Research

We study how disability beneficiary work behavior responds to a rule change that replaces a cash cliff—a threshold above which benefits reduce to zero—with a benefit offset ramp—where benefits are gradually phased out. Using a randomized controlled trial with over 10,000 Social Security Disability Insurance beneficiaries who voluntarily enrolled in the demonstration, we find precisely estimated null effects on earnings, income, and benefit amounts. An analysis of mechanisms indicates that administrative burden, the limited size of the incentive, and individual and systemic barriers to employment for people with disabilities likely contributed to the limited impacts.

We provide the first evidence on the effects of minimum wage increases on labor market outcomes for people with disabilities. We use a novel dataset consisting of quarterly data on employment, earnings, and hours for workers at nonprofit firms that participate in the federal AbilityOne program. The nonprofits in this program are offered advantages in government contracting, though must primarily employ workers with disabilities. Using recent local variation in minimum wage changes, we find that increasing the minimum wage does not affect employment outcomes for workers with disabilities in this specific context, with precisely estimated null effects. However, these nonprofits respond along non-employment related margins after relatively large minimum wage increases.

The administrative processes that govern the delivery of social safety net benefits have important implications for beneficiaries. We use variation in the occurrence of medical continuing disability reviews (CDRs) to explain trends of children receiving Supplemental Security Income (SSI) payments. CDR frequency is a major driver of SSI caseload dynamics, significantly influencing both program growth and decline. The percent of caseload changes that can be explained by CDRs varied substantially by geography. Understanding these regional variations in a federal program with a uniform set of rules across the entire country is critical to ensuring equitable access to the program.

We explore how schools affect children’s applications to Supplemental Security Income (SSI). Because of the COVID-19 pandemic, schools varied in offering virtual or in-person learning during the 2020–21 school year. We use this variation to better understand the way schools, potentially through teacher referrals and informal networks, influence SSI applications. We find that applications were nearly 20 percent lower in counties with virtual learning relative to counties where all learning was in-person. Subgroup analysis suggests that school staff, likely through offering identification and referral services, and informal networks were mechanisms contributing to these differentials.

While substantial progress has been made in combating malnutrition at a global level, chronic maternal and child malnutrition remains a serious problem in many parts of the developing world. In this paper, using a randomized control trial design in Nepal, we evaluate a program that provided information on best practices regarding infant health and cash to families in extremely poor areas with pregnant mothers and/or children below the age of 2. We find significant and sizable impacts of the information plus cash intervention on maternal knowledge and behavior in the short run. We also find suggestive evidence of improvements in child development for the information plus cash intervention relative to groups that received information only. In a long-run 2 year follow up survey, we find that the information plus cash group retained significantly higher knowledge and implementation of best practices regarding early childhood health. However, there appear to be no sustained impacts on child development or anthropometrics in the follow up.

I estimate the labor market effects of gaining eligibility for Supplemental Security Income disability benefits during childhood. A Supreme Court decision eased the criteria to be considered disabled, disproportionately affecting child applicants with mental disorders. For individuals with mental disorders, each additional year of exposure to eased standards during childhood increased their SSI receipt by 0.3 years. The additional benefit receipt reduced cumulative labor market earnings through age 30 by $1,600 for each additional year of exposure for those with mental disorders. Importantly, this does not address the full range of outcomes that may be affected by receiving benefits.

We estimate the impacts of losing access to parental health insurance on Supplemental Security Income (SSI) participation, focusing on the age-26 limit for dependent coverage. We analyze the age pattern of SSI claims to develop counterfactual predictions that assume no change in access to insurance. Relative to this prediction, we find a 3.4 percent spike in SSI applications in the months immediately surrounding the 26th birthday, along with a slightly smaller increase in awards. These claims are primarily motivated by losing coverage; there might be more direct ways to address unmet insurance needs without also increasing reliance on cash payments.

This study explores the interplay between two important public programs for vulnerable children: Medicaid and the Supplemental Security Income (SSI) program. Children’s public health insurance eligibility increased dramatically during the late 1990s with the launch of the Children’s Health Insurance Program along with concurrent Medicaid expansions. We use a measure of simulated eligibility as an exogenous source of variation in Medicaid generosity to identify the effects of the eligibility expansions on SSI outcomes. Though increases in eligibility for public health insurance did not affect contemporaneous youth SSI applications or awards on average, expansions in coverage significantly decreased both applications and awards in states where SSI recipients did not automatically receive Medicaid. We attribute the difference in findings to the higher transactions costs associated with entering Medicaid via SSI in such states. In the long-term, increased public insurance eligibility during childhood reduces young adult SSI applications to some extent, consistent with recent findings that Medicaid coverage in youth improves adult health and economic outcomes. 

We find that experienced poker players typically change their style of play after winning or losing a big pot—most notably, playing less cautiously after a big loss, evidently hoping for lucky cards that will erase their loss. This finding is consistent with Kahneman and Tversky's break-even hypothesis and suggests that when investors incur a large loss, it might be time to take a vacation or be monitored closely.

Child applications and awards for Supplemental Security Income (SSI) fell sharply at the outset of the COVID-19 pandemic. Cumulative applications from April to September 2020 were about 30% lower than applications over the same period in 2019 with substantial variation in rates of decline across local areas. In this paper, we explore the factors correlated with the change in applications and awards across localities at the beginning of the pandemic. Our findings point to three particularly important factors influencing the magnitude of the change in applications and awards: (1) the restriction of in-person services in all Social Security Administration field offices in March 2020, (2) the pandemic’s disruptions to social and service networks through which people may learn about SSI, and (3) new macroeconomic stabilization policies, such as economic impact payments and supplemental unemployment insurance payments. These results highlight the substantial local variation in SSI participation. This variation is especially important in considering general issues around access to SSI, particularly for policies that aim to improve SSI access through outreach. Our findings underscore the importance of local networks in creating program awareness at local levels, and that they might be fruitful avenues for further outreach efforts.

Families of youth with disabilities often access services to promote youth’s transitions to adulthood. Such services can be oriented toward the youth or family. Using descriptive statistics and regression modeling of survey and administrative data, we explored patterns of service use and the association between outcomes for 9,013 youth with disabilities who enrolled in a demonstration project. Those randomly assigned to a treatment group used family services more frequently than those in a control group, and youth in families using family services were more likely to use services themselves. Use of family and youth services together was associated with better youth employment. Because few programs offer family services, policymakers and practitioners might consider ways to connect families to such services. 

The Social Security Administration conducts periodic continuing disability reviews (CDRs) to determine ongoing medical eligibility for children receiving Supplemental Security Income (SSI) payments. CDR volumes have varied over time because of funding availability. This article examines longitudinal patterns in the characteristics of and outcomes for child SSI recipients whose payments ceased because of a CDR. It also quantifies the extent to which CDR cessation patterns affect child SSI caseloads over time. We find that CDRs strongly influence child SSI caseloads. CDR cessations can explain three-fifths to two-thirds of changes in the number of SSI recipients, both as the program grew from 2002 through 2013 and as it subsequently declined. Despite variation in CDR cessation frequency, the characteristics of children with payments ceased because of a CDR were mostly stable, with relatively few children returning to SSI. Minimizing CDR volume fluctuations may help families plan for the potential loss of SSI payments.

This article examines how socioeconomic deprivation relates to child Supplemental Security Income (SSI) participation in local areas. We construct a deprivation index that reflects a range of socioeconomic factors. We find that local areas with higher deprivation generally have higher levels of child SSI participation, but we also see substantial geographic variation. To explore this variation, we assess the demographic and economic factors associated with the deviation between observed child SSI participation and a level of participation predicted by the deprivation index. Local areas in which child SSI participation is substantially lower than the deprivation index predicts might be promising targets for outreach to better inform families about the SSI program. By measuring the deviation between predicted and actual SSI participation at the census tract level, outreach efforts can pinpoint the precise locations where they might plausibly have the greatest effect.

We use resident-level assessment data from Connecticut nursing homes to quantify the effects of the COVID-19 pandemic on nursing home resident well-being. These analyses highlight tradeoffs between the strictest possible measures to limit the spread of the virus and protecting the physical and emotional well-being of residents. We find that nursing home resident outcomes worsened on a broad array of measures. For example, the prevalence of depressive symptoms increased by 15 percent and the share of residents with unplanned substantial weigh loss increased by 150 percent. Our findings suggest that loneliness and isolation play an important role, potentially stemming from general trends of reductions in direct care provision or from policies that restricted visitors. While unplanned substantial weight loss was greatest for those who contracted COVID-19, residents who did not also physically deteriorated. Episodes of incontinence, a physical manifestation, also increased. These analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents.

Take-up of employment programs among people with disabilities can be limited by the administrative burdens of decision-making, which must factor in the complexities of how work affects disability cash assistance payments. This study presents evidence on using outreach motivated by behavioral research to encourage enrollment in a pilot initiative with the Social Security Administration that simplified Social Security Disability Insurance payment rules. Because enrolling would leave some beneficiaries worse off, informed enrollment decisions required understanding both the complexities of current rules and potential effects of the new demonstration rules. We sought to counteract bottlenecks stemming from decision-making burdens through increased outreach with tailored messaging. A randomized controlled trial was used to test two features of a reminder postcard. First, we compared fold-over postcards containing information about the demonstration to open postcards with more generic information, finding that fold-over postcards increased enrollment by around 25 percent (or 0.12 percentage points). Second, we compared an urgent message framing with no stated enrollment end-date to a deadline framing with an explicit enrollment cutoff date. Although the final enrollment rate was similar across timeline framing options, the urgent framing appears to have resulted in faster enrollment.

This paper provides new evidence of the changing role of the Supplemental Security Income (SSI) program for low-income children over the past 20 years. We use administrative records from the Social Security Administration (SSA) to identify new SSI awardees and track their histories in SSI and in the Social Security Disability Insurance program. Program duration for beneficiaries awarded in 2007 and 2012 was much longer than for their counterparts awarded in 1997. SSI is therefore playing a bigger role in the safety net than it did 20 years ago. However, we also find that the volume of continuing disability reviews for SSI eligibility, which were more extensive in the 1997 cohort than the subsequent cohorts, had a major effect on program durations. This latter finding is especially important for considering future SSI program dynamics, given that the number of continuing disability reviews has grown substantially, particularly since 2015.

PROMISE was a federal initiative to support youth receiving Supplemental Security Income (SSI) during the transition to adulthood. This article presents estimates of the impacts of the six PROMISE projects on youth and family outcomes as of 18 months after enrolling in PROMISE. The six PROMISE projects each enrolled a minimum of 2000 treatment and control youth (and their parents) residing in their service areas who were aged 14 to 16 and receiving SSI. Using a randomized controlled trial design, we estimated impacts on outcomes related to youth and family service use, school enrollment, training, employment, earnings, and federal disability program participation using survey and administrative data. The projects succeeded in connecting more youth to transition services and more families to support services during the 18 months after enrollment, and most increased the likelihood that youth applied for state vocational rehabilitation services. On average, there was no impact on youth’s school enrollment, but there were favorable impacts on youth’s receipt of job-related training, employment, earnings, and total income. The projects did not affect parents’ employment, earnings, or income, on average. For most outcomes PROMISE affected, the impacts varied substantially across the projects. The positive short-term impacts of PROMISE on youth’s use of transition services, youth employment, and families’ use of services are consistent with the program logic model and suggest there might be potential for longer-term favorable impacts on youth and family outcomes.

This study examined how partnerships between early care and education providers were developed and how they worked together to deliver comprehensive, high-quality services to infants and toddlers from low-income families. Survey data were collected from 220 Early Head Start (EHS) program directors and 386 child care center directors and family child care providers participating in EHS-child care partnerships. Nearly half of EHS programs chose partners with whom they had prior relationships, and most engaged them early (often before receiving the grant). Both EHS programs and child care providers described their relationships as mutually respectful and focused on similar goals. Through the partnerships, child care providers had access to professional development opportunities and offered children and families comprehensive services, such as health screenings. This study provided a nationally representative picture of EHS-child care partnerships. The findings suggest that strong relationships are foundational to the implementation of early care and education collaborations aimed at expanding access to high-quality care for infants and toddlers from low-income families. Collaborations are a potentially important policy lever that can help support the expansion of high-quality early care and education. 

Though numerous programs and policies have been shown to improve long-term outcomes for youth, finding similar successful efforts for youth with disabilities has been historically difficult. In this paper, we report on the results of a randomized controlled trial with 12,000 Supplemental Security Income recipients that offered intensive supports and services to youth with disabilities from low-income backgrounds. These services improved youth’s employment and health outcomes as they transitioned into adulthood. Mediation analysis suggests that early paid employment experiences played a critical role in these long-term improvements.  

Though safety net programs offer important benefits, take-up is often incomplete. Using machine learning models on Medicaid data, we estimate the take-up rate for children’s Supplemental Security Income (SSI), and the characteristics of potentially eligible children with disabilities who do not receive benefits. Using over 1,000 measures of health care utilization, we estimate state-specific models that generate the probability that each child not receiving SSI is eligible. Using the expected number of potentially eligible children, the implied take-up of SSI is approximately 70 percent. Potentially eligible children have intensive health care usage, often more intensive than current child SSI recipients.  

A burgeoning literature documents ways that programmatic barriers hinder efforts by individuals to obtain needed public benefits, and otherwise harm recipients of public aid. The $2,000 resource limit on countable financial assets for individual Supplemental Security Income (SSI) recipients is one such barrier. Last raised in 1989, that stringent resource limit sharply constrains recipients’ ability to finance uncovered medical expenses, make essential home or auto repairs, and pursue educational and other opportunities crucial for personal development, independence, and wellbeing. The Stephen Beck Jr. Achieving a Better Life Experience Act of 2014 allowed the creation of ABLE accounts, tax-advantaged savings vehicles that allow persons with disabilities to accumulate significant financial assets without endangering their SSI or Medicaid benefits. Despite the potential advantages of ABLE accounts, only about 1 percent of eligible SSI recipients possess such accounts. Our mixed-methods study uses administrative and survey data from the State of Illinois to explore barriers to take-up of ABLE accounts. We find sharp income gradients in ABLE account take-up. We document an array of barriers, including financial constraints as well as diverse administrative burdens and misperceptions, that deter eligible persons from opening ABLE accounts. We provide a set of recommendations for scalable solutions to improve program participation, especially among under-represented communities.