Health-related unmet needs of supplemental security income youth after the age-18 redetermination.

To be eligible for the Supplemental Security Income (SSI) program, a means-tested income support program for the blind, disabled, and elderly administered by the Social Security Administration (SSA), children must have a medically determinable physical or mental impairment that is expected to last (or has lasted) at least 12 continuous months or to result in death and results in marked and severe functional limitations and have sufficiently low income and assets. At age 18, the medical eligibility of all youth is redetermined under adult program rules, which requires them to have an impairment that prevents them from performing substantial gainful activity (defined as work activity of more than U.S.$980 per month in 2009). About one-third of these age-18 redeterminations result in a cessation of SSI eligibility each year (SSA 2009).1 Although these young adults do not meet SSA's adult disability criteria, many of them may still require significant amounts of medical care to address their medical condition. Lack of appropriate health care may lead to health complications or deterioration of their medical condition, which could result in a transition back to SSI. In addition to the heightened risk of having an unmet need due to their condition, many of these young adults are also at an increased risk of having an unmet need because they also lose Medicaid coverage when they are determined to be medically ineligible for SSI because SSI eligibility also determines Medicaid eligibility in most states. Whether these young adults are actually receiving less care than needed and to what extent this may be due to their exit from SSI is unknown. While not having insurance is common among young adults with and without disabilities (Fishman 2001; Callahan and Cooper 2006, 2007), former SSI children are more likely to lack health insurance at ages 19–23 than their peers who remained on SSI (Loprest and Wittenburg 2007). The lack of insurance for young adults with disabilities may result in limited access to preventive or required care, precluding these young adults from obtaining employment or becoming economically self-sufficient.2 Alternatively, young adults who exit SSI are relatively healthier individuals and thus may have fewer needs than their peers who remain on SSI. Additionally, few youth with disabilities receive help with health services, such as the coordination of care between and within pediatric and adult services, which would smooth their transition into adulthood (Scal and Ireland 2005). Even young adults remaining on SSI may require assistance because they receive a different package of health care services as an adult (Williams and Tolbert 2007). More important for young adults who exit SSI, even short periods of time without health insurance have been shown to impact health outcomes (Olson, Tang, and Newacheck 2005; Cummings et al. 2009;). Changes in insurance coverage have also been shown to delay receipt of, or reduce access to, care (Burstin et al. 1998/1999). Because few studies have explored the relationship between SSI's age-18 redetermination and the unmet health needs of transition-age youth, this study addresses the following questions: Are young adults who leave SSI after the age-18 redetermination more likely to have health-related unmet needs than those who remain on SSI? If so, does health status or lack of insurance explain this difference?