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Report calls for research on how SSI funds are granted

A national panel called Wednesday for additional research into the state-to-state disparity in the distribution of federal disability benefits to poor children with behavioral, emotional, and mental disorders.

The report found, for instance, that more than 5 percent of all indigent children from Pennsylvania received monthly benefits due to ADHD and other mental impairments through the $10 billion Supplemental Security Income program, compared with fewer than 1 percent from Hawaii, Colorado, and North Dakota.

Though the authors of the report made clear they found no basis to believe the program is plagued by fraud or mismanagement, the state-to-state variations may bolster critics of the program who argue that the SSI program has morphed into a loosely monitored alternative welfare program with potentially perverse incentives for poor parents to introduce and maintain disability labels for their children.


The program serves about 1.3 million children nationwide, and roughly two out of three obtain about $700 in monthly benefits because of mental impairments. It began in the early 1970s as a program serving primarily poor families coping with severely physically disabled children.

The report did not provide reasons for the state-to-state differences, other than to say it was a “significant and concerning observation” worthy of further investigation. It suggested the variations may be due to different levels of outreach by local agencies in educating poor families about this program, or varying regional practices in determining eligibility of benefits.

The 395-page report comes after more than a year of study by a committee of more than a dozen pediatricians, psychologists, and public health specialists appointed by the Institute of Medicine, the nonprofit health research wing of the National Academies of Sciences, Engineering and Medicine. The Social Security Administration, which paid $1.1 million for the study, had asked the panel to explore the growing dominance of mental impairments within SSI.


Federal authorities sought the study after congressional hearings were held to examine the program and after media accounts about SSI were published, including the Globe’s 2010 three-part series called “The Other Welfare.”

The authors of Wednesday’s report, “Mental Disorders and Disability among Low-Income Children,” refrained from calling for any major changes, emphasizing it lacked reliable data upon which to fully study the program. The children’s SSI program now eclipses traditional welfare programs in offering the most cash aid to families nationwide.

“We spent a considerable amount of time bemoaning our data,” said Dr. Kelly Kelleher, a committee member who is a professor of pediatrics at Ohio State University in Columbus, Ohio.

Dr. James Perrin, a professor of pediatrics at Massachusetts General Hospital and another committee member, said the panel could not assess the level of impairment of children in the SSI program without better data.

The committee went outside Social Security records, and drew on some data sets from Medicaid as well as other published studies, including work on state-to-state variations.

It took a close look at 10 major mental impairment categories, though it excluded one of the top categories, “speech and language delay,” saying it was being scrutinized by a separate panel.

The committee largely defended the rise in enrollment for mental impairments, saying it reflected an overall increased incidence of these mental conditions among low-income US children. It found that the percentage of poor children who received SSI benefits for at least one of 10 major mental disorders increased from about 1.9 percent in 2004 to 2.1 percent in 2013, and such growth was consistent with national trends.


In the report, committee members identified attention-deficit disorder as “the largest in terms of the numbers and proportions of child SSI disability allowances and recipients.”

Medication — often combined with therapy — played a major role in treating SSI children with mental impairments, according to the report. About 95 percent of children with bipolar disorder, and 91 percent of children with ADHD took medication as part of their treatment.

The committee stayed away from the most controversial aspects of the program, including the role of so-called perverse incentives and methods to determine eligibility.

Members said they either didn’t have enough data to draw conclusions, or some topics were outside the scope of their mission. The state-to-state variations in SSI enrollment was one area where committee members appeared to pause with concern.

They added, however, that its examination of low-income children with mental impairments led it to believe that many greatly benefitted from these SSI cash supports, and ultimately, this program is helping children in desperate need.

“Breaking the poverty-disability cycle is an important goal of the childhood SSI program, and, in the opinion of many, the current $10.5 billion annual investment provides a sizeable return,” wrote Dr. Thomas Boat, the panel chairman and a professor of pediatrics at the University of Cincinnati College of Medicine, in the report.


Patricia Wen can be reached at Follow her on Twitter at @GlobePatty.

Correction: An earlier version of this story misspelled Kimberly Hoagwood’s name.