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: