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Reduced assistance in Puerto Rico for the elderly, blind or disabled

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Reduced assistance in Puerto Rico for the elderly, blind or disabled

This is the fourth article in the series titled “SSI: Discrimination against Puerto Rico,” a special project in collaboration with the USC Annnenberg Center for Health Journalism's 2022 Impact Fund for Health Equity and Health Systems.

Other stories include:

Plaintiffs demand a halt to discrimination on SSI in Puerto Rico

SSI extension to Puerto Rico lies in Congress’s court

Victims of discrimination: family recounts how they lost SSI when they returned to Puerto Rico

Between the aforementioned categories, until last month, there were 30,207 beneficiaries in Puerto Rico.
Between the aforementioned categories, until last month, there were 30,207 beneficiaries in Puerto Rico.
El Nuevodia
Tuesday, June 7, 2022

While U.S. citizens and non-citizens who legally live in all 50 states, Washington D.C. and the Northern Mariana Islands can access the Supplemental Security Income (SSI) program, people in Puerto Rico cannot. They are only eligible for a federal assistance program called Aid for the Aged, Blind and Disabled (AABD), which provides substantially less help.

The categories covered by the AABD are administered on the island by the Temporary Aid Program for Needy Families (TANF), which in turn is managed by the Puerto Rico Family Department.

“The main difference lies in the benefits that the participant receives. Right now, participants who receive TANF in one of those three categories receive minimal benefits, compared to a citizen who receives regular SSI benefits,” said Alberto Fradera, administrator of the Family Socioeconomic Development Administration (ADSEF, in Spanish), in an interview with El Nuevo Día newspaper.

In TANF, under Category A, poor adults over the age of 65 receive $80 per month. Under Category B, poor blind people with a 20/200 vision or less receive $128 per month. Meanwhile, in Category D, people over 18 with a total and permanent disability receive $80 per month.

“In most cases, these participants are concerned about their medication,” Fradera said. “The amount received by older adults, who mostly live on their own, does not give them enough to cover monthly expenses.”

Contrary to the limited help in the AABD program, the maximum SSI payment in the United States is $841 per month, with an eligible couple receiving up to $1,261, according to the most recent review by the Social Security Administration (SSA), which manages this program.

The maximum amount of SSI payments increases alongside the cost of living increase that is applied to Social Security benefits. The last increase of this type was 5.9% and was implemented in January.

Between the aforementioned categories, until last month, there were 30,207 beneficiaries in Puerto Rico. However, according to a five-year estimate from the Puerto Rico Community Survey that the Census Bureau carried out in 2020, some 455,200 people on the island could be eligible to receive SSI under the three available categories.

That estimate, which represents an update to the number of eligible individuals in Puerto Rico, was reviewed for El Nuevo Día by Judith Rodríguez, a demographer and retired professor at the University of Puerto Rico (UPR), and Rafael Irizarry, a biostatistician and professor at Harvard University, with the collaboration of demographer Wilmari de Jesús and Mónica Robles, a statistician at the Puerto Rico Department of Health.

Prior to the new estimate, the Center for a New Economy (CNE), a San Juan-based think-tank, had calculated that there were 435,886 potential beneficiaries, based on data from the 2018 Puerto Rico Community Survey.

Through the AABD, the federal government grants some $26 million annually to Puerto Rico, to which $6.2 million in state funds are added. The benefits of this assistance could be expanded, but only with the Puerto Rico government’s own resources.

Fradera explained that, under TANF, there are three other categories. In all, the government has received approximately $71 million per year since it began operating in 1998, he added. The federal government doesn’t cover the administrative costs, so the state government must supply more than $20 million in matching funds to run the program. Categories A, B and D have been administered by the state government since at least 1981, Fradera specified.

In 2020, the SSA estimated that extending the SSI to the island would cost $2.27 billion per year. When Congress created the SSI in 1972, it did so to standardize federal assistance to several of the most vulnerable groups in the United States and to combat poverty. However, Puerto Rico, the U.S. Virgin Islands and Guam were expressly excluded.

Under SSI, there are three categories of eligibility: adults age 65 and older, and blind or disabled people with low income and resources. One of the main differences is that the AABD does not grant benefits to children, whereas a person of any age can become eligible for SSI.

Another difference is that a person who receives some type of income, including Social Security benefits, may still be eligible for SSI. In Puerto Rico, beneficiaries of categories A, B and D cannot have any income.

“It is a matter of civil rights, of human rights,” Fradera stressed. “In the times we are living as a population in an island, where everything increases (in cost), it’s time for us to be heard and for Puerto Rico to receive the equal treatment it deserves.”

In April, the United States Supreme Court upheld the exclusion of residents of Puerto Rico from SSI in the case of José Luis Vaello Madero. Most of the Supreme Court justices held that the Territorial Clause of the Constitution gives Congress the power to extend a welfare program without any obligation to do so. It also determined that the exclusion of island residents from the SSI program is not a constitutional violation of the Due Process Clause in the Fifth Amendment.

A class-action lawsuit, which was paused by the Vaello Madero case and is now seeking an opportunity before the federal district court, states that the exclusion of SSI to Puerto Rico residents violates the Citizenship Clause of the Fourteenth Amendment. The group of plaintiffs is made up of seven women and five men ranging in age from 26 to 75 years, all U.S. citizens.

Three of the plaintiffs are adults 65 or older who, despite meeting the age established by one of the eligibility categories, cannot receive SSI in Puerto Rico. The rest are individuals suffering from various disabling health conditions, including severe intellectual disability, cerebral palsy, spastic quadriparesis, lupus, schizophrenia, spina bifida and hydrocephalus, total vision loss and kidney conditions, among others.

The most vulnerable, excluded from SSI

Kidney disease, like many other chronic conditions, leads patients to a life of fragility and disability, making their daily activities difficult, said Zaisca Pacheco, a social worker at the Pediatric Renal Center. Data from the Puerto Rico Renal Council shows that, out of 6,200 people under dialysis on the island, 11 of them are children. “It seems a small number, but the fact that there is a single boy or girl who is on dialysis is a lot,” she said.

According to the Renal Council, by 2017, 17.8% of the population (473,959 people) had diabetes and 45.1% (1,228,492) suffered from hypertension, while 68.3% (1,778,464) are obese or overweight. Those conditions are the main risk factors of kidney disease.

“(Apart from the disease), economic stressors are the most complex issue families face because the costs involved are so great. For example, vitamins and specific nutritional supplements are not covered by the plans, and a case of 24 eight-ounce bottles can cost $60,” Pacheco estimated.

Transportation is another economic challenge families must deal with. The Pediatric Hospital is the only place that offers dialysis to this population and receives patients from all over the island. For adults, there are Medicare Advantage plans that limit the number of trips per month, despite the fact that many patients must undergo dialysis three or four times a week, Pacheco denounced.

“The high costs of treating a chronic disease, without a cure or (with prolonged treatment), can displace anyone into poverty and affect the quality of life (of these patients and their families),” stressed the social worker.

She added that 60% of kidney patients have diabetes, which in turn can cause blindness.

“Any chronic disease not treated in time can become a disability. We see that in dialysis patients. It is very difficult for them to be able to remain active in the labor force, so their income goes down, and kidney failure becomes a disability. At the pediatric level, it is also difficult for them to go to classes, although there are reasonable accommodations,” she said.

“Gender, age and poverty status are linked to more deaths and disability in patients with chronic conditions. It is a population hit by multiple economic stressors and many limitations. Being able to count on other assistance helps with those stressors,” Pacheco said.

Moving to the United States is not easy for kidney patients, she added. Acceptance into other state programs depends on the patient’s medical coverage, and many programs have new patients on long waiting lists. But dialysis patients qualify “almost immediately” for SSI in the United States, Pacheco said. In Puerto Rico, however, that access is blocked.

Gabriel Corchado, who heads the Ombudsman for People with Disabilities office, said most of the calls his office receives are related to basic and economic needs.

“Out of 20 calls a day, half may be for some type of financial aid or some expense due to their condition. These types of calls are channeled through referrals to municipalities, nonprofit institutions or government agencies that could help that person,” the official said.

Low income versus great needs

The ombudsman for the Elderly, Carmen Delia Sánchez, urged access to SSI for the more than 256,000 adults 65 or older who live below poverty levels in Puerto Rico. “Many receive minimum income from Social Security. Few make more than $1,000 in Social Security (per month). That is why SSI is created… Social Security is not enough to survive,” she noted.

The need to achieve higher incomes that would contribute to a better quality of life in this sector is urgent, she added. Although the need for long-term care prevails, in Puerto Rico there is no federal aid for this type of service, Sánchez explained. This means elderly care homes are usually paid for by their relatives, out of the patient’s own savings if there are any or by the Puerto Rico Family Department, if the person qualifies.

The official indicated that barely 8% of the population 60 or older remains on the active labor force, which places further pressures for additional income, particularly to buy medicines, cover medical expenses, transportation, nutrition and housing.

The spokesman for the Puerto Rico National Association of the Blind, Frank Pérez, also made an urgent call to the federal government so that this population has access to SSI in Puerto Rico. “With the cost of living and medicine so high and the few employment opportunities for this population, many live in poverty,” Pérez said.

[This article was originally published by El Nuevodia.]

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