Meeting Disability Needs at the Expense of Basic Needs: Financial Tradeoffs and Social Work Implications

Background

Disabled people often incur substantial out-of-pocket expenses for disability-related goods and services. These additional costs present difficult financial tradeoffs in which people with disabilities, under conditions of scarce resources, must prioritize spending on basic needs, like food and housing, or needed disability-related goods and services, like assistive technologies or medical and rehabilitation services. To date, research has yet to document these financial tradeoffs and how they vary according to the income sources people with disabilities rely upon. We hypothesize that, controlling for the number of functional limitations and other sociodemographic predictors: (a) people with disabilities in paid work will experience fewer disability-related financial tradeoffs than those not working, and (b) SSI/SSDI recipients will report more disability-related financial tradeoffs, reflecting the limited generosity of benefits and programmatic design features that limit disposable income, including asset limits and benefit cliffs.

Methods

We draw upon the Survey of Disability-Related Goods and Services, which was fielded to people with disabilities in the nationally representative Understanding America Study in June of 2023. Specifically, we analyze responses to questions on whether out-of-pocket disability-related expenses contributed to not being able to make ends meet, cutting the amount spent on food, going into debt, being unable to make rent, and feeling anxious because of costs. Data were analyzed using OLS regression.

Results

Among a nationally representative sample of working-age adults with disabilities ages 18-67 (N=1,076), 37% reported that their disability-related expenses make it difficult to make ends meet. In addition, 21% reported going into debt, 12% reported being unable to make rent, 23% reported cutting back on food due to their disability-related costs, and 40% reported that their extra costs of living make them feel anxious. Nearly one-third (31%) of the sample received SSDI and/or SSI benefits, and 40% were currently working. Disability benefit recipients consistently reported significantly higher hardships from their out-of-pocket, while people with disabilities in paid work reported significantly less financial burden.

Controlling for socio-demographics and state fixed effects, SSI/SSDI recipients are significantly more likely to go into debt (+11.6 percentage points, p < .001) and have difficulty making ends meet (+16.3 pp, p < .001), yet not significantly more likely to experience rent burden (+2.1 pp, p = .491). Conversely, current employment is associated with reduced anxiety resulting from disability-related costs (-9.8 pp, p < .01) while its protective effects against food and rent hardships are no longer significant once covariates are controlled.

Conclusion and Implications

Our results provide novel information on the difficult economic tradeoffs disabled people face meeting their disability-related needs and how these tradeoffs differ by income source. People with disabilities in work experienced less financial tradeoffs, relative to people with disabilities who rely upon public disability benefits. Future research should move beyond the assumption that employment ensures financial stability and address the structural benefit traps that perpetuate financial instability. Social workers should be aware of the financial tradeoffs facing their clients with disabilities and seek to provide access to resources that can help to meet their disability-related needs.