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We must address the threats to SSI and SSDI

September 20, 2015
by Ron Manderscheid, PhD
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For almost 35 years, the Supplemental Security Income (SSI) Program and the Social Security Disability Insurance (SSDI) Program have been an essential part of our national safety net for persons with disabilities. Many millions of persons with mental illness or with intellectual development/developmental disabilities (ID/DD) have depended upon the meager payments from one or both of these programs for their essential living expenses. Currently, both programs are threatened because they will begin running out of funds at the end of 2016; Congressional action will be required to maintain current funding.

Equally important, both programs also are essential because they confer eligibility for public health insurance. Qualification for SSI confers immediate eligibility for Medicaid; qualification for SSDI, eligibility for Medicare. Originally, SSDI had a two year waiting period prior to eligibility for Medicare; now, under the Affordable Care Act, eligibility is immediate.  

The SSI Program is designed for persons with disabilities who are poor and who have not worked under Social Security; the SSDI Program, for persons with disabilities who have worked under Social Security or for their dependents, including adult children and widows or widowers.

Entrance into either program is based upon a determination of disability. This stringent disability assessment focuses upon four ability factors: activities of daily living, instrumental activities of daily living, social functioning, and cognitive impairment.

Participation by persons disabled with mental illness or ID/DD

In 2013, almost 13 million persons with disabilities participated in these two programs. Of that number, almost one third, or 4 million persons, were disabled by mental illness. An additional 11 percent, or almost 1.5 million, were disabled by ID/DD. For both groups, program eligibility is very clear proof of severe disability.

In 1990, persons disabled by mental illness represented slightly more than 20% of the SSI rolls. By 2013, this percentage had risen to 38%. Similarly, in 2013, persons disabled by ID/DD comprised a very large percentage of persons on the SSDI rolls. Almost half of all adult children receiving only SSDI payments and about half of all adult children receiving both SSI and SSDI payments were disabled by ID/DD.

The reason for these large and growing numbers is very straightforward. Persons disabled by mental illness frequently develop these conditions in their late teens or early twenties. Persons disabled by ID/DD develop these conditions as very young children. Consequently, both groups are disabled at a young age, join the SSI and/or SSDI rolls while they are young, and can be expected to receive SSI or SSDI payments for many years. Other groups participating in these programs, e.g., persons with cancer, become disabled at a later age, come on the rolls at a later age, and die within a much shorter period. Thus, over time, persons disabled by mental illness or ID/DD come to predominate on the rolls of both programs.

Persons disabled primarily by substance use conditions are not permitted to enroll in SSI or SSDI. This policy was put in place in the latter years of the Clinton Administration, and remains in effect to this day.

What actions must we take?

As we contemplate the future of these important programs, we need to seek important changes in their implementation:

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Comments

I would like to make the following responses to the two comments received yesterday:

Comment 1: Because SSI is funded with general revenue rather than SSA trust funds, which are used for SSDI, SSI is not threatened in 2016. Response: This funding pattern puts SSI at even greater risk, since the Congress can easily move SSI funds to make up the shortfalls in SSDI funds.

Comment 2: SSDI does not qualify one for Medicare immediately. Response: Yes, this is correct. The draft ACA legislation included this change, and it was removed in the final version. However, qualification for SSDI can be used as the occasion to enroll immediately in Medicaid or in the state health insurance marketplace, depending on one's income, until the waiting period of Medicare has passed.

I appreciate receiving both of these comments.

Ron Manderscheid

Social Security Disability Insurance is often the sole financial support for a person living with a psychiatric label and currently (dis)abled and not in a place to seek or retain employment.

For many Certified Peer Specialists, it is more than commonplace for the Peer Workforce employers (e.g., Local Mental Health Authorities or state behavioral health providers) to remit less than livable, sustainable wage for work performed. Most Certified Peer Specialist positions are half-time (>50% FTE) in order that the CPS might work under provisions of SSDI/SSI re-employment, however it is fallable.

I'm the first to agree with you, Ron, that SSDI recipients who are also Certified Peer Specialists should receive greater than livable wages, however as it is currently, if one receives SSDI, the individual is in a box and it's living in > poverty. As you and I concur, Integrating or co-locating Behavioral Health and Primary Care in community public health market environments is the Great HOPE for the US Peer Workforce. May we please deliver it sooner than later? The person living with a psychiatric label, quite often a CPS, and who is currently on SSDI cannot and does not live fully.

That Medicare is provided post-two (2) years is a benefit to be sure; however, most do not qualify for Medicaid and are in the cycle of living impoverishedly, relying on subsidies, food stamps, utility supports by cities or churches which is most commonplace.

The individual who is SSDI (dis)placed living in frontier or rural faces ultimate challenges. Urban located SSDI recipients at least have options for supportive, emergency or long-term sustained public housing. Those living frontier or rural are more than not without shelter sans familial or community supports.

While SSDI is a Step Up for many, most commonly, the odds to "work" one's way off of living on SSDI is a very difficult task. We must, I agree with you, advocate fully for greater supports, training and real opportunities ringing Hope and accessibility to care.

I speak from experience.

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Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid

@DrRonM

www.nacbhdd.org

Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...