Report Nº: 112004/05/2025
Disability assistance operates under a complex set of rules that promise many benefits without contemplating how to finance them. The adjustment occurs by updating the price list of benefits below inflation. The main consequence is that many disabled people are left without coverage.
At the national level, the disability protection system is regulated by two overlapping laws. One is Law 22.431, dictated in 1981 by the military dictatorship, and the other is Law 24.901, passed in 1997. Each province has its own disability protection law, which also overlaps with the two national laws. The National Disability Agency (ANDIS) grants the Single Disability Certificate (CUD, in Spanish) based on medical evaluations carried out by the provinces.
Law 24.901 establishes that people who have the CUD are entitled to rehabilitation, education and social assistance benefits (habitat, food, transportation and accompaniment). The set of benefits is understood to be unlimited in terms of what the disabled person requires. The provision and financing are the responsibility of health insurance entities. For people without insurance, the provincial health systems are supposed to be responsible for these benefits. There is a registry of disability providers that passes the bill to health insurance entities for the services provided to the disabled and a prices list (NUD, in Spanish) that sets the rates for the services to be billed.
The values of the NUD are set by the national government. Taking as a base December 2017 = 100, the moment before the beginning of the inflationary acceleration, it is observed that:
These data show that the prices list (NUD) suffered a profound loss of real value, i.e., the amounts paid to disability benefits providers have been updated well below inflation. The natural consequence is accessibility limits to disability services and the proliferation of co-payments. In other words, the real value loss of the NUD ends up being paid by families with denial of services and/or out-of-pocket expenses.
The origin of the problem is excessive opportunism. On the one hand, rights are established in a broad, ambiguous manner, with indeterminate limits and free of charge. On the other hand, their provision and financing are delegated to private entities (health insurance entities) or the provinces. As the scheme is financially inconsistent, the excess consumption of services is compensated with the loss of real value of the prices list. The declaration of rights in favor of the disabled without an appropriate financing mechanism ends in helplessness.
The disability coverage system needs an integral ordering. Firstly, it is essential to establish an objective and professional process for granting the Single Disability Certificate (CUD). The Medical Commissions of the Superintendence of Labor Risks are the best prepared for this challenge. On the other hand, the National Disability Agency (ANDIS) should be in charge of providing benefits with state funds, after reviewing the set of benefits to be provided. The objective is that the entire population with disabilities (not only those with health insurance) should have access to the same disability assistance services. In this way, a system of social protection for disability with equity would be achieved.
The social assistance system for disability suffers from the same disease as the social security system. Rights are granted indiscriminately with moratoriums, special regimes and multiple benefits, and then inflation and the manipulation of pension indexing rules reduce the benefits. In the case of disability, rights are regulated with demagogy and liberality and CUDs are distributed indiscriminately. To compensate for the lack of financing, inflation is set free to erode the price list real value (NUD). In both cases –distribution of CUDs and updating of NUDs– a comprehensive transformation is needed, not patches.
