Safety Net or Tangled Web?: An Overview of Programs and Services for Adults with Disabilities

Safety Net orTangled Web?An Overview ofPrograms and Services for Adults with DisabilitiesDavid WittenburgMelissa FavreaultAn Urban InstituteProgram to AssessChanging Social PoliciesOccasional Paper Number 68Assessingthe NewFederalismSafety Net orTangled Web?An Overview ofPrograms andServices for Adultswith DisabilitiesDavid WittenburgMelissa Favreault Safety Net or Tangled Web?An Overview ofPrograms and Services for Adults with DisabilitiesDavid WittenburgMelissa FavreaultOccasional Paper Number 68The Urban Institute2100 M Street, NWWashington, DC 20037Phone: 202.833.7200Fax: 202.429.0687E-mail: paffairs@ui.urban.orghttp://www.urban.orgAssessingthe NewFederalismAn Urban InstituteProgram to AssessChanging Social Policies Copyright © November 2003. The Urban Institute. All rights reserved. Except for short quotes, no part of this paper may be reproduced in any form or used in any form by any means, electronic or mechanical, including photocopying,recording, or by information storage or retrieval system, without written permission from the Urban Institute.This report is part of the Urban Institute’s Assessing the New Federalism project, a multiyear effort to monitor and assessthe devolution of social programs from the federal to the state and local levels. Alan Weil is the project director. Theproject analyzes changes in income support, social services, and health programs. In collaboration with Child Trends, theproject studies child and family well-being.The Assessing the New Federalismproject is currently supported by The Annie E. Casey Foundation, The Robert WoodJohnson Foundation, the W. K. Kellogg Foundation, The John D. and Catherine T. MacArthur Foundation, and TheFord Foundation.The authors would like to thank Amelia Gruber, Kevin McManus, and Joyce Morton for helpful research assistance onthis 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. Theviews expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. About the SeriesAssessing the New Federalism is a multiyear Urban Institute project designed to analyze thedevolution of responsibility for social programs from the federal government to the states,focusing primarily on health care, income security, employment and training programs, andsocial services. Researchers monitor program changes and fiscal developments. In collabora-tion with Child Trends, the project studies changes in family well-being. The project aimsto provide timely, nonpartisan information to inform public debate and to help state andlocal 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 theUrban Institute’s web site. This paper is one in a series of occasional papers analyzing infor-mation from these and other sources. ContentsHealth Problems in Low-Income Populations2Data Description2Findings3Overview of the Safety Net4Disability Cash Transfer Programs5Other Cash Transfer Programs11Health Programs11Rehabilitation, Education, and Training Programs13Impairment-Specific Programs14Other Programs Not Tied to Disability15Disability Policy15Disability Program and Policy Challenges16Eligibility Requirements16Access to Short-Term Benefit Programs/Program Coordination17Work Incentives19Summary19Policy Options20Disability Determinations20Temporary Disability Programs21Employment Supports21Summary22 SAFETY NET OR TANGLED WEB? PROGRAMS AND SERVICES FOR ADULTS WITH DISABILITIESConclusion23Notes24References27About the Authors31▲vi SAFETY NET OR TANGLED WEB? PROGRAMS AND SERVICES FOR ADULTS WITH DISABILITIESTHE URBANINSTITUTESafety Net or Tangled Web?An Overview of Programs and Services forAdults with DisabilitiesFor many low-income adults, a disabling health condition represents a major obsta-cle to daily activities. The costs of a disability can take various forms, includingincreased medical costs, lost wages, and diminished psychological well-being.Because these costs can be quite substantial, particularly for health care, a significantportion of these adults must turn for support to outside help, including govern-ment programs. Policymakers have developed a range of programs and supports to address thecomplex needs of adults with disabilities who meet certain medical and other (e.g.,income) criteria. In recent years, spending on many of these programs, particularlyMedicaid and the Social Security Administration’s (SSA) disability cash transferprograms, has increased substantially. Nonetheless, significant portions of low-income adults with disabilities participate in other non-disability programs, such asTemporary Assistance for Needy Families (TANF). This pap