How does losing health insurance affect disability claims? Evidence from the Affordable Care Act's dependent care mandate.

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% 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.

The Adverse Effects of the COVID-19 Pandemic on Nursing Home Resident Well-Being.

OBJECTIVE: Quantify the effects of the COVID-19 pandemic on nursing home resident well-being. DESIGN: Quantitative analysis of resident-level assessment data. SETTING AND PARTICIPANTS: Long-stay residents living in Connecticut nursing homes. METHODS: We used Minimum Data Set assessments to measure nursing home resident outcomes observed in each week between March and July 2020 for long-stay residents (eg, those in the nursing home for at least 100 days) who lived in a nursing home at the beginning of the pandemic. We compared outcomes to those observed at the beginning of the pandemic, controlling for both resident characteristics and patterns for outcomes observed in 2017-2019. RESULTS: We found that nursing home resident outcomes worsened on a broad array of measures. The prevalence of depressive symptoms increased by 6 percentage points relative to before the pandemic in the beginning of March-representing a 15% increase. The share of residents with unplanned substantial weight loss also increased by 6 percentage points relative to the beginning of March-representing a 150% increase. We also found significant increases in episodes of incontinence (4 percentage points) and significant reductions in cognitive functioning. Our findings suggest that loneliness and isolation play an important role. Though unplanned substantial weight loss was greatest for those who contracted COVID-19 (about 10% of residents observed in each week), residents who did not contract COVID-19 also physically deteriorated (about 7.5% of residents in each week). CONCLUSIONS AND IMPLICATIONS: 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. Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19.

Promoting Readiness of Minors in Supplemental Security Income (PROMISE): Early Impacts from a Multi-Site Random Assignment Evaluation.

BACKGROUND: PROMISE was a federal initiative to support youth receiving Supplemental Security Income (SSI) during the transition to adulthood. OBJECTIVES: 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. RESEARCH DESIGN: The study uses a randomized controlled trial design. SUBJECTS: 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. MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.

Contemporaneous and long-term effects of children's public health insurance expansions on Supplemental Security Income participation.

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.