Supplemental Security Income: Growth and Changes in Recipient Population
Call for Reexamining Program (Letter Report, 07/07/95, GAO/HEHS-95-137).

GAO provided information on the Supplemental Security Income (SSI)
program, focusing on the factors contributing to caseload growth and
changes in the characteristics of SSI recipients.

GAO found that: (1) the SSI program is making benefits available to a
broader population than it did in the 1980s, as congressional actions
and court decisions allow a wider range of impairments to qualify as
disabilities, particularly for mentally impaired adults and children;
(2) Congress has mandated outreach and publicity efforts to help
overcome barriers to getting SSI benefits; (3) disabled recipients may
stay on SSI longer and receive more benefits because the program has
devoted little effort to ensuring that recipients are disabled and
helping them return to work; (4) since the mid-1980s, the number of
disabled SSI recipients has increased an average of over 8 percent
annually, while the number of aged recipients has remained almost level;
(5) children, noncitizens, and mentally impaired adults have accounted
for almost 90 percent of SSI growth since 1991; (6) SSI recipients tend
to be younger, stay on SSI longer, and depend more on SSI as a primary
source of income; (7) the SSI program should emphasize helping
recipients achieve their productive capacity and decrease their
dependence on SSI; and (8) increasing the number of recipients'
disability reviews would help ensure that those who are no longer
disabled do not receive SSI benefits.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-95-137
     TITLE:  Supplemental Security Income: Growth and Changes in 
             Recipient Population Call for Reexamining Program
      DATE:  07/07/95
   SUBJECT:  Supplemental security income
             Social security benefits
             Disability benefits
             Beneficiaries
             Disadvantaged persons
             Handicapped persons
             Federal social security programs
             Aid for the handicapped
             Eligibility criteria
             Resident aliens
IDENTIFIER:  Supplemental Security Income Program
             OASDI
             Old Age Survivors and Disability Insurance Program
             Social Security Disability Insurance Program
             Medicaid Program
             Food Stamp Program
             AFDC
             Aid to Families with Dependent Children Program
             
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Cover
================================================================ COVER


Report to the Chairman, Committee on Finance, U.S.  Senate, and the
Chairman, Committee on Ways and Means, House of Representatives

July 1995

SUPPLEMENTAL SECURITY INCOME -
GROWTH AND CHANGES IN RECIPIENT
POPULATION CALL FOR REEXAMINING
PROGRAM

GAO/HEHS-95-137

SSI Caseload Growth


Abbreviations
=============================================================== ABBREV

  AFDC - Aid to Families With Dependent Children
  CDR - continuing disability review
  DA&A - drug addicts and alcoholics
  DBRA - Disability Benefits Reform Act of 1984
  DI - Social Security Disability Insurance
  IFA - individualized functional assessment
  OASDI - Social Security Old Age, Survivors, and Disability
     Insurance
  PRUCOL - permanently residing under color of law
  SSA - Social Security Administration
  SSI - Supplemental Security Income
  SSIPIA - Social Security Independence and Program Improvements Act
     of 1994
  SSR - Supplemental Security Record
  VR - vocational rehabilitation

Letter
=============================================================== LETTER


B-260598

July 7, 1995

The Honorable Bob Packwood
Chairman, Committee on Finance
United States Senate

The Honorable Bill Archer
Chairman, Committee on Ways and Means
House of Representatives

The Supplemental Security Income (SSI) program is the largest cash
assistance program for the poor and one of the fastest growing
entitlement programs; program costs have grown 20 percent annually in
the last 4 years.  SSI provides means-tested income support payments
to eligible aged, blind, or disabled persons.  Last year, over 6
million SSI recipients received nearly $22 billion in federal
benefits and over $3 billion in state benefits. 

In the past year, the Congress has focused much attention on SSI's
growth.  Last year it enacted provisions limiting drug addicts'
benefits, and this year it is considering further restrictions for
these recipients as well as for children and noncitizens.  Since
January, we have reported several times on SSI and related issues.\1
We initiated this report to provide an overview of the SSI program
and its recent history.  Specifically, the report examines factors
contributing to caseload growth and changes in the characteristics of
SSI recipients. 

We developed the information for this report by reviewing the
literature as well as interviewing officials and analyzing data from
the Social Security Administration (SSA), which has overall
responsibility for administering the SSI program.  To examine state
caseloads and different recipient populations, we analyzed 10-percent
sample data files for each December from 1986 to 1993, the only years
these files were available.  These files are random samples of all
cases in a given month on the Supplemental Security Record (SSR),
which is the master administrative database on SSI recipients. 


--------------------
\1 See list of related GAO products inside the back cover. 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

Since the mid-1980s, a variety of changes in the SSI program have
made benefits available to a broader population.  Both congressional
actions and court decisions have allowed a wider range of impairments
to qualify as disabilities, notably for mentally impaired adults and
for children.  Also, the Congress has mandated increased outreach and
publicity efforts to help overcome barriers to getting SSI. 
Meanwhile, some disabled recipients may stay on SSI longer and
receive larger benefits than they would otherwise because the program
has devoted little effort to checking that recipients continue to be
disabled and helping them return to work. 

Since these program changes began, the SSI recipient population has
changed dramatically; disabled recipients now account for nearly 80
percent of federal SSI payments.\2 Before the mid-1980s, the number
of SSI recipients was relatively stable, and the number of aged
recipients was decreasing.  Since then, the number of disabled SSI
recipients has increased an average of over 8 percent annually; the
number of aged recipients has remained almost level.  (See fig.  1.)

   Figure 1:  Number of SSI
   Recipients by Eligibility Group

   (See figure in printed
   edition.)

Source:  Annual Statistical Supplement to the Social Security
Bulletin, 1976-1993, and SSA data. 

Three groups have accounted for nearly 90 percent of SSI's growth
since 1991--adults with mental impairments, children, and
noncitizens.  SSI recipients now tend to be younger, stay on SSI
longer, receive larger benefits, and depend more on SSI as a primary
source of income. 

These changes in the SSI program and its recipients call for
reexamining how best to serve this needy population while reassuring
the public of the program's integrity.  Moreover, medical,
technological, and social changes are challenging the historic
presumption that the disabilities that SSI covers are total and long
term.  Therefore, the program should emphasize helping SSI recipients
achieve their productive capacity and thereby help decrease their
dependence on SSI.  As the administration and the Congress explore
how to help these recipients return to work, SSA can take steps now
to strengthen program integrity.  For example, increasing the number
of reviews of recipients' disability status beyond the minimal number
currently required would help ensure that those who are no longer
disabled do not receive benefits. 


--------------------
\2 Unless otherwise specified, we use the word "disabled" only for
those recipients under age 65 and "aged" for all recipients aged 65
and over.  When disabled recipients turn 65, SSI program data
typically continue to count them among the disabled.  Disabled
recipients aged 65 and over accounted for 10 percent of all SSI
recipients in 1993, and their number increased an average of 2.4
percent annually from 1986 through 1993. 


   BACKGROUND
------------------------------------------------------------ Letter :2

The Congress established SSI in 1972 to replace federal grants to
similar state-administered programs, which varied substantially in
benefit levels and eligibility requirements.  The Congress intended
SSI as a supplement to the Social Security Old Age, Survivors, and
Disability Insurance (OASDI) program for those who had little or no
Social Security coverage. 

Federal SSI benefits are funded by general revenues and based on
need, unlike Social Security benefits, which are funded by payroll
taxes and, in effect, based on the contributions of individuals and
their employers. 

To be eligible for SSI, individuals must be either at least 65 years
old, blind, or disabled.  Individuals cannot have income greater than
the maximum benefit level or own resources worth more than $2,000
($3,000 for a couple), subject to certain exclusions, such as a home. 
This financial eligibility test also factors in the income and
resources of spouses living in the same household or parents, in the
case of children.  Individuals must also be U.S.  citizens or
immigrants lawfully admitted for permanent residence or aliens
"permanently residing under color of law" (PRUCOL).\3

To be considered disabled, adults must be unable to engage in any
substantial gainful activity\4 because of a physical or mental
impairment expected to result in death or last at least 12 months. 
For children, the impairment must be "of comparable severity" to one
that qualifies an adult as disabled.  SSI and the Social Security
Disability Insurance (DI) program use the same standards and
procedures for determining disability.  An applicant whose disability
claim has been rejected can appeal at four levels.  Exhausting all
appeals can take more than 2 years.  Applicants whose appeals succeed
are awarded SSI payments retroactive to the date of their
application. 

In 1995, the maximum federal SSI monthly benefit is $458 per month
for an individual and $687 for a couple if both spouses are eligible;
these benefit rates are adjusted annually for cost-of-living
increases.  This monthly benefit level is intended as a guaranteed
minimum income and therefore is reduced depending upon recipients'
incomes, living arrangements, and other sources of support, including
Social Security benefits and the income of spouses living in the same
household or parents, in the case of children.  Still, because SSI is
an individual entitlement, no cap exists on the benefits a household
may receive.  Because of the various benefit adjustments, the average
federal monthly benefit in 1993 was $324 for the disabled and $195
for the aged. 

Since SSI provides income support as a last resort, SSI recipients
must file for any other benefits for which they may be eligible, such
as Social Security or workers' compensation.  In 1993, 40 percent of
SSI recipients also received Social Security benefits, down from 49
percent in 1986.  Under DI, someone must be disabled continuously for
5 months before benefits begin, which is not true under SSI. 
Therefore, many receive SSI benefits only until they become eligible
for DI, if their DI benefit is then large enough to make them
ineligible for SSI.  About 75 percent of disabled adult SSI
recipients who also qualify for DI benefits stop getting SSI within 1
year, compared with about 29 percent of other disabled adults.\5

In addition to federal SSI benefits, states may provide supplemental
benefits.\6 The District of Columbia and all but seven states provide
these supplements.\7 These supplements vary, reflecting differences
in regional living costs as well as in living arrangements.  In
December 1994, nearly 3 million SSI recipients, or roughly half,
received an average of about $110 per month in state supplemental
benefits at a total cost to the states of about $3.5 billion. 

Most SSI recipients are automatically eligible for Medicaid and Food
Stamps.  In 1993, Medicaid benefits averaged about $2,600 for aged
SSI recipients who received Medicaid benefits and about $5,000 for
blind and disabled SSI recipients, excluding nursing home and
institutional care.\8 In September 1994, a one-person household
eligible for both Food Stamps and SSI, with no other income, could
receive up to $83 per month, or nearly $1,000 per year, in Food Stamp
benefits, depending on the state.\9 (Income, including SSI benefits,
reduces Food Stamp benefits.) Thus, the cost of Medicaid and Food
Stamps for SSI recipients may exceed the cost of SSI benefits, which
averages more than $4,000 per year, though many SSI recipients might
qualify for these programs even if they were not on SSI. 

Some families receiving Aid to Families With Dependent Children
(AFDC) have one or more family members who receive SSI, though no
recipient may receive both SSI and AFDC benefits.  In determining a
family's AFDC benefit, the program does not consider an SSI recipient
part of the family.  In 1992, the average AFDC monthly payment per
family was $374.  By having one child qualified as disabled under
SSI, an AFDC family can increase its income by as much as $458 per
month, which would more than double the average AFDC benefit. 

In addition to providing cash benefits, both SSI and the DI program
include return-to-work components.  Both programs include work
incentive provisions and screen and refer disabled and blind
recipients to state vocational rehabilitation agencies.  Refusing
rehabilitation services is cause for benefits termination.  SSI's
work incentives include

  disregarding the first $65 to $85 of earned income and half of the
     remaining earned income in determining benefit levels;

  disregarding income used for impairment-related work expenses for
     the disabled and any work expenses for the blind;

  disregarding income or resources set aside to achieve a work goal,
     such as education or starting a business;

  continuing benefits even if earnings exceed the "substantial
     gainful activity" amount, though earnings still reduce benefits
     as described above;

  continuing eligibility for Medicaid even though earnings may reduce
     SSI cash benefits to nothing; and

  allowing recipients to be reinstated if their work attempts fail or
     their ability to work is erratic. 


--------------------
\3 PRUCOL is not an immigration status, such as immigrant or refugee. 
Rather, it is an eligibility status defined in the enabling
legislation for major federal assistance programs, including SSI. 
PRUCOL is more frequently a transitional status for aliens who are
becoming permanent residents than for those whose deportation has
been delayed, though it can be either.  Initially, PRUCOL was
interpreted to include primarily refugees and asylees.  Court
decisions have broadened it to include other categories of aliens. 
Nearly 75 percent of SSI recipients in this PRUCOL category are
refugees or asylees. 

\4 "Substantial gainful activity" is defined as earning more than
$500 per month. 

\5 Kalman Rupp and Charles G.  Scott, "Length of Stay on the
Supplemental Security Income Disability Program," Social Security
Bulletin, Vol.  58, No.  1 (1995), pp.  29-47. 

\6 Also, states must supplement benefits for those covered by the
state assistance programs that SSI replaced in 1974 if the previous
benefit was higher than the federal benefit level. 

\7 These seven states are Arkansas, Georgia, Kansas, Mississippi,
Tennessee, Texas, and West Virginia.  North Dakota leaves the
supplements up to the counties but pays 50 percent of the benefit
costs.  Also, the Northern Mariana Islands do not provide
supplemental benefits.  The Northern Mariana Islands are the only
U.S.  territory whose residents are eligible for SSI. 

\8 In this instance, disabled recipients aged 65 and over are counted
with the disabled, not the aged. 

\9 In Hawaii, because of higher food costs, the maximum Food Stamp
benefit for SSI recipients was $187 per month.  California provides
increased cash aid instead of Food Stamps. 


   FACTORS CONTRIBUTING TO SSI'S
   GROWTH
------------------------------------------------------------ Letter :3

A variety of factors has contributed to the rapid growth in the SSI
caseload, although the relative effects of these factors on growth
are not fully understood.  Program factors, such as expanded
disability criteria and major outreach efforts, have brought more
individuals onto the rolls at younger ages.  Widely publicized
reports of fraud and abuse suggest another potential source of new
recipients, and such reports can also significantly erode public
confidence in the program's integrity. 

Meanwhile, some disabled recipients may stay on SSI longer and
receive more in benefits than they would otherwise because SSA has
devoted little effort to (1) checking that recipients continue to be
disabled and (2) helping recipients return to work. 

In addition, various other factors have contributed to growth; some
of these are external to SSI, such as increased immigration and
economic conditions.  We summarize these factors in table 1 and
discuss them below.\10



                           Table 1
           
             Factors Contributing to SSI's Growth

-----------------------------  -----------------------------
Program factors
------------------------------------------------------------
More persons brought into the  Eligibility expansion:
program                        Legislative and regulatory
                               changes have increased access
                               to disability benefits.

                               Program outreach: The
                               Congress mandated that SSA
                               seek eligible persons to
                               apply for SSI through
                               outreach campaigns.

                               Fraud and abuse: Allegations
                               have been made that certain
                               SSI recipients, such as some
                               children and immigrants, have
                               received benefits though
                               ineligible.

Some recipients on SSI longer  Continuing disability reviews
                               (CDR): Until 1994, the law
                               did not require SSA to
                               perform CDRs for SSI cases,
                               and SSA spent little effort
                               on CDRs.

                               Return to work efforts:
                               Helping people with
                               disabilities return to work
                               is a low priority of the SSI
                               program.


Additional factors
------------------------------------------------------------
Immigration                    Growing numbers of
                               noncitizens have been
                               admitted to the United
                               States, and noncitizens are
                               more likely to receive SSI
                               than citizens.

Economic conditions            Recession may increase
                               applications and affect
                               eligibility and benefit
                               levels.

Medical breakthroughs          Disabled individuals now have
                               better chances to live longer
                               through medical and
                               technological advances.

Transfers from state programs  Some states help public
                               assistance recipients enroll
                               in SSI.

Health insurance               Individuals may be applying
                               for SSI or staying on the
                               rolls longer to have Medicaid
                               coverage.
------------------------------------------------------------

--------------------
\10 See also Social Security:  Federal Disability Programs Face Major
Issues (GAO/T-HEHS-95-97, Mar.  2, 1995). 


      ELIGIBILITY EXPANSION
---------------------------------------------------------- Letter :3.1

A congressional oversight committee in the early 1980s found that
federal courts, psychiatric and vocational counseling professionals,
and we had raised serious questions about the adequacy of SSA's
standards for assessing mental impairment for both DI and SSI. 
Addressing these concerns, the Congress passed the Disability
Benefits Reform Act (DBRA) in 1984, effectively expanding the
definition of disability for both adults and children.  In
particular, the act required new standards for mental impairments
that incorporated a person's ability to compete in the job market. 
It also required SSA to consider the combined effects of multiple
impairments if no single impairment were sufficiently disabling to
allow someone to qualify for benefits and required increased
attention to pain's effect on the ability to work.  Further, the act
allowed SSA to consider nonmedical evidence offered, for example, by
an applicant's family and friends.  Finally, the act required
increased emphasis on opinions of physicians treating the individuals
and on evaluating their functional limitations. 

In addition to DBRA, a 1990 Supreme Court decision, Sullivan v. 
Zebley,
493 U.S.  521, ruled that SSA's disability determination process for
children "does not account for all impairments `of comparable
severity' [to adults]..." and thus violated the law because it held
children to a more restrictive standard.  For those children who do
not qualify by meeting SSA's strict listings of impairments, the
Court required SSA to add an individualized functional assessment
(IFA) of how their impairment limits their ability to act and behave
in age-appropriate ways.  Also in 1990, SSA issued regulations
revising and expanding its standards for assessing mental
impairments, specifically in children.  These standards incorporated
functional criteria, added impairments that qualified as
disabilities, such as attention deficit hyperactivity disorder, and
added more weight to nonmedical evidence from parents, teachers,
social workers, and others. 


      PROGRAM OUTREACH
---------------------------------------------------------- Letter :3.2

At the direction of the Congress and on its own initiative, SSA has
increased its outreach efforts to better inform potential recipients
of their SSI eligibility.  These efforts have attempted to reduce
barriers for potential applicants, such as a lack of information
about the program, perceived stigma from accepting benefits, and the
complexity of the application process.  Along the same lines, state
and local agencies and nonprofit groups serving the poor have focused
more attention on encouraging eligible persons to enroll, not just
for cash payments but to establish eligibility for Medicaid and Food
Stamps as well. 

In 1983, the Congress passed legislation requiring SSA to identify
all Social Security Old Age recipients whose benefits fell below the
SSI benefit level and to notify them of the availability of SSI
benefits.  In addition to this one-time effort, the law required
ongoing notices to Social Security recipients who reach age 65 and to
certain disabled recipients. 

Beginning in 1989, SSA made SSI outreach an ongoing agency priority;
it conducted demonstration programs, increased coordination with
other agencies serving the poor, and encouraged field office outreach
initiatives.  The Omnibus Budget Reconciliation Act of 1989
established a permanent outreach program for disabled and blind
children.  Also, as part of a settlement related to the Zebley
decision, SSA launched a national media campaign and conducted
outreach in schools and welfare offices to enroll more children. 

In 1990, we reported on SSA district managers' views on SSI
outreach.\11 They acknowledged the need for outreach and believed
they were doing enough.  They were implementing a wide range of
outreach activities, but it was not clear which were most effective. 
About 40 percent believed outreach was needed for
non-English-speaking people. 

Also, in 1990, the Congress mandated that SSA expand the scope of its
outreach efforts and provided funds for SSA to complete a series of
outreach demonstration projects.  Since then, SSA has provided $33
million for 136 cooperative agreements targeting diverse populations
such as African Americans, Native Americans, the homeless, the
mentally ill, and persons who have tested positive for the human
immunodeficiency virus. 


--------------------
\11 Social Security:  District Managers' Views on Outreach for
Supplemental Security Income Program (GAO/HRD-91-19FS, Oct.  30,
1990). 


      FRAUD AND ABUSE
---------------------------------------------------------- Letter :3.3

A portion of SSI's growth may be attributable to increased incidence
of fraud and abuse in the past decade.  A lack of empirical evidence
makes it difficult to estimate the extent of the problem. 
Nevertheless, news reports have provided accounts of foreign-born SSI
applicants coached by middlemen or translators to feign mental
illness and children coached by parents to fake mental impairments by
misbehaving or doing poorly in school to qualify for SSI benefits. 
Regardless of the actual extent of such abuse, reports like these can
significantly erode public confidence in the program's integrity. 


      LIMITED NUMBERS OF CDRS
---------------------------------------------------------- Letter :3.4

The purpose of CDRs is to verify that disabled recipients still have
an impairment that prevents them from working.  In 1993 and 1994, we
reported\12 that while SSA has had authority to perform such reviews
for SSI recipients, it has done relatively few.  In 1994, the
Congress directed SSA to perform a minimum number of disability
reviews for SSI recipients.  Accordingly, SSA plans to conduct
reviews on 100,000 SSI adults and on one-third of SSI children
turning age 18 for each of the 3 fiscal years beginning in 1996. 

In contrast, before 1994, the law already required SSA to conduct
reviews at least once every 3 years for Social Security DI recipients
in cases in which medical improvement is possible or expected, and
regulations required that a review be scheduled every 7 years in
cases in which medical improvement is not expected.  About 500,000 DI
cases come due for a review each year.  However, while SSA has
improved the review process, it has a current backlog of 1.8 million
DI reviews.  Given available resources, it has planned for only
234,000 CDRs in fiscal year 1996.  Since DI benefit rates are larger
than SSI's, the cost-effectiveness of DI reviews may be higher. 
Still, since 1 in 6 DI recipients also receives concurrent SSI
benefits, the backlog has also reduced to some degree the number of
SSI terminations. 


--------------------
\12 Social Security:  Continuing Disability Review Process Improved,
But More Targeted Reviews Needed (GAO/T-HEHS-94-121, Mar.  10, 1994);
Social Security Disability:  SSA Needs to Improve Continuing
Disability Review Program (GAO/HRD-93-109, July 8, 1993). 


      LIMITED RETURN TO WORK
      EFFORTS
---------------------------------------------------------- Letter :3.5

Helping people with disabilities return to work has been a low
priority of SSA and the Congress for both the SSI and DI programs,
and, in fact, SSI and DI return virtually no one to work.  This low
priority is especially evident in vocational rehabilitation (VR), to
which relatively few resources are allocated.  For example, for every
$100 SSA spends on cash benefits, it spends little more than $.10 on
VR, and few recipients are referred for VR services.  As we reported
in 1993, VR beneficiaries receive, on average, only modest services
and show limited long-term improvement.\13 In 1993, compared with $52
billion in combined SSI and DI benefit payments, $63 million was
spent for VR.  Of over 7 million SSI and DI disabled recipients, only
300,000 were referred for VR, and 6,000 were successfully
rehabilitated. 

Recipients may also perceive that the risk of losing benefits upon
returning to work is too high.  The SSI program has work incentive
provisions to encourage recipients to try returning to work, without
jeopardizing their cash and medical benefits should they fail, as
well as ease the transition to work.  However, many recipients are
not familiar with these provisions or do not understand them.  As a
result, a significant unrealized potential may exist for returning
recipients to work or reducing their dependence on SSI. 


--------------------
\13 Vocational Rehabilitation:  Evidence for Federal Program's
Effectiveness Is Mixed (GAO/PEMD-93-19, Aug.  27, 1993). 


      GROWTH IN IMMIGRATION
---------------------------------------------------------- Letter :3.6

The number of immigrants steadily increased in the 1980s, from about
500,000 per year early in the decade to 900,000 in 1993.  Altogether,
immigrants in the 1980s totaled more than 7.3 million.  Over 30
percent of U.S.  population growth in the 1980s can be attributed to
immigration. 

For this report, we use "immigrants" to refer to those with "lawful
permanent resident" status.  Foreign-born people seeking to immigrate
to the United States can obtain this status with an immigrant visa
issued overseas by the U.S.  State Department.  However, those
already residing in the United States can also obtain this status. 
For example, refugees and asylees are not considered immigrants upon
arrival here but are eligible for lawful permanent resident status
after 1 year of continuous residence in the United States.  Also,
under the Immigration Reform and Control Act of 1986, certain
undocumented aliens can change to permanent status.  Because
noncitizens other than immigrants may receive SSI benefits and
because some immigrants eventually become citizens and then receive
benefits, we use "noncitizens" to refer to all foreign-born residents
who have not yet become citizens. 

Since the 1980s, noncitizens have been one of the fastest growing
groups of both aged and disabled SSI recipients.  Also, noncitizens
are more likely to receive SSI than citizens; roughly 3 percent of
noncitizens receive SSI compared with 1.8 percent of citizens.  Among
other reasons that may explain this, noncitizens typically have more
limited histories of working in the United States than life-long
residents and therefore qualify for smaller Social Security benefits;
in turn, they are more likely to qualify for SSI.  Still, the
likelihood of receiving SSI probably varies for different types of
noncitizens.  Refugees and asylees may be more likely than citizens
to receive benefits while immigrants admitted through normal
procedures may be no more likely or even less likely than citizens to
be on SSI; data limitations make it difficult to say.\14

Roughly half of those granted immigrant status in the 1980s were not
subject to immigration policies that attempt to exclude people who
are likely to become public charges.  Included are about 1 million
refugees and asylees who obtained full permanent resident status. 
Also, the Congress passed the Immigration Reform and Control Act in
1986, which legalized over 2.5 million previously illegal aliens. 


--------------------
\14 Data limitations that prevent drawing firmer conclusions include
the following:  (1) the general population data we examined estimated
the noncitizens' status on the basis of country of origin rather than
their actual status and (2) SSI data about noncitizens reflect their
status at the time of application and not upon entering the United
States.  See Michael Fix and Jeffrey S.  Passel, Immigration and
Immigrants:  Setting the Record Straight, The Urban Institute
(Washington, D.C.:  1994), pp.  19-22, 34, and 63-67. 


      OTHER FACTORS CONTRIBUTE TO
      CASELOAD GROWTH
---------------------------------------------------------- Letter :3.7

In addition to changes in the SSI program and the general population
increases, a variety of other factors has contributed to caseload
growth. 

Economic factors--such as the 1990-91 recession--may account for some
of the increase.  In times of high unemployment, aged or disabled
persons may lose their jobs and turn to SSI for support.  Losing even
part of their income may allow them to meet SSI's financial
eligibility requirements. 

Also, the prevalence of some disabilities may have increased.  For
example, those who 10 years ago would not have been expected to
survive certain health conditions, such as kidney disease, are now
being kept alive by medical and therapeutic advances.  Further, young
adults who would not have been expected to survive spinal cord
injuries now have a much better chance of survival and more
opportunity to regain many functions.  Finally, infants born with
congenital defects or low birth weight have a better chance of
survival today than in the past, although they may sustain
disabilities. 

Many state and local governments have enrolled recipients of other
welfare programs in SSI.  When such recipients are eligible for SSI,
state and local governments can reduce their own spending as well as
increase benefit levels for their beneficiaries.  From discussions
with 10 state welfare administrators, we estimate that at least half
of all states fund programs that actively assist disabled welfare
recipients through the SSI application process.  For example, five
states reported using such programs to generate gross savings of
about $90 million in a given year by helping enroll in SSI nearly
26,000 individuals receiving state benefits.  Most of these gains
came from one state, which reportedly saved over $60 million by
helping nearly 15,400 public assistance recipients enroll in SSI
instead of state general assistance in fiscal year 1994. 

Finally, the recent increase in the number of people without
affordable health insurance may have affected the size of SSI.  The
uninsured population under age 65 in the United States grew by 5
million between 1988 and 1992.  Coupled with this growth, limitations
in employer-based health care coverage for chronic conditions may
have prompted some individuals to apply for SSI to obtain Medicaid. 


   CHARACTERISTICS OF CURRENT SSI
   RECIPIENTS
------------------------------------------------------------ Letter :4

Overall SSI caseload growth has been concentrated almost exclusively
in the disabled population, which grew an average of over 8 percent
annually from 1986 through 1993 and now accounts for nearly 80
percent of federal SSI payments.  During this period, the aged SSI
population stayed almost level but would have decreased by 10 percent
without the growth in noncitizen cases.\15 The aged SSI population
has decreased from 47 to 35 percent of all SSI recipients.  Even
among the disabled SSI population, the proportion of older recipients
has decreased; those aged 50 and older have decreased from 36 to 28
percent of disabled recipients.  Blind recipients have been a
constant and small share of the total.  (See app.  I for more detail
on age demographics.)

Three subpopulations have accounted for nearly 90 percent of the
growth since 1991--adults with mental impairments, children, and
noncitizens.\16 These groups typically have not contributed much in
Social Security taxes.  Accordingly, they receive smaller concurrent
Social Security benefits than other SSI recipients, or none at all,
and therefore receive higher SSI benefits.  (See table 2.) Among the
aged, recipients who did not qualify for any Social Security benefit
increased from 12 to 36 percent of cases between 1986 and 1993. 
Among the disabled, such recipients increased from 69 to 73 percent
of cases over the same period.  (See app.  I for more detail on
concurrent benefit and SSI benefit levels.)



                           Table 2
           
           Summary of SSI Caseload Growth Patterns

                                              Percen
                                                tage
                                              averag  Averag
                                      Percen       e       e
                              Number    tage  annual  monthl
                                  of  of all  growth       y
                               cases   cases    rate  benefi
                              (1993)  (1993)  (1986-       t
                                  \a      \a     93)  (1993)
----------------------------  ------  ------  ------  ------
By selected subpopulations
------------------------------------------------------------
Mentally disabled adults      1,751,   29.3%   11.0%    $325
                                 000
Blind or disabled children    770,50    12.9    16.4     397
                                   1
Aged or disabled noncitizens  674,15    11.3    15.5     316
                                   0
All other recipients          2,900,    48.0    <2.0
                                 000

By eligibility group
------------------------------------------------------------
Aged                          2,091,    35.0     0.7     195
                                 651
Disabled                      3,807,    63.6     8.2     324
                                 223
============================================================
All SSI recipients            5,984,   100.0     4.9    $278
                                 330
------------------------------------------------------------
\a Subgroups may not add up to the total because of overlaps in the
populations listed.  Blind recipients accounted for 1.4 percent of
all cases in 1993, down from 2 percent in 1986. 

Because many children and mentally disabled adults would not have
qualified previously, much of the growth reflects a one-time addition
of such recipients.  Because of this, it is not clear that such
dramatic growth will continue indefinitely; in fact, rates of
caseload growth in the past 2 years have declined somewhat, though
they are still high. 

Caseload growth varies dramatically by state.  For example, growth in
the disabled SSI population ranged from 4 to 17 percent on average
annually from 1986 through 1993.  Moreover, states experienced
concentrations of growth in different recipient subpopulations.  (See
app.  I for state-level detail.) For noncitizen cases, seven states
accounted for 84 percent of the growth--California, New York,
Florida, Texas, Illinois, New Jersey, and Massachusetts, in
descending order; these states receive the largest shares of
immigrants.  Across all states, the rates of growth in noncitizen
cases varied considerably, from 7 to more than 25 percent annually on
average. 


--------------------
\15 This and many of the other statistics cited in this report are
estimates based on our analysis of a 10-percent random sample of SSI
recipients.  Therefore, these estimates are subject to sampling
error.  However, because of the extremely large sample sizes (roughly
500,000 cases per year), the sampling errors for national estimates
are very small, generally less than plus or minus 1 percentage point
at a 95-percent confidence level. 

\16 See also Supplemental Security Income:  Recent Growth in the
Rolls Raises Fundamental Program Concerns (GAO/T-HEHS-95-67, Jan. 
27, 1995). 


      MENTAL IMPAIRMENTS
      PREDOMINATE AMONG DISABLED
      ADULTS
---------------------------------------------------------- Letter :4.1

Among disabled adults on SSI, mental impairments predominate,
accounting for 56 percent of such cases in 1993.  Moreover, they
accounted for 64 percent of the growth from 1986 through 1993 in
cases for which diagnoses were available.  Mental retardation cases
grew an average of 9 percent annually but constituted a fairly level
25 percent of the disabled adult caseload.  However, growth in other
mental impairment cases was more dramatic, averaging 13 percent
annually and increasing from 26 to 33 percent of cases over this
period. 

Mentally disabled adult recipients are younger on average than other
disabled adults; 82 percent are under age 50 compared with 57 percent
for other impairments.  As a result, these recipients are likely to
contribute to sustained growth in the caseload and benefit costs
since they enroll in SSI at a younger age and typically stay on
longer.  Also, because these recipients are younger, whatever
contributions they may have made to Social Security may be based on
lower average wages than those disabled at later ages.  As a result,
any Social Security benefits they receive may be smaller than those
of older recipients, and so their SSI benefits may be larger.  (See
app.  I for more detail on the age and benefit levels of the mentally
disabled.)

Included in the category of "mental impairment other than
retardation" are those recipients designated as drug addicts and
alcoholics (DA&A), who numbered over 100,000 in February 1995.  From
1988 through 1994, these cases grew an average of 41 percent
annually, multiplying eightfold.  Addicts required to participate in
the DA&A program are those who would not qualify for disability if
their addiction ended.  Thus, the DA&A designation does not apply to
all addicts on SSI.  In May 1994, we reported on the DA&A program and
found that 150,000 addicts receive SSI benefits; of these, more than
half would qualify as disabled without their addiction.\17

By law, these designated DA&A recipients must have a representative
payee, or third party, manage their benefits, and they must
participate in treatment when it is available.  In our May 1994
report, we noted that finding qualified payees for addicts has been a
long-standing problem for SSA.  Payees are generally unpaid
volunteers; the vast majority are relatives or friends.  An SSA study
found payee controls to be lax in many cases, particularly when
addicts' friends were the payees.  The study also showed that
organizational payees tended to provide the most control because they
can more effectively deal with abusive or threatening addicts. 

Further, while substance abuse treatment is required, SSA is not
permitted to pay for treatment nor can the addict be required to pay
for it.  Exactly who pays for what types of treatment for SSI DA&A
recipients is not known.  Some services are covered by state Medicaid
programs, but states vary greatly in the type, amount, duration, and
scope of services provided.  In our May 1994 report, we noted that
only about 9 percent of DA&A recipients were in treatment; the
remainder were either not in treatment (7 percent) or their treatment
status was not known (84 percent).  SSA was then taking steps to
correct shortcomings in its monitoring efforts. 

The alarming growth in DA&A cases and allegations of program abuse
prompted the Congress to strengthen controls of payments to addicts
in the Social Security Independence and Program Improvements Act of
1994 (SSIPIA).  The act generally requires that SSI benefit payments
to DA&A recipients end after 3 years.  It also expands the DA&A
program requirements to cover DI recipients; gives preference to
organizations as representative payees; and mandates an SSA study of
the feasibility, cost, and equity of requiring representative payees
for all DI and SSI addicts, even if they would be disabled without
the addiction. 


--------------------
\17 Social Security:  Major Changes Needed for Disability Benefits
for Addicts (GAO/HEHS-94-128, May 13, 1994). 


      NUMBER OF CHILDREN ON SSI,
      ESPECIALLY WITH MENTAL
      IMPAIRMENTS, IS GROWING FAST
---------------------------------------------------------- Letter :4.2

Before 1990, the growth in the number of disabled children receiving
SSI was moderate, averaging 3 percent annually since 1984.  Then,
from the beginning of 1990 through 1994, the growth averaged 25
percent annually, and the number tripled to nearly 900,000.  Their
share of the disabled SSI population grew from about 12 percent
before 1990 to 22 percent in 1994.  Also, SSA researchers project
that, from age of first eligibility to age 65, children on SSI will
receive benefits for more than 25 years on average compared with
about 15 years for those aged 18 to 34 and less than 10 years for
those aged 35 and above.\18 So children recipients especially
contribute to sustaining higher caseloads. 

Mental impairments predominate among children, accounting for over
half of all cases.  Mental retardation, one of two broad categories
of mental impairments, has consistently accounted for 37 percent of
children receiving SSI, both before and after 1990.  However, other
mental impairments have increased from 5 to nearly 18 percent of
children's cases, increasing from 17,000 cases in 1989 to 136,000
cases in 1993.  In 1994, we reported that the portion of mental
disability awards to children with behavior problems, such as
attention deficit disorder, is just 22 percent but growing.\19

As required by the Zebley ruling, SSA began to use IFAs to make
disability determinations for children whose impairments do not meet
SSA's strict listings of impairments.  The new IFA process, which
added 219,000 children to the benefit rolls through September 1994,
permits the award of benefits to children with less severe
impairments than those in SSA's medical listings of impairments.  In
our recent report on the IFA, we noted that about 84 percent of
children qualifying based on IFAs have mental impairments.\20 Also,
about one-half of the awards for behavioral disorders, including
attention deficit disorder, are based on the IFA criteria. 

The news media have widely reported allegations that parents coach
their children to fake mental impairments by misbehaving or doing
poorly in school so they can qualify for SSI benefits.  Our recent
report in part attempted to assess the IFA's vulnerability to such
coaching.  However, we found that substantiating and measuring the
extent of such coaching are extremely difficult.  Studies we reviewed
found little evidence of widespread coaching but could not rule it
out. 

Nevertheless, our report documented the many subjective judgments
built into each step of the IFA process, which make it difficult to
administer consistently and leave it susceptible to manipulation.  We
concluded that the likelihood of significantly reducing the judgment
involved in evaluating age-appropriate functioning was remote and
that more consistent decisions could be reached if children were
evaluated on the basis of the functional criteria in SSA's medical
listings.  Given our findings, we suggested that the Congress could
consider eliminating the IFA, which would reduce the growth in awards
and target disability benefits to children with more severe
impairments. 

Some households have more than one child on SSI.  SSI benefits are
adjusted only for the income of parents, not of other children, so
benefits for each additional child may be as high as for the first
child.  According to a recent SSA study,\21 8.5 percent of SSI
recipients live in households receiving two or more checks, excluding
group living situations and couples with no other SSI recipients in
the household.  Nearly three-quarters of these recipients live in
households with only two recipients.  About 0.6 percent of SSI
recipients live in households with more than three recipients.  About
24 percent of those in multirecipient households are children under
age 18 while another 35 percent are adults living with their parents. 


--------------------
\18 Rupp and Scott, pp.  29-47. 

\19 Social Security:  Rapid Rise in Children on SSI Disability Rolls
Follows New Regulations (GAO/HEHS-94-225, Sept.  9, 1994). 

\20 Social Security:  New Functional Assessments for Children Raise
Eligibility Questions (GAO/HEHS-95-66, Mar.  10, 1995). 

\21 Alfreda Brooks, Lenna Kennedy, and Charles Scott, SSI Recipients
in Multirecipient Households, Social Security Administration,
unpublished, March 1994. 


      NUMBER OF NONCITIZENS
      GROWING FAST AMONG BOTH AGED
      AND DISABLED RECIPIENTS
---------------------------------------------------------- Letter :4.3

From 1986 through 1993, the number of aged or disabled noncitizen
recipients grew an average of 15 percent annually, reaching nearly
700,000 in 1993.  In 1982, noncitizens constituted 3 percent of all
SSI recipients, and, in 1986, they constituted 6 percent; by 1993,
they constituted nearly 12 percent.  Of these, 69 percent were at
least 65 years old, and 31 percent were disabled. 

Had it not been for the growth in noncitizens, the aged SSI
population would have decreased 10 percent from 1986 through 1993. 
The noncitizen caseload grew from 9 percent of aged cases to 23
percent in this period. 

Although disabled recipients constitute a smaller share of noncitizen
cases, their number is growing faster, averaging 19 percent annually
compared with 14 percent for aged cases from 1986 through 1993.  They
have increased from 3 percent of disabled cases to 5.5 percent. 

Recent media reports and congressional hearings have focused
attention on allegations that translators and other intermediaries
help non-English-speaking noncitizens fraudulently qualify for SSI
disability benefits.  In some parts of the United States, the
noncitizen populations speak so many different languages and dialects
that SSA is unlikely to have staff proficient in each of them.  While
the full extent of such activities is unknown, translators are known
to have coached claimants to fake mental impairments, such as delayed
stress syndrome or depression.  They have controlled disability
determination interviews by answering all questions asked of the
claimants.  They have prepared applications for numerous claimants
using identical wording to describe the same mental impairment.  They
have also established relationships with unscrupulous doctors who
have submitted false medical evidence. 

More generally, noncitizens on SSI have come to this country under a
variety of circumstances, as discussed earlier.  For example, some
have come through normal immigration channels, and others have come
as refugees or asylees.  Different provisions in both immigration law
and SSI policy apply to these groups.  Patterns of caseload growth
also vary among groups of noncitizens.  However, SSI data only permit
analysis of recipients' immigration status when they applied.  Some
refugees may have converted to normal immigrant status by the time
they apply, and some immigrants may have become citizens. 

Some legal immigrants are admitted to the country under the financial
sponsorship of a U.S.  resident.  The Immigration and Nationality Act
of 1952, as amended, provides for excluding aliens who are likely to
become public charges.  Aliens can show they will be self-sufficient,
among several other ways, by getting a financial sponsor.  Sponsors
sign an affidavit of support, in which they agree to provide
financial assistance to the immigrant for 3 years.  However, several
courts have ruled that these affidavits of support are not legally
binding.  Refugees and asylees, moreover, do not need a sponsor to
reside in the United States; in 1993, 18 percent of SSI's noncitizen
recipients were refugees or asylees when they applied.  In addition,
the undocumented aliens legalized by the Immigration Reform and
Control Act of 1986 were not admitted to the United States under
these sponsorship provisions; in 1993, roughly 3 percent of SSI's
noncitizen recipients were identified as part of this group when they
applied. 

SSI's "deeming" provisions attempt to reinforce this immigration
policy by factoring a portion of sponsors' resources into financial
eligibility decisions and benefit calculations for the immigrants
they sponsor.\22 In 1993, as many as 75 percent of SSI's noncitizen
recipients could have been subject to these provisions when they
applied, but many of these may not have come to the United States
under financial sponsorship.  Before 1994, this deeming applied for 3
years from the immigration date.  About 25 percent of immigrants
receiving SSI applied for benefits within a year of their 3-year
sponsorship period's expiring.  The Congress temporarily extended the
deeming period from 3 to 5 years starting in January 1994 and
continuing through September 1996. 

Refugee and asylee cases are growing somewhat faster than immigrant
cases, averaging 18 percent annually from 1986 through 1993 compared
with 15 percent.  Still, they constitute just 18 percent of all
noncitizens on SSI compared with 74 percent for immigrants.  Refugees
and asylees constitute a larger share of SSI's disabled noncitizen
population than SSI's aged population, 23 percent compared with 16
percent. 

About 46 percent of noncitizen recipients applied for SSI within 4
years of entering the United States.  Only 5 percent of SSI
immigrants applied within a year of entry compared with 52 percent of
the remaining SSI noncitizens, as might be expected from the
sponsorship provisions for immigrants.  About 44 percent of disabled
SSI noncitizens have been in the United States less than 5 years as
of 1993, compared with 57 percent of aged noncitizens.\23

Of noncitizens on SSI, 51 percent come from six countries--Mexico,
the former Soviet Union, Cuba, Vietnam, the Philippines, and China,
in descending order of caseloads.  However, rates of growth vary
substantially by country of origin, from an average of 11 percent
annually for Cuba to 33 percent for the former Soviet Union, among
these six countries.  Except for Cuba, these are the countries with
the largest shares of immigrants to the United States overall. 


--------------------
\22 These deeming provisions do not apply if an immigrant becomes
blind or disabled after admission to the United States as a permanent
resident. 

\23 In these percentages, disabled recipients aged 65 and over (who
constituted 8 percent of all noncitizens) are counted with the
disabled, not the aged. 


   CONCLUDING OBSERVATIONS
------------------------------------------------------------ Letter :5

As SSI caseloads have grown rapidly, they have become increasingly
dominated by younger, mentally disabled recipients, who stay in the
program longer.  Disabled recipients now account for nearly 80
percent of federal SSI payments.  Rapid growth in noncitizen cases
further contributes to changes in the program's character.  Both
these younger and noncitizen recipients tend to depend more on SSI as
their primary source of income. 

Over the long term, these trends provide compelling reasons to
reexamine the program's assumptions and priorities, which will
require thoughtful attention.  They raise issues not only of which
populations the program should serve but also whether the program
should provide cash benefits only or work with recipients more
actively to help them increase their self-sufficiency. 

More specifically, technology and medical treatment to help the
disabled adapt are constantly improving, and society's perceptions of
disability are changing.  These trends, combined with the increased
number of younger recipients, especially children, challenge the
program's historic presumption that the disabilities it covers are
total and long term.  In cases of physical disabilities among older
workers, who previously predominated in the SSI program,
rehabilitation and returning to work were perhaps reasonably not
emphasized.  The program has thus had little experience in supporting
rehabilitative efforts, which may hold more promise for younger
recipients. 

Therefore, finding effective ways to help disabled recipients achieve
their productive capacity and work as much as possible should have a
higher priority.  This applies at least as much to children as
adults; disability has a very different meaning for them.  Children
who cannot function at an age-appropriate level may be able to
develop so that they can work by the time they reach adulthood. 
Also, finding effective approaches for recipients with mental
impairments, particularly those with limited work histories, may
require special attention.  More emphasis on returning to work should
signal to recipients that work, where feasible, is a program
expectation.  Such efforts should help decrease their dependence on
SSI, help them achieve their productive capacity, and improve program
integrity as well. 

The growth in noncitizen cases raises issues about immigration policy
in addition to issues about SSI policy.  The immigration law's
provisions on sponsorship and the SSI provisions about deeming
sponsors' income and resources may not adequately exclude immigrants
from the United States who are likely to become public charges. 

Over the short term, however, SSA can do a variety of things to
bolster program integrity.  For example, we have previously
recommended conducting more CDRs, which would help reassure the
public that benefits are not available to those who are no longer
disabled; although the Congress last year required a minimal number
of these, more could be done.  Also, as we have previously
recommended, increased monitoring of drug addicts and alcoholics
would help ensure that they are getting treatment; also, finding
organizations instead of family and friends to serve as their
representative payees would help ensure that their cash benefits are
spent for food, clothing, and shelter, not drugs and alcohol.  In the
case of applicants who do not speak English, increased monitoring of
translators and finding ways to use agency-selected translators would
help minimize the opportunities for fraud and abuse. 

The Congress could also consider a variety of program changes.  For
example, we have already noted that the Congress could consider
eliminating the IFA used in making some disability determinations for
children.  This would improve the consistency of the process and make
it less susceptible to manipulation.  It would also reduce the growth
in awards and target disability benefits to children with more severe
impairments. 


   AGENCY COMMENTS
------------------------------------------------------------ Letter :6

We shared a draft of this report with SSA program officials for a
technical review.  They found our report and our analysis of SSA data
to be generally accurate.  They had some technical comments, which we
have incorporated where appropriate. 

SSA officials objected that we cited fraud, waste, and abuse as
causes of program growth even though determining the extent of such
problems is difficult.  However, we state only that these are
possible causes of growth and clearly acknowledge the lack of
information about their extent. 

SSA officials also noted that, with regard to the drug addict and
alcoholic population, SSA is well on the way to implementing the
stringent requirements of SSIPIA, which address both monitoring
treatment and using institutional payees.  They also noted that SSA
has taken strong measures to combat interpreter fraud.  Assessing
such activities is beyond the scope of this report. 


---------------------------------------------------------- Letter :6.1

Please contact me on (202) 512-7215 if you have any questions about
this report.  Other GAO contacts and staff acknowledgments are listed
in appendix II. 

Jane L.  Ross
Director, Income Security Issues


ADDITIONAL INFORMATION ON SSI
CASELOAD GROWTH
=========================================================== Appendix I

Since 1986, more SSI recipients are younger and receive smaller
concurrent Social Security benefits and larger SSI benefits.  Three
groups of recipients have accounted for the vast majority SSI's
caseload growth--adults with mental impairments, children, and
noncitizens.  The first two groups tend to be younger than other
recipients.  All three groups are less likely to qualify for
concurrent Social Security benefits at all, and those recipients who
do qualify tend to get smaller Social Security benefits.  In turn,
all three groups tend to get larger SSI benefits.  At the state
level, patterns of caseload growth among these three groups vary
considerably. 


   RECIPIENT POPULATION IS GETTING
   YOUNGER
--------------------------------------------------------- Appendix I:1

Younger SSI recipients are increasing as a share of all recipients. 
(See fig.  I.1.) From 1986 through 1993, every age group under 60
except one has increased as a share of SSI recipients, although those
aged 60 and over have decreased substantially.\24 The 50 to 59 age
group increased its share slightly but only because of the dramatic
decline in the 65 and over age group's share; as a share of disabled
cases alone, the 50 to 59 age group decreased from 21 to 18 percent
(not shown in graph).  The most dramatic increase was in the under-18
age group, from 5 to 12 percent of all cases. 

   Figure I.1:  Younger Recipients
   Are Growing Share of SSI Cases
   (1986-1993)

   (See figure in printed
   edition.)

Comparing these results with U.S.  population trends puts them in
perspective and reveals a notable increase in recipiency rates.  The
small drop in the 18 to 29 age group as a share of cases corresponds
with a larger drop as a share of the U.S.  population, which reflects
the aging of the baby boom generation.  (See fig.  I.2.) Dividing the
SSI population by the U.S.  population for each age group gives us a
recipiency rate.  Recipiency rates increased for every age group
under age 65; again, the most dramatic increase proportionally was in
the under-18 age group.  (See fig.  I.3.) Overall, SSI's recipiency
rate increased from 1.7 to 2.3 percent from 1986 through 1993. 

   Figure I.2:  Change in Age
   Distribution in U.S. 
   Population (1986-1993)

   (See figure in printed
   edition.)

   Figure I.3:  Change in SSI
   Recipiency Rates by Age Group
   (1986-1993)

   (See figure in printed
   edition.)

Mentally disabled recipients tend to be younger than those with
physical disabilities.  Nearly 65 percent of all mentally disabled
recipients are under age 40 compared with about 41 percent of the
physically disabled.  (See fig.  I.4.) Conversely, nearly 70 percent
of disabled recipients under age 40 have mental disabilities compared
with less than 50 percent of those aged 40 and over. 

   Figure I.4:  Mentally Disabled
   Recipients Tend to Be Younger
   Than Other Disabled Recipients
   (1993)

   (See figure in printed
   edition.)


--------------------
\24 All of the analysis in this appendix excludes blind recipients,
who accounted for 1.4 percent of all cases in 1993, down from 2
percent in 1986. 


   RECIPIENTS ARE GETTING FEWER
   AND SMALLER SOCIAL SECURITY
   BENEFITS
--------------------------------------------------------- Appendix I:2

Since 1986, the share of SSI recipients who do not qualify for any
concurrent Social Security benefit has increased from 51 to 60
percent.  (See fig.  I.5.) Meanwhile, the share of all recipients who
receive concurrent benefits decreased in the highest categories of
Social Security benefit amounts. 

   Figure I.5:  SSI Recipients
   Receiving Social Security
   Benefits, by Amount of Social
   Security Benefit (1986 Versus
   1993)

   (See figure in printed
   edition.)

Each of the three fast-growing groups that we highlight--adults with
mental impairments, children, and noncitizens--have proportionally
fewer recipients who also qualify for Social Security benefits than
the SSI population as a whole.  (See fig.  I.6.) Of those group
members who do qualify for Social Security, a smaller share get
larger benefits compared with other SSI recipients.\25

   Figure I.6:  SSI Recipients
   Receiving Social Security
   Benefits--Three Fast-Growing
   Subpopulations, by Benefit
   Amount (1993)

   (See figure in printed
   edition.)

Note:  These numbers exclude blind recipients. 


--------------------
\25 About 8 percent of children on SSI received Social Security
benefits in 1993.  Children can receive Social Security benefits as
dependents or survivors of workers that qualify for Social Security. 


   RECIPIENTS ARE GETTING LARGER
   SSI BENEFITS
--------------------------------------------------------- Appendix I:3

More SSI recipients got larger SSI benefits in 1993 than in 1986,
even after adjusting for inflation.  (See fig.  I.7.) The share of
SSI recipients in each benefit amount category under $300 per month
declined while the share in the highest benefit categories increased. 
In fact, the average SSI benefit increased 16 percent in constant,
that is, inflation-adjusted dollars.  The declining share of SSI
recipients who also qualify for Social Security contributes to this
trend, but some of the trend could result from decreases in other
sources of income and financial support.  The increasing share of SSI
recipients who are disabled also contributes to this trend because
the disabled have higher average benefits. 

   Figure I.7:  More SSI
   Recipients Are Getting Larger
   Benefits (1986 Versus 1993)

   (See figure in printed
   edition.)


   STATE EXPERIENCES VARY WIDELY
--------------------------------------------------------- Appendix I:4

Figures I.8 and I.9 summarize by state patterns of SSI caseload
growth overall and for the three fast-growing populations we
highlight.\26 Rates of SSI caseload growth varied considerably by
state and for different subpopulations within states.  For 1986
through 1993, average annual growth rates for all SSI recipients
ranged from 3 to 12 percent.\27

   Figure I.8:  State Data on SSI
   Caseload Growth, by Eligibility
   Group

   (See figure in printed
   edition.)

Source:  Data on recipiency rates from Committee on Ways and Means,
U.S.  House of Representatives, Overview of Entitlement Programs: 
1994 Greenbook.  Other data from GAO analysis of SSA's 10-percent
sample of the Supplemental Security Record file. 

   Figure I.9:  State Data on SSI
   Caseload Growth, by Selected
   Subpopulations

   (See figure in printed
   edition.)

\a We omitted these estimates because the number of cases in these
categories in these states was very small, especially in 1986. 

The states with the most SSI recipients, in order of caseloads, are
California, with 16.3 percent of all cases; New York, with 9.1
percent; Texas, with 6.2 percent; and Florida, with 5.0 percent.  To
put each state's share in perspective, recipiency rates also vary
widely by state, from 0.8 percent in New Hampshire to 5 percent in
Mississippi for 1993; the U.S.  rate was 2.3 percent.  These
percentages are calculated as the average number of monthly SSI
recipients over the state's July population.  For the four largest
states, the recipiency rates were as follows:  California, 3.1
percent; New York, 2.9 percent; Texas, 2.0 percent; and Florida, 2.1
percent. 

Of the four largest states, none had both growth rates and shares of
cases consistently higher or lower than the national average for all
three highlighted populations.  California had a faster growth rate
and a larger share of cases than average only for noncitizens.  New
York and Texas generally mirrored the national experience, but New
York had a substantially larger share of noncitizens, and Texas had a
substantially smaller share of mentally disabled recipients than the
national average.  Florida had a slower rate of growth for
noncitizens but a larger share of them. 

For the mentally disabled, average annual growth rates varied from 9
percent in three states, including California, to 24 percent in
Louisiana.  This group as a share of state cases ranged from 30
percent in New Mexico to 53 percent in Ohio. 

For children, average annual growth rates varied from 9 percent in
Hawaii and Maine to 23 percent in Michigan.  This group as a share of
state cases ranged from 5 percent in Hawaii to 21 percent in Idaho. 

For noncitizens, average annual growth rates varied from 7 percent in
Maine to 27 percent in New Mexico.  This group as a share of state
cases ranged from virtually 0 percent in five states to 30 percent in
California. 


--------------------
\26 Unless otherwise specified, we use the word "disabled" only for
those recipients under age 65 and "aged" for those aged 65 and over. 
When disabled recipients turn 65, SSI program data typically continue
to count them among the disabled. 

\27 All of the state-level statistics cited in this appendix, except
for recipiency rates, are estimates based on our analysis of a
10-percent random sample of SSI recipients nationwide.  Sampling
errors do not exceed plus or minus 4.1 percentage points at a
95-percent confidence level.  Given these sampling errors, readers
should be cautious when making their own comparisons between these
state-level estimates because the difference between estimates may
not be statistically significant. 


GAO CONTACTS AND ACKNOWLEDGMENTS
========================================================== Appendix II

CONTACTS

Donald C.  Snyder, Assistant Director, (202) 512-7204
Kenneth C.  Stockbridge, Evaluator-in-Charge, (202) 512-7264

ACKNOWLEDGMENTS

In addition to those named above, the following individuals made
major contributions to this report:  Cynthia A.  Bascetta, Assistant
Director, and Vanessa R.  Taylor, Senior Evaluator (computer
science). 



RELATED GAO PRODUCTS
============================================================ Chapter 0

Supplemental Security Income:  Recent Population Has Changed as
Caseloads Have Burgeoned (GAO/T-HEHS-95-120, Mar.  27, 1995). 

Social Security:  New Functional Assessments for Children Raise
Eligibility Questions (GAO/HEHS-95-66, Mar.  10, 1995). 

Social Security:  Federal Disability Programs Face Major Issues
(GAO/T-HEHS-95-97, Mar.  2, 1995). 

Welfare Reform:  Implications of Proposals on Legal Immigrants'
Benefits (GAO/HEHS-95-58, Feb.  2, 1995). 

Supplemental Security Income:  Recent Growth in the Rolls Raises
Fundamental Program Concerns (GAO/T-HEHS-95-67, Jan.  27, 1995). 

Social Security:  Rapid Rise in Children on SSI Disability Rolls
Follows New Regulations (GAO/HEHS-94-225, Sept.  9, 1994). 

Disability Benefits for Addicts (GAO/HEHS-94-178R, June 8, 1994). 

Social Security:  Major Changes Needed for Disability Benefits for
Addicts (GAO/HEHS-94-128, May 13, 1994). 

Social Security:  Continuing Disability Review Process Improved, But
More Targeted Reviews Needed (GAO/T-HEHS-94-121, Mar.  10, 1994). 

Social Security:  Disability Rolls Keep Growing, While Explanations
Remain Elusive (GAO/HEHS-94-34, Feb.  8, 1994). 

Social Security:  Increasing Number of Disability Claims and
Deteriorating Service (GAO/HRD-94-11, Nov.  10, 1993). 

Vocational Rehabilitation:  Evidence for Federal Program's
Effectiveness Is Mixed (GAO/PEMD-93-19, Aug.  27, 1993). 

Social Security Disability:  SSA Needs to Improve Continuing
Disability Review Program (GAO/HRD-93-109, July 8, 1993). 

Social Security:  District Managers' Views on Outreach for
Supplemental Security Income Program (GAO/HRD-91-19FS, Oct.  30,
1990). 

