The SSA Program for Reviewing the Continuing Eligibility of Disabled Persons

In testimony before a Senate committee, GAO discussed the Social Security Administration's (SSA) reexamination of the eligibility of disabled persons receiving benefits, commonly referred to as continuing disability investigations, which began in March 1981. Because of congressional concern about the large number of beneficiaries terminated from the rolls, in January 1982 GAO began to review SSA policies and practices for conducting these investigations which are performed by various State disability determination services. GAO found that the States reviewed about 240,000 cases in the past year and terminated benefits in about 44 percent of the cases. Many of the terminated cases have been appealed to the administrative law judges, and benefits for about 67 percent of those reviewed were reinstated. GAO found that the current high termination rate is due to the States' new criteria and guidance which has been furnished by SSA. GAO also found two problems in the SSA decisionmaking process: (1) the attending physician's data are often not useful to the examiners; and (2) decisions are too frequently based solely on evidence no more than 2 to 3 months old and on "one-shot" consultative medical examinations. As a result, many persons whose medical condition has not changed or has worsened are being terminated from the rolls. GAO believes that Congress should state whether terminations are appropriate for those already on the disability rolls whose medical condition has not improved. GAO also suggests that Congress clarify other medical improvement issues, such as how to deal with those who are on the rolls as a result of clearly erroneous awards and those who, despite no medical improvement, clearly come under changed eligibility criteria or definitions.