I.
EXECUTIVE SUMMARY
II.
ACKNOWLEDGMENTS
III.
INTRODUCTION
IV.
OVERVIEW OF THE SOCIAL SECURITY DISABILITY BENEFITS PROGRAMS
V. THE
HEALTH CARE FOR THE HOMELESS STUDY
VI.
APPENDIX
VII.
ENDNOTES
I. EXECUTIVE SUMMARY
The Supplemental Security Income program (SSI) was created to provide
critically needed income support for aged and disabled individuals. Similarly,
the Social Security Disability Insurance program (SSD) provides cash
assistance to disabled workers. While the benefits in these programs are low,
for many disabled persons, these benefits can mean the difference between
having a home or being homeless.
In 1996, the Social Security Act was amended to provide that an
individual may not be eligible for SSI or SSD benefits if drug addiction or
alcoholism (DA&A) is material to the disability determination. DA&A is
"material" if the individual would not be deemed disabled if the use of drugs
or alcohol were to stop. Because of the automatic link in most states between
SSI and Medicaid, the loss of SSI benefits due to the DA&A benefits
elimination necessarily means the elimination of health coverage for the
affected individuals. In addition, loss of SSD benefits means the loss of
Medicare coverage. The new provisions went into effect as of March 29, 1996,
for new applicants. For people who were already receiving SSI or SSD benefits,
the changes took effect on January 1, 1997, unless the recipient successfully
pursued a redetermination of benefits.
This paper reports on findings from a study conducted to examine the
impacts of these changes in the law on people who received services through
Health Care for the Homeless Projects nationwide. Specifically, the study
looked at changes in housing arrangements and access to substance abuse
treatment services in people whose benefits were terminated as a result of the
changes in the law.
Key Findings of the Health Care for the Homeless (HCH) Study
A total of 3,648 people were interviewed in the course of the HCH
study. A total of 193 of the people interviewed (5.6%) lost their SSI or SSD
benefits in the 12 months before they were surveyed. 101 of the 193 persons
(52.3%) reported that their cases were closed as a result of the new DA&A
benefits elimination provisions. With respect to housing and access to
substance abuse treatment, the study found that:
-
76% of individuals who had been paying for their own housing prior
to the termination of their benefits lost their housing and were either
living in shelters, on the streets, with friends and relatives, or in a
treatment facility.
-
26.4% of the people who lost their SSI or SSD benefits (51 of 193)
were enrolled in a substance abuse treatment program at the time their
benefits were ended.
-
Following the termination of their SSI or SSD benefits, 15 of the
51 persons (29.4%) were required to leave their treatment program.
These findings reveal the negative impacts that resulted from this
ill-conceived change in the law. As was predicted at the time, loss of income
and health resources can only mean increased homelessness and more untreated
illness -- clearly undesirable public policy.
Recommendations
To remedy the negative impacts caused by the elimination of SSI or
SSD benefits in those cases where DA&A is material to the disability
determination, we recommend that federal, state, and local policy makers
undertake effective and coordinated efforts to address the needs of persons
who are homeless and without health insurance as a result of the changes in
these Social Security Act programs. Specifically, we recommend that the
Administration and Congress
-
restore Social Security benefits, Medicaid and Medicare, to
individuals whose disabilities are caused by their addictive disorders;
-
appropriate federal funds to implement the provisions of the Social
Security Act that authorize SSA to make grants for SSI outreach projects,
-
require that the funds be used to assist homeless persons in
obtaining federal disability benefits, and that the outreach team assist
beneficiaries in using their benefits to obtain housing, and related
services;
-
increase housing resources through increased appropriations for the
HUD McKinney Programs and increased funding of Section 8 vouchers; and
-
increase federal substance abuse services for homeless people.
Finally, the National Law Center supports the National Health Care
for the Homeless Council's recommendation that the federal government, the
states, localities, and the private sector should jointly establish a $50
billion Community Housing Investment Trust to create or preserve one million
units of affordable housing for very low income individuals.
II. ACKNOWLEDGMENTS
The National Health Care for the Homeless Council and the National
Law Center on Homelessness & Poverty gratefully acknowledge the participation
of numerous Health Care for the Homeless Projects in administering the survey
and providing information for this report.
This paper is the product of a collaborative effort between the
National Health Care for the Homeless Council (NHCHC) and the National Law
Center on Homelessness & Poverty (NLCHP). Wayne Anderson of the National
Health Care for the Homeless Council designed the survey, oversaw its use by
Health Care for the Homeless Projects nationwide, and interpreted the results.
Margaret Celebreze of Regions Hospital in Minneapolis graciously coded and
analyzed the data. Jeff Singer of Health Care for the Homeless of Maryland,
David Berris of the University of New Orleans and John Lozier of NHCHC
provided guidance throughout the process.
Sarah McCarthy of the National Law Center on Homelessness & Poverty
was primarily responsible for drafting and researching this paper. Laurel Weir
of NLCHP participated with NHCHC in designing the survey and provided
principal editorial assistance.
The National Law Center gratefully acknowledges the generous support
of the Public Welfare Foundation, and other Law Center supporters and
contributors for providing the funding to make this research possible.
III. INTRODUCTION
This paper reports on findings from a study conducted to examine
changes in housing arrangements and access to substance abuse treatment
services for people who lost federal benefits as a result of the changes in
the Social Security disability program in 1996.
The cash assistance provided under the Supplemental Security Income
(SSI) and Social Security Disability Insurance (SSD) programs is critically
important to low-income disabled people. For homeless people, receipt of these
benefits can enable them to afford housing and secure health insurance
coverage. Predictably, the loss of such benefits can be devastating.
In 1996, Congress enacted the Contract with America Advancement Act
1 and in doing so made a significant change to the
rules governing eligibility for disability benefits under the Social Security
Act. The CAA amended the Social Security Act to eliminate eligibility for SSI
and SSD benefits for individuals whose drug addiction or alcoholism (DA&A) is
a contributing factor material to their disability.2
Advocates for the homeless suspected that this change to the Social
Security law might become a risk factor for increased housing instability.
Their concerns were informed by research which has shown that inadequate
income, at a time when the supply of affordable housing is on the decline,
undercuts the ability of people with disabilities to remain housed.3 In addition, this same research found that more
people who were chemically dependent or mentally ill became and remained
homeless in the 1980s than had been the case since the Depression.4
IV. OVERVIEW OF THE SOCIAL
SECURITY DISABILITY BENEFITS PROGRAMS
A.The SSI and SSD Programs
The Social Security Administration administers two cash assistance
programs for people with disabilities: Supplemental Security Income (SSI) and
Social Security Disability Insurance (SSD).
The SSI program provides cash assistance to low-income individuals
who are either 65 years of age or older, legally blind, or disabled.5 Because the SSI program is intended to assist poor
people, there are income and resource eligibility limits. The national monthly
benefit level is set each year by the federal government. For 1999, the
maximum federal SSI benefit level is $500 for one person; $751 for a couple.
Some states also provide a supplement to the federal benefits, so that
individual SSI benefit levels can vary from state to state.
By contrast, the SSD program provides monthly cash assistance to
disabled people who are former wage earners.6
There are no income or resource eligibility standards; however, a disabled
person must prove payment of social security taxes on earned income in covered
employment for a sufficient period of time in order to qualify for SSD
benefits.
A state must provide Medicaid benefits to persons who receive SSI,7 unless the state has opted to use more restrictive
Medicaid eligibility criteria than is used in the SSI program.8
Individuals who receive SSD benefits are eligible for Medicare in the 25th
month following their receipt of such benefits.9
B. Receipt of SSI and SSD
Benefits by Homeless People
In the past two decades, research has shown that homeless persons
suffer from higher rates of chronic and acute physical illness than those of
the general population.10 The conditions range
from malnutrition and chronic respiratory infections to communicable diseases
such as tuberculosis. The stresses of homelessness and the difficulties in
obtaining treatment for persistent health problems often cause even common
ailments to escalate into more serious illnesses. Homeless persons also suffer
from high rates of mental illness and substance abuse disorders. One current
estimate is that between 20%-25% of homeless persons studied have at some time
experienced severe and often extremely disabling mental illnesses such as
schizophrenia or the major affective disorders (clinical depression or bipolar
disorder).11 As for substance abuse, as many as
50% of homeless persons have had "diagnosable substance use disorders at some
point in their lives."12
Despite the prevalence of serious physical and mental illnesses in
homeless persons, only a small percentage of homeless people receive SSI
and/or SSD benefits. In 1995, the National Health Care for the Homeless
Program reported that only 6% of the persons receiving medical services
through Health Care for the Homeless clinics were SSI recipients.13 This data is consistent with an earlier national
survey of homeless people which found that 4% of the homeless population
receive SSI benefits.14 Local studies point to
even higher numbers of potentially eligible homeless people who are not
receiving assistance.15 For example, a 1986 study
in Los Angeles found that, although about 30% of the homeless population
suffered from mental illness, fewer than 9% received SSI benefits.16
C. Legislative Background to
the DA&A Benefits Elimination
The receipt of Social Security disability benefits by individuals
impaired due to drug addictions or alcoholism was the subject of Congressional
concern of suspected fraud and abuse by such recipients for many years. In
1992, SSI beneficiaries whose cases were labeled as having disabilities caused
by drug addiction or alcoholism (DA&A) were required to have a representative
payee and participate in an alcohol or drug treatment program.17
The effectiveness of the representative payee rules were questioned only two
years later in 1994 during Congressional hearings into alleged abuse in the
Social Security disability benefits program.18 In
response, Congress imposed further restrictions for both SSI and SSD
recipients including a 36-month payment limitation, suspension for
non-compliance with treatment, and limits on the payment of retroactive
benefits.19
The efficacy of these provisions in remedying real or assumed fraud
in the system was never tested. Before the 1994 restrictions were implemented,
Congress began to reexamine the allegations of fraud and abuse in these
programs. In 1995, at a hearing on welfare reform, witnesses testified to an
alleged alarming increase in the number of drug addicts or alcoholics in the
SSI program.20
One year later, in response to these concerns, Congress included in
the Contract with America Act provisions which eliminated drug addiction and
alcoholism as a basis for disability in both the SSI and SSD programs.21 On March 29, 1996, President Clinton signed the
bill into law. The testimony on fraud among DA&A beneficiaries appears to have
been influential in causing Congress to completely eliminate benefits for
individuals in this category.22
Subsequent to the passage of the law, a research study was published
which called into question the assumption made by Congress that public
assistance contributed to substance abuse among DA&A cases. The study found
that, on average, public support recipients reported significantly lower
levels of substance use and spending than did those who did not receive any
form of public assistance.23
D. The New DA&A Benefits
Elimination Provisions
The new SSI and SSD provisions in the Contract with America Act
changed those programs by eliminating eligibility for benefits in cases where
an individual's drug addiction or alcoholism would be a contributing factor
material to the Social Security Administration's determination that the
individual is disabled.24 A drug or alcohol
addiction is "material" when the individual would not be found disabled if the
use of drugs or alcohol stopped.25 People who
have other disabling conditions which are independent of their drug addiction
or alcoholism are still eligible to qualify for benefits. The law's provisions
regarding DA&A cases went into effect immediately for all new applicants.26 For people who were already receiving SSI or SSD,
the changes took effect on January 1, 1997, unless the beneficiaries were
successful in challenging the termination of benefits.27
E. Implementation of the
DA&A Benefits Elimination
The Social Security Administration (SSA) was responsible for
notifying all ongoing recipients who were likely to become ineligible for
benefits of the change in the law and their right to appeal the termination of
their benefits.28 Thus in June and July of 1996,
the SSA mailed notices to over 209,000 SSI and SSD beneficiaries, informing
them of the pending termination of their benefits and the appeal process.29
Of the 209,000 cases subject to the new law, 71,000 (34%) were found
medically eligible on the basis of another disabling condition as of the end
of 1997.30 As of December 31, 1997, a total of
138,000 individuals (66%) lost their SSI or SSD benefits -- this total
includes both individuals who did not respond to the SSA's notice and people
who failed to prove another disabling condition either upon appeal or
reapplication.31
V. THE HEALTH CARE FOR THE
HOMELESS STUDY
A. Summary of Study and
Findings
In early 1997, 36 Health Care for the Homeless (HCH) Projects
collected data as part of a study to examine the effect on housing status and
access to substance abuse treatment among homeless people and formerly
homeless people whose SSI and SSD benefits were ended due to the recently
enacted DA&A exclusion. (Details on the study design and procedures are
included in an appendix to this report.)
A total of 3,468 people were interviewed in the course of the HCH
study. Nearly 20% (687) of the individuals surveyed were currently receiving
SSI and/or SSD benefits.32 The study found that
5% (193) of the individuals surveyed had lost their SSI or SSD benefits in the
12-month period before being interviewed by HCH staff. Over 50% of these
individuals (101) reported that their benefits were terminated as a result of
the new DA&A benefits elimination rule.
As expected, the loss of SSI or SSD benefits was associated with a
negative change in housing status for the subjects of this survey. In
particular, loss of benefits had a strong effect on housing status for persons
who had been paying for their own housing -- 76% of the people in that group
lost their housing and were either living in shelters, on the streets, with
friends or relatives, or in a treatment facility. The results of this study
suggest that a significant number of SSI or SSD recipients were using their
benefits to pay for their housing. Although the sample size prohibits
generalizations to the entire homeless population that experienced changes in
housing status due to the loss of SSI or SSD benefits, the study does support
the theory that some persons became homeless because they could no longer
afford to pay their rent after losing their Social Security benefits.
Furthermore, the study shows that of the 193 people who lost their
SSI or SSD benefits in the 12-month period before the survey began, 51 (26.4%)
were currently in a treatment program. However, when their benefits were
ended, 15 of these 51 persons (29.4%) were required to leave the treatment
program.
B. Other Studies Tracking
the Impact of the DA&A Benefits Elimination
Preliminary findings from other projects tracking the impact of the
DA&A benefits elimination on SSI and SSD beneficiaries are consistent with the
HCH findings. For example, a study based in Cook County, Illinois found that
with respect to housing impacts:
-
49% of SSI/SSD recipients who did not requalify for benefits moved
since their benefits were cut;
-
61% of those who moved entered shelters; and
-
50% of people who lost their benefits but were able to retain
housing, were able to do so in part due to Section 8 housing assistance.33
With respect to impacts on health insurance, the Illinois study found
that 74% of those persons who lost their benefits also lost Medicaid or
Medicare coverage as a result of the changes in federal law.34
In addition, the Cook County study found that only half of the former SSI and
SSD recipients who were in substance abuse treatment programs prior to the
changes in the federal law sought treatment after losing their benefits.35
C. Discussion
Overall, the decision by Congress to eliminate SSI or SSD benefits to
individuals with substance abuse-related disabilities is harmful public
policy. Loss of income and health resources can only mean increased
homelessness and more untreated illnesses; neither result is desirable.
The decrease in participation rates in substance abuse treatment
among the persons affected by the new DA&A benefits elimination law comes in
the context of research that shows that treatment helps to reduce substance
abuse. For example, research supported by the U.S. Department of Health and
Human Services' National Treatment Improvement Evaluation Study (NTIES), as
well as state-level studies reported by the National Association of State
Alcohol and Drug Abuse Directors (NASADAD), show that treatment is one of the
most effective ways of reducing the social costs of alcohol and drug problems,
e.g., crime, welfare receipt, and homelessness.36
In a survey of nonprofit health projects, homeless shelters and other
providers serving homeless people with alcohol and other drug problems, more
than half of the providers cited clients' lack of Medicaid as either an
"extremely serious" or "very serious" problem in acting as a barrier to
sobriety.37 Without any form of health insurance,
it is likely that some addiction treatment programs will refuse to accept
clients. As it is, many State alcohol and drug treatment systems have a
shortage of treatment slots. The National Association of State Alcohol and
Drug Abuse Directors reports that special needs populations, including
homeless people, are the largest category of substance abusers whose need for
services goes unmet.38
Moreover, the loss of Medicaid coverage means not only a loss of
access to substance abuse treatment services but also a loss of access to
primary heath care for a population which is at risk for many dangerous
conditions, including infectious diseases such as HIV, TB, and hepatitis.
Often, the sole resource for uninsured individuals is to seek medical
attention in hospital emergency departments, the most expensive place of care.
In a study comparing the length of hospital stays in New York City for
homeless and housed public hospital and private hospital patients, researchers
found that homeless patients stayed 4.1 days, or 36%, longer per admission on
average than housed patients.39 The report also
found that the average cost of additional days per discharge ($2,414) among
homeless patients nearly equaled the annual public assistance rent allowance
for a single person in New York City ($2,580).40
Admissions for mental health and substance abuse treatment, which accounted
for 51.5% of the homeless patient admissions, cost $4,094 per discharge of a
psychiatric patient.41
With respect to housing, obtaining and maintaining affordable
permanent housing is a constant struggle for people who rely upon federal or
state public assistance benefits as their regular source of income. This is
particularly true of disabled SSI and SSD recipients who may have no hope of
recovering sufficiently to re-enter the workforce. For individuals living in
unsubsidized housing, a change in monthly income will likely have a
significant effect on the ability to pay housing costs. The complete
termination of benefits can be disastrous.
Finding affordable housing will be extremely challenging for people
who lost their SSI or SSD benefits. In 1998, the U.S. Department of Housing
and Urban Development (HUD) reported that there are between 1.1. and 1.4
million disabled adults living alone or with other singles in households with
incomes less than 50% of the area median, who pay more than half of their
income for rent, or who live in severely substandard housing -- in other
words, households with worse case housing needs.42
While the stock of affordable housing has fallen, the waiting time for rental
assistance such as public housing or Section 8 vouchers has risen
dramatically. New figures from HUD reveal that the average waiting time for
public housing rose from 10 months to 11 months between 1996 and 1998 and the
average waiting time for Section 8 vouchers rose from 26 to 28 months in the
same time period.43 In large cities, the wait is
dramatically longer -- for example, in New York City, both the Section 8 and
public housing waiting time are up to 8 years.44
Loss of housing seriously jeopardizes a person's recovery from
alcohol and other drug problems. Findings from the National Institute on
Alcohol Abuse and Alcoholism (NIAAA) indicate that the basic needs of homeless
individuals, such as shelter, should be met before addressing an individual's
need for treatment.45 And persons in substance
abuse treatment programs are more likely to overcome substance abuse problems
than persons who do not have access to treatment.46
In the past, SSI and SSD benefits helped homeless substance abusers to get
access to these important resources, which improved their chances for success
recoveries - an outcome that has now been seriously undercut for questionable
political ends.
D. Recommendations
The federal government and states and local governments should take
steps to increase access to housing and treatment services for homeless
persons struggling with substance abuse problems.
We recommend that the following steps be taken:
-
Undo the damage. Most simply, the federal government should revoke
the DA&A benefits elimination and make disabilities resulting from substance
abuse a basis for eligibility for SSI and SSD benefits again and restore
Medicaid and Medicare benefits for these individuals.
-
Remove barriers to the Social Security disability benefits
application process. Few disabled homeless people receive SSI or SSD
benefits. To a large extent, this may be due to the rigorous application
process and stringent standards for proving a disability.47
The applicant must be able to navigate SSA's complex application process.
Success at each stage of the evaluation process hinges upon the ability to
collect and submit medical records that document the nature of the
disability and its expected duration. Collecting past medical records and
obtaining current medical assessments can be a daunting task for many
homeless people. Some people may have lost records, moved far from their
original treatment source, or be unable to reconstruct the names of doctors
and facilities that provided treatment. The transiency of homelessness and
the lack of personal space for storing important documents contribute to the
difficulties in pursuing an application for disability benefits. In
addition, many health care providers are unfamiliar with the application
process and unprepared to offer sufficient assistance.48
Finally, once an application is submitted, there are long delays between the
date of application and the determination date; homeless applicants may lose
touch with the Agency during this extended period.
We recommend that:
-
Congress appropriate funds specifically for outreach to homeless
people regarding their rights to apply for SSI and SSD benefits. Under the
Social Security Act, funds may be appropriated to be used by the Social
Security Administration to make grants to the states for projects designed
to demonstrate and test the feasibility of special procedures and services
to ensure that homeless individuals are provided with SSI and other
benefits to which they may be entitled and to receive assistance in using
such benefits to obtain permanent housing, food, and medical care.49 Projects funded under this provision of the
law are required to include procedures and services to overcome barriers
that prevent homeless individuals from receiving and using SSI and other
benefits under the Social Security Act.
-
Create additional housing resources. Housing should be a
fundamental human right. The federal government, together with state and
local governments, should create additional housing resources for all
homeless persons, including those with substance abuse disorders.
We recommend that:
-
Congress should increase the appropriations for HUD McKinney Act
programs to 1.6 million in FY 2000;
-
Congress should fund 100,000 new Section 8 vouchers, including
34,000 vouchers targeted to homeless persons in FY 2000;
-
In addition, the National Law Center supports the National Health
Care for the Homeless Council's recommendation that the federal
government, the states, localities, and the private sector should jointly
establish a $50 billion Community Housing Investment Trust to create or
preserve one million units of affordable housing for very low income
individuals.
-
Increase substance abuse treatment resources. There should be
universal access to health care as a fundamental human right. In addition,
the federal government along with state and local governments should
increase the availability of substance abuse treatment for homeless persons
by providing funding targeted for homeless persons.
We recommend that:
-
Congress establish an addictive disorder treatment and recovery
program targeted to the unique needs and life circumstances of homeless
people;
-
Congress reauthorize and appropriate funds in FY 2000 of at least
$1.885 billion for the Substance Abuse Prevention and Treatment Block
Grant;
-
federal, state, and local governments establish policies that
adopt harm reduction and relapse-tolerant mechanisms that respond to the
needs of persons with addictive disorders;
-
Congress require parity between coverage of addictive disorders
and other health conditions in private and public health insurance;
-
Congress should designate homeless people as a priority
population for substance abuse block grant-funded services.
VI.
APPENDIX
STUDY
The purposes of this study are to:
-
assess the extent to which people who are currently or recently
homeless were affected by changes in SSI and SSD eligibility that took
effect on January 1, 1997;
-
assess the impact of termination of SSI and SSD benefits on the
housing status of affected persons; and
-
assess the impact of termination of SSI and SSD benefits on
affected persons' participation in drug or alcohol treatment.
METHODOLOGY
In a six month field survey beginning in the 1st quarter of 1997,
clinic staff at 36 Health Care for the Homeless (HCH) clinics around the
country collected data on changes in housing status and access to substance
abuse treatment experienced by clients who had been cut off from SSI or SSD in
the preceding twelve months. HCH facilities were chosen as the survey sites
because they were more likely than shelters or transitional housing facilities
to serve clients from a variety of housing situations. HCH facilities serve
persons residing on the streets, in shelters, in transitional housing, living
with friends and relatives, in treatment facilities, and in permanent housing
(i.e., formerly homeless clients who continue to rely on the services of HCH
programs to maintain their health and stability).
SUBJECTS
Persons surveyed were currently or formerly homeless clients who
sought services from the participating HCH Projects on a day the survey was
being administered. A total of 3,468 unduplicated persons were surveyed during
the study period.
PROCEDURE
During the study period on pre-determined days each month, HCH clinic
staff at the participating clinics administered the survey instrument to each
client who received services from the clinics or to a random sample of
clients. Participation was not mandatory, but all clients present at the
survey sites on the survey days were asked to participate, except where random
surveys where conducted.
During the course of the survey day, clients were asked to
participate in the study. Surveys were read verbatim to clients by project
staff who then recorded the answers to each question.
All clients who participated were asked their age, race/ethnicity,
gender, marital status, whether or not they had minor children in their care,
and if so, how many children. Clients were also asked whether they were
currently receiving any government benefits and were given a list of federal
and state benefits to assist them in identifying the source of their income.
Clients who were receiving or who had ever received SSI or SSD benefits were
then asked whether or not their benefits had stopped in the past year. Clients
who indicated "no" were not asked any further questions based on the changes
in the SSI and SSD programs.
Clients who indicated that their SSI or SSD benefits had been
terminated in the past year were asked for three additional pieces of
information: (1) whether they had received a notice that their benefits would
be terminated; (2) whether their benefits were ended due to a drug or alcohol
problem; and (3) whether the individual had appealed the termination of
benefits.
All clients who lost SSI or SSD benefits in the last year were next
asked about any changes in their housing status, as well as whether or not
they were paying for their own housing. These same clients were then asked a
series of questions about their participation in and access to substance abuse
treatment. The survey subjects were asked if they were in substance abuse
treatment both while receiving SSI or SSD benefits and at the time their
benefits ended. They were asked if they were required to leave the program
upon losing their SSI or SSD benefits. Clients were also asked whether they
had received drug or alcohol treatment since their benefits ended.
RESULTS
1. Termination of SSI or SSD benefits
Of the total sample of 3,468 persons interviewed, 687 (19.8%) persons
were currently receiving SSI or SSD benefits, or both. (see Figure 1.1). A
total of 193 (5.6%) lost their SSI or SSD benefits in the 12 months before
they were surveyed either as a result of the application of the new drug and
alcohol addiction exclusion rule or for other reasons. 101 of the 193 persons
who lost benefits (52.3%) reported that their cases were closed by the Social
Security Administration because their disability was caused by a substance
abuse disorder. 83 of these 101 (83%) individuals appealed the Social Security
Administration's decision to terminate their benefits. Only 14 (16.9%) of
these 83 persons who appealed were receiving SSI or SSD at the time of the
survey.
Figure 1.1
Current Benefits Received
by Respondents
(n=3468)
2. Housing Impacts
Loss of benefits was associated with a down-grading of housing status
for the majority of the subjects. Of the 193 persons whose SSI or SSD benefits
were terminated, 124 persons (64.2%) experienced a negative change in their
housing status.
Of the 91 persons who had been paying for their own housing before
losing their SSI or SSD benefits, 46 persons (50.5%) lost their housing and
were staying in emergency shelters or on the streets, 24 persons (26.4%) were
staying with friend, relatives, in a substance abuse treatment facility or in
transitional housing, and only 13 persons (14.3%) had been able to continue
paying for their own housing. The housing status of 8 persons (8.8%) was not
reported (See Figure 1.2). The majority of these persons, 56 of 91 (61.5%)
persons, had their benefits terminated because of the changes in eligibility
relating to substance abuse problems.
Figure 1.2
Change in Housing Status
for Persons Paying for their Own Rent
(n=91)
3. Impact on Access to Substance Abuse Treatment
Regarding drug and alcohol treatment, a little under half of all
persons who had lost their SSI or SSD benefits had received drug or alcohol
treatment at some time while receiving those benefits.
Of the 193 people who lost their SSI or SSD benefits in the 12 month
period before the survey began, 95 (49.2%) had participated in substance abuse
treatment at some time while receiving federal disability benefits. At the
time that their benefits were ended, 51 of the 193 persons (26.4%) were
currently in a treatment program. Of these 51 persons, 15 (29.4%) were
required to leave the treatment program when their SSI or SSD ended.
VII.
ENDNOTES
1. Contract with America
Advancement Act of 1996, Pub. L. No. 104-110 Stat. 847 (1996).
2. Id. §105(a)(1),
(b)(1) 110 Stat. 847, 852-853 (amending 42 U.S.C. §423(d)(2) and
§1382c(a)(3)).
3. Martha R. Burt, "Over the
Edge: The Growth of Homelessness in the 1980s," 106 (1992).
4. Id. at 120.
5. 45 U.S.C. §§1381-1383(f)
(1998).
6. 42 U.S.C. §§403-433
(1998).
7. 42 U.S.C.
§1396a(a)(10)(A)(i)(II).
8. Id. §1396a(f).
9. Id. §§426, 1395c.
10. Irving Piliavin et al.,
"Health Status and Health-Care Utilization among the Homeless," 68 Soc.
Serv. Rev. 236, 250 n.1 (1994).
11. Paul Koegel et al., "The
Causes of Homelessness" in Homelessness In America 24, 31 (Jim Baumohol
ed., 1996).
12. Id.
13. Bureau of Primary Health
Care, U.S. Dept. of Health and Human Services, Health Care for the Homeless
Program Fact Sheet (1996).
14. Martha R. Burt & Barbara
E. Cohen, America's Homeless: Numbers, Characteristics, and Programs that
Serve Them 43 (1989).
15. National Law Center on
Homelessness & Poverty, Abandoned to the Streets: An Analysis of Social
Security's Pre-Release Program 4 (1992).
16. Id. at 4 n.13.
17. 42 U.S.C. §1382(e)(3)
(1992) (prior to 1994 amendments).
18. Ethel Zelenske and
Thomas Yates, "Recent Legislation Eliminates Drug Addiction and Alcoholism as
a Basis for Social Security and Supplemental Security Income Disability
Benefits," 30(4) Clearinghouse Rev. 401, 402 (1996).
19. Social Security Reform
Act of 1994, Pub. L. No. 103-296, §201, 108 Stat. 1464 (1994).
20. "Changing Eligibility
for Supplemental Security Income," Hearing Before the Subcommittee on Human
Resources of the House Committee on Ways and Means, 104th Cong., 1st Sess.
360, 422-423 (January 27, 1995).
21. Contract with America
Advancement Act of 1996, Pub. L. No. 104-121, §105, 110 Stat. 847, 852 (1996).
22. Nicole Fiocco, "The
Unpopular Disabled: Drug Addicts and Alcoholics Lose Benefits," 49
Administrative Law Review 1007, 1025-1026 (1997).
23. Robert Rosenheck and
Linda Frisman, "Do Public Support Payments Encourage Substance Abuse?" 15(3)
Health Affairs 192,194 (Fall 1996).
24. Pub. L. No. 104-121,
§105(a)(1), (b)(1) (amending 42 U.S.C. §423 (d)(2) (SSD benefits) and
§1382c(a)(3) (SSI benefits)).
25. 20 C.F.R.
§§404.1535(b)(1), 416.935(b)(1).
26. Pub. L. No. 104-121,
§105(a)(5)(A), (b)(5)(A).
27. Id. at
§105(a)(5)(C), (b)(5)(C).
28. Id.
29. The Lewin Group,
Policy Evaluation of the Effect of Legislation Prohibiting the Payment of
Disability Benefits to Individuals Whose Disability is Based on Drug Addiction
and Alcoholism 1 (July 21, 1998).
30. Id. at 19.
31. In Maryland, a class of
SSI and SSD beneficiaries successfully challenged the termination of their
disability and medical assistance benefits. The lawsuit alleged that SSA
unlawfully implemented the new DA&A provisions by, among other things, failing
to take into account prior medical histories and prior administrative
decisions in beneficiaries' cases in processing appeals under the new AD&A
aprovisions. See Stipulation and Order of Settlement, Montague v.
Callahan, Civ. No. CCB-96-4073 (D. Md. March 6, 1997).
32. This unusually high rate
for a homeless sample is probably due to a selection bias on the part of the
interviewers.
33. Mid-Atlantic Institute
on Poverty and the SSI Coalition for a Responsible Safety Net, Without a
Net: A Study of the Early Impacts of Supplemental Security Income Benefits
Elimination for Persons with Disabiliteis Due to Drug and Alcohol Abuse in
Cook County, Ilinois, 9 (May 1998).
34. Id. at 15.
35. Id. at 19.
36. Substance Abuse and
Mental Health Services Administration, U.S. Dept. of Health and Human
Services, The National Treatment Improvement Evaluation Study: Highlights
(1997); National Association of State Alcohol and Drug Abuse Directors, Inc.,
Invest in Alcohol and Other Drug Treatment: It Pays (1994).
37. Lydia Williams, National
Coalition for the Homeless, Addiction on the Streets 23 & n.62 (1992).
38. National Association of
State Alcohol and Drug Abuse Directors, Inc., State Resources and Services
Related to Alcohol and Other Drug Problems for Fiscal Year 1994 58 (1996).
39. Sharon A. Salit et al.,
"Hospitalization Costs Associated with Homelessness in New York City," 24
New Eng. J. Med. 1734, 1738 (1998).
40. Id. at 1739.
41. Id. at 1738.
42. U.S. Dept. of Housing
and Urban Development, Rental Housing Assistance -- The Crisis Continues:
The 1997 Report to Congress on Worst Case Housing Needs 30 (April 1998).
43. U.S. Dept of Housing and
Urban Development, Waiting in Vain: An Update on America's Rental Housing
Crisis 8 (March 1999).
44. Id. at 7.
45. Deirdre Oakley & Deborah
L. Dennis, "Responding to the Needs of Homeless People with Alcohol, Drug
and/or Mental Disorders" in Homelessness in America 179, 180 (Jim
Baumohl, ed., 1996).
46. Robert G. Orwin, U.S.
Dept. of Health and Human Services, "Community Demonstration Grant Projects
for Alcohol and Drug Abuse Treatment of Homeless Individuals: Executive
Summary" 17 (1993) (reporting on the differences in improvement between
homeless clients receiving substance abuse treatment and the comparison group
not participating in treatment. For many treatment clients, alcohol and other
drug use not only declined, but was eliminated.)
47. The Social Security Act
requires an adult applicant to prove that he or she is unable to engage in any
substantial gainful activity (work for pay or profit) due to a severe physical
or mental impairment that is expected to result in death or has lasted or will
be expected to last as least 12 continuous months. 42 U.S.C. §§416(i),
1382c(a)(3)(A); 20 C.F.R. §416.905 (1998). For information on the barriers
that prevent homeless people from accessing Social Security disability
benefits, see Naltional Law Center on Homelessness & Poverty, Social
Security: Broken Promises to America's Homeless (1990).
48. James J. O'Connell,
National Health Care for the Homeless Council, Determining Disability:
Simple Strategies for Clinicians (1997).
49. 42 U.S.C. §1383 note.
There is precedent for the funding of SSI outreach teams. For more
information, see National Law Center on Homelessness & Poverty, supra
note 47.
