Income Security Policy Paper No. 17

Expensive Children in Poor Families: Out-of-Pocket Expenditures for the Care of Disabled and Chronically Ill Children and Welform Reform

Anna Lukemeyer, Marcia K. Meyers, and Timothy M. Smeeding

July 1997 

Abstract:  This study explores one aspect of the costs experienced by low-income families with one or more special needs children: direct, out-of-pocket expenses for items related to the child's disability, such as special foods, transportation to medical clinics, or medical costs not covered by insurance. We find that almost half (46 percent) of a sample of California AFDC families with special needs children experienced some special expenses in the preceding month. About 20 percent of these low-income families experienced total costs exceeding $100. Families with severely disabled children were more likely to experience costs and tended to experience higher costs. While no more likely to experience special expenses, families of children with mental impairments tended to have higher costs than those with physical impairments. The primary impact of special expenses was to increase the percentage of families in deep poverty: those at or below 75 percent of poverty-level income. Taken as a group, however, families with special needs children appeared no more poor than other families. Much of this parity may be due to the Supplemental Security Income (SSI) program. Among families with severely disabled children, only 32 percent of those receiving SSI lived at or below poverty, while three quarters of those without SSI lived at or below poverty. Our findings suggest that out-of-pocket expenses are a substantial burden for some low-income families with special needs children and that the Supplemental Security Income program does a good job of alleviating these extraordinary outlays.

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