Differential Take-Up of Supplemental Security Income in Florida for Very Low Birth Weight Infants

OBJECTIVE: Supplemental Security Income (SSI) eligibility is automatically granted for the subset of very low birth weight (VLBW) infants born below 1200 g. We estimated the effects of automatic eligibility on SSI take-up among VLBW infants near the cutoff, both overall and for key subgroups. METHODS: We analyzed Florida birth certificates merged with Social Security Administration records from 1990 to 2015. Our sample included 21 606 infants with gestational age under 32 weeks and birth weight between 1000 to 1400 g. Using a regression discontinuity approach, we tested whether SSI take-up by VLBW infants was higher under the 1200 g cutoff and whether take-up differed by individual characteristics. RESULTS: Our results indicated that SSI take-up increased by 19.1 percentage points at the 1200 g cutoff. Baseline take-up rates were the highest for mothers who were Black, less educated, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants, or low-income county residents. Increases in take-up at the SSI eligibility threshold were the largest for mothers who were non-Hispanic Black, other race and ethnicity, or WIC participants. CONCLUSION: Our results suggest that the SSI 1200 g eligibility threshold matters-infants just below it were significantly more likely to participate in the program. Take-up among eligible infants varied by individual characteristics, in ways consistent with the program being well-targeted-reaching many infants with worse health and lower income-and yet take-up was far less than universal even for birth weight eligible infants, suggesting a need for additional outreach. Participation was even lower for VLBW infants who were not automatically eligible but could have benefited from the program.