Saturday, 14 January 2006 - 8:44 AM

The Effect of Eliminating Supplemental Security Income Drug Addiction and Alcoholism Eligibility: A Panel Study of Public Assistance and Low-Income Substance Abusers in Northern California

Sean R. Hogan, PhD, University of California, Berkeley.

Purpose: In March 1996, the Contract with America Advancement Act (PL 104-121) eliminated drug addiction and alcoholism (DA&A) as qualifying impairments for disability benefits under the Supplemental Security Income (SSI) program. As a result, on January 1, 1997, more than 166,000 SSI DA&A recipients lost their monthly income and health care (i.e., Medicaid) benefits. This population accounted for approximately 2.5% of all SSI recipients. In California, where nearly 30% of all DA&A beneficiaries resided, nearly 50,000 individuals were directly affected. This study examined the effect eliminating SSI benefits had on low-income substance abusers in Northern California. The purpose of the study was to identify which outcome domains (e.g., substance use, mental health, material hardship) were differentially affected following termination of the DA&A program.

Methods: A secondary data analysis of former DA&A beneficiaries in the San Francisco Bay Area, originally surveyed in conjunction with the “Multi-Site Study of the Termination of Supplemental Security Income Benefits for Drug Addicts and Alcoholics” and an independent 3.5-year follow-up, was conducted to examine the longitudinal impact losing SSI benefits had on low-income substance abusers. A panel of 412 study participants was surveyed at six time points (baseline, and 6-, 12-, 18-, 24-, and 42-month follow-up) to assess changes in multiple domains, including alcohol and drug use, physical and mental health, housing, food and hunger, income maintenance, employment, and criminal activity. To examine the effect losing SSI benefits had on this population, the study sample was divided into three categories based on primary income source: 1) retained SSI benefits, 2) acquired some other public assistance, and 3) received no public assistance. Pearson's chi-square, ANOVA, and logistic regression were utilized to assess differences in each domain by primary income group.

Results: Results indicated that primary income groups that lost SSI benefits were differentially affected in many outcome domains, including health care, mental health, and income maintenance. For example, at 42-month follow-up, approximately 40% of study participants that lost SSI benefits reported having no medical insurance compared to only 2% of individuals that retained SSI benefits. By far, the greatest effect was felt in housing. While homelessness was not a significant issue, housing independence and autonomy were severely compromised for groups that lost stable monthly income benefits. These groups were approximately 15 times more likely to “double-up” with friends and family than study participants that retained SSI benefits.

Conclusions: Eliminating SSI drug addiction and alcoholism eligibility had differential effects on low-income substance abusers. While some recipients were able to retain SSI benefits under another disability category, those that lost SSI benefits suffered discriminate hardships in many areas. Fulfilling basic needs, such as housing, health care, and income maintenance, were particularly compromised. The findings from this study should alert policymakers to the unintended consequences that can occur when abrupt changes are made to social welfare policies and programs that affect vulnerable populations.


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