Globe Editorial

Revamp SSI to help caregivers while discouraging abuses

December 16, 2010

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THE $10 billion Social Security Income program, serving children with disabilities, became a growing source of support for poor families after federal welfare reform took hold in 1996. Around that time, however, a program that once supported mostly children with severe physical conditions such as cerebral palsy or blindness became increasingly sought after by families whose kids had mental or behavioral issues, such as attention-deficit disorder or slow development of language skills.

These are real needs, and when parents need help addressing them government should be of service. But with some poor families desperate for relief, and SSI offering monthly checks designed to offset the lost income of parents who are caregivers, there is an obvious temptation to exaggerate or aggressively diagnose a child’s condition. The Social Security Administration must therefore set more explicit standards for eligibility, and watch carefully to determine that children have been properly diagnosed. Recipients should be re-evaluated regularly to determine when they’ve been cured.

A Globe series this week offered clear evidence that Social Security is failing at these tasks. This is not primarily an issue of rooting out undeserving recipients. Rather, it’s a vital need to protect children whose parents may be so eager to prove their disabilities that they seek treatments and medication that are not strictly necessary.

Congress should move quickly to enact a thorough revamping. Among other changes, Congress should:

■set more rigorous eligibility standards for children’s mental, behavioral, and learning disorders, and investigate whether parents are seeking unnecessary drug prescriptions for their children to help buttress their SSI claims;

■ensure that Social Security devotes more resources to re-evaluating cases regularly and ending payments when children have, for instance, overcome a speech defect;

■restructure payments to end the perverse incentive that reduces benefits for families whose disabled teenagers go to work. Job experience is crucial to helping disabled teenagers obtain the skills to live independently as adults. But the Globe series demonstrated that many disabled teens face a heart-breaking conflict between gaining practical experience and costing their families a portion of a benefit check. Helping young people with disabilities grow into independent adults must be a prime goal.

The need for more investigation is particularly pressing. Cases are supposed to undergo full medical reviews every three years, but in 2007 and 2008 fewer than 1 percent of cases were re-evaluated and preliminary data for 2009 and 2010 are also low. A Social Security study found that 40 percent of SSI children reaching age 18 had never been reviewed.

Beyond these specific correctives, Congress should also address basic questions: Do families have access to sufficient support services and education to get their childrens’ disabilities corrected? Should wage-replacement checks designed for families coping with children with severe physical disabilities also go to families whose child’s speech is delayed?

SSI is an important part of the safety net for low-income families. There is nothing wrong with monthly payments to the caregivers of disabled children. But the needs must be clear, and the conditions must be real.

The Globe titled its series “The Other Welfare.’’ One underlying problem may be that parents ineligible for public assistance are struggling to support their families. Congress should confront that dynamic directly, through the earned-income tax credit and other initiatives that make low-wage work more rewarding, rather than by letting SSI become a de facto substitute.

SSI has recreated some aspects of the culture of dependency that led to calls for welfare reform in the first place. A program that gives paychecks to poor families if they can find a way to define their child as disabled has built-in potential for abuse. A program that rewards families for keeping teenagers who are willing to work out of the job market only fosters greater dependence. The country can do better. SSI for children is a humane and necessary program whose good intentions should, through better targeting and monitoring, not fall victim to unintended and corrosive consequences.