Association for Public Policy Analysis & Management

The Supplemental Security Income (SSI) program provides means-tested income support to individuals with disabilities in the United States. Between 1990 and 2010, the number of children receiving SSI benefits rose over 300%. Beyond income support, many SSI recipients also receive publicly-provided health insurance through state Medicaid programs; thirty-two states automatically enroll SSI recipients into their Medicaid programs. However, little is known about how the receipt of SSI income and the corresponding health insurance coverage affect child and family outcomes.  In this paper, we examine the relationship between SSI, Medicaid, and child outcomes. We use the fact that infants born below certain Social Security Administration-defined low birth weight cut-offs (different from the cut-offs used by the medical profession) are eligible for SSI regardless of family income. First, we employ a regression discontinuity approach and compare outcomes for infants born just under the SSI eligibility birth weight cut-offs to those for infants born just above the cut-offs. We show that SSI receipt is discontinuous using SSA administrative data, National Health Interview Survey (NHIS) data, and data from the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B). Next, we estimate the relationship between SSI eligibility and birth and early childhood outcomes using a wide variety of data sets including the Vital Statistics Natality Detail, the Early Childhood Longitudinal Study Birth Cohort, NHIS, and Healthcare Cost and Utilization Project. We find evidence that SSI receipt significantly improves child development outcomes and parenting practices.  Last, since Medicaid policies produce variation in the access to Medicaid among SSI-eligible infants, we use a difference-in-difference model comparing infants around the SSI birth weight cut-offs, but who live in different states. First, we compare more generous self-enroll states with less generous self-enroll states to see whether the difference in Medicaid resources improves health. Second, we compare auto-enroll states with self-enroll states to see whether default enrolling leads to increased Medicaid enrollment, greater utilization of health services and better health.