SSA’s Disability Determination Process

SSA’s disability determination process is complex and involves offices at  the federal and state level (see fig.1). 2.) State General Assistance: These programs provide cash assistance  to poor individuals who do not qualify for other assistance programs  (e.g., they do not have children and are not elderly). Little Is Known About the Extent of Advocacy Contracts, but Evidence Suggests Such Contracts Account for a Small Proportion of Claims Nationwide

		Limited Information Exists, but We Identified 16 States with Some Type of SSI/DI Advocacy Contract in 2014

Little is known about the extent to which states or counties contract for  SSI/DI advocacy services. For example, Tennessee  officials stated they provided a grant to a legal aid organization to work  with about 100 TANF recipients per year who may be eligible for federal  disability benefits. Westchester  County also had a contract with a for-profit organization for SSI/DI  advocacy. Claims from these government SSI/DI advocacy contracts represent  about 1 percent of all initial SSI and DI claims in 2010. Selected Sites Represented Different Approaches to SSI/DI Advocacy but Were Similar in Many Respects

We selected three sites—Hawaii; Minnesota; and Westchester County,  New York—to illustrate different approaches to SSI/DI advocacy, in terms  of the number and types of organizations they contracted with and  geographic coverage. For example, all three sites articulated a  similar goal for their SSI/DI advocacy contracts, targeted similar  populations, and generally paid SSI/DI advocacy contractors only for  approved claims, among other similarities (see table 1). At the same time, officials from all three sites told us that  moving individuals off state benefit programs and onto federal disability  programs has financial benefits for the state or county. SSA’s Controls over Representatives Providing SSI/DI Advocacy Services to States and Other Third Parties Are Limited

		SSA Does Not Have Specific Controls and Readily Available Data on Representatives, Particularly Those Paid by States and Other Third Parties

SSA has a number of controls in place—including rules and  regulations—related to appointed representatives in the disability  determination process, but it does not have controls specific to  organizations providing SSI/DI advocacy services to states and other third  parties. SSA Does Not Coordinate with Third Parties Contracting for SSI/DI Advocacy, Which May Result in Overpayments

SSA does not coordinate its direct payments to representatives with  states and other third parties that might also pay representatives. In 2007, we reported on this risk of overpayments to representatives and  recommended that SSA take steps to address it. 5.) SSA anticipates being  able to combine data across its systems in order to evaluate data  variations on representatives but those plans are under development. Recommendations for Executive Action

As part of initiatives currently under way to improve agency information  on claims with appointed representatives and detect potential fraud  associated with representatives, the Commissioner of the Social Security  Administration should consider actions to provide more timely access to  data on representatives and enhance mechanisms for identifying and  monitoring trends and patterns related to representation, particularly  trends that may present risks to program integrity. We did note that other  types of SSI/DI advocacy contracts—such as those held by insurance  companies or hospitals—represented an estimated 30 percent of initial  disability claims with nonattorney representatives in 2010. SSA partially agreed with our second recommendation to take steps to  enhance coordination with states, counties, and other third parties with  the goal of improving oversight and preventing and identifying potential  overpayments. Appendix I: Objectives, Scope, and Methodology

In conducting our review of state Supplemental Security Income  (SSI)/Disability Insurance (DI) advocacy practices, our objectives were to  examine (1) what is known about the extent to which states are  contracting with private organizations to identify and move eligible  individuals from state- or county- administered benefit programs to Social  Security disability programs, (2) how SSI/DI advocacy practices compare  across selected sites, and (3) the key controls the Social Security  Administration (SSA) has in place to ensure these organizations follow  SSI/DI program rules and regulations. Data Analysis

			Analysis of a Random Sample of Social Security Disability Claims

We used data from a 2014 report issued by SSA’s OIG to estimate the  percentage of initial claims in 2010 with nonattorney representatives  working under a government SSI/DI advocacy contract, as well as the  percentage that were potentially working under contract with another third  party, such as a hospital or long-term disability insurance company.
Why GAO Did This Study

For years, states and counties have helped individuals who receive state or county assistance apply for federal disability programs. Federal benefits can be more generous, and moving individuals to these programs can allow states and counties to reduce their benefit costs or reinvest savings into other services. Some states have hired private organizations to help individuals apply for federal benefits, but the extent and nature of this practice is not well-known. GAO was asked to study this practice.
This report examines (1) what is known about the extent to which states have SSI/DI advocacy contracts with private organizations, (2) how SSI/DI advocacy practices compare across selected sites, and (3) the key controls SSA has to ensure these organizations follow SSI/DI program rules and regulations. GAO reviewed relevant federal laws, regulations, and program rules; selected three sites to illustrate different contracting approaches; reviewed prior studies, including one by SSA's Office of the Inspector General with a generalizable sample of disability claim files; and interviewed SSA, state, and county officials and contractors.

What GAO Found

Little is known about the extent to which states are contracting with private organizations to help individuals who receive state or county assistance apply for federal disability programs. Representatives from these private organizations help individuals apply for Supplemental Security Income (SSI) and Disability Insurance (DI) from the Social Security Administration (SSA). Available evidence suggests that this practice—known as SSI/DI advocacy—accounts for a small proportion of federal disability claims. Using a variety of methods, including interviewing stakeholders, GAO identified 16 states with some type of SSI/DI advocacy contract in 2014. In addition, GAO analyzed a sample of 2010 claims nationwide and estimated that such contracts accounted for about 5 percent of initial disability claims with nonattorney representatives, or about 1 percent of all initial disability claims. Representatives working under contract to other third parties, such as private insurers and hospitals, accounted for an estimated 30 percent of initial disability claims with nonattorney representatives.
Three selected sites represented different approaches to SSI/DI advocacy, but were similar in many respects. For example, Minnesota contracted with 55 nonprofit and for-profit organizations, while Hawaii and Westchester County, New York, each had a single contractor: a legal aid organization, and a for-profit company, respectively. At the same time, all three sites targeted recipients of similar state and county programs, such as General Assistance, and generally paid contractors only for approved disability claims, among other similarities.
SSA has controls to ensure representatives follow program rules and regulations, but these controls are not specific to those working under contract to states or other third parties and may not be sufficient to assess risks and prevent overpayments—known by SSA as fee violations. Specifically:
Despite the growing involvement of different types of representatives in the initial disability determination process, SSA does not have readily available data on representatives, particularly those it does not pay directly. This hinders SSA's ability to identify trends and assess risks, a key internal control. SSA's existing data are limited and are not used to provide staff with routine information, such as the number of claims associated with a given representative. SSA has plans to combine data on representatives across systems, but these plans are still in development.
SSA does not coordinate its direct payments to representatives with states or other third parties that might also pay representatives, a risk GAO identified in 2007. In cases involving SSI/DI advocacy contracts, a representative may be able to collect payments from both the state and from SSA, potentially resulting in an overpayment—a violation of SSA's regulations.

What GAO Recommends

GAO recommends that SSA (1) consider ways to improve data and identify and monitor trends related to representatives, and (2) enhance coordination with states, counties, and other third parties with the goal of improving oversight and preventing potential overpayments. SSA partially agreed with our recommendations and noted that it may consider additional actions related to representatives.