Improving and Modernizing Federal Disability Programs
Federal disability programs remain in need of modernization. Numerous federal programs provide a range of services and supports for people with disabilitiesincluding 45 employment-related programsthat together represent a patchwork of policies and programs without a unified strategy or set of national goals. Further, three of the largest federal disability programsmanaged by the Social Security Administration (SSA) and Department of Veterans Affairs (VA)rely on out-of-date criteria to a great extent in making disability benefit decisions. While SSA and VA have taken concrete steps toward updating their criteria, these disability programs emphasize medical conditions in assessing an individuals work incapacity without adequate consideration of the work opportunities afforded by advances in medicine, technology, and job demands. Finally, federal disability benefit programs are experiencing growing disability claim workloads as the demand for benefits has increased under a difficult job market. Thus, challenges are likely to persist, despite concerted efforts to process more claims annually. GAO designated improving and modernizing federal disability programs as high risk in 2003.
GAO recently identified 45 programs under nine agencies that helped people with disabilities obtain or retain employment, reflecting a fragmented system of services and supports. Many of these programs overlapped in whom they served and the types of services they provided. Such fragmentation and overlap may frustrate and confuse program beneficiaries and limit the overall effectiveness of the federal effort. Having extensive coordination and overarching goals can help address program fragmentation. Although GAO identified promising coordination efforts among some programs, most reported not coordinating with each other, and some officials told us they lacked funding and staff time to pursue coordination. Coordination efforts can be enhanced when programs work toward a common goal; however, the number and type of outcome measures used by the 45 programs varied greatly. To improve coordination, efficiency, and effectiveness, GAO suggested that the Office of Management and Budget (OMB)the focal point for management in the executive branchconsider establishing government-wide goals for employment of people with disabilities. Consistent with this suggestion, OMB officials stated that the Domestic Policy Council began an internal review intended to improve the effectiveness of some disability programs through better coordination and alignment. According to OMB officials, this review included six agencies and, to date, has resulted in the U.S. Departments of Education and Labor coordinating their spending plans related to disability technical assistance and research. Further, OMB officials reported that Education is coordinating with three other federal agencies to implement a pilot that supports positive education and employment outcomes for youth receiving Social Securitys Supplemental Security Income benefits. The administration also issued an executive order that reaffirmed goals for hiring people with disabilities in the federal government and has reported making progress toward those goals. However, hiring goals do not extend to hiring sectors other than the federal government.
Since the 2011 high risk update, SSA and VA have taken important and concrete steps toward updating and modernizing their eligibility criteria used to determine disability benefits, but varied challenges may impede their progress. SSA and VA have developed plans and committed resources toward comprehensively updating the medical and labor market information that underlie their respective disability criteria. However, GAO recently found that both agencies face challenges in ensuring timely updates. For example, resource constraints have impeded SSAs efforts to ensure timely updates to its medical criteria, while VA lacks sufficient capacity to produce timely research on veterans average earnings loss associated with service-connected disabilities. Further, SSA lacks a complete, reliable, and transparent cost estimate and schedule for replacing its outdated occupational information system, and risks schedule and performance shortfalls. VA lacks complete planning in key areas that could jeopardize project outcomes and, in the end, could result in outdated disability criteria whereby some individuals may be overcompensated while others may be unfairly denied benefits or undercompensated. GAO recommended actions the agencies could take to address these issues, and SSA and VA agreed with GAOs recommendations.
Finally, although both agencies have taken steps toward greater consideration of an individuals ability to function with a disabilityconsistent with modern views of disabilitythe agencies still do not take into consideration the full range of assistive devicessuch as a device to assist with vision impairmentor, in the case of SSA, workplace accommodations available today. SSA has disagreed with GAOs recommendation to conduct limited, focused studies on how to more fully consider such factors in its disability determinations, stating that such studies would be inconsistent with Congress intentions. However, GAO noted that Congress has not explicitly prohibited SSA from considering these factors and believes that conducting these studies would put SSA in a better position to thoughtfully weigh the costs and benefits of these various policy options before deciding on a course of action.
Agencies have made real progress in managing growing workloads related to processing claims for disability benefits; however, workload challenges persist due in part to unprecedented demand for benefits. Over the last several years and through fiscal year 2012, SSA and VA have steadily and significantly increased the number of disability claims processedat the initial decision level for both agencies and the appellate level for SSA. Thus, for initial claims, SSA has reported drops in claims pending since fiscal year 2010 and improvements in processing times, while for hearings workloads, SSA reported improved processing times for and reductions in the number of aged casesthe oldest and often the most complex casesthrough 2011. Likewise, VA has increased case completion since 2009 by 6 percent. Finally, VAs and the Department of Defenses (DOD) Integrated Disability Evaluation System (IDES) has shown promise for expediting the delivery of VA and DOD benefits for wounded, injured, and ill servicemembers leaving military service. However, with a challenging job market, a fiscally strained environment, and hundreds of thousands of military servicemembers returning to civilian life, these agencies still face challenges associated with managing significant and persistent workload increases.
- While SSA is processing more initial claims annually, and has reduced initial claims pending since fiscal year 2010, incoming claims are growing, such that SSAs 759,000 initial claims pending in fiscal year 2011 were 36 percent higher than fiscal year 2008 levels. Further, many claims denied at the initial level often result in a request for a hearing. As a result, SSA experienced sizeable new hearings workloads and a substantial number of pending hearings (about 850,000) in 2012. SSAs mitigation plans to address these challenges include leveraging technology and identifying ways to simplify its claims process.
- The number of claims that VA received grew 29 percent from fiscal year 2009 to fiscal year 2011. As a result, as of August 2012, VA had more than 856,092 claims pending, of which 66 percent were considered backlogged. The overall time VA takes to decide veterans claims has also increased: average days pending more than doubled from 2009 to August 2012, and timeliness for processing appeals also worsened. VA is taking steps to redesign the claims process but is not yet fully positioned to evaluate its effectiveness.
- Although still faster than the legacy process, IDES case processing timeliness has worsened, as the program has expanded from a pilot with smaller caseloads to 139 locations with larger caseloads worldwide. Specifically, GAO found that annual average processing times increased by more than 100 days between fiscal years 2008 and 2011. DOD subsequently reported improved overall processing times compared to fiscal year 2011 levels, but still above agency goals. Extended time in the disability determination process has, in turn, negatively affected servicemembers ability to plan for their future as well as lengthened the period for which the military must care for and house these servicemembers. VA and DOD are undertaking a business process review to understand and address the complex factors influencing timeliness, but the completion date and efficacy of that review are not yet known.
Actions taken by OMB and the Domestic Policy Council to study and consider options for better coordinating and improving the effectiveness of federal disability programs represent an important step forward. However, sustained attention is needed in this area to assure enduring progress. Specifically, OMB needs to maintain and expand its role in improving coordination across programssuch as the 45 GAO identifiedthat support employment for those with disabilities, and ultimately work with all relevant agencies to develop measurable government-wide goals to spur further coordination and improved outcomes for those who are seeking to find and maintain employment.
With respect to updating and modernizing disability criteria, SSA and VA have demonstrated a strong commitment, but still need to take additional actions to manage this process more strategically, particularly around the agencies planning and research efforts. Specifically, GAO recently recommended that SSA explicitly identify resources needed to update its medical listings and that VA develop a written strategy for seamlessly implementing revisions to its criteria. Further, GAO recommended that SSA complete plans to replace its occupational information system in line with best practices for developing a cost estimate, schedule, and risk assessment, and that VA develop a more complete plan to conduct earnings loss and validation studies. In terms of research, GAO recommended that SSA conduct focused studies on how to more fully consider assistive devices and workplace accommodations in its disability determinations. GAO also recommended that VA increase its research capacity to determine the impact of impairments on veterans earnings in a timely manner, ensuring that decisions about compensation benefits are informed by current information.
To address growing claims workloads, SSA, VA, and DOD leadership have demonstrated a strong commitment and invested additional resources. However, in the face of persistent disability claims workloads and constrained resources, SSA will require continued management attention to initiatives articulated in its strategic plan to sustain progress toward meeting key goals. As GAO has noted in recent work, VA needs to ensure the development of a robust backlog reduction plan that includes performance goals incorporating the impact of improvement initiatives on processing timeliness. Finally, VA and DOD need to develop frames for the ongoing IDES business process review as well as for implementing any resulting recommendations.