The Impacts of the COVID-19 Pandemic on Households with SSI and SSDI Beneficiaries: Results from the 2020 National Health Interview Survey

Background and Purpose: In the US, people with disabilities are twice as likely as people without disabilities to live in poverty. More than 8.1 million Americans with disabilities meet the income and asset requirements needed to qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), and SSI and SSDI impacts both Americans with disabilities and their households. Between 2020 and 2021, approximately 1.2 million more people were identified as having a disability, a potential consequence of the COVID-19 pandemic. In addition to these new diagnoses, some of those most susceptible to COVID-19 infection and severe illness were individuals with disabilities that predated the pandemic, which may alter both individual and household behavior. However, research on the impact of COVID-19 on individuals with disabilities and their families remains limited. We used nationally representative data on households with SSI and SSDI beneficiaries to determine the impact of the COVID-19 pandemic on receipt of needed medical care and at-home support on households with SSI and SSDI beneficiaries.

Methods: We extracted data from the 2020 National Health Interview Survey, which added a set of COVID-related questions halfway through the year to evaluate the impact of the pandemic on receipt of healthcare and at home support. Our sample (N=16576) compared households with SSI and/or SSDI beneficiaries (N=1184) to households without beneficiaries (N=15392). Respondents were 48.0% male and 63.7% non-Hispanic white, with an average age of 49. We compared demographic characteristics (age, race, sex, income, education, employment, health status) between the two groups. Bivariate and multivariate logistic regression models were used to predict COVID-19-related outcomes (delaying medical care, not receiving needed medical care, and not receiving needed personal and household care at home), incorporating strata and weights to produce nationally representative estimates.

Results: Respondents from households with SSI/SSDI beneficiaries with disabilities had lower educational attainment, higher unemployment, and worse health and were more likely to be from minoritized racial and ethnic groups compared to households without beneficiaries. Regression analyses suggested net of demographic factors, households with beneficiaries were associated had significantly greater odds of delaying medical care (OR = 1.29), not receiving needed medical care (OR = 1.42), and not receiving needed personal and household care at home (OR = 1.95) due to COVID-19 (p < .001) compared to households without beneficiaries.

Conclusions and Implications: Our findings provide preliminary evidence that individuals with disabilities and their families have been disproportionately impacted by the COVID-19 pandemic. Further, the racial, ethnic, and sociodemographic disparities seen among SSI and SSDI beneficiaries with disabilities point to significant social and structural determinants of health among this community that can detrimentally influence the ways in which households receive care amidst public health emergencies. Results may inform public health efforts in providing a more robust, inclusive approach to navigating healthcare during a pandemic and preventing future disease.