“I'm not one of those people:” Why people delay applying for Social Security Disability benefits when they need them

We conducted 11 focus groups with 67 underinsured urban and rural Kansans with chronic health conditions who were potentially eligible for, but not receiving, federal disability benefits (e.g., SSDI). Many individuals in these groups reported an inability to afford health care and discussed potentially harmful strategies to offset care costs such as delaying prescribed procedures, forgoing preventive care, and skipping doses of medications—behaviors similar to those reported by people without insurance who could not afford care. Studies show that previously uninsured Medicare recipients have increased morbidity, use more medical services, and spend more on treatment than their previously insured counterparts in Medicare. While the individuals in focus groups were potentially eligible for benefits that would have eventually provided them with access to needed medical services, several reported that they delayed applying for disability, particularly those from rural areas. Such application delays extend the already lengthy disability application process of, on average, 503 days when a disability hearing is required. The application process also precedes a 24 month waiting period before medical benefits are available. For individuals like those in our focus groups, such delays may result in poorer long-term health outcomes and cost the government additional monies to treat conditions that could otherwise have been prevented. This paper presents themes explaining why some individuals delay their disability applications until they have no other recourse (e.g., stigmas associated with SSDI and people who receive it; self-perceptions of non-disability; and awareness of others' negative experiences with disability determination process).