State-to-State Variation in SSI Enrollment for Children With Mental Disabilities: An Administrative and Ethical Challenge.
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.



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.



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.



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.
Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: kimberly.hoagwood@nyumc.org ). 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.
Kimberly E
KE
Hoagwood
Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: kimberly.hoagwood@nyumc.org ). 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
BT
Zima
Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: kimberly.hoagwood@nyumc.org ). 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
SL
Buka
Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: kimberly.hoagwood@nyumc.org ). 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
A
Houtrow
Dr. Hoagwood is with the Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York City (e-mail: kimberly.hoagwood@nyumc.org ). 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
KJ
Kelleher
D002648:Child; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D019989:Persons with Intellectual Disabilities / Q000706:statistics & numerical data*; D011632:Public Assistance / Q000941:ethics / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States
Child and adolescent mental disorders; Child psychiatry/general; Mental disabilities; Public policy issues; State policy; Supplemental Security Income
JAMA. 2003 Oct 15;290(15):2023-9
14559956
Am J Psychiatry. 2002 Sep;159(9):1548-55
12202276
J Dev Behav Pediatr. 2012 Jan;33(1):42-54
22218014
JAMA. 2015 Nov 17;314(19):2019-20
26361217
Health Aff (Millwood). 2016 Jul 1;35(7):1266-70
27385243
J Dev Behav Pediatr. 2016 May;37(4):267-8
27128341
Arch Phys Med Rehabil. 2015 Dec;96(12):2094-5
26433045
J Am Acad Child Adolesc Psychiatry. 2012 May;51(5):506-17
22525957
Pediatrics. 2016 Mar;137(3):e20153342
26908684
Pediatrics. 2016 Jul;138(1):
27279648