P2.F115: Supplemental Security Income Application Assistance in a Medical-Legal Partnership: A Qualitative Study with NICU Families

Background: Children in low-income settings disproportionately suffer adverse social determinants of health and experience health disparities. Neonatal intensive care unit (NICU) families may bear high financial burdens while navigating psychological distress and caring for infants with special healthcare needs, thus perpetuating health inequities. Supplemental Security Income (SSI) can provide a meaningful difference in the health and well-being of children by improving families’ financial stability. Many NICU infants are medically eligible for SSI benefits, but the application process is long and complicated for overwhelmed, distressed families.

Project Description: In 2020, Doernbecher Children’s Hospital established a medical-legal partnership (MLP) within a NICU and fetal care program (FCP), the first of its kind in the nation. Once this perinatal MLP identified trends in social and legal needs, it created the SSI Assistance Program, a novel interdisciplinary approach to helping families complete the SSI application for their newborn. We conducted semi-structured qualitative interviews via telephone with NICU/FCP families who engaged with the MLP SSI Assistance Program. Questions examined: how assistance in completing the SSI application impacted families, families’ perspectives on the application, and opportunities for program improvement. Inductive coding and descriptive inquiry methods were used to analyze the data. Descriptive statistics were used to describe the client population. Participants received a gift card in appreciation of their time.

Discussion: Out of nine eligible families, five consented to participate. All five participants spoke English and most participants self-identified as white (80%) with at least some college education (80%). Four out of five participants successfully received SSI benefits. Two primary themes emerged from the data: 1) personal and technical barriers prevented participants from completing the SSI application independently; and, 2) the SSI Assistance Program offered immediate and long-term benefits. Personal challenges included postpartum stress, managing childcare for siblings, and literacy challenges. Technical application barriers included challenges with navigating lengthy online forms, medical literacy, and the ability to retrieve detailed medical information for their infants. Participants reported they appreciated the friendly and knowledgeable staff and the welcoming, collaborative environment during the application assistance process. Longer-term benefits included reduced stress and improved transition home.

Conclusion: NICU/FCP families deserve access to supports, such as SSI assistance, that can improve financial stability. Our findings suggest that the MLP SSI Assistance Program was beneficial to NICU families by helping them overcome barriers to completing the application, especially in a challenging healthcare context. Novel approaches, such as the MLP SSI Assistance Program, may be effective solutions to improve the accessibility of public benefits and advance health equity among high-risk infants and families within healthcare systems.