Social Security Disability:

Alternatives Would Boost Cost-Effectiveness of Continuing Disability Reviews

HEHS-97-2: Published: Oct 16, 1996. Publicly Released: Oct 29, 1996.

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Pursuant to a congressional request, GAO reviewed the Disability Insurance (DI) and Supplemental Security Income (SSI) programs, focusing on: (1) the backlog of DI and SSI cases due for continuing disability reviews (CDR); (2) the number and characteristics of individuals who are due for CDR; (3) whether adequate resources are available for conducting CDR; and (4) ways to improve the CDR process.

GAO found that: (1) almost half of all DI and SSI beneficiaries are due or overdue for CDR in fiscal year 1996; (2) the typical beneficiary awaiting CDR is under age 59, has been receiving benefits for an average of 8 years, is unlikely to medically improve, and has been overdue for CDR for 3 years; (3) SSA uses either a full medical examination or a mail-in form to conduct CDR, depending on the likelihood that it will find reason to terminate a recipient's benefits; (4) it is too soon to tell if authorized funding will be adequate to conduct all required CDR through 2002; (5) the SSA plan to conduct over 8 million CDR over 7 years is ambitious; and (6) SSA could improve the CDR process by reviewing beneficiaries most likely to medically improve, conducting CDR on a random sample from all other beneficiaries, and using CDR contact to determine beneficiaries' rehabilitation needs.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: SSA disagreed with the recommendation regarding specific changes to the CDR process. SSA believes that its redesigned CDR strategy will result in reliable, cost-effective monitoring of all disabled beneficiaries. SSA said its use of profiles is effective in identifying cases with the most potential for program savings. SSA officials told GAO at the time of the review that SSA does not know which type of CDR--full medical or mailer--is more appropriate for beneficiaries in the middle group; thus, random samples should be done to correct such a weakness. SSA officials told GAO that the agency is committed to eliminating the backlog over a 7-year period for all beneficiaries. If the agency cannot develop a profile to identify which type of CDR should be done for the middle group, it will conduct a full medical CDR on all such beneficiaries. SSA officials said the agency has other higher priority workloads and does not have the resources to conduct mass mailings and recontacts in case of nonresponse.

    Recommendation: To the extent SSA is authorized to act, the Commissioner of Social Security should replace the routine scheduling for CDR of all who receive DI and SSI program benefits with a more cost-effective process that would: (1) select for review beneficiaries with the greatest potential for medical improvement and subsequent benefit termination; (2) correct a weakness in the SSA CDR process by conducting CDR on a random sample from all other beneficiaries; and (3) help ensure program integrity by instituting contact with beneficiaries not selected for CDR.

    Agency Affected: Social Security Administration

  2. Status: Closed - Not Implemented

    Comments: SSA agrees with GAO that it should continually seek ways to maintain stewardship of the disability programs in the most cost-effective manner. To that end, SSA intends to begin considering which legislative changes, if any, will produce such a result. However, because SSA disagreed with the recommendation regarding changes to the CDR process, any legislation it proposes will not address the recommendation.

    Recommendation: The Commissioner of Social Security should develop a legislative package to obtain the authority the agency needs to enact the new process for those portions of the DI and SSI populations that are subject to required CDR.

    Agency Affected: Social Security Administration

  3. Status: Closed - Not Implemented

    Comments: SSA evaluated the recommended action using FY 1996 vocational rehabilitation (VR) cases to determine its utility. The results of SSA's evaluation were inconclusive. Beneficiaries can enter VR in many ways before a CDR occurs. This decreases the number of cases for which a VR referral made during a CDR is the first referral, which is material to a successful employment outcome. Also, in 1998 SSA proposed "The Ticket to Independence Program" as an alternative to SSA VR programs. In March 1998, Representatives Bunning and Kennelly introduced H.R. 3433, the "Ticket to Work and Self-Sufficiency Act of 1998," and Senators Jeffords and Kennedy introduced S. 1858, the "Work Incentives Improvement Act of 1998." SSA expects to have legislation by the end of the current congressional session that will enhance beneficiaries' ability to gain from rehabilitation and employment opportunities. As a result, SSA plans no further actions on the recommendation.

    Recommendation: To enable as many disabled individuals as possible to become self-sufficient, the Commissioner of Social Security should test the use of CDR contacts with beneficiaries to determine individuals' rehabilitation service needs and help them obtain the services and employment assistance they need to enter or reenter the workforce.

    Agency Affected: Social Security Administration


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