Health-Conscious Safety Net? Health Problems and Program Use among Low-Income Adults with Disabilities

Many low-income adults have a health problem or impairment that limits their ability to participate in social activities, including work. A health problem or impairment can also increase personal costs on medical expenditures and accommodations (e.g., wheelchair ramps). These combined factors represent an important potential barrier to social and economic mobility.

Policymakers have developed several federal and state programs and other supports to offset the costs and lost earnings associated with the onset of a disability. These programs share a general goal to provide income or in-kind assistance to offset the "costs" of a disability, but their target populations vary. As a result, a patchwork of programs and policies targets different segments of the population. For example, some programs provide benefits to offset the lost income of workers, including those injured on the job, while others provide benefits specifically targeted to low-income populations with severe permanent disabilities (e.g., means-tested benefits).

In recent years, policymakers and the disability community have increased momentum to create laws, policies, and programs that promote integrating people with disabilities into the mainstream, especially in work activities. One key factor in attaining these goals is expanding employment opportunities, as emphasized in the ratification of the Americans with Disabilities Act (ADA) in 1990. Unlike most income support programs that make eligibility determinations based on a person's inability to complete certain activities, employment-focused policies, such as ADA, emphasize an individual's ability to participate in social activities.

This brief examines the employment and program participation patterns of low-income adults with disabilities, and how well the current safety net meets their needs. It compares low-income adults with and without disabilities across employment, program participation, and income status. These comparisons highlight some of the unique challenges faced by low-income adults with disabilities and motivate broader discussion of gaps in the safety net. Particularly striking are the possibly conflicting messages regarding work and program participation sent by existing programs and policies.

The findings question the current structure of the benefits and services safety net. A significant share of low-income adults report a limitation, and the employment rates of those with limitations are much lower than those of low-income adults without disabilities. Although a number of disability programs exist, support options for many low-income adults with disabilities are limited to a small set of programs that will likely lead to a lifetime of benefit support.