The goal of the proposed research is to test how expectations about the availability of disability benefits in adulthood affect investments in child health. Although there is evidence on how disability enrollment affects contemporaneous labor supply, there is little evidence on how the expected future availability of disability benefits affects current incentives to invest in health and human capital. The PIs will study how beliefs about the availability of Supplemental Security Income (SSI) benefits in adulthood affect health investments during childhood and the long-term well-being of disadvantaged children. SSI is a rapidly expanding program that provides cash benefits and Medicaid eligibility to 1.3 million low-income, disabled children in the U.S., many of whom are at risk for poor life outcomes. Nearly 70 percent of children with mental conditions other than intellectual disability are removed from SSI at age 18, but qualitative evidence indicates that SSI families underestimate the likelihood of removal from SSI. The hypothesis motivating this project is that inaccurate beliefs about removal lead SSI households to underinvest in the health and human capital of their children.
The ultimate goal is to conduct a randomized controlled trial (RCT) of providing the families of SSI children with information about the SSI likelihood of removal at age 18 as well as “nudges” and resources to promote health and human capital investments. The PIs will evaluate the effects of the RCT on health and human capital investments and the long-term well-being of SSI children in adulthood. To accomplish this goal, the PIs will 1) conduct a survey on parent and child belief inaccuracies to inform the design of the RCT and 2) pilot the RCT. The survey will serve three primary purposes: filling a gap in the literature by providing quantitative evidence on whether households overestimate the availability of future SSI benefits; informing RCT design by identifying subpopulations with particularly inaccurate beliefs and identifying barriers to investment; and providing “baseline” beliefs about removal to facilitate analysis and interpretation of the RCT effects.
In addition, the PIs will pilot the RCT design, including written communication and counselor outreach on the likelihood of removal and specific “nudges” and resources. For the written communication, the PIs will test the number of responses to different letter and envelope designs. For the counselor calls, the PIs will compare the effectiveness of several approaches in contacting families, such as cold calling versus calling after an introductory text message. In addition, the PIs will pilot various “nudges” to promote health investment, such as sending pre-filled applications for vocational rehabilitation services, referring families to the closest Community Health Center, and offering paid subscriptions to disability support groups and literature. Piloting these approaches will improve the cost-effectiveness and power of the intervention.
Supported by the National Institute of Child Health & Human Development grant #1R21HD09147201A1
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