Safety Net or Tangled Web?

Assessing the New Federalism Occasional Paper No. 68

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

This report is available in its entirety in the Portable Document Format (PDF).

About the Series

Assessing the New Federalism is a multiyear Urban Institute project designed to analyze the devolution of responsibility for social programs from the federal government to the states, focusing primarily on health care, income security, employment and training programs, and social services. Researchers monitor program changes and fiscal developments. In collaboration with Child Trends, the project studies changes in family well-being. The project aims to provide timely, nonpartisan information to inform public debate and to help state and local decisionmakers carry out their new responsibilities more effectively.

Key components of the project include a household survey, studies of policies in 13 states, and a database with information on all states and the District of Columbia, available at the Urban Institute's web site. This paper is one in a series of occasional papers analyzing information from these and other sources.

Contents

Health Problems in Low-Income Populations
Data Description
Findings

Overview of the Safety Net
Disability Cash Transfer Programs
Other Cash Transfer Programs
Health Programs
Rehabilitation, Education, and Training Programs
Impairment-Specific Programs
Other Programs Not Tied to Disability

Disability Policy

Disability Program and Policy Challenges
Eligibility Requirements
Access to Short-Term Benefit Programs/Program Coordination
Work Incentives
Summary

Policy Options
Disability Determinations
Temporary Disability Programs
Employment Supports
Summary

Conclusion

Notes

References

About the Authors

For many low-income adults, a disabling health condition represents a major obstacle to daily activities. The costs of a disability can take various forms, including increased medical costs, lost wages, and diminished psychological well-being. Because these costs can be quite substantial, particularly for health care, a significant portion of these adults must turn for support to outside help, including government programs.

Policymakers have developed a range of programs and supports to address the complex needs of adults with disabilities who meet certain medical and other (e.g., income) criteria. In recent years, spending on many of these programs, particularly Medicaid and the Social Security Administration's (SSA) disability cash transfer programs, has increased substantially. Nonetheless, significant portions of low-income adults with disabilities participate in other non-disability programs, such as Temporary Assistance for Needy Families (TANF).

This paper examines the role that government safety net programs play in the lives of low-income adults with disabilities. We begin by providing background information on the prevalence of health conditions in the low-income population and the economic problems faced by adults with disabilities using data from the National Survey of America's Families (NSAF). According to our findings, an extensive overlap exists across disability and low-income issues that is relevant to general policies targeting low-income populations. Next, we summarize the programs and policies that assist low-income adults with disabilities. Our review includes information on disability-specific programs, other low-income programs that do not necessarily target disability status (e.g., TANF), and recent disability policy initiatives, such as the Americans with Disabilities Act (ADA). We use our descriptive findings and program review as a framework for discussing some challenges that low-income adults might face when accessing benefits and services from the existing safety net. We identify several issues associated with program access, including difficulties in meeting disability eligibility requirements, reduced program options for certain groups, and work disincentives. We then examine some potential policy options for addressing each of these issues, including ongoing efforts by some state and federal agencies. Finally, we conclude with a summary of our findings.

Policymakers interested in improving economic outcomes need to address the inconsistencies across these programs to improve the tangled web of services currently available to adults with disabilities. While several programs provide services targeted specifically to those with disabilities, inconsistencies across programs create potentially conflicting messages regarding program access and work for many low-income adults. These issues can be particularly confusing for those who have less severe disabilities and/or very limited work histories.

This report is available in its entirety in the Portable Document Format (PDF).

Acknowledgments

This report is part of the Urban Institute's Assessing the New Federalism project, a multiyear effort to monitor and assess the devolution of social programs from the federal to the state and local levels. Alan Weil is the project director. The project analyzes changes in income support, social services, and health programs. In collaboration with Child Trends, the project studies child and family well-being.

The Assessing the New Federalism project is currently supported by The Annie E. Casey Foundation, The Robert Wood Johnson Foundation, the W. K. Kellogg Foundation, The John D. and Catherine T. MacArthur Foundation, and The Ford Foundation.

The authors would like to thank Amelia Gruber, Kevin McManus, and Joyce Morton for helpful research assistance on this project. Pamela Loprest, Grant Revell, Alan Weil, and Sheila Zedlewski provided extensive comments.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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