Losing SSI at 18 Might Impact Access to Medical Care

The families of more than 1 million children and teenagers with serious physical and intellectual disabilities are receiving Supplemental Security Income, or SSI. But a 1996 reform made it harder to keep those benefits when the child turns 18.

The 18-year-olds who don’t meet the tougher requirement for eligibility lose not only SSI’s monthly cash payments but potentially the Medicaid health insurance that usually goes with it. Anywhere from 20 percent to nearly half of all 18-year-olds lose their SSI, depending on the state where they live.

New research by Priyanka Anand at George Mason University shows that adults who had likely lost their benefits at 18 have fewer diagnoses of a range of health conditions than people who turned 18 prior to the reform and kept their benefits.  

But fewer diagnoses do not necessarily indicate better health. Rather, fewer diagnoses “likely reflect a higher prevalence of untreated conditions due to lack of access to insurance and healthcare,” she concluded from a series of analyses.

The August 1996 reform required 18-year-olds to undergo a medical review to see if they meet the stricter adult standard that the disability makes it very difficult or impossible for them to work. A child under 18 qualifies for SSI solely on the basis of a severe physical or mental disability that results in long-lasting functional limitations.

The diagnoses that declined for adults who were most likely to lose their SSI – and probably Medicaid – were both physical and mental: hypertension, diabetes, depression and anxiety.

Depression is one example of how Anand put together different analyses to reach her conclusions. Unable to show a direct link between losing SSI at 18 and depression as older adults, she looked at whether the decrease in depression was concentrated among the uninsured. She found that this was, in fact, the case and that the uninsured had fewer depression diagnoses.

The long-term impact of the tougher standards could be substantial, she said. Losing SSI at 18 “has wide-reaching impacts on the long-term well-being of the child SSI beneficiaries.” 

To read this study by Priyanka Anand, see “The Impact of Losing Child Disability Benefits on Health Outcomes.”

The research reported herein was performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium. The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA or any agency of the Federal Government. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.