Place and Disability Program Enrollment: Comparing Two Rural Counties

Abstract

Enrollment in disability programs is shaped by both individual- and community-level factors. How does the process of getting on Social Security disability assistance differ between places? To answer this question, we draw on interviews with 47 disability assistance recipients or heads of households and 21 community experts in two rural counties with high rates of disability claims: Clay County, Kentucky, and Humphreys County, Mississippi. There are notable differences between the two sites. Clay County is over 90 percent non-Hispanic white, and Kentucky adopted Medicaid expansion in its implementation of the Affordable Care Act. Conversely, Humphreys County is majority-Black, and Mississippi has yet to adopt Medicaid expansion. In our analyses, we find that most recipients in Clay County followed an institutionally supported model to claim disability benefits. Potential claimants were encouraged to enroll by different organizations—schools, hospitals, healthcare clinics, and government agencies—and were often approved quickly. In Humphreys County, people largely followed a self-help model for receiving benefits. They were encouraged by friends and family members to apply but frequently experienced long wait times and multiple rejections. Most respondents in Humphreys County hired lawyers. Our results highlight how the institutional infrastructure of communities shapes the burdens of applying for disability assistance. Changes to disability programs can make a difference for recipients, but policies and programs that support the viability of healthcare systems and social service providers in rural areas are also highly consequential.