 24-month Medicare waiting period. A third paper (Riley and Rupp, 2012) tracks expenditures for 2000-2006 for the SSDI, SSI, Medicare, and Medicaid programs and finds that SSI is a relatively low-expenditure program with important implications for the other three programs. The authors conclude that SSI and Medicaid provide a temporary safety net supporting SSDI beneficiaries during their SSDI and Medicare waiting periods. Ongoing work by the authors focuses on estimated cumulative expenditure patterns over the working-age adult portion of the life cycle for the year 2000 awardees for the four programs (SSDI, SSI, Medicare, and Medicaid). An additional piece of ongoing analysis focuses on the effect of State variations in Medicaid enrollment policy and implementation regimes on Medicaid coverage and expenditures. The three State policy regimes compared include: (1) automatic enrollment of SSI awardees; (2) requiring a separate Medicaid application in “Criteria States”; and (3) more restrictive Medicaid eligibility requirements in “209B States.” Coe and Rupp (2013) analyzes whether disability benefit recipients (SSDI and SSI) in States with easier access to health insurance will be more likely to work and exit from SSDI and/or SSI than their peers in States where health insurance is more difficult to access.

Wamhoff and Wiseman (2005/2006) examines the financial consequences of Temporary Assistance for Needy Families (TANF)-to-SSI transfers and develops new estimates of both the prevalence of receipt of SSI benefits among families receiving cash assistance from TANF and the proportion of new SSI awards that go to adults and children residing in families receiving TANF-related benefits. Trenkamp and Wiseman (2007) addresses the connections between the SSI and Food Stamp programs. Meijer, Karoly, and Michaud (2009, 2010) analyzes eligibility for the Medicare Part D Low Income Subsidy, which relies on a simplified SSI methodology.

A number of studies utilize the NSCF to focus on children and young adults receiving SSI. Rupp et al. (2005/2006) presents highlights from the survey characterizing SSI children with disabilities and their families. Hemmeter (2011) analyzes the unmet health care needs of SSI children after the age-18 redetermination. Additional research studies employment and caregiving patterns of parents of SSI children (Rupp and Ressler 2009), examines employment and program outcomes among young adults after their eligibility redetermination at age 18 (Hemmeter, Kauff, and Wittenburg 2009), and analyzes factors affecting out-of-pocket medical expenses and unmet health care needs of disabled children (DeCesaro and Hemmeter 2009). These papers appear in a special issue of the Journal of Vocational Rehabilitation (volume 30, number 3, 2009) devoted to SSI children and young adults and the transition to adulthood. The special issue also includes a paper that introduces the issue and examines the life-cycle human capital development and longer-term SSI and earnings outcomes of SSI youth as they transition to adulthood (Davies, Rupp, and Wittenburg 2009), as well as two papers that focus on SSA’s Youth Transition Demonstration (YTD) (Fraker and Rangarajan 2009; Luecking and Wittenburg 2009). The articles from the special issue are available on SSA’s web site at www.ssa.gov/policy/JVR.html. Camacho and Hemmeter (2013) summarize the findings from two earlier YTD projects.

The Ticket to Work and Work Incentives Improvement Act of 1999 (the Ticket Act) required the Commissioner of Social Security to provide independent evaluations to assess the effectiveness of the Ticket to Work program. We conducted all Ticket to Work evaluation reports through an independent evaluation contractor, Mathematica Policy Research, Inc. Our contractor completed the evaluation of the Ticket to Work program in 2013. There are seven Ticket to Work evaluation reports in all, and all reports are available on SSA’s website at www.ssa.gov/disabilityresearch/twe_reports.htm.

The findings through the fourth report indicated that, while the program may have significant potential, we need to improve both beneficiary awareness of the program and employment network (EN) incentives. Partly in response to these findings, we implemented new regulations for the Ticket to Work program in July 2008 to improve EN and beneficiary participation and outcomes. The fifth and sixth reports consist of studies focused on the employment efforts of working-age SSI recipients and SSDI beneficiaries, and on the Social Security work incentives and supports designed to encourage their employment. The seventh (final) report focused primarily on the overall success of the Ticket to Work program and on the effect of the changes to the Ticket to Work regulations in 2008.

Overall, the Ticket to Work evaluation finds that beneficiaries who use Ticket to Work generally like the program, that the program has increased use of return-to-work services, and those who participate in Ticket to Work have better outcomes than those who return to work without the help of SSA-financed employment services. However, we also find that the increase in service use and better outcomes by participants has not translated into net increases in benefit suspension or termination for work or an increase in the number of months spent in suspension or termination for work. This suggests that Ticket to Work has primarily extended the types of services that were available under the program that preceded Ticket to Work, where services were offered only though State vocational rehabilitation agencies, and has achieved the same level of success as before Ticket to Work. More beneficiaries are getting these services now, but the success rate has not measurably changed.

The Ticket to Work evaluation has also produced two by-products that will continue beyond the end of our specific evaluation efforts for the Ticket to Work program that was mandated in the Ticket Act. One of the foundations of the evaluation was an annual research file, the Disability Analysis File (DAF), previously called the Ticket Research File, which contains the agency's disparate administrative data resources for child and working-age adult beneficiaries who have received disability cash benefits from the SSI; Old-Age, Survivors, and Disability Insurance (OASDI); or both programs since 1996. We initially produced the DAF to support the Ticket to Work evaluation, and researchers now use it for a wide array of disability-related research.

A second foundation of the Ticket to Work evaluation was the National Beneficiary Survey (NBS). In the NBS, we collect information that is not available from our administrative records from a representative sample of SSI and OASDI disability beneficiaries, called the Representative Beneficiary Sample (RBS). Key items of interest in the NBS include work attitudes and work-related activities, health and functional status, education, access to health insurance, household composition, and sources of income. We implemented the first four rounds between 2004 and 2010, with a particular focus on participation in the Ticket to Work program. We completed additional rounds in 2015 and 2017, which included a broader focus on all SSA beneficiaries who work. In particular, the 2017 NBS included both the RBS and a large-scale focus on beneficiaries who have experienced employment success—the Successful Worker Sample (SWS). In 2019, we plan to field the next round of the survey, which will contain both RBS and SWS components and will add a longitudinal sample of successful workers who were part of the 2017 SWS. In 2017, we published a compendium of disability statistics from the 2015 NBS, “National Beneficiary Survey: Disability Statistics, 2015” (http://www.ssa.gov/policy/docs/statcomps/nbs/index.html). The publication provides descriptive statistics on the health, program and service participation, employment interest and activity, job characteristics, and benefits and employment interaction of SSI recipients and SSDI beneficiaries.

Other researchers and policy analysts within SSA and at other Federal agencies and academic institutions use the DAF and the NBS for general disability research and analysis not limited to Ticket to Work program participants. Examples of these papers include: interactions between SSDI and SSI for new beneficiaries with disabilities (Rupp and Riley 2011); the differences in employment outcomes between young participants (ages 18 to 30) with psychiatric disabilities versus young participants with other disabilities (Schimmel, Liu, and Croake 2012); the impact of workplace injuries on receipt of SSDI benefits (O'Leary et al. 2012); work activities and employment outcomes for our beneficiaries with disabilities in seven articles in a special issue of the Social Security Bulletin (volume 71, number 3, 2011); the long-term effects of evidence-based supported employment services on vocational outcomes (Cook, Burke-Miller, and Roessel 2016); the employment and benefit receipt outcomes of vocational rehabilitation applicants (Mann et al. 2017); the income effect of SSDI payments on earnings (Gelber, Moore, and Strand 2016); a profile of working-age SSDI and SSI beneficiaries with psychiatric disabilities (Livermore and Bardos 2017); outcomes for transition-age youth with disabilities who applied and were eligible for Vocational Rehabilitation services (Honeycutt, Martin, and Wittenburg 2017); the characteristics associated with return-to-work success (Ben-Shalom and Mamun, 2015); a review of work incentive use by transition age youth (Bertoni, 2017); an assessment of the cost effectiveness of vocational rehabilitation services for SSA disabled beneficiaries (Office of the Inspector General, 2017); an examination of how social insurance, family support and work capacity enhance individuals' economic well-being following significant health and income shocks (Rennane, 2016); and the effect of the Affordable Care Act (ACA) on SSI disability applications (Hyde, et al, 2017).

The YTD established partnerships to improve employment outcomes for youths age 14-25 who receive (or could receive) SSI or OASDI payments based on their own disability. The YTD projects included service delivery systems and a broad array of services and supports to assist youth with disabilities in their transition from school to employment and to help them gain economic self-sufficiency.

YTD began in 2003, with seven projects in six States. In 2007, we piloted new projects in five States, choosing three new projects in Florida, Maryland, and West Virginia. These three projects joined three (Colorado; Bronx County, New York; and Erie County, New York) of the original seven projects in a random assignment study. This study will produce the first evaluation of the empirical evidence of the effects of youth transition programs and modified SSI work incentives.

The modified SSI program rules that we tested under the YTD included five program waivers.

The YTD projects in Colorado and New York ended in 2010. The Florida, Maryland, and West Virginia projects ended in 2012. We have released the 12-month, post-random-assignment reports for all the sites to the public. We published a 24-month, post-random-assignment report covering all the sites in the February 2014 edition of the Social Security Bulletin (Hemmeter 2014). We posted the comprehensive final report of the six random assignment projects to our website in November 2014. This demonstration produced mixed evidence on whether YTD impacts on paid employment is sustainable.

Two of the six projects showed an increase in employment three years after random assignment. Florida and Bronx, New York showed positive impacts on paid employment during the year after participants entered the evaluation. In Florida, 23 percent of participants in the program group worked for pay during that year, compared with just 13 percent of control group members. Because several youths took advantage of the modified program rules (listed in bullets above), participants of five of the six projects had higher total income from earnings and disability benefits in the third year after random assignment. These impacts ranged from $1,010 higher total income in West Virginia to $1,729 higher in Bronx, New York. The YTD showed that substantial doses of well-designed service to youth with disabilities can improve key transition outcomes in the medium term.

We will follow participants using administrative data and conduct cost-benefit analyses at specified periods, such as 5 to 10 years to test the longer-term outcomes of these projects.

Our findings from YTD influenced the development of Promoting Readiness of Minors in SSI
(PROMISE) project, a joint initiative of SSA and the Departments of Education, Health and Human Services, and Labor that funds model demonstration projects in several States to promote positive outcomes for children with disabilities who receive SSI and their families (described in section j).

To determine whether adult disability applicants qualify for benefits, our adjudicators follow a sequential five-step evaluation process. At steps four and five, where we decide the majority of our claims, we require information about work in the national economy to determine whether claimants’ impairment-related limitations would prevent them from working. Currently, we base these medical-vocational decisions on the occupational information found in the Department of Labor's (DOL) Dictionary of Occupational Titles (DOT) and its companion volume, the Selected Characteristics of Occupations. Although DOL did not design the DOT for our use, we incorporated many of its concepts and definitions into our regulations and policy. DOL stopped updating the DOT in 1991 and later replaced it with the Occupational Information Network (O*NET), which we would not be able to use in our disability adjudication process without significant modifications. We could not identify any other existing Occupational Information System (OIS) that would meet our unique needs.

In July 2012, we signed an Interagency Agreement with the Bureau of Labor Statistics (BLS) to test the feasibility of using the National Compensation Survey (NCS) platform to collect updated occupational information about the skill level, physical, environmental, and mental and cognitive requirements of work. This information will provide us with data about work in the national economy to inform current and future policy. We signed additional agreements with BLS for fiscal years (FY) 2013 through 2018 to continue testing and, in FY 2015, began production data collection. In FY 2013 and 2014, BLS conducted feasibility testing and worked with us to improve the survey tools and testing protocols. We also met periodically with DOL's Employment and Training Administration to discuss how to incorporate elements of O*NET with the data collected by BLS and began working with a contractor to outline the requirements for a web-based IT platform to house the OIS. In FY 2015, we began developing the IT platform, conducted a nationwide pre-production test, and began production data collection. In FY 2016, BLS completed the first round of production data collection and continued testing to resolve any issues raised by earlier data collection. In May 2016, BLS began the second year of production data collection.

In FY 2017, BLS completed the second year of data collection. BLS released the first-year production estimates in December 2016, and the second-year estimates in November 2017. In FY 2018, BLS will complete the initial three years of data collection, which they plan to publish in December 2018. We will continue to test the OIS IT platform and BLS will conduct ongoing data validity and sample design research to ensure the data continues to meet our needs. In FY 2019, BLS will complete the first year of the first OIS refresh cycle, which will run for five years, and begin the second year. BLS has proposed a sampling approach that will target rarer occupations in the first two years of the refresh, which they estimate will result in more publishable occupations at the end of the five year period. In FY 2020, BLS will complete the second year, and begin the third year of production data collection as part of the first 5-year refresh cycle. BLS will publish the data from the first year of the first 5-year refresh cycle. SSA will implement the OIS in December 2020 when final regulations take effect.

The goal of the Homeless with Schizophrenia Presumptive Disability (HSPD) Pilot Demonstration is to improve the economic well-being of adult SSI applicants who are both homeless and diagnosed with schizophrenia or schizoaffective disorder. We partnered with clinicians and case managers in California from the Health Services Agencies of San Francisco and Santa Cruz counties, the Department of Public Health of the City of San Francisco, and the Department of Mental Health of Los Angeles County, who are actively assisting their clients to navigate the SSI application process and have established relationships with patients diagnosed with schizophrenia and schizoaffective disorder who are also homeless. There were two main features of the project: (1) the SSI application assistance; and (2) the use of presumptive disability (PD). The clinicians and case managers assisted these individuals with gathering supporting medical evidence, coordinating medical appointments, and submitting the SSI application. Along with the SSI application, a Presumptive Disability Recommendation Form, created for this pilot demonstration, was also submitted. Clinicians from the community agencies certified that the applicant met the SSA criteria for a diagnosis of schizophrenia or schizoaffective disorder. To provide economic relief to the applicant while we processed the application, we awarded up to 6 months of SSI payments to the applicant based on PD. Applicants were not required to pay back these payments if we ultimately denied their applications, as long as we did not deny the applications for non-medical reasons; therefore, there must be a high degree of probability that the applicant was disabled when we conferred PD SSI payments. Our field offices generally make PD findings only for specific disability categories, which do not include schizophrenia or schizoaffective disorder.

Project implementation began in April 2012, with a goal of recruiting at least 200 participants. We met this enrollment goal and completed the implementation phase in April 2014. The community partners identified 260 individuals to assist through the SSI application process. Among the 238 we are using for our evaluation, we approved 223 of these applicants, denied 14, and 1 had no decision.

In our evaluation (Bailey, Engler, and Hemmeter 2016), we examined whether the program improves the administration of the SSI application and determination process. The evaluation is based on a quasi-experimental design, in which we compared outcomes for applicants who receive assistance and PD payments with applicants from a previous period and applicants in surrounding areas. Within this framework, we examined differences in initial allowance rates, appeals, failure-to-cooperate denials, processing times, total payments, exits from SSI, mortality, and the need for consultative exams. Relative to the comparison groups chosen in the surrounding geographic areas, in an earlier period, and in the same locations, we found that the pilot led to higher allowance rates at the initial adjudicative level, fewer requests for consultative examinations, and reduced time to award.

PROMISE is a joint project between SSA and the Departments of Education (ED), Labor, and Health and Human Services. The goals of the project are to improve the provision and coordination of services and supports for children with disabilities who receive SSI and their families in order to achieve improved education and employment outcomes. The targeted outcomes include completing postsecondary education and job training to obtain competitive employment in an integrated setting that may result in long-term reductions in the child recipient's reliance on SSI. In 2013, ED funded model demonstration projects in five individual States (Arkansas, California, Maryland, New York, and Wisconsin) and one consortium of States (Arizona, Colorado, Montana, North Dakota, South Dakota, and Utah) for 5 years. SSA is responsible for evaluating PROMISE.

Each PROMISE project enrolled at least 2,000 youths ages 14-16. The projects provide youths randomly assigned into the treatment group services including: case management; benefits counseling; career and work-based learnings experiences; and parent/guardian training and information. Youths randomly assigned to a control group receive the services usually available in their communities.

The PROMISE evaluation includes process, impact, and cost-benefit analyses. Enrollment began in April 2014 and ended in April 2016. Services will continue through late 2018. The project-specific process analyses and the interim impact and services report will be available in late 2018. The final evaluation report (on the longer-term impacts and cost-benefit analyses) will be available in 2022.

The Supported Employment Demonstration (SED) will evaluate whether offering evidence-based packages of integrated vocational, medical, and mental health services to recently denied disability applicants promotes employment, self-sufficiency, and improved mental health and quality of life. The project focuses on individuals aged 18 to 50 who express a desire to work and who have recently been denied disability benefits (SSDI or SSI) while alleging a mental illness.

With the cooperation of 30 community health centers across the country, SED will enroll and randomly assign 3,000 participants into one of three groups: 1) The Full-Service Treatment Group; 2) The Basic-Service Treatment Group; or 3) The Control Group (usual services). Participants assigned to the Full-Treatment Group will receive Individual Placement and Support (IPS) services, a nurse care coordinator, systematic medication management, and assistance with cost sharing for medications and behavioral health and work-related expenses. Participants assigned to the Basic-Service Treatment Group will also receive the IPS services and assistance with behavioral health and work-related expenses, but will not receive the services of a nurse care coordinator, systematic medication management, or assistance with cost sharing for medications. Participants assigned to the control group will have access to all standard behavioral health or employment-related services available at the community health center and will receive a local Community Resources information book.

The SED project will run from August 2016 to August 2022. Recruitment and participant enrollment began in early FY 2018. Participants receive 36 months of intervention services after entry. Field operations end in FY 2020 and include technical assistance, training, and data collection activities for process and outcome evaluations. The final evaluation reports will be available in FY 2022.

Several research studies indicate that a large number of low-income seniors do not receive SSI even though they are potentially eligible for payments. In FY 2017, SSA, in partnership with the General Services Administration's Office of Evaluation Science, conducted a pilot to identify what specific language, if any, has the greatest effect on SSI participation among potentially-eligible low-benefit OASDI beneficiaries. In September 2017, we sent one of four differently worded notices to randomly selected groups of low-benefit OASDI beneficiaries meeting the inclusion criteria. We will use program records on the rates of SSI applications and awards to measure the effect of the notices on SSI applications as compared to a control group, who did not receive a notice (Hemmeter, Safran, and Wilson 2018).

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Moulta-Ali, Umar. Child Welfare: Social Security and Supplemental Security Income (SSI) Benefits for Children in Foster Care. Washington, DC: Library of Congress, Congressional Research Service Report No. RL33855, September 2012.

________. Supplemental Security Income (SSI). Washington, DC: Library of Congress, Congressional Research Service Report No. 94-486, January 2014.

________. Supplemental Security Income (SSI): Accounts Not Counted as Resources. Washington, DC: Library of Congress, Congressional Research Service Report No. RS22512, August 2011.

Moulta-Ali, Umar. Supplemental Security Income (SSI): Income/Resource Limits and Accounts Exempt From Benefit Determinations. Washington, DC: Library of Congress, Congressional Research Service Report No. RS20294, January 2014.

National Academies of Sciences, Engineering, and Medicine. Informing Social Security's Process for Financial Capability Determination. Washington, DC: National Academies Press, 2016.

________. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: National Academies Press, 2015.

________. Psychological Testing in the Service of Disability Determination. Washington, DC: National Academies Press, 2015.

________. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: National Academies Press, 2016.

Nicholas, Joyce. “Prevalence, Characteristics, and Poverty Status of Supplemental Security Income Mutirecipients.” Social Security Bulletin 73, 3 (2013): 11-21.

________. “Source, Form, and Amount of In-kind Support and Maintenance Received by Supplemental Security Income Applicants and Recipients.” Social Security Bulletin 74, 3 (2014): 39-54.

Nicholas, Joyce and Michael Wiseman. “Elderly Poverty and Supplemental Security Income.” Social Security Bulletin 69, 1 (2009): 45-73.

________. “Elderly Poverty and Supplemental Security Income, 2002-2005.” Social Security Bulletin 70, 2 (2010): 1-29.

Nichols, Austin, Lucie Schmidt, and Purvi Sevak. “Economic Conditions and Supplemental Security Income Application.” Social Security Bulletin 77, 4 (2017): 27-44.

O’Day, Bonnie, Allison Roche, Norma Altshuler, Liz Clary, and Krista Harrison. Process Evaluation of the Work Incentives Planning and Assistance Program. Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations Report No. 1. Washington, DC: Mathematica Policy Research, 2009.

________. Process Evaluation of the Work Incentives Planning and Assistance Program. Evaluation of the Ticket to Work Program, Report 5: Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations Washington, DC: Mathematica Policy Research, 2011.

O'Day, Bonnie and David Stapleton. Transforming Disability Policy for Youth and Young Adults with Disabilities. Center for Studying Disability Policy Research Brief Number 09-01. Princeton, NJ: Mathematica Policy Research, Inc., March 2009.

O’Leary, Paul, Leslie I. Boden, Seth A. Seabury, Al Ozonoff, and Ethan Scherer. “Workplace Injuries and the Take-Up of Social Security Disability Benefits.” Social Security Bulletin 72, 3 (2012): 1-17.

O’Leary, Paul, Gina A. Livermore, and David C. Stapleton. “Employment of Individuals in the Social Security Disability Programs.” Social Security Bulletin 71, 3 (2011): 1-10.

O’Neill, John, Arif A. Mamun, Elizabeth Potamites, Fong Chan, and Elizabeth da Silva Cordoso. “Return to Work of Disability Insurance Beneficiaries Who Do and Do Not Access State Vocational Rehabilitation Agency Services.” Journal of Disability Policy Studies 26, 2 (2015): 111-123.

Pardoe, Rachel. Understanding Supplemental Security Income (SSI): A Guide for TANF Staff Members, OPRE Report 2013-50, Washington, DC: Office of Planning, Research, and Evaluation; Administration for Children and Families; U.S. Department of Health and Human Services, December 2013.

Parent, Rene, Jeffrey Hemmeter, and Nancy Early. Selected Characteristics and Self-Perceived Performance of Individual Social Security and Supplemental Security Income Representative Payees. Research and Statistics Note No. 2009-02. Washington, DC: Office of Retirement and Disability Policy, Social Security Administration, December 2009.

Parent, Rene, Incigul Sayman, and Kevin Kulzer. Profile of Social Security Disabled Workers and Dependents Who Have a Connection to Workers’ Compensation or Public Disability Benefits. Research and Statistics Note No. 2012-03. Washington, DC: Office of Research, Evaluation, and Statistics, Office of Retirement and Disability Policy, Social Security Administration, September 2012.

Perrin, James M., Amy Houtrow, Kelly Kelleher, Kimberly Hoagwood, Ruth E.K. Stein, and Bonnie Zima. “Supplemental Security Income Benefits for Mental Disorders” Pediatrics 138, 1 (2016): DOI: 10.1542/peds.2016-0354.

Prenovitz, Sarah. Service Providers’ Experiences Under the Revised Ticket to Work Regulations. Center for Studying Disability Policy Issue Brief Number 12-04. Princeton, NJ: Mathematica Policy Research, Inc., February 2012.

Prenovitz, Sarah, Maura Bardos, and Bonnie O’Day. Ticket to Work After the Release of the 2008 Revised Regulations: Progress and Prospects. Evaluation of the Ticket to Work Program, Final (Seventh) Report. Washington, DC: Mathematica Policy Research, 2012.

Pulcini, Christian D., Milton Kotelchuck, Karen A. Kuhlthau, Alixandra A. Nozzolillo, and James M. Perrin. “Potential Savings From Redetermining Disability Among Children Receiving Supplemental Security Income Benefits.” Academic Pediatrics 12, 6 (2012): 489-494.

Rangarajan, Anu, Thomas Fraker, Todd Honeycutt, Arif Mamun, John Martinez, Bonnie O’Day, and David Wittenburg. The Social Security Administration’s Youth Transition Demonstration Projects: Evaluation Design Report. Report prepared under contract to the Office of Disability and Retirement Research, Social Security Administration, January 2009.

Rennane, Stephanie Louisa. Essays on the Effects of Social Security Insurance for Disability, Dissertation, University of Maryland, 2016.

Riley, Gerald F., and Kalman Rupp. “Cumulative Expenditures under the DI, SSI, Medicare, and Medicaid Programs for a Cohort of Disabled Working-Age Adults.” Health Services Research (2014b): DOI: 10.1111/1475-6773.12219.

________. “Expenditure Patterns Under the Four Major Public Cash Benefit and Health Insurance Programs for Working-Age Adults With Disabilities.” Journal of Disability Policy Studies 25, 2 (2014a): 71-80.

Rupp, Kalman. “Factors Affecting Initial Disability Allowance Rates for the Disability Insurance and Supplemental Security Income Programs: The Role of the Demographic and Diagnostic Composition of Applicants and Local Labor Market Conditions.” Social Security Bulletin 72, 4 (2012): 11-36.

Rupp, Kalman and Paul S. Davies. “A Long-Term View of Health Status, Disabilities, Mortality, and Participation in the DI and SSI Disability Programs.” In Research in Labor Economics, Accounting for Worker Well-Being, Volume 23, edited by Solomon W. Polachek. Amsterdam: Elsevier, JAI Press, 2004.

Rupp, Kalman, Paul S. Davies, Chad Newcomb, Howard Iams, Carrie Becker, Shanti Mulpuru, Stephen Ressler, Kathleen Romig, and Baylor Miller. “A Profile of Children with Disabilities Receiving SSI Benefits: Highlights from the National Survey of SSI Children and Families.” Social Security Bulletin 66, 2 (2005/2006): 21-36.

Rupp, Kalman, Paul S. Davies, and Alexander Strand. “Disability Benefit Coverage and Program Interactions in the Working-Age Population.” Social Security Bulletin 68, 1 (2008): 1-30.

Rupp, Kalman, Jeffrey Hemmeter, and Paul S. Davies. “Longitudinal Patterns of Disability Program Participation and Mortality Across Childhood SSI Award Cohorts.” Social Security Bulletin 75, 1 (2015): 35-64.

Rupp, Kalman and Steve Ressler. “Family Caregiving and Employment Among Parents of Children with Disabilities on SSI.” Journal of Vocational Rehabilitation 30, 3 (2009): 153-175.

Rupp, Kalman and Gerald F. Riley. “Longitudinal Patterns of Medicaid and Medicare Coverage Among Disability Cash Benefits Awardees.” Social Security Bulletin 72, 3 (2012): 19-35.

________. “Longitudinal Patterns of Participation in the Social Security Disability Insurance and Supplemental Security Income Programs for People With Disabilities.” Social Security Bulletin 71, 2 (2011): 25-51.

________. “State Medicaid Eligibility and Enrollment Policies and Rates of Medicaid Participation among Disabled Supplemental Security Income Recipients.” Social Security Bulletin 76, 3 (2016): 17-40.

Rupp, Kalman and James Sears. “Eligibility for the Medicare Buy-In Programs, Based on a Survey of Income and Program Participation Simulation.” Social Security Bulletin 63, 3 (2000): 13-25.

Rupp, Kalman, Alexander Strand, Paul S. Davies, and James Sears. “Benefit Adequacy Among Elderly Social Security Retired Worker Beneficiaries and the SSI Federal Benefit Rate.” Social Security Bulletin 67, 3 (2007): 29-52.

Schimmel, Jody. New Evidence on the Role of Provider Business Model in the Economic Viability of Employment Networks in Ticket to Work. Center for Studying Disability Policy Issue Brief Number 13-04. Princeton, NJ: Mathematica Policy Research, Inc., July 2013.

________. Regulatory Changes and the Recession: How Did They Affect Ticket to Work Participants' Employment Efforts. Center for Studying Disability Policy Issue Brief Number 13-03. Princeton, NJ: Mathematica Policy Research, Inc., July 2013.

Schimmel, Jody, Su Liu, and Sarah Croake. “Employment Experiences of Young Medicaid Buy-In Participants with Psychiatric Disabilities” Psychiatric Rehabilitation Journal, 2012 Winter, 259-64.

Schimmel, Jody, Bonnie O'Day, and Allison Roche. “The Work Incentives Planning and Assistance Program: Promoting Employment Among Social Security Disability Beneficiaries.” Center for Studying Disability Policy Issue Brief Number 11-05. Princeton, NJ: Mathematica Policy Research, Inc., January 2012.

Schimmel, Jody, Bonnie O'Day, Allison Roche, Gina Livermore, and Dominic Harris. Evaluation of the Work Incentives Planning and Assistance (WIPA) Program: Beneficiaries Served, Services Provided, and Program Costs. Final Report. Report prepared for the Social Security Administration, September 2010.

Schimmel, Jody, Allison Roche, and Gina Livermore. Evaluation of the Recent Experience of the Work Incentives Planning and Assistance (WIPA) Program: Beneficiaries Served, Services Provided, and Pro- gram Costs. Evaluation of the Ticket to Work Program, Final (Seventh) Report. Washington, DC: Mathematica Policy Research, 2011.

Schimmel, Jody and David C. Stapleton. “Disability Benefits Suspended or Terminated Because of Work.” Social Security Bulletin 71, 3 (2011): 83-103.

________. How Many Disability Beneficiaries Forgo Cash Benefits Because of Work? Evidence From a New Measure. Center for Studying Disability Policy Issue Brief Number 12-03. Princeton, NJ: Mathematica Policy Research, Inc., February 2012.

Schimmel, Jody, David Stapleton, David R. Mann, and Dawn Phelps. Participant and Provider Outcomes Since the Inception of Ticket to Work and the Effects of the 2008 Regulatory Changes. Evaluation of the Ticket to Work Program, Final (Seventh) Report. Washington, DC: Mathematica Policy Research, 2013.

Schimmel Hyde, Jody and Paul O'Leary. Social Security Administration Payments to State Vocational Rehabilitation Agencies for Beneficiaries Who Work: Evidence from Linked Administrative Data. DRC Working Paper No. 2017-02, Mathematica Center for Studying Disability Policy, March 2017.

Schmidt, Lucie. “The Supplemental Security Income Program and Welfare Reform.” Public Policy Discussion Paper 12-3, Boston, MA: Federal Reserve Bank of Boston, May 2012.

________. “Supplemental Security Income, Welfare Reform, and the Recession.” Communities & Banking 24, 3 (2013): 20-21.

Schmidt, Lucie and Purvi Sevak. “Child Participation in Supplemental Security Income: Cross- and Within-State Determinants of Caseload Growth.” Journal of Disability Policy Studies 28, 3 (2017): 131-140.

Sears, James. “Comparing Beneficiaries of the Medicare Savings Programs with Eligible Nonparticipants.” Social Security Bulletin 64, 3 (2001/2002): 76-80.

Sevak, Purvi and Lucie Schmidt. What Can We Learn from County-Level Variation in Child SSI Participation Rates? DRC Data Brief No. 2016-08, Mathematica Center for Studying Disability Policy, June 2016.

Skemer, Melanie and Brian Bayes. Examining the Interaction Between Welfare and Disability: Lessons from an In-Depth Data Analysis, OPRE Report 2013-49, Washington, DC: Office of Planning, Research, and Evaluation; Administration for Children and Families; U.S. Department of Health and Human Services, December 2013.

Smith-Kaprosy, Nolan, Patricia P. Martin, and Kevin Whitman. “An Overview of American Indians and Alaskan Natives in the Context of Social Security and Supplemental Security Income.” Social Security Bulletin 72, 4 (2012): 1-10.

Stahl, Anne, Jody Schimmel Hyde, and Harnam Singh. The Effect of a 1999 Rule Change on Obesity as a Factor in Social Security Disability Determinations. DRC Working Paper No. 2016-01, Mathematica Center for Studying Disability Policy, February 2016.

Stapleton, David, Burt Barnow, Kevin Coleman, Kimberly Dietrich, Jeff Furman, and Gilbert Lo. Labor Market Conditions, Socioeconomic Factors, and the Growth of Applications and Awards for SSDI and SSI Disability Benefits, final report and appendix prepared under contract to the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services and the Social Security Administration, May 23, 1995.

Stapleton, David, Cindy Gruman, and Sarah Prenovitz. Participation in Ticket to Work Continues to Grow but Assignments Under the Traditional Payment System Still Dominate. Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations Report No. 3. Washington, DC: Mathematica Policy Research, 2009.

________. “Participation in Ticket to Work Continues to Grow but Assignments Under the Traditional Payment System Still Dominate.” Evaluation of the Ticket to Work Program, Report 5: Work Activity and Use of Employment Supports Under the Original Ticket to Work Regulations Washington, DC: Mathematica Policy Research, 2011.

Stapleton, David C., Gina Livermore, Craig Thornton, Bonnie O’Day, Robert Weathers, Krista Harrison, So O’Neil, Emily Sama Martin, and David Wittenburg. Ticket to Work at the Crossroads: A Solid Foundation with an Uncertain Future. Report prepared under contract to the Office of Disability and Income Security Programs, Social Security Administration, September 2008.

Stapleton, David, Gina Livermore, Andrea Zeuschner, Jeffery Furman, Kimberly Dietrich, and Gilbert Lo. Impairment Trends in the Growth of Applications and Awards for SSA Disability Benefits, final report and appendix prepared under contract to the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services and the Social Security Administration, May 24, 1995.


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2018 Annual Report of the SSI Program