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Changing patterns of conditions among children receiving Supplemental Security Income disability benefits
J M Perrin1, K Kuhlthau, T J McLaughlin
1Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Insights
The number of children with chronic health conditions receiving Supplemental Security Income (SSI) benefits grew significantly between 1989 and 1992. This growth was most pronounced for children diagnosed with asthma and attention-deficit/hyperactivity disorder (ADHD).
Area of Science:
- Pediatric Health
- Public Health Policy
- Social Security Administration
Background:
- Supplemental Security Income (SSI) program changes in the early 1990s altered disability definitions and outreach efforts.
- Understanding the impact of these policy changes on the health profiles of enrolled children is crucial.
- Previous research has not fully detailed the shifts in chronic condition prevalence among SSI-eligible youth.
Purpose of the Study:
- To analyze the relative growth of various chronic health conditions in children and adolescents enrolled in SSI.
- To compare condition prevalence before and after significant SSI program modifications.
- To identify specific conditions that experienced notable increases or decreases in SSI recipients.
Main Methods:
- Retrospective analysis of Medicaid claims data from four US states (California, Georgia, Michigan, Tennessee).
- Included children aged 21 years or younger newly enrolled in SSI between July 1989 and June 1992.
- Examined first 6 months of enrollment claims to determine rates of general chronic conditions, asthma, ADHD, and mental retardation.
Main Results:
- The number of new SSI enrollees nearly doubled during the study period.
- The proportion of new enrollees with chronic condition claims rose from 29% to 36%.
- Significant increases observed in asthma (73%) and ADHD (nearly 3-fold), while mental retardation decreased (29%).
Conclusions:
- The population of children with chronic conditions receiving SSI benefits grew rapidly from 1989 to 1992.
- Asthma and attention-deficit/hyperactivity disorder (ADHD) were key drivers of this growth.
- Policy changes likely influenced the types and prevalence of chronic conditions among SSI-eligible children.
Objective:
To determine the relative growth of types of chronic health conditions among children and adolescents receiving Supplemental Security Income (SSI) benefits before and after major SSI program changes, including changes in definitions of childhood disability and outreach to identify eligible children.
Design:
Retrospective analysis of Medicaid claims from California, Georgia, Michigan, and Tennessee.
Participants:
All children (aged < or = 21 years) newly enrolled in SSI programs in these states from July 1989 (n=21 222) to June 1992 (n=38 789).
Methods:
Medicaid data indicate eligibility status and diagnoses for services rendered. For children newly enrolled before (time 1, July 1989 to June 1990), during (time 2, July 1990 to June 1991), and after (time 3, July 1991 to June 1992) the program changes, we used claims for the first 6 months of enrollment to determine rates of chronic conditions in general and rates of asthma, attention-deficit/hyperactivity disorder (ADHD), and mental retardation specifically. We also followed up time 1 enrollees during the study period to determine the likelihood of a chronic condition claim at any time.
Main Outcome Measure:
Presence of claims for chronic conditions.
Results:
New SSI enrollees almost doubled during the study period. Increasing numbers of new enrollees had chronic condition claims in their first 6 months (from 29% to 36%); 58% of time 1 enrollees had such claims during any study month. Rates of chronic physical conditions other than asthma increased 14% (time 1 to time 3); asthma rates increased 73%. Rates of mental health conditions other than mental retardation and ADHD increased 63%; rates of mental retardation decreased 29%, while rates of ADHD increased almost 3-fold.
Conclusions:
The number of children with chronic conditions receiving SSI benefits experienced rapid growth from 1989 to 1992. Growth was particularly marked for children with diagnoses of asthma and ADHD.
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