Health Status Declines in Disabled Adults Prior to Receipt of SSI Benefits Interview with:

Rajan Sonik, PhD JD MPHResearch ScientistTucker-Seeley Research LabLeonard Davis School of GerontologyPostdoctoral Research FellowLeonard D. Schaeffer Center for Health Policy and EconomicsLeonard Davis School of GerontologyUniversity of Southern CaliforniaLos Angeles, CA 90089-3333

Dr. Sonik

Rajan Sonik, PhD JD MPH
Research Scientist
Tucker-Seeley Research Lab
Leonard Davis School of Gerontology
Postdoctoral Research Fellow
Leonard D. Schaeffer Center for Health Policy and Economics
Leonard Davis School of Gerontology
University of Southern California
Los Angeles, CA 90089-3333 What is the background for this study? What are the main findings?

Response: Not everyone who is eligible for public benefits like Supplemental Security Income (SSI) tries to receive them. One distinguishing factor is that those who apply for benefits disproportionately experience shocks (e.g., divorce, job loss, health problems) and sharp increases in material hardships (e.g., food insecurity, housing insecurity) shortly before applying. Typically, these increases in hardships are then partially—but not fully—alleviated by receipt of the public benefits.

Given strong associations between these hardships and poor health outcomes, we wanted to examine whether health status might fluctuate before and after the receipt of public benefits as well. We examined SSI in particular given its focus on individuals with disabilities, keeping in mind the particular health vulnerabilities experienced by this population. In line with patterns previously observed for material hardships, we found in a nationally representative sample that the health status of eventual SSI recipients worsened significantly in the period prior to program entry. After enrollment began, the decline in health status stopped but was not fully reversed.

In the paper, we discuss why these findings were more likely to be driven by changes in material hardship levels rather than changes in disability status. What should readers take away from your report? 

Response: In a nationally representative sample, we found that the health status of eventual SSI recipients declined significantly prior to program entry. Following SSI receipt, this health decline ended but was not fully reversed. What recommendations do you have for future research as a result of this work? 

Response: The present study focuses on health outcomes. Given that SSI recipients are high-utilizers of healthcare services, potential relationships between the SSI program and healthcare outcomes should be examined as well and could have important policy implications. In particular, preventing sharp declines in health status in this population—such as the one observed here among eventual SSI recipients just prior to SSI receipt—may yield systemic benefits. Is there anything else you would like to add? 

Response: Financial support for this project was provided through grants from the Social Security Administration Disability Determination Process Small Grant Program and the Heller Annual Fund. The funders had no other roles in any aspect of the study. Any opinions and conclusions expressed do not represent those of the funders.


Sonik RA, Parish SL, Mitra M. Association of Health Status With Receipt of Supplemental Security Income Among Individuals With Severe Disabilities and Very Low Income and Assets. JAMA Intern Med. Published online April 01, 2019. doi:10.1001/jamainternmed.2018.8609

Apr 1, 2019 @ 11:30 pm 

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