What About the Lowest Income Disabled?

Steve Gold's Information Bulletin #272 (12/08) With all the talk of reforms, it's fascinating that disabled people with the lowest incomes have been either ignored or forgotten. With all the chatter about health reforms, economic stimulus packages, and employment programs, the lowest income disabled people are not mentioned. First, we'll provide some background data, and second some suggestions. [The following data is from the SSA's SSI Annual Statistical Report, 12/2007, Tables 14, 7. D1, and 65 and this data is available for your state.] Disabled Low-Income People 18-64: There were 10,627,905 disabled people ages 18-64 who received Social Security Disability Insurance only, Supplemental Security Income only, or both. These disabled people were among the lowest-income groups in the country. Here's a breakdown of the income of these people. (The federal poverty level in 2007 for one person was $851 monthly and annually $10,210.)

• Social Security disability insurance (SSDI) payments only - 6,405,985 people. Monthly average benefits were $1,063, annually $12,756.
• SSI payments only - 2,966,648 people. Monthly average payments were $595.75, annually $7,149.
• SSDI/SSI both - 1,255,272 people. Monthly average payments for people receiving a combination of SSDI and SSI were $713.90 monthly and annually$8,566.80.

Disabled Low-Income People 65 and Over:

When disabled people ages 18-64 on SSDI reach 65, they convert to the Social Security "aged" category, and separate disability data is not collected any longer. When, however, disabled people on SSI reach 65, they remain a disabled SSI recipient, and disability data is separately maintained. As a consequence, we have data only for SSI disabled people over 65, of whom there were 776,600.

There is a total of 3,743,248 disabled low-income people who receive SSI (the 2,966,648 million disabled people ages 18-64 plus the 776,600 over 65). Adding these people with the SSDI only and SSID/SSI both recipients for a grand total of 11,404,505 disabled people whose incomes are from federal SSI, SSDI, or both programs.

The Last Eleven Years:

• The number of SSDI only recipients increased by 55% since 1996. Average monthly payments increased 43%.
• The number of SSI only recipients increased only 16%. Average monthly payments increased 30%.
• The number of SSDI/SSI both recipients increased 25% since 1996. Average monthly payments increased 31%.

Some ideas for discussion:

1. Health programs

A. Health reforms should consider how Medicare does not pay for much Long-Term Care for the 6,505,985 people who receive SSDI only. These disabled people on Medicare have to impoverish themselves in order to become eligible for and therefore to receive Medicaid's Long Term Care services that the 1,255,272 SSDI/SSI both and 2,966,648 SSI only (under65) and the 776,600 (over 65) disabled people are eligible to receive because they receive SSI. That's nearly 5 million disabled people.

If you are disabled and receive SSDI only and therefore receive Medicare only, you are not automatically eligible for Medicaid and consequently receive substantially less LTC coverage than if you were on SSI or SSDI/SSI.

B. While we're at it, what about Medicare Part LTC for all disabled people. (See Information Bulletin #269). Let's remember that the overwhelming number of the above 11.4 million disabled people do not need or require any LTC services. For those disabled people on SSDI who do require LTC, nearly all will have to impoverish themselves to become eligible for Medicaid, despite having worked most of their lives. Given the modest average monthly payments they receive ($1,063), they cannot afford to pay for LTC insurance and they do not qualify for Medicaid's LTC services.

LTC for all disabled people whose incomes are SSDI, SSI, or both must be addressed. So far, public discussions regarding health reforms have ignored them.

C. And what about prescriptions? The 6.5 million disabled people on SSDI and therefore on Medicare pay a much larger co-pay for their prescriptions under Part D out of their minimal monthly benefits than the nearly 5 million disabled people SSI recipients who either receive their prescriptions under Medicaid without paying or who pay, at most, minimal co-pays.

People with the exact same disabilities receive different health care benefits (whether LTC services or prescriptions) depending solely on a past work history and thus their eligibility for SSI, SSDI, or SSDI/SSI - not based on their needs, impairments, or any other meaningful criterion.

2. Income Inequality - Narrow the Gap

Economic stimulus discussions have focused on roads and bridges for cars and other bricks and mortar programs. None have talked about ensuring that people who are disabled receive at least poverty-level incomes, to say nothing incomes at a decent living standard. The income gap for these low-income disabled people grows wider by year.

Here's what we figure it would cost to bring disabled people up to the minimal poverty level.

Increase the SSI payments by 43% for the nearly 3.7 million people (all ages) on SSI only and increase the payments by 19% for the nearly 1.3 million for the SSDI/SSI (both) category. Annually, this means a monthly increase of $255 for people on SSI and a monthly increase of $137 for people on both SSI/SSDI the total federal expenditures will be far less than what Congress is allocating to the banks and car manufacturers.

Increasing the monthly SSI payments to the poverty level would result in an immediate economic stimulus because these low-income people would have more income for necessities. To survive, they must and will spend all their income.

3. Employment

Many of the total 10.6 million disabled people under 65 (and probably a number of the 776,600 disabled people over 65) want to work, whether full-time or part-time.

Given the archaic employment related restrictions in both the SSI and SSDI income programs and the medical programs and benefits affixed to each these income programs, many disabled people will not jeopardize these benefits by seeking employment.

How about a jobs program for disabled people? Funny? Don't forget that during WWII, when the country needed disabled workers, disabled people were hired in significant numbers.

How about an employment program that would also reduce federal and state Medicaid expenditures by focusing on disabled people to provide community-based personal care services to other disabled people who are currently institutionalized and want to reside in the community. There are people on SSI and/or SSDI who can work IF the archaic employment related restrictions in SSI and SSDI were changed and IF there were meaningful economic incentives.