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Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities.

ABSTRACT: The liberty of individuals who receive Social Security disability payments is constrained if they are judged incapable of managing their payments and are assigned a payee or conservator to manage benefit payments on their behalf. Conversely, beneficiaries' well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and that capability guidelines appear to be applied inconsistently. This article describes ambiguities that remained for individuals even after a comprehensive assessment of financial capability was conducted by independent assessors.Trained, experienced assessors rated the financial capability of 118 individuals in intensive outpatient or inpatient psychiatric facilities who received Social Security Disability Insurance or Supplemental Security Income.Ten individuals' cases were determined to be difficult to judge. Six sources of ambiguity were identified by case review: distinguishing incapability from the challenges of navigating poverty, the amount of nonessential spending that indicates incapability, the amount of spending on harmful things that indicates incapability, how to consider intermittent periods of capability and incapability, the relative weighting of past behavior and future plans to change, and discrepancies between different sources of information.The cases raise fundamental questions about how to define and identify financial incapability, but they also illustrate how detailed consideration of beneficiaries' living situations and decision making can inform the difficult dichotomous decision about capability.

SUBMITTER: Lazar CM

PROVIDER: S-EPMC4402222 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities.

Lazar Christina M CM Black Anne C AC McMahon Thomas J TJ O'Shea Kevin K Rosen Marc I MI

Psychiatric services (Washington, D.C.) 20141201 3

<h4>Objective</h4>The liberty of individuals who receive Social Security disability payments is constrained if they are judged incapable of managing their payments and are assigned a payee or conservator to manage benefit payments on their behalf. Conversely, beneficiaries' well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and that capability guidelines appear to be applie ...[more]

PMID: 25727116

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Project description:Background:Financial capability is an essential feature of the organisation of one's personal life and engagement with society. Very little is known of how adequately individuals with developmental language disorder handle financial matters. It is known that language difficulties place them at a disadvantage in many aspects of their development and during their transition into adulthood, leading to the possibility that financial issues may prove burdensome for them. This study examines the financial capability and functional financial literacy of young adults with developmental language disorder and compares them to those of age matched peers. We tested the expectation that those with developmental language disorder would find financial management more challenging than would their peers, and that they would need to seek greater support from family members or other people. Methods:Participants completed a detailed individual interview, which included items drawn from the British Household Panel Survey and additional measures of financial capability, functional financial literacy and of perceived support. Nonverbal IQ, language, reading and numeracy measures were also collected. Results:Compared to typically developing age matched peers, young people with developmental language disorder report less extensive engagement with financial products and lower competence in functional financial literacy. A considerably higher proportion of those with developmental language disorder (48% vs. 16% of age matched peers) report that they draw on support, primarily from parents, in various financial tasks, including paying bills, choosing financial products, and taking loans from family or friends. Conclusions:This is the first study to consider the financial capability skills and functional financial literacy of young adults with developmental language disorder. We provide novel evidence that some young adults with developmental language disorder lack functional financial skills and require support to successfully manage their finances. This has policy implications that relate not only to engaging affected individuals in discussions about financial management but also to wider familial support.

Project description:ImportanceMedicare beneficiaries with cancer are at risk for financial hardship given increasingly expensive cancer care and significant cost sharing by beneficiaries.ObjectivesTo measure out-of-pocket (OOP) costs incurred by Medicare beneficiaries with cancer and identify which factors and services contribute to high OOP costs.Design, setting, and participantsWe prospectively collected survey data from 18 166 community-dwelling Medicare beneficiaries, including 1409 individuals who were diagnosed with cancer during the study period, who participated in the January 1, 2002, to December 31, 2012, waves of the Health and Retirement Study, a nationally representative panel study of US residents older than 50 years. Data analysis was performed from July 1, 2014, to June 30, 2015.Main outcomes and measuresOut-of-pocket medical spending and financial burden (OOP expenditures divided by total household income).ResultsAmong the 1409 participants (median age, 73 years [interquartile range, 69-79 years]; 46.4% female and 53.6% male) diagnosed with cancer during the study period, the type of supplementary insurance was significantly associated with mean annual OOP costs incurred after a cancer diagnosis ($2116 among those insured by Medicaid, $2367 among those insured by the Veterans Health Administration, $5976 among those insured by a Medicare health maintenance organization, $5492 among those with employer-sponsored insurance, $5670 among those with Medigap insurance coverage, and $8115 among those insured by traditional fee-for-service Medicare but without supplemental insurance coverage). A new diagnosis of cancer or common chronic noncancer condition was associated with increased odds of incurring costs in the highest decile of OOP expenditures (cancer: adjusted odds ratio, 1.86; 95% CI, 1.55-2.23; P < .001; chronic noncancer condition: adjusted odds ratio, 1.82; 95% CI, 1.69-1.97; P < .001). Beneficiaries with a new cancer diagnosis and Medicare alone incurred OOP expenditures that were a mean of 23.7% of their household income; 10% of these beneficiaries incurred OOP expenditures that were 63.1% of their household income. Among the 10% of beneficiaries with cancer who incurred the highest OOP costs, hospitalization contributed to 41.6% of total OOP costs.Conclusions and relevanceMedicare beneficiaries without supplemental insurance incur significant OOP costs following a diagnosis of cancer. Costs associated with hospitalization may be a primary contributor to these high OOP costs. Medicare reform proposals that restructure the benefit design for hospital-based services and incorporate an OOP maximum may help alleviate financial burden, as can interventions that reduce hospitalization in this population.

Dataset Information

Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities.

Publications

Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities.

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