American Indian and Alaska Natives (AIAN) participate in the Supplemental Security Income (SSI) program at about twice the rate of the general population. Despite experiencing some of the worst poverty and mortality rates of demographic groups in the US, there is very little research examining how the social safety net affects these individuals. Are there specific factors that drive utilization of public support and public health programs? How do these programs interact with one another to improve wellbeing? In this study, we propose to examine the expansion of Medicaid to eligible adults on SSI participation by AIAN individuals with particular attention to the interaction between Medicaid, SSI, and the geographic variation in the resources available through the Indian Health Service (IHS) system and tribes.
Prior to the expansion of Medicaid to low income childless adults primarily gained access to Medicaid through SSI. As a result, previous research has shown that the expansion of Medicaid coverage led to reductions in this group’s SSI participation. There is a high probability that the effects of Medicaid on SSI use for the AIAN population are even larger than in the general US population. This is due to high rates of participation in SSI, large take-up rates of Medicaid by AIAN individuals after state expansions, the interaction between Indian Health Services and Medicaid, and other tribal policies that affect SSI use.
The two aims of this study are to (1) develop a rich source of data on IHS and tribally specific resources that impact AIAN SSI participation, and (2) to provide the first estimates of the relationship between access to health insurance and health services, the quality of health services, and SSI use by Native individuals.