DI and SSI Beneficiaries Due for CDRs Have Similar Characteristics

The DI and SSI programs have about 4.3 million beneficiaries due or overdue for a CDR in fiscal year 1996. SSA Primarily Selects Beneficiaries for CDRs on the Basis of the Likelihood Their Benefits Will Be Terminated

SSA does not include in its selection process all DI and SSI beneficiaries. First, SSA plans to obtain Medicare and Medicaid data and integrate the data into the statistical formulas to increase the validity of the estimated likelihood of benefit termination. Incorporating Additional Required CDRs Into Its Plan and Implementing Process Improvements Are Among the Challenges SSA Must Address

In the past year, new legislation has increased authorized funding for CDRs to about $3 billion by 2002, but has also required CDRs for some SSI beneficiaries for whom the reviews were previously elective. However, others believe that it could create a large backlog of disability claims when those who are terminated because of the time limit reapply for benefits. Recommendations to the Commissioner of Social Security

We recommend that, to the extent SSA is authorized to act, the Commissioner of SSA replace the routine scheduling for CDRs 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 SSA’s CDR process by conducting CDRs on a random sample from all other beneficiaries, and (3) help ensure program integrity by instituting contact with beneficiaries not selected for CDRs. For the sample of SSI beneficiaries, we obtained information on characteristics from SSA’s Supplemental Security Income Record Description (SSIRD) and OD’s CDR database. Calculation of number of beneficiaries expected to be dropped from the programs Beneficiaries due or overdue for CDRs in fiscal year 1996 Less: planned financial eligibility redeterminations for those who are not receiving a CDR Beneficiaries not contacted during the year Multiplied by: percentage of beneficiaries who fail to cooperate Total beneficiaries expected to be dropped from the program Per-beneficiary savings and offsetting costs Gross savings to DI trust fund/SSI program Gross savings to Medicare/federal portion of Medicaid Less: offsetting costs of additional food stamps Net savings per beneficiary dropped from the program Total estimated savings to the federal government Net program savings (number of beneficiaries dropped multiplied by net savings per beneficiary)
Less: cost of sending scannable mailer (number of beneficiaries contacted at $25)
Total estimated net savings from proposed initiative (combined total = $1,477,236,040)

How SSA Conducts Continuing Disability Reviews

This appendix provides details on SSA’s procedures for conducting CDRs. Not available. 2. 4. 5. 6. 7. 8.
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on how to improve the Social Security Administration's (SSA) continuing disability reviews (CDR) process for Disability Insurance (DI) and Supplemental Security Income (SSI) beneficiaries, focusing on: (1) the number and characteristics of individuals who are due for CDR; (2) how SSA selects individuals for and conducts CDR; (3) whether available resources are adequate for conducting required CDR; and (4) potential options for improving the CDR process.

What GAO Found

GAO found that: (1) about 4.3 million DI and SSI beneficiaries are due or overdue for CDR in fiscal year 1996; (2) SSA selects beneficiaries for CDR on the basis of the likelihood that their benefits will be terminated; (3) SSA plans to improve its CDR selection process by obtaining Medicare and Medicaid data and mailing questionnaires to beneficiaries' physicians; (4) funding for CDR could exceed $4 billion by 2002; (5) SSA must incorporate additional CDR required by legislation into the agency's workload and conduct CDR for beneficiaries whose CDR were previously done at the agency's discretion; (6) SSA should conduct CDR on a random sample of beneficiaries normally excluded from the selection process to improve program integrity; (7) SSA proposal for time-limited benefits may increase the agency's workload when beneficiaries who are terminated from the program reapply for benefits; (8) the formula used by SSA to select beneficiaries for CDR excludes approximately half of those who are due or overdue for CDR; and (9) SSA could utilize CDR to strengthen its return-to-work initiatives.