In 2002, about 5.5 million  people with disabilities received SSI benefits. SSA has estimated that it will need a total of about $4 billion  to process its projected CDR workload over the next 5 years. If another large CDR backlog is generated, SSA is at  risk of foregoing cost-savings, thereby compromising the integrity of its  disability programs as a result of paying benefits to disability beneficiaries  who are no longer eligible to receive them. SSA officials attributed the delay in obtaining a fiscal year 2003 budget as  the main factor in hampering their ability to conduct all of the planned  CDRs for the fiscal year. As a result, most of the backlog that is expected to reemerge by the end of  fiscal year 2003 will likely consist of SSI CDRs and, according to SSA  officials, this makes the backlog less problematic than if the backlog  consisted of mostly DI cases. Decisions on Timing of CDRs Are Not Based on Systematic Analysis of Available Information

While DDS personnel review available information on beneficiaries to  establish a diary date indicating when beneficiaries should undergo a CDR,  they do not conduct a systematic analysis of this information. SSA’s Process for Determining CDR Method Not Always Based on Best Information Available

SSA’s process for determining what method to use for a CDR is not always  based on the best information available. This is the case even when the profile  score indicates that improvement is unlikely. SSA Has Not Fully Studied and Pursued the Use of Medical Treatment Data from Medicare and Medicaid

SSA has not fully studied and pursued the use of medical treatment data  on beneficiaries available from the Medicare and Medicaid programs  despite the potential of these data to improve SSA’s decisions regarding  whether to use a mailer or full medical review to complete a CDR. Missing or Incomplete Case Folders May Result in Fewer Benefit Cessations

SSA continues to be hampered in its CDR decisions by missing or  incomplete information on beneficiaries’ case history, which may prevent  SSA from ceasing benefits for some individuals who no longer qualify for  benefits. However, our analysis of SSA data  indicates that the vast majority of MIE beneficiaries in the DI and SSI  programs—about 94 percent—are not found to have medically improved  upon completion of a CDR. Delaying  services to some disability beneficiaries, therefore, undermines SSA’s  recent efforts to increase its emphasis on helping these beneficiaries  return to work. For example, SSA could  develop a better means of identifying beneficiaries who are expected to  medically improve. In addition, SSA  would still be able to achieve the cost savings that are derived from CDRs  for beneficiaries that it considers most likely to medically improve. While SSA has taken a number of steps to improve the CDR process, it has  not taken advantage of other opportunities that could further improve the  cost-effectiveness of this process and its ability to stay current. Finally, SSA’s initial assessments of which beneficiaries are most likely to  improve are not very accurate and, therefore, may not be the most  appropriate criteria to use for delaying beneficiary access to a ticket for  return-to-work services. SSA has the challenge of developing a policy that will make return-to-work  assistance available to beneficiaries at the appropriate time while  providing adequate mechanisms for ensuring program integrity.
Why GAO Did This Study

The Social Security Administration (SSA) has had difficulty in conducting timely reviews of beneficiaries' cases to ensure they are still eligible for disability benefits. SSA has been taking steps to improve the cost-effectiveness of its review process. SSA has linked the review process to eligibility for a new benefit that provides return-to-work services. This report looks at SSA's ability to stay current with future reviews, identifies potential improvements to the review process, and assesses the review process--return-to-work link.

What GAO Found

SSA will likely face a backlog of about 200,000 continuing disability review (CDR) cases by the end of fiscal year 2003. SSA officials attribute the pending backlog to its decision to reduce the number of cases reviewed as a result of the delay in obtaining fiscal year 2003 funding. In addition, the pending backlog resulted from putting more emphasis on initial applications over CDRs. To ensure CDRs receive adequate attention, SSA has requested some fiscal year 2004 funds be "earmarked" for these reviews. Given SSA's ability to eliminate its previous CDR backlog using targeted funds, this maneuver could help SSA. Over the next 5 years, SSA has estimated that 8.5 million CDRs, costing about $4 billion, are needed to stay current. If SSA generates another backlog, cost savings and program integrity may be compromised by paying benefits to disability beneficiaries who are no longer eligible to receive them. SSA is not making the best use of available information when conducting its CDRs, leaving opportunities for improvement. First, SSA's decisions on the timing of CDRs are not based on systematic analysis of available information. Second, SSA's process for determining which CDR method to use is not always based on the best available information. For example, SSA requires an in-depth review for all beneficiaries who, upon entering the program, are expected to medically improve even if current information on certain of those beneficiaries indicates that improvement is unlikely and that the review would be better handled through a shorter, less expensive method. Third, SSA has not fully pursued medical treatment data available from the Medicare and Medicaid programs despite their potential to improve SSA's decisions regarding which review method to use. Fourth, SSA's CDRs continue to be hampered by missing or incomplete information on beneficiaries' case history. SSA delays the provision of new return-to-work benefits to beneficiaries expected to medically improve based on the assumption that such beneficiaries are least likely to need them. However, according to SSA data, about 94 percent of such beneficiaries are not found to have medically improved upon completion of a disability review. As a result, some individuals who might benefit from return-to-work services are initially denied access to them. SSA is reviewing this policy and while doing so, will need to consider how to best balance its financial stewardship and return-to-work goals.