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Trends Over Time and Jurisdiction Variability in Supplemental Security Income and State Supplementary Payment Programs for Children With Disabilities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26 Suppl 2, Advancing Legal Epidemiology:S45-S53. [PMID: 32004222 DOI: 10.1097/phh.0000000000001122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CONTEXT Nearly 1.2 million children with disabilities received federally administered Supplemental Security Income (SSI) payments in 2017. Based on a robust review of research and evaluation evidence and microsimulations, The National Academies of Sciences, Engineering, and Medicine committee identified modifications to SSI (ie, increasing the federal SSI benefit maximum by one-third or two-thirds) as 1 of 10 strategies that could reduce the US child poverty rate, improving child health and well-being on a population level. OBJECTIVE Describing the availability and amount of SSI and State Supplementary Payment (SSP) program benefits to support families of children with disabilities may be a first step toward evaluating The National Academies of Sciences, Engineering, and Medicine-proposed modification to SSI as a potential poverty alleviation and health improvement tool for children with disabilities and their families. DESIGN We used public health law research methods to characterize the laws (statutes and state agency regulations) governing the federal SSI program and SSP programs in the 50 states and District of Columbia from January 1, 1996, through November 1, 2018. RESULTS The number of jurisdictions offering supplementary payments (SSP) was relatively stable between 1996 and 2018. In 2018, 23 US jurisdictions legally mandated that SSP programs were available for children. Among the states with SSP payment amounts in their codified laws, SSP monthly benefit amounts ranged from $8 to $64.35 in 1996 and $3.13 to $60.43 in 2018. CONCLUSION Our initial exploration of SSI-related policies as a tool for improving the economic stability of children with disabilities and their families suggests that current SSPs, in combination with SSI, would not rise to the level of SSI increases proposed by The National Academies of Sciences, Engineering, and Medicine. Understanding more about how SSI and SSP reach children and work in combination with other federal and state income security programs may help identify policies and strategies that better support children with disabilities in low-income households.
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Lakshmanan A, Kubicek K, Williams R, Robles M, Vanderbilt DL, Mirzaian CB, Friedlich PS, Kipke M. Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study. BMC Pediatr 2019; 19:223. [PMID: 31277630 PMCID: PMC6610911 DOI: 10.1186/s12887-019-1604-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background We have limited information on families’ experiences during transition and after discharge from the neonatal intensive care unit. Methods Open-ended semi-structured interviews were conducted with English or Spanish- speaking families enrolled in Medicaid in an urban high-risk infant follow up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. Results Twenty-one participants completed the study. The infant’s median (IQR) birth weight was 1750 (1305, 2641) grams; 71% were Hispanic and 10% were Black non-Hispanic; 62% reported living in a neighborhood with 3-4th quartile economic hardship. All were classified as having chronic disease per the Pediatric Medical Complexity Algorithm and 67% had medical complexity. A conceptual model was constructed and the analysis revealed major themes describing families’ challenges and ideas to support transition centered on the parent-child role and parent self-efficacy. The challenges were: (1) comparison to normal babies, (2) caregiver mental health, (3) need for information. Ideas to support transition included, (1) support systems, (2) interventions using mobile health technology (3) improved communication to the primary care provider and (4) information regarding financial assistance programs. Specific subthemes differed in frequency counts between infants with and without medical complexity. Conclusions Families often compare their preterm or high-risk infant to their peers and mothers feel great anxiety and stress. However, families often found hope and resilience in peer support and cited that in addition to information needs, interventions using mobile health technology and transition and financial systems could better support families after discharge. Electronic supplementary material The online version of this article (10.1186/s12887-019-1604-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Katrina Kubicek
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Roberta Williams
- Division of Cardiology, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marisela Robles
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Douglas L Vanderbilt
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA
| | - Michele Kipke
- USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Hoagwood KE, Zima BT, Buka SL, Houtrow A, Kelleher KJ. State-to-State Variation in SSI Enrollment for Children With Mental Disabilities: An Administrative and Ethical Challenge. Psychiatr Serv 2017; 68:195-198. [PMID: 27691374 PMCID: PMC5538568 DOI: 10.1176/appi.ps.201600118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined state variation in rates of Supplemental Security Income (SSI) determinations, allowances, and receipt of benefits for ten selected child mental disabilities in 2013. METHODS SSI administrative and U.S. Census Bureau data collected by a multidisciplinary consensus committee convened by the National Academies of Science, Engineering, and Medicine in 2015 were examined. RESULTS Less than 1% of children in 2013 were recipients of SSI for mental disabilities. Determination rates ranged from 1,441 to 251 per 100,000 low-income children, an almost sixfold difference. Allowance rates varied from 16% to 78%, a fivefold difference. Receipt of benefits ranged from .7% to 5.3%, a sevenfold difference. CONCLUSIONS Large unexplained discrepancies across states were found in review and receipt of SSI benefits for low-income children with mental disabilities. Inequities that cannot be explained by disability severity or financial need violate the ethos of equitable access to federally entitled services.
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Affiliation(s)
- Kimberly E Hoagwood
- Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: ). Dr. Zima is with the Center for Health Services and Society at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Buka is with the Department of Epidemiology, Brown University, Providence, Rhode Island. Dr. Houtrow is with the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Kelleher is with the Research Institute of the Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio
| | - Bonnie T Zima
- Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: ). Dr. Zima is with the Center for Health Services and Society at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Buka is with the Department of Epidemiology, Brown University, Providence, Rhode Island. Dr. Houtrow is with the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Kelleher is with the Research Institute of the Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephen L Buka
- Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: ). Dr. Zima is with the Center for Health Services and Society at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Buka is with the Department of Epidemiology, Brown University, Providence, Rhode Island. Dr. Houtrow is with the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Kelleher is with the Research Institute of the Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy Houtrow
- Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: ). Dr. Zima is with the Center for Health Services and Society at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Buka is with the Department of Epidemiology, Brown University, Providence, Rhode Island. Dr. Houtrow is with the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Kelleher is with the Research Institute of the Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly J Kelleher
- Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: ). Dr. Zima is with the Center for Health Services and Society at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Buka is with the Department of Epidemiology, Brown University, Providence, Rhode Island. Dr. Houtrow is with the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Kelleher is with the Research Institute of the Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio
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