Geographies of medicalized welfare: Spatial analysis of supplemental security income in the U.S., 2000-2010

In the post-1996 welfare reform period in the U.S., disability assistance has become a significant source of government aid for low-income residents as other forms of public support have faced considerable reductions and restrictions. In order to qualify for Supplemental Security Income (SSI) - a means-tested assistance program that provides income stipends to qualified residents - working-age individuals with disabilities must have little income and resources, and procure medical documentation that confirms that they are unable to work due to a disability. The result of rising SSI enrollment in the face of cutbacks to other government programs is the increasing medicalization of welfare, whereby receipt of welfare benefits is contingent on a medical diagnosis of disability. Using county-level data from the American Community Survey and the Social Security Administration, this paper examines the changing spatial patterns of SSI participation of the working-age population in 2000 and 2010 across the U.S. in addition to the interconnections between disability, welfare, and poverty. Results from spatial analyses illustrate geographic variation in SSI prevalence, with distinctive spatial clusters of higher than average SSI participation in the southeast and Appalachian regions of the U.S. and in northern California. Multiple linear regression model results reveal that SSI participation is significantly correlated with disability, poverty, race, family type, and level of education in both 2000 and 2010. The findings suggest that spatial concentrations of disability, poverty, and underemployment persist in largely rural areas. The discussion explores the potential social and economic implications of long-term SSI clustering on localities and residents, and points to future research directions.