As more people leave the welfare rolls, it's increasingly clear that many who remain--or who leave but end up jobless--are those with physical, mental and other disabilities.

The number of people with these conditions is still unclear, particularly in the case of less visible cognitive, emotional and physical impairments. But a report from the Washington, D.C.-based Center on Budget and Policy Priorities estimates that of those who qualify for Temporary Assistance to Needy Families (TANF) 25 to 33 percent have a serious mental health problem, nearly 20 percent have physical disabilities and 2 percent to 20 percent report substance abuse problems.

At particular risk, analysts say, are people with less visible disabilities such as depression, chronic health conditions, hearing loss, some developmental disabilities and learning impairments. They don't qualify for special disability funds under the Supplemental Security Income (SSI) program and tend to fall through the cracks because of difficulty navigating TANF, say experts.

In fact, many of those having difficulty leaving the welfare rolls because of hidden disabilities might actually qualify for SSI but would likely face bureaucratic tangles because many states have treated SSI and TANF as separate and unrelated funding streams, comments Susan Prokop, associate advocacy director at the advocacy organization Paralyzed Veterans of America (PVA). Capitol Hill is likely to start sounding alarm bells as the possibility arises that those who still need welfare funds will attempt to gain SSI coverage, she says. Likewise, she notes, disability advocacy groups like PVA are starting to worry that these individuals will be barred from such funds because of possible political maneuvers to reduce SSI coverage.

"The new welfare rules have a particularly strong impact on people with these more 'invisible' impairments," comments Cheryl Bates-Harris of the National Association of Protection and Advocacy Systems, a Washington, D.C.-based organization that provides legal and advocacy services to people with disabilities.

The rigid, complicated nature of TANF often undermines people's intentions of getting off welfare, Bates-Harris explains. TANF's requirements--which include such elements as attending job-search sessions and completing complex paperwork--could tax anyone's organizational skills, she says.

"In effect, the system says to recipients, 'If you don't do these four, five or six things in the right order, you're not in compliance with our program."

Those with substance use problems or mental health disorders are a second category of people whose disabilities keep them from navigating the system, though for different reasons. These people are often afraid to admit to their problems for fear of reprisal, in particular from child-protective services, Bates-Harris says.

"As soon as they admit to having these impairments, it kicks up a whole host of other issues, not the least of which is the system asking them whether they're fit [parents]," she says. When it comes to substance abuse, employers and insurance companies who are applying the Americans with Disabilities Act (ADA) are allowed to consider people with these problems as people with disabilities, as long as they are seeking or receiving treatment and aren't actively using a substance.

But the issue becomes confounded, says Bates-Harris, when welfare reform enters the picture: Sobriety requires a full-time commitment, yet these people feel their benefit-limit "clock" ticking away. "This pressure to 'work first' can add pressure to an already pressured individual who may be using drugs or alcohol to self-medicate other problems in her life," Bates-Harris says.

The situation is further complicated by the fact that disability is defined differently by the ADA--a civil rights act designed to cover as many people as possible--and SSI--a welfare-like benefits program that seeks to narrow the definition of disability to reduce the amount it pays out, says PVA's Prokop. These differing attitudes toward the meaning of disability are likely to create confusion about who's eligible to receive SSI benefits and who's required to work once TANF eligibility ends, she says.

APA is weighing in on these issues as a member of the Consortium of Citizens with Disabilities, a public policy coalition of about 100 national disability organizations that advocates for the empowerment of people with disabilities and their inclusion in all aspects of life. The organization is busy drafting arguments favoring supports for people with disabilities and their children in preparation for the reauthorization of TANF in 2002.