A Health-Conscious Safety Net? Health Problems and Program Use among Low-Income Adults with Disabilities

No. B-62 in Series, "New Federalism: National Survey of America's Families"

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.

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

Many low-income adults have a health problem or impairment that limits their ability to participate in social activities, including work. A health problem or impairment can also increase personal costs on medical expenditures and accommodations (e.g., wheelchair ramps). These combined factors represent an important potential barrier to social and economic mobility.

Policymakers have developed several federal and state programs and other supports to offset the costs and lost earnings associated with the onset of a disability. These programs share a general goal to provide income or in-kind assistance to offset the "costs" of a disability, but their target populations vary. As a result, a patchwork of programs and policies targets different segments of the population. For example, some programs provide benefits to offset the lost income of workers, including those injured on the job, while others provide benefits specifically targeted to low-income populations with severe permanent disabilities (e.g., means-tested benefits).

In recent years, policymakers and the disability community have increased momentum to create laws, policies, and programs that promote integrating people with disabilities into the mainstream, especially in work activities. One key factor in attaining these goals is expanding employment opportunities, as emphasized in the ratification of the Americans with Disabilities Act (ADA) in 1990. Unlike most income support programs that make eligibility determinations based on a person's inability to complete certain activities, employment-focused policies, such as ADA, emphasize an individual's ability to participate in social activities.

This brief examines the employment and program participation patterns of low-income adults with disabilities, and how well the current safety net meets their needs. It compares low-income adults with and without disabilities across employment, program participation, and income status. These comparisons highlight some of the unique challenges faced by low-income adults with disabilities and motivate broader discussion of gaps in the safety net. Particularly striking are the possibly conflicting messages regarding work and program participation sent by existing programs and policies.

The findings question the current structure of the benefits and services safety net. A significant share of low-income adults report a limitation, and the employment rates of those with limitations are much lower than those of low-income adults without disabilities. Although a number of disability programs exist, support options for many low-income adults with disabilities are limited to a small set of programs that will likely lead to a lifetime of benefit support.

Methodology

The analysis uses data from the third round of the National Survey of America's Families (NSAF). The NSAF is a nationally representative survey of households that provides a wide range of economic, demographic, and program participation indicators for noninstitutionalized adults in calendar year 2001. These data include detailed health, income, and program participation information that can examine the role of policies affecting low-income adults with disabilities.

The analysis builds off earlier work that used the second round of the NSAF to compare low-income adults with and without disabilities (Wittenburg and Favreault 2003). Low-income adults are defined as adults age 25 to 55 living in families with incomes below 200 percent of the federal poverty level (FPL). Adults with disabilities are defined as respondents who report a work limitation. No single definition of disability captures the complexity of disability across all programs, but people who report work limitations are generally considered an important subsample of all people with disabilities affected by disability policies. In past studies, researchers have used the work-limited population to examine various outcomes of people with disabilities, including employment and program participation (see Burkhauser, Houtenville, and Wittenburg [2003] for more details).

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

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.

Usage, posting and reprint of materials on the UI web site:

Most publications may be downloaded free of charge from the web site in PDF format. This information may be used and copies made for research, academic, policy or other non-commercial purposes. Proper attribution is required.

Copyright of the written materials contained within the Urban Institute website is owned or controlled by the Urban Institute. Posting UI research papers on other websites is permitted subject to prior approval from the Urban Institute—contact paffairs@urban.org.

If you are unable to access or print the PDF document please contact us or call the Publications Office at (202) 261-5687.