Social Security Disability: Improvements Needed to Continuing Disability
Review Process (Letter Report, 10/16/96, GAO/HEHS-97-1).
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.
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.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-97-1
TITLE: Social Security Disability: Improvements Needed to
Continuing Disability Review Process
DATE: 10/16/96
SUBJECT: Cost control
Eligibility determinations
Persons with disabilities
Medical examinations
Cost effectiveness analysis
Disability benefits
Vocational rehabilitation
Social security benefits
Federal social security programs
Eligibility criteria
IDENTIFIER: Social Security Disability Insurance Program
Supplemental Security Income Program
Medicare Program
Medicaid Program
SSA Master Beneficiary Record
Supplemental Security Income Record Description Data Base
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Cover
================================================================ COVER
Report to the Chairman, Special Committee on Aging, U.S. Senate
October 1996
SOCIAL SECURITY DISABILITY -
IMPROVEMENTS NEEDED TO CONTINUING
DISABILITY REVIEW PROCESS
GAO/HEHS-97-1
Continuing Disability Reviews
(106807)
Abbreviations
=============================================================== ABBREV
CDR - continuing disability review
DDS - disability determination service
DI - Disability Insurance
IFA - individualized functional assessment
MBR - Master Beneficiary Record
MI - medical improvement
MIE - medical improvement expected
MINE - medical improvement not expected
MIP - medical improvement possible
NASI - National Academy of Social Insurance
OD - Office of Disability
RFC - residual functional capacity
SGA - substantial gainful activity
SSA - Social Security Administration
SSI - Supplemental Security Income
SSIRD - Supplemental Security Income Record Description
VR - vocational rehabilitation
Letter
=============================================================== LETTER
B-270338
October 16, 1996
The Honorable William S. Cohen
Chairman, Special Committee on Aging
United States Senate
Dear Mr. Chairman:
In recent years, the Social Security Administration (SSA) has had
difficulty ensuring that people receiving disability benefits under
the Disability Insurance (DI) program are eligible for benefits. SSA
is required by law to conduct periodic examinations, called
continuing disability reviews (CDR), to determine whether a
beneficiary has medically improved to the extent that the person is
no longer considered disabled. SSA is also authorized to conduct
CDRs on individuals receiving disability benefits under the
Supplemental Security Income (SSI) program, and recent legislation
requires CDRs for some who receive SSI benefits. Together, the
programs pay about $60 billion annually to 9 million disabled
beneficiaries;\1 an additional 1.6 million nondisabled dependents of
DI beneficiaries also receive benefits.
Programs of this magnitude require sound management to ensure that
funds are being spent as the Congress intended and to achieve the
most effective use of resources. Such management includes (1)
monitoring the disability status of all beneficiaries to help ensure
program integrity and (2) helping as many beneficiaries as possible
to become self-sufficient by determining their vocational
rehabilitation (VR) service needs and providing them assistance to
enter or reenter the workforce. The amounts in cash and medical
benefits that beneficiaries can receive by age 65 average about
$113,000 for SSI beneficiaries and about $225,000 for DI
beneficiaries.\2
Concerned about SSA's ability to conduct all the CDRs required by
law, you asked us to provide information on how to improve the CDR
process. We were also asked by the Chairman, Subcommittee on Social
Security, House Committee on Ways and Means, to provide information
about the backlog of cases due for CDRs under the DI program. As
agreed with your office, we are providing the same information to you
and the Chairman, Subcommittee on Social Security, in separate
reports.\3 Both reports also include information about cases
scheduled for CDRs under the SSI program. Specifically, we are
providing information on (1) the number and characteristics of
individuals who are due for CDRs, (2) how SSA selects individuals for
and conducts CDRs, (3) whether available resources are adequate for
conducting required CDRs, and (4) what potential options exist for
improving the CDR process. In addition, in a forthcoming report on
SSA's review of SSI recipients' disability status, we discuss SSA's
strategy for meeting new legislative requirements for CDRs under the
SSI program.
To develop this information, we interviewed SSA and state disability
determination services officials and members of the National Academy
of Social Insurance (NASI) disability policy panel. We analyzed
extracts from the SSA Master Beneficiary Record (MBR) and
Supplemental Security Income Record Description (SSIRD) databases and
electronic files provided by the Office of Disability, which
contained information on beneficiaries who were due or overdue for a
CDR in fiscal year 1996. We also reviewed applicable laws and
regulations and relevant SSA documents, including procedures,
guidance, work plans, budgets, and CDR costs. We reviewed reports
and papers by others, including the NASI disability policy panel and
its members. Furthermore, we reviewed the process SSA uses in
determining which beneficiaries should receive a CDR and the
composition of the formulas that process uses to estimate the
likelihood of benefit termination for beneficiaries. We also
analyzed the electronic databases as provided to us by SSA officials
but did not evaluate the validity of the databases or the SSA
formulas used to estimate the likelihood of benefit termination. Our
scope and methodology are discussed further in appendix I.
--------------------
\1 We use the term beneficiary to refer to any individual who
receives either DI or SSI disability benefits, or both. About 1.1
million of the 9 million beneficiaries were concurrently enrolled in
both programs.
\2 See Supplemental Security Income: Disability Program Vulnerable
to Applicant Fraud When Middlemen Are Used (GAO/HEHS-95-116, Aug.
31, 1995) and Social Security: Federal Disability Programs Face
Major Issues (GAO/T-HEHS-95-97, Mar. 2, 1995).
\3 See Social Security Disability: Alternatives Would Boost
Cost-Effectiveness of Continuing Disability Reviews (GAO/HEHS-97-2,
Oct. 16, 1996).
RESULTS IN BRIEF
------------------------------------------------------------ Letter :1
About 4.3 million DI and SSI beneficiaries are due or overdue for
CDRs in fiscal year 1996.\4 Of those reviews, about 2.5 million are
required by law; SSA has the authority but is not required to review
another 1.8 million beneficiaries. The typical beneficiary awaiting
a CDR is middle-aged, is disabled by mental illness, has been
receiving benefits for at least 8 years, and is overdue for a CDR by
at least 3 years.
Although many beneficiaries have limited potential for medical
improvement because of severe disability or terminal illness, the CDR
process provides SSA a means to ensure that only eligible people
receive benefits.\5 SSA typically performs CDRs on only a portion of
those beneficiaries who the agency determines are cost-effective to
review, as estimated by formulas SSA developed. SSA's process for
selecting beneficiaries to receive CDRs, however, excludes
approximately one-half of beneficiaries who are due or overdue for a
CDR--those who fall in the middle group, between beneficiaries with
the greatest and least likelihood of benefit termination--and its
formulas are not useful for a majority of these beneficiaries.
Recognizing that it needs to improve its selection process, SSA is
developing plans to include more beneficiary groups and is making
other process improvements to facilitate identifying beneficiaries
who may no longer be disabled and should be removed from the
disability rolls.
With funding that could exceed $4 billion over 7 years (1996 through
2002, inclusive), SSA is developing a plan to eliminate the backlog
of CDRs for workers under the age of 59 in the DI program and to
conduct CDRs that have recently been required in the SSI program. To
avoid continuing the backlog, from 1996 through 2002, SSA will need
to conduct about twice as many CDRs as it has conducted over the past
20 years combined. SSA will likely face other challenges, including
expanding the plan it is developing to accommodate the additional SSI
CDRs required by recently enacted legislation and making the
improvements to the CDR process that are necessary to fully implement
the plan. SSA's plan to conduct CDRs on 8,182,300 beneficiaries in 7
years is ambitious. Furthermore, because SSA has not completed
incorporating new CDR requirements into its plan, it is too early to
tell whether authorized funding will be sufficient to conduct all
required CDRs. However, even if SSA could meet these challenges and
conduct these CDRs, it would still have to forgo conducting CDRs that
are authorized but not required for SSI beneficiaries and CDRs for DI
beneficiaries that SSA currently excludes from the CDR selection
process.
The workload challenges that SSA may encounter between now and 2002
and limitations in the existing CDR process suggest a need to examine
alternative means of conducting CDRs more cost-effectively. SSA
estimates that only a very small percentage of beneficiaries leave
the program as a result of the current CDR process. Instead of
requiring periodic CDRs on all beneficiaries, a more cost-effective
approach that imposed less rigid requirements on who must be reviewed
and how often might better serve SSA's needs. This would give SSA
greater flexibility to concentrate its CDR efforts on beneficiaries
with the greatest potential for medical improvement and subsequent
benefit termination.
While ensuring that it performs CDRs cost-effectively, SSA must also
ensure program integrity. With more flexible scheduling of CDRs, SSA
would also need a process that both ensured that all groups of
beneficiaries were subject to selection for a CDR and provided more
frequent contacts with beneficiaries who were not selected. Although
SSA would incur some administrative costs to implement an alternative
process like this, the costs would likely be offset by a one-time net
savings of over $1.4 billion that would result from identifying
ineligible beneficiaries and terminating their benefits when they
failed to respond to SSA's CDR contacts. Furthermore, SSA might be
able to use the CDR process to strengthen its return-to-work
initiatives and help more beneficiaries move off disability by using
CDR contacts to assess beneficiaries' work potential and help them
obtain the services they need to enter or reenter the workforce.
--------------------
\4 Beneficiaries are "due" for a CDR if they are due in the current
year; they are overdue if they were due for a CDR in a previous year.
\5 SSA performs two types of CDRs: full medical CDRs and mailer
CDRs. Full medical CDRs are labor-intensive reviews of
beneficiaries' employment and disability status. Mailer CDRs are
questionnaires through which the beneficiary provides medical care,
health, and other information to SSA. Mailer CDRs enable SSA to do
more CDRs without performing the costlier full medical CDRs on
beneficiaries who have little likelihood of leaving the beneficiary
rolls through medical improvement.
BACKGROUND
------------------------------------------------------------ Letter :2
The DI and SSI programs are the two largest federal programs
providing assistance to people with disabilities.\6
DI is the nation's primary source of income replacement for workers
with disabilities who have paid Social Security taxes and are
entitled to benefits. The DI program also pays benefits to disabled
dependents of disabled, retired, or deceased workers--disabled adult
children and disabled widows and widowers. SSI provides assistance
to disabled people who have a limited or no work history and whose
income and resources are below specified amounts.\7 State disability
determination service (DDS) agencies, which are funded by SSA, decide
whether individuals applying for DI or SSI benefits are disabled.
Federal laws specify those who must receive CDRs. The 1980
amendments to the Social Security Act require that SSA review at
least every 3 years the status of DI beneficiaries whose disabilities
are not permanent to determine their continuing eligibility for
benefits. The law does not specify the frequency of the required
reviews for beneficiaries with permanent disabilities. The Social
Security Independence and Program Improvements Act of 1994 requires
that SSA conduct CDRs on one-third of the SSI beneficiaries who reach
age 18 and a minimum of 100,000 additional SSI beneficiaries annually
in fiscal years 1996 through 1998. The 1996 amendments to the Social
Security Act require that SSA conduct CDRs (1) at least every 3 years
for children under age 18 who are likely to improve or, at the option
of the Commissioner, who are unlikely to improve and (2) on
low-birth-weight babies within their first year of life. The 1996
legislation also requires disability eligibility redeterminations,
instead of CDRs, for all 18-year-olds beginning on their 18th
birthdays, using adult criteria for disability.\8
State DDS agencies set the frequency of CDRs for each beneficiary
according to his or her outlook for medical improvement, which is
determined on the basis of impairment and age. Beneficiaries
expected to improve medically, classified as "medical improvement
expected" (MIE), are scheduled for review at 6- to 18-month
intervals; beneficiaries classified as medical improvement possible
(MIP) are scheduled for review at least once every 3 years; and those
classified as medical improvement not expected (MINE) are scheduled
for review once every 5 to 7 years.
For almost a decade, because of budget and staffing reductions and
competing priorities, SSA has been unable to conduct all the DI CDRs
required by the Social Security Act. Moreover, the agency has
conducted relatively few elective SSI CDRs. (See tables III.1 and
III.2 for numbers of previous CDRs conducted and CDR funding.) In
1996, the Congress authorized about $3 billion for CDRs for fiscal
years 1996 through 2002. In addition, SSA plans to earmark over $1
billion in its administrative budget for CDRs during that same time
period.
--------------------
\6 The Social Security Act defines disability for adults in the DI
and SSI programs as the inability to engage in any substantial
gainful activity because of any medically determinable physical or
mental impairment that can be expected to result in death or that has
lasted or can be expected to last 12 months or longer. Individuals
under age 18 are also covered under the SSI program if their physical
or mental impairments are of comparable severity. In this report,
the term disabled includes individuals classified as either blind or
disabled.
\7 People over age 65 who are not disabled also receive SSI if their
income and resources fall below specified amounts. However, the
nondisabled elderly receiving SSI are not included in this report.
\8 The 1996 legislation also repeals the provision on CDRs for
18-year-olds in the 1994 legislation and allows the disability
eligibility redeterminations of 18-year-olds to count as required SSI
CDRs.
DI AND SSI BENEFICIARIES DUE
FOR CDRS HAVE SIMILAR
CHARACTERISTICS
------------------------------------------------------------ Letter :3
The DI and SSI programs have about 4.3 million beneficiaries due or
overdue for a CDR in fiscal year 1996. About 2.5 million of these
reviews are required by law, including about 2.4 million DI CDRs and
118,000 SSI CDRs. SSA is authorized, but not required by law, to
conduct the remaining CDRs. As shown in table 1, about half of all
beneficiaries are awaiting CDRs, the largest category of which is
disabled workers receiving DI benefits.\9
Table 1
Beneficiaries Due or Overdue for CDRs in
1996 Compared With Total Disability
Beneficiaries, by Program
Total
Number of disability
beneficiar beneficiar
ies due ies as of
for CDRs January
Beneficiary description in FY 1996 1996
---------------------------------- ---------- ----------
Disability Insurance program (includes beneficiaries
receiving DI and SSI benefit
----------------------------------------------------------
Disabled workers 1,991,529 4,300,720
Disabled widows and widowers of 69,105 177,820
workers
Disabled adult children of workers 292,715 847,320
Subtotal 2,353,349 5,325,860
Supplemental Security Income program
----------------------------------------------------------
Disabled adults 1,393,693\ 2,617,920
a
Disabled children 515,739\a 1,081,420
Subtotal 1,909,432\ 3,699,340
a
Total, DI and SSI programs 4,262,781 9,025,200
----------------------------------------------------------
\a Estimates are based on a 15-percent sample.
Sources: GAO analysis of MBR and SSIRD extracts, records supplied by
SSA's Office of Disability, and data supplied by SSA's Office of
Systems Requirements.
SSA calculated a smaller number of CDRs due or overdue of about 1.4
million DI beneficiaries and 1.6 million SSI beneficiaries. It
excluded from its calculation DI worker beneficiaries aged 59 and
older, disabled widows and widowers and disabled adult children of DI
worker beneficiaries, and SSI beneficiaries aged 59 and older. SSA
officials acknowledged that CDRs are required for all of the DI
beneficiaries it has excluded, but stated that, because of the
backlog, the agency is focusing its attention on the portions of the
CDR population that it estimates are more cost-effective to review.
In general, DI worker beneficiaries\10 and adult SSI beneficiaries in
the backlog have similar characteristics, and SSA estimates a low
likelihood of benefit termination as a result of medical improvement.
On average, workers receiving DI and adult SSI beneficiaries have
been receiving benefits for over 9 years and their predominant
disability is mental disorders. While both are middle-aged, the
average SSI adult beneficiary is about 9 years younger than the
average DI worker beneficiary. In addition, the average estimated
likelihood of benefit termination for DI and SSI MIE and MIP
beneficiaries under age 60 is less than 5 percent.\11 More data on DI
and SSI characteristics are provided in tables IV.1 through IV.12.
Table 2
Selected Characteristics of DI and SSI
Populations Due for a CDR
DI worker
beneficiar
Characteristic y Adult Child
---------------------- ---------- ---------- ----------
Average age in years 51 42 11
Predominant disability Mental Mental Mental
disorder disorder retardatio
n
Average number of 10 9 6
years receiving
benefits
Average number of 3 3 2
years CDR is overdue
Average (mean) 4% 5% Not
estimated likelihood applicable
of benefit
termination of MIEs
and MIPs under age 60
Average (median) 2% 2% Not
estimated likelihood applicable
of benefit
termination of MIEs
and MIPs under age 60
----------------------------------------------------------
Sources: GAO analysis of MBR and SSIRD extracts, and records
supplied by SSA's Office of Disability.
--------------------
\9 Of those receiving DI benefits, about 20 percent have a benefit
amount sufficiently low that they also receive some SSI benefits.
These individuals are referred to as concurrent beneficiaries.
\10 We excluded disabled widows and widowers and disabled adult
children of DI worker beneficiaries from our analysis because SSA
could not supply us with reliable data that would allow us to locate
needed MBR files for individuals in these groups.
\11 SSA estimates the likelihood of benefit termination only for MIE
and MIP beneficiaries under age 59. It does not estimate the
likelihood of benefit termination for MINEs, beneficiaries aged 59
and older, SSI child beneficiaries, or adult disabled children or
disabled widows and widowers of DI worker beneficiaries. However,
when SSA provided data to us on workers receiving DI, it used a
cutoff of under age 60 rather than under age 59 to define younger and
older workers. Our analyses reflect that same definition for both DI
and SSI data. SSA's more recent work has used age 59 as the cutoff
between younger and older beneficiaries.
SSA ONLY CONDUCTS CDRS ON
BENEFICIARIES IT CONSIDERS
COST-EFFECTIVE TO REVIEW
------------------------------------------------------------ Letter :4
SSA uses two types of CDRs, a full medical CDR and a mailer CDR, to
review beneficiaries' status. The full medical CDR process is
labor-intensive and generally involves (1) one of 1,300 SSA field
offices to determine whether the beneficiary is engaged in any
substantial gainful activity (SGA)\12 and (2) one of 54 state DDS
agencies to determine whether the beneficiary continues to be
disabled, a step that frequently involves examination of the
beneficiary by at least one medical doctor. Beginning in 1993,
questionnaires--called mailer CDRs--replaced full medical CDRs for
some beneficiaries to increase the cost-effectiveness of the CDR
process.
SSA also developed statistical formulas for estimating the likelihood
of medical improvement and subsequent benefit termination based on
computerized beneficiary information such as age, impairment, length
of time on the disability rolls, and date of last CDR.\13 For
beneficiaries for whom application of the formulas indicates a
relatively low likelihood of benefit termination, SSA uses a mailer
CDR; when the formula application indicates a relatively high
likelihood of benefit termination, SSA uses a full medical CDR. For
those who receive mailer CDRs, SSA takes an additional step to
determine whether responses to a mailer CDR, when combined with data
used in the formulas, indicate that medical improvement may have
occurred; in this small number of cases, the beneficiary is also
given a full medical CDR. Individuals who have responded to a mailer
CDR and are found to be still disabled are not referred for full
medical CDRs, and SSA sets a future CDR date. Currently, SSA
estimates that the average cost of a full medical CDR is about
$1,000, while the average cost of a mailer CDR is between about $25
and $50. (See app. II for more details on the steps in the CDR
process.)
--------------------
\12 SSA currently defines SGA as employment that produces eligible
earnings of more than $960 a month for blind individuals and $500 a
month for other disabled individuals.
\13 On the basis of the beneficiary's impairment type and recent work
activity, if any, SSA decides which of 23 formulas to use. Also,
when SSA uses the formulas on SSI beneficiaries, it does not use the
variables on length of time since the last CDR and number of previous
CDRs because relatively few SSI beneficiaries have undergone a CDR.
SSA PRIMARILY SELECTS
BENEFICIARIES FOR CDRS ON
THE BASIS OF THE LIKELIHOOD
THEIR BENEFITS WILL BE
TERMINATED
---------------------------------------------------------- Letter :4.1
SSA does not include in its selection process all DI and SSI
beneficiaries. SSA limits its selection process to those beneficiary
categories it considers cost-effective to review on the basis of
their potential for medical improvement. Approximately one-half of
the DI and SSI beneficiaries currently due for CDRs are included in
SSA's process for estimating the likelihood of benefit termination
through the use of statistical formulas; these estimates are the
basis of selection for CDRs. Adult beneficiaries that SSA includes
in its selection process are DI worker and SSI beneficiaries under
age 59 who have been classified as MIEs or MIPs. SSA currently
excludes MINE beneficiaries, beneficiaries aged 59 and older, and
disabled adult children and disabled widows and widowers of DI worker
beneficiaries from its estimation process because it considers these
categories not cost-effective to review. While SSA considers some
SSI child beneficiaries cost-effective to review, children are
currently selected for CDRs without the use of formulas to estimate
the likelihood of benefit termination. (See fig. 1 and table
III.4.)
Figure 1: Distribution of DI
and SSI Beneficiaries Due for
CDRs in SSA's Selection Process
for Estimating the Likelihood
of Benefit Termination
(See figure in printed
edition.)
Sources: GAO analysis of MBR and SSIRD extracts, and reports
supplied by SSA's Office of Disability.
The development and use of formulas reflect SSA's effort to make the
CDR process more cost-effective by using the estimates to identify
beneficiaries who should receive a mailer CDR and those who should
receive a full medical CDR. However, SSA acknowledges that the
formulas are not useful for estimating the likelihood of benefit
termination for most beneficiaries in this process. The formulas are
primarily useful for identifying beneficiaries who SSA estimates are
most or least likely to have their benefits terminated from a CDR.
For individuals who fall in the middle category--which constitutes
the majority of beneficiaries included in the estimation process--the
formulas provide less accurate estimates, according to SSA. At this
time, SSA does not select for CDRs any beneficiaries from this middle
group because it is unable to determine whether a mailer or a full
medical CDR is most appropriate for these beneficiaries. According
to SSA, if it conducted mailer CDRs on the middle group, this would
likely result in more beneficiaries being subsequently referred for
full medical CDRs than the agency can accommodate in its budget.
Similarly, if it conducted full medical CDRs on the middle group, it
would be using a higher-cost process than SSA believes is necessary
for some in this group. (See fig. 2 and table III.5.) Consequently,
SSA selects a portion of the beneficiaries with the highest and
lowest estimated likelihood of benefit termination for full medical
and mailer CDRs, respectively.
Figure 2: Estimated Likelihood
of Benefit Termination for DI
and SSI Beneficiaries Included
in SSA's Estimation Process for
CDR Selection
(See figure in printed
edition.)
Note: SSA estimates the likelihood of benefit termination for DI MIE
and MIP worker beneficiaries under age 60 and SSI MIE and MIP adult
beneficiaries under age 60 as part of its CDR selection process.
Sources: GAO analysis of MBR and SSIRD extracts, and records
supplied by SSA's Office of Disability.
SSA has not developed statistical formulas to use in selecting SSI
child and 18-year-old beneficiaries for CDRs. According to SSA, it
selected low-birth-weight babies for CDRs of children for fiscal year
1996 because historically about 40 percent of this category have
benefits terminated as a result of a CDR. Selecting low-birth-weight
babies for CDRs is also consistent with CDR requirements that take
effect in fiscal year 1997.
For 18-year-old SSI beneficiaries in fiscal year 1996, SSA selected a
judgmental sample classified as either MIE or MIP who had
characteristics associated with a high likelihood of benefit
termination. For fiscal year 1996, all reviews of child and
18-year-old SSI beneficiaries are to be full medical CDRs.\14
--------------------
\14 Beginning in fiscal year 1997, as a result of the 1996 amendments
to the Social Security Act, the disability eligibility status of all
18-years-olds will be redetermined on the basis of adult criteria.
SSA PLANS TO INCLUDE MORE
BENEFICIARY CATEGORIES AND
MAKE OTHER SELECTION PROCESS
IMPROVEMENTS TO BETTER
IDENTIFY THE NONDISABLED
---------------------------------------------------------- Letter :4.2
Recognizing the need to improve the current process, SSA plans to
expand and enhance its procedures for selecting beneficiaries for
CDRs and conducting the reviews. Furthermore, SSA told us that these
planned process improvements will limit the extent to which SSA can
conduct the planned number of CDRs and reduce the CDR backlog.
SSA plans to include more beneficiary categories in its selection
process by expanding the use of the statistical formulas for certain
MINE-classified beneficiaries and children and enhancing the
formulas. Beginning in fiscal year 1997, according to SSA, formulas
will be used for those beneficiaries who are classified as MINEs
because they are older rather than because of their impairment. SSA
also plans to develop formulas to use for children receiving SSI
beginning in about fiscal year 1998. According to SSA, postponing
the development of formulas for SSI child beneficiaries will allow
the agency to integrate this process improvement with the knowledge
it will gain about impairments that afflict children as a result of
the new requirement to conduct CDRs for children in the SSI program
beginning in fiscal year 1997.
SSA also plans to pursue two approaches for the collection of medical
treatment information about 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. SSA expects that the additional
information will allow it to better determine the appropriateness of
either mailer or full medical CDR for beneficiaries with estimates of
benefit termination in the middle range. Second, SSA plans to
develop a new type of CDR that would be conducted by mail to obtain
current information about a beneficiary's disability and treatment.
Unlike the current mailer CDR, the new type of CDR would collect
information directly from beneficiaries' physicians and other medical
treating sources. This information will be combined with
computerized beneficiary data to help identify the beneficiaries in
the middle range who are most likely to be no longer disabled and
therefore warrant full medical CDRs.
INCORPORATING ADDITIONAL
REQUIRED CDRS INTO ITS PLAN AND
IMPLEMENTING PROCESS
IMPROVEMENTS ARE AMONG THE
CHALLENGES SSA MUST ADDRESS
------------------------------------------------------------ Letter :5
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.
Because SSA has not finished incorporating the new CDR requirements
into its plans, it is too early to determine whether the authorized
funding will be adequate for all required CDRs. However, exclusions
from the estimates SSA used regarding the size of the backlog in
fiscal year 1996, SSA's need to complete process improvements in
order to conduct a greater number of CDRs, and other challenges all
contribute to the uncertainty that SSA will be able to be current
with required CDRs within 7 years.
CDR FUNDING AUTHORIZED IN
TWO LAWS AND EARMARKED IN
SSA BUDGET
---------------------------------------------------------- Letter :5.1
Funding for CDRs from all sources could exceed $4 billion by 2002.
The bulk of the funding for CDRs is authorized by the Contract With
America Advancement Act of 1996, which authorized about $2.7 billion
between 1996 and 2002. While the funding is primarily for DI CDRs, a
portion can be used for SSI CDRs. Most recently, the 1996 amendments
to the Social Security Act authorized a total of about $250 million
for SSI CDRs and medical eligibility redeterminations in fiscal years
1997 and 1998. For the first time in 1996, SSA designated $200
million of its administrative budget to be used solely to conduct
CDRs. By comparison, SSA spent almost $69 million to conduct CDRs in
fiscal year 1995. SSA expects to continue to earmark moneys in
future budgets at the same level as fiscal year 1996. (See table
III.2 for SSA's CDR spending in past years.)
SSA'S PLAN IN PROGRESS,
CONTAINS WEAKNESSES
---------------------------------------------------------- Letter :5.2
SSA's plan to conduct CDRs on 8,182,300 beneficiaries between 1996
and 2002 is ambitious. The plan, as of August 1, 1996, called for
SSA to conduct nearly twice as many CDRs as it has conducted over the
past 20 years combined. If the plan is fully implemented, SSA will
conduct the CDRs for DI worker beneficiaries under age 59, the
beneficiary category the plan defines as constituting the DI backlog.
In addition, it will conduct about 350,000 SSI CDRs required under
the Social Security Independence and Program Improvements Act of 1994
and about 2 million additional elective SSI CDRs. (See table III.6
for the number of full medical and mailer CDRs SSA plans to conduct.)
SSA's plan reflects increased authorizations from the Contract With
America Advancement Act but does not yet account for the increased
authorizations or increased CDRs and related work required by the
1996 amendments to the Social Security Act.
SSA's estimate of the size of the DI CDR backlog in fiscal year 1996
excludes about 848,000 beneficiaries, composed of disabled widows and
widowers, disabled adult children, and workers aged 59 and older.
SSA officials acknowledge that CDRs are required for these
beneficiaries, but SSA has excluded them from the plan because it
focuses on those categories SSA considers more cost-effective to
review. In addition, an SSA official said that a large number of
beneficiaries in the excluded categories are expected to leave the
program because either they will die or convert to retirement
benefits before SSA can conduct their CDRs. However, SSA has not
estimated the proportion of excluded categories who may leave the
program, nor does it include in its plan beneficiaries in these
categories who will come due for CDRs in fiscal years 1997 through
2002.
Process improvements are critical to SSA's ability to implement the
portion of the plan that relies on the mailer CDR, a component whose
use is planned to triple in fiscal year 1998. SSA's success with the
mailer CDR will rely on yet-to-be-tried improvements. Although plans
to expand the formulas to more beneficiary categories and collect
medical treatment information appear promising, some improvements are
in the earliest stages of development with only about 1 year
available for completion. Thus, SSA will need to develop these
initiatives more quickly than it did previous improvements. The
integration of Medicare and Medicaid data into the formulas used to
estimate the likelihood of benefit termination, and the development
of a new type of CDR that collects information from physicians and
other medical treating sources, are expected to allow SSA to begin
conducting CDRs on beneficiaries with an estimated benefit
termination in the middle range. SSA said that it currently is
unable to determine whether the beneficiaries with estimates in the
middle range should have a full medical CDR or a mailer CDR. Without
that ability, SSA cannot determine the most cost-effective type of
CDR to use, and its planned expansion of the use of the mailer CDR
will be in jeopardy.
SSA faces a variety of other challenges to the implementation of its
plan and the elimination of the backlog of required CDRs:
-- First, SSA must incorporate into its workload SSI CDRs and
disability eligibility redeterminations required by the 1996
amendments to the Social Security Act. These requirements
include performing CDRs once every 3 years for children under 18
years old who are likely to medically improve and for all
low-birth-weight babies by their first birthday. This law also
requires SSA to conduct disability eligibility redeterminations
on all child beneficiaries who turn 18 years old, within 1 year
of their birthday, and for between 300,000 and 400,000 children
who qualified for SSI under individualized functional
assessments (IFA). These reviews of children would take
precedence over required CDRs and may shift resources away from
other CDRs.\15 The law also changes SSI eligibility for legal
aliens who have not resided in this country for 5 years before
receiving benefits, necessitating CDRs of the beneficiaries to
determine continuing eligibility.
-- Second, other recent legislation poses a competing priority.
The law eliminates drug and alcohol abuse as a basis for
receiving disability benefits; as a result, benefits will
terminate for many of an estimated 196,000 DI and SSI
beneficiaries whose primary impairments are drug abuse and/or
alcoholism. SSA expects many of those terminated to reapply on
the basis of other impairments, thus increasing SSA's workload
of initial claims for benefits. Previous increases in initial
claims adversely affected the number of CDRs conducted as
resources were shifted away from that activity to process
initial applications.
-- Third, SSA's plan includes doing CDRs for many of the estimated
3.7 million SSI beneficiaries whose CDRs may be conducted at
SSA's discretion. While conducting these discretionary SSI
reviews may be warranted largely because relatively few SSI CDRs
have been conducted in the past, it shifts resources away from
conducting required DI reviews.
-- Fourth, the daunting effort to gear up for the unprecedented CDR
workload will include negotiations between SSA and 50 state DDS
agencies to increase CDR workloads and DDS efforts to hire,
train, and supervise additional staff.
--------------------
\15 The IFA reviews would, however, be counted toward the total
number of SSI CDRs required under the Contract With America
Advancement Act.
ALTERNATE APPROACHES FOCUS ON
CDRS' COST-EFFECTIVENESS AND
THEIR USE IN HELPING
BENEFICIARIES MOVE OFF
DISABILITY
------------------------------------------------------------ Letter :6
In the Contract With America Advancement Act, the Congress emphasized
maximizing the combined savings from CDRs under the DI and SSI
programs. SSA has been working to improve its ability to identify
beneficiaries for whom conducting CDRs would be most cost-effective.
Other alternatives exist, however, that would likely make CDRs more
cost-effective and improve program integrity.
REVISING REQUIREMENTS COULD
IMPROVE CDRS'
COST-EFFECTIVENESS
---------------------------------------------------------- Letter :6.1
The current system of periodic CDRs for all beneficiaries, including
those with virtually no potential for medical improvement, is a
costly approach for identifying the approximately 5 percent of
beneficiaries who medically improve to the point of being found
ineligible for benefits. Furthermore, the frequency of CDRs is
currently based on medical improvement classifications that do not
clearly differentiate between those most and least likely to have
their benefits terminated as a result of a CDR. Our analysis found
that the estimated likelihood of benefit termination, as determined
by SSA's formulas, was very similar for beneficiaries classified as
MIEs and MIPs. Although millions of dollars are spent annually to
conduct periodic CDRs, some beneficiaries, especially those in the DI
program, have received benefits for years without having any contact
with SSA regarding their disability or their ability to return to
work despite continuing disability. An alternate approach could
build on SSA's efforts to identify those beneficiaries whose CDRs are
likely to be cost-effective and also increase contact with
beneficiaries who remain in the program. Such an approach involves
requiring (1) CDRs of beneficiaries with the greatest potential for
medical improvement, (2) CDRs of a random sample from all other
beneficiaries, and (3) regular contact with the remainder of the
beneficiaries to increase program integrity.
Less rigid requirements regarding the frequency of CDRs are necessary
if reviews are to be conducted primarily on those beneficiaries whose
cases are cost-effective to review--that is, those beneficiaries with
the greatest potential for medical improvement--and for SSA to still
be in compliance with laws governing CDRs. According to SSA, one of
the best indicators of whether beneficiaries will remain on
disability rolls is whether they have previously undergone a CDR. If
an initial CDR finds that the beneficiary continues to be medically
eligible for disability benefits, subsequent CDRs may not be
cost-effective or appropriate. Because few CDRs actually result in
benefit terminations, periodic reviews, even at the maximum 3- and
7-year intervals currently used, may not be appropriate for certain
beneficiaries if further reviews are not warranted after the initial
CDR and at least several years on the disability rolls.
Conducting CDRs on a random sample of beneficiaries from among those
whose cases are believed by SSA to be less cost-effective to review
is consistent with a more cost-effective and flexible approach to
scheduling CDRs. It also addresses a weakness in SSA's current
process by ensuring overall program integrity. SSA's current process
excludes some categories of beneficiaries from portions of the
selection process. As a result, about one-half of all beneficiaries
due for a CDR will go without oversight unless SSA changes its
selection process. If periodic CDRs are not conducted for all
beneficiaries, it is increasingly important to develop a strategy to
ensure overall program integrity.
Contact with beneficiaries, in addition to the contact that occurs in
the CDR process, can improve program integrity by reminding
beneficiaries that their medical conditions are being monitored and
serving as a deterrent to abuse by those no longer medically eligible
for benefits. It could also support SSA's process improvement
efforts, particularly within the next year. We believe that a new
type of brief mailed contact would, at a minimum, in the year it is
implemented, allow SSA to contact a majority of beneficiaries with
overdue CDRs to remind them of their responsibility to report medical
improvements and to inquire about their interest in returning to
work.\16 By collecting CDR-related information as part of this new
contact, it could also speed the development of SSA's planned
improvements to the CDR process. For example, SSA could gather
information on physicians and other treating sources seen by
beneficiaries since their last CDR. Such information is needed to
implement SSA's new medical treating source CDR.
SSA has not evaluated this three-pronged proposal for improving the
CDR process, but in our discussions with agency officials, some
provided comments on one aspect of it. In discussing additional,
more frequent contact with beneficiaries in addition to that which
occurs during a CDR, several officials raised the issue of the cost
of such an initiative. Although some administrative funds would be
used for this contact, it should result in significant savings
because a considerable number of beneficiaries, on the basis of SSA's
experience, can be expected to refuse repeatedly to provide requested
information and, as a result, will have their benefits terminated
after a prescribed due-process procedure is followed.\17 According to
SSA, those who fail to cooperate generally do so because they believe
that they are no longer eligible for benefits. On the basis of SSA's
experience with CDRs and financial eligibility redeterminations, we
assumed that .71 percent of the DI beneficiaries and 1 percent of the
SSI beneficiaries who were contacted would have their benefits
terminated for noncooperation after all due-process procedures were
followed. These termination rates represent an estimated one-time
net federal savings of over $1.4 billion from contacting
beneficiaries in the CDR backlog, with DI savings accounting for
about $1.2 billion and SSI savings accounting for about $230 million.
If extended to all beneficiaries not receiving CDRs or financial
eligibility redeterminations, the costs and subsequent savings from
such a contact would likely be higher. See appendix I for a further
discussion of our estimated savings.
--------------------
\16 In order to minimize the burden placed on beneficiaries to
provide SSA with information, those who would be receiving financial
eligibility redeterminations or who are selected for a CDR are
excluded from the proposed contact. Currently, SSA does not have a
system for coordinating the collection of CDR and financial
eligibility redetermination information. If a system for providing
coordination is developed, SSA may want to consider collecting the
CDR-related information contained in the proposed mail contact at the
same time that it collects information for financial eligibility
redeterminations. SSA is currently exploring the potential for
better coordinating CDRs and financial eligibility redeterminations.
We discuss SSA's efforts to coordinate CDRs and financial eligibility
redeterminations in our forthcoming report on SSA's review of SSI
recipients' disability status.
\17 Although the savings would accrue to trust funds and the general
fund, rather than to the agency's administrative operations, that is
true as well for savings from CDRs.
ESTABLISHING DATA-BASED
CRITERIA FOR TIME-LIMITED
BENEFITS MAY BE DIFFICULT
---------------------------------------------------------- Letter :6.2
Time-limiting disability benefits has been proposed as a way to
reduce beneficiaries' dependence on cash benefits by removing them
from the rolls after set periods of time. Time limits are intended
to encourage beneficiaries to obtain treatment and pursue
rehabilitation to overcome their disabling conditions and obtain
productive employment. Proposals for time-limited benefits generally
establish criteria for deciding which categories of beneficiaries
would be subject to time limits and no longer subject to required
CDRs.\18 Some believe that such broad application of time limits
could significantly reduce the number of people who would continue on
the rolls indefinitely and eliminate the CDR backlog. 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. Time limits are also thought to increase the
number of people on the rolls because SSA and DDS staff may, in
certain cases, be more likely to award benefits because of the
limited payment period. Instead of subjecting all beneficiaries with
nonpermanent impairments to time limits, some believe that time
limits should be applied to certain subsets or categories of
beneficiaries--those with impairments that are likely to improve with
treatment or surgery. Such impairments include affective disorders,
tuberculosis, certain fractures, and orthopedic impairments for which
surgery can restore or improve function.
However, our analysis of the characteristics of those in the CDR
backlog suggests that implementing time-limited benefits on the basis
of either medical improvement classifications or specific impairments
is not currently feasible. As explained earlier, on the basis of our
analysis of available CDR population characteristics, there is little
correlation between the MIE and MIP classifications and the estimated
likelihood of benefit termination. Moreover, our analysis did not
associate any specific impairment or other characteristic with a
greater likelihood of benefit termination. Furthermore, SSA and the
NASI disability policy panel concluded that the MIE, MIP, and MINE
classifications do not accurately reflect the likelihood of medical
improvement and subsequent benefit termination.
--------------------
\18 See, for example, National Academy of Social Insurance, Balancing
Security and Opportunity: The Challenge of Disability Income Policy.
Findings and Recommendations of the Disability Policy Panel
(Washington, D.C.: NASI, Jan. 25, 1996).
SSA COULD BETTER UTILIZE THE
CDR PROCESS TO ENCOURAGE
RETURN TO WORK
---------------------------------------------------------- Letter :6.3
The CDR process has the potential to be used to further SSA's
return-to-work initiatives, strengthening that effort and offering
greater opportunity for beneficiaries to become self-sufficient
despite their continuing disabilities. While the Social Security Act
states that as many individuals as possible applying for benefits
under the DI program should be rehabilitated into productive
activity, only about 8 percent of DI and SSI beneficiaries are
referred for vocational rehabilitation (VR) services.\19
SSA generally does little during the CDR process to determine
beneficiaries' VR needs and provide assistance to help beneficiaries
become self-sufficient. Although in conducting full medical CDRs SSA
obtains information from the beneficiary on VR services received
since the initial application or last CDR, SSA and DDS staff are
neither required nor instructed to assess beneficiaries' work
potential, make beneficiaries aware of rehabilitation opportunities,
or encourage them to seek VR services. When conducting mailer CDRs,
SSA provides beneficiaries the opportunity to indicate an interest in
VR services.
In our April 1996 report, we noted that medical advances and new
technologies are creating more opportunities than ever for disabled
people to work, and some beneficiaries who do not medically improve
may nonetheless be able to engage in substantial gainful activity.\20
Yet, weaknesses in the design and implementation of DI and SSI
program components have limited SSA's capacity to identify and assist
in expanding beneficiaries' productive capacities. Beneficiaries
receive little encouragement to use rehabilitation services. We
recommended in that report that the Commissioner of Social Security
take immediate action to place greater priority on return to work,
including designing a more effective means to identify and expand
beneficiaries' work capacities and better implementing existing
return-to-work mechanisms.
--------------------
\19 DI and SSI applicants are to be promptly referred to state VR
agencies for services intended to prepare them for work
opportunities. SSA field office employees are required to inform
applicants that they may be contacted by a state VR agency; employees
are also expected to give written materials about VR services to
anyone who inquires about disability benefits. However, according to
SSA's guidelines, applicants should not be referred for VR services
if they have terminal illnesses or severe or rapidly progressive
impairments not responding to treatment. VR referrals are also
subject to state policies that screen out applicants who are not
considered reasonable candidates for rehabilitation.
\20 SSA Disability: Program Redesign Necessary to Encourage Return
to Work (GAO/HEHS-96-62, Apr. 24, 1996).
CONCLUSIONS
------------------------------------------------------------ Letter :7
Our analysis of the characteristics of beneficiaries awaiting DI and
SSI CDRs supports SSA's conclusion that there is little likelihood a
large proportion of beneficiaries will show sufficient medical
improvement to no longer be disabled. Therefore, if SSA is to
decrease long-term reliance on these programs as the primary source
of income for the severely impaired, it will need to shift its
emphasis. It must rely less on assessing medical improvement and
more on return-to-work programs to better gauge the potential for
self-sufficiency despite the lack of medical improvement.
SSA's plan to conduct repeated CDRs at regularly scheduled intervals
may not be warranted for some beneficiaries, given the large number
of beneficiaries with little likelihood of benefit termination and
the emphasis on cost-effectiveness in the Contract With America
Advancement Act. A more cost-effective approach might incorporate
(1) a focus on conducting CDRs for beneficiaries with the greatest
likelihood of benefit termination due to medical improvement, (2)
conducting CDRs on a random sample of all other beneficiaries to
correct a weakness in SSA's process, and (3) contact with
beneficiaries not selected for a CDR or a financial eligibility
redetermination to strengthen program integrity.
However, for this cost-effective approach to work, SSA needs to be
able to accurately estimate the likelihood of benefit termination for
all beneficiaries. Currently, our analysis shows that about one-half
of all beneficiaries due or overdue for a CDR have been excluded from
SSA's process that utilizes formulas to estimate the likelihood of
benefit termination. Furthermore, for many beneficiaries, the
formulas result in less accurate estimates. If SSA is to be current
with CDRs by 2002, it will need to meet many challenges, including
expanding the use of its mailer CDR. Because such an expansion is
dependent upon SSA's ability to implement at least two of its planned
process improvements, this raises further questions about SSA's
ability to implement its plan.
RECOMMENDATIONS TO THE
COMMISSIONER OF SOCIAL SECURITY
------------------------------------------------------------ Letter :8
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. As part of this effort, the
Commissioner should develop a legislative package to obtain the
authority the agency needs to enact the new process for those
portions of the DI and SSI populations that are subject to required
CDRs.
To enable as many disabled individuals as possible to become
self-sufficient, SSA should test the use of CDR contacts with
beneficiaries to determine individuals' rehabilitation service needs
and help them obtain the services and employment assistance they need
to enter or reenter the workforce.
AGENCY COMMENTS AND OUR
EVALUATION
------------------------------------------------------------ Letter :9
In commenting on a draft of this report, SSA agreed to test the use
of CDR contacts with beneficiaries to determine individuals'
rehabilitation service needs and help them obtain the services and
employment assistance they need to enter or reenter the workforce.
SSA also agreed to begin to consider changing the current statutory
requirements for CDRs as part of its effort to continually seek ways
to maintain stewardship of the disability program in the most
cost-effective manner. However, it disagreed with our recommendation
on specific changes it should make to the CDR process. In
particular, it disagreed with conducting CDRs on random samples of
beneficiaries who are less cost-effective to review and with making
more frequent contact with all beneficiaries. We continue to believe
that ensuring program integrity requires that all beneficiaries have
an opportunity to be selected for a CDR. In addition, we believe
that efforts to monitor disability status will serve as a deterrent
to abuse by those no longer medically eligible for benefits, and that
maintaining periodic contacts with all beneficiaries is a sound
management practice. SSA also made technical comments on our report,
which we incorporated as appropriate. The full text of SSA's
comments and our responses are contained in appendix V.
---------------------------------------------------------- Letter :9.1
As arranged with your office, unless you announce its contents
earlier, we plan no further distribution of the report until 7 days
after the date of this letter. At that time, we will send copies to
the Commissioner of Social Security. We will make copies available
to others on request.
Please contact me at (202) 512-7215 if you or your staff have any
questions about this report. Other GAO contacts and staff
acknowledgments are listed in appendix VI.
Sincerely yours,
Jane L. Ross
Director, Income Security Issues
SCOPE AND METHODOLOGY
=========================================================== Appendix I
This appendix provides additional details concerning our methodology.
Information is included about databases used in estimating for the DI
and SSI programs the number of beneficiaries due or overdue for a CDR
in fiscal year 1996 and analyzing their characteristics. We also
include information on our calculations of the potential one-time
savings from our proposed mailed contact to collect CDR-related
information from beneficiaries. We analyzed the electronic databases
as provided to us by SSA officials but did not evaluate the validity
of the databases or the SSA formulas used to estimate the likelihood
of benefit termination. We did our review from September 1995 to
August 1996 in accordance with generally accepted government auditing
standards.
NUMBER OF BENEFICIARIES DUE OR
OVERDUE FOR A CDR IN FISCAL
YEAR 1996
--------------------------------------------------------- Appendix I:1
To determine the number of DI worker beneficiaries currently due or
overdue for a CDR, we used SSA's Office of Disability's (OD) CDR
database and the Master Beneficiary Record (MBR). OD's database
contains information on all beneficiaries SSA has determined were due
or overdue for a CDR in fiscal year 1996. We eliminated records for
DI beneficiaries who were included in OD's database but whose MBR
could not be found or who did not meet the definition of being due or
overdue for a CDR in fiscal year 1996. The eliminated records
primarily involved cases that were not due for a CDR until the next
century and were incorrectly included in the backlog population.
Table I.1 contains initial and final population sizes after
adjustments.
Table I.1
Initial and Final Record Counts for DI
Workers Due or Overdue for a CDR in FY
1996
Number of records
-------------------------------------- ------------------
Records received from OD 2,720,411
Records without an MBR match 52
Records that mature in the next 728,830
century
Records used in the analysis 1,991,529
----------------------------------------------------------
OD provided the number of disabled widows and widowers and disabled
adult children in the backlog but did not supply other information
about them.
To determine the number of SSI beneficiaries currently due or overdue
for a CDR, we used OD's database that contains information on all SSI
beneficiaries SSA has determined were due or overdue for a CDR in
fiscal year 1996. We drew a random sample of 15 percent of these
beneficiaries stratified by whether the (1) beneficiary was an adult
or a child and (2) state disability determination services (DDS) had
classified the likelihood of medical improvement as expected (MIE),
possible (MIP), or not expected (MINE). We eliminated from our
sample beneficiaries whose CDR due dates were after fiscal year 1996
or who were over 65.\21 On the basis of our sample data, we estimated
the size of the population with these exclusions. Table I.2 contains
initial population and sample sizes and final sizes after
adjustments.
Table I.2
Initial and Final Population and Sample
Sizes for SSI Beneficiaries Due or
Overdue for a CDR in FY 1996
Adult
MIEs and Adult Child Child Child
MIPs\a MINEs MIEs MIPs MINEs Total
---------------------------- -------- -------- -------- -------- -------- ---------
Population provided by OD 998,671 641,697 114,464 348,516 92,167 2,185,515
15% random sample 148,300 96,253 17,170 52,275 13,825 327,823
CDR due date after FY 96 251 32,213 35 54 5,822 38,375
Over age 65 2,233 804 0 0 0 3,037
Final sample 145,816 63,236 17,135 52,221 8,003 286,411
Adjusted population 972,111 421,580 114,231 348,156 53,354 1,909,432
-----------------------------------------------------------------------------------------
Note: Estimates based on a 15-percent sample.
\a For 236 sample records, a MIE or MIP classification was not
specified. When we analyzed records by MIE or MIP classification
separately, we classified those records as MIPs.
--------------------
\21 We excluded from our analysis SSI beneficiaries receiving
disability benefits who are over 65 because SSA does not conduct CDRs
on these beneficiaries. If CDRs were conducted and these
beneficiaries were found to be no longer disabled, they would
continue to qualify for SSI benefits on the basis of their age. At
age 65, individuals receiving SSI disability benefits also become
eligible for SSI age benefits. Such individuals can choose to
continue receiving disability benefits or can switch to age benefits.
ANALYSIS OF CHARACTERISTICS
--------------------------------------------------------- Appendix I:2
For the population of DI workers, we obtained information on
characteristics from the MBR and OD's CDR database. From the MBR, we
obtained information on age, gender, race, impairment, time receiving
benefits, and time overdue for a CDR. Because information obtained
from OD did not differentiate between MIE and MIP beneficiaries, we
used MBR data to classify beneficiaries in the two categories.\22
From OD's CDR database, we obtained information on (1) records for
all those classified as MINE and (2) estimates of the likelihood of
benefit termination for MIE and MIP beneficiaries, the only
categories for which likelihood data were available. We did not
analyze the characteristics of DI beneficiaries who are disabled
widows and widowers and disabled adult children because we did not
have sufficient information to identify them in the MBR.
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. From the SSIRD, we
obtained information on age, gender, race, impairment, time receiving
benefits, and time overdue for a CDR. We also used SSIRD data to
classify adults into MIE and MIP categories. From OD's CDR database,
we obtained information on (1) medical improvement classifications
for all children and MINE adults; (2) records for all adults
classified as MINE; and (3) estimates of the likelihood of benefit
termination for adult MIE and MIP beneficiaries, the only categories
for whom likelihood data were available.
Because we used a sample to estimate characteristics of the universe
of SSI beneficiaries due or overdue for CDRs in fiscal year 1996, the
reported estimates in tables IV.7 through IV.12 have sampling errors
associated with them. Sampling error is variation that occurs by
chance because a sample was used rather than the entire population.
The size of the sampling error reflects the precision of the
estimate--the smaller the sampling error, the more precise the
estimate. The tables in appendix IV contain sampling errors for
reported estimates calculated at the 95-percent confidence level.
This means that the chances are about 95 out of 100 that the range
defined by the estimate, plus or minus the sample error, contains the
true percentage. With few exceptions, the sampling errors were less
than 1 percentage point. This means that for most percentages, there
is a 95-percent chance that the actual percentage falls within plus
or minus 1 percentage point of the estimated percentage.
--------------------
\22 We classified as MIP 583 of the records for worker beneficiaries
under the age of 60, because a MIE or MIP classification was not
specified.
SAVINGS ESTIMATE FOR PROPOSED
CONTACT WITH BENEFICIARIES IN
THE CDR BACKLOG
--------------------------------------------------------- Appendix I:3
Our estimate of a one-time savings associated with our recommendation
to begin a process for more frequent contact with beneficiaries who
are not selected for either a CDR or a financial eligibility
redetermination during the year is based on the following SSA costs
and savings estimates and assumptions. The number of DI
beneficiaries who would be contacted by this initiative was estimated
by subtracting the number of DI CDRs planned for fiscal year 1996
from the DI population due or overdue for CDRs as of fiscal year
1996. For the SSI program, the number of beneficiaries who would be
contacted by this initiative was estimated by subtracting the
estimated number of SSI beneficiaries who would receive either a
financial eligibility redetermination or a CDR from the SSI
population currently due or overdue for CDRs as of fiscal year
1996.\23 We assumed that the percentage of beneficiaries who would
fail to cooperate with this initiative would be the same as the most
recent SSA estimates for DI CDRs and SSI financial eligibility
redeterminations. We used savings estimates resulting from DI
benefit terminations as provided by the Office of the Actuary. To
estimate federal savings from SSI benefit terminations, we used
estimates provided by SSA's Office of the Actuary and the Department
of Health and Human Services' Health Care Financing Administration
for adult beneficiaries, and offsetting cost estimates to account for
the resultant increase in food stamps. Because these SSI
beneficiaries would be contacted for financial eligibility
redeterminations within the next 5 years, the SSI estimates we used
reflect only 5 years of savings and offsetting food stamps. Because
many DI beneficiaries who have been receiving benefits for years may
never have been contacted for CDRs, the DI estimates we used reflect
a lifetime of savings. As a proxy for the cost of the mailer, we
used an SSA estimate of the cost of the current nonscannable mailer.
Because this figure overestimates the cost of a scannable mail
contact, it provides a conservative estimate, including some
administrative and developmental costs.
Table I.3
Estimated Costs and Savings of Mail
Contact
DI program SSI program
---------------------------- ------------- -------------
Calculation of number of beneficiaries expected to be
dropped from the programs
----------------------------------------------------------
Beneficiaries due or overdue 2,353,349 1,909,432
for CDRs in fiscal year
1996
Less: planned financial Not 552,233
eligibility applicable
redeterminations for those
who are not receiving a CDR
Less: planned CDRs 329,000 236,000
Beneficiaries not contacted 2,024,349 1,121,199
during the year
Multiplied by: percentage of .71% 1.00%
beneficiaries who fail to
cooperate
Total beneficiaries expected 14,373 11,212
to be dropped from the
program
Per-beneficiary savings and offsetting costs
----------------------------------------------------------
Gross savings to DI trust $60,000 $17,424
fund/SSI program
Gross savings to Medicare/ $30,000 $9,071
federal portion of Medicaid
Less: offsetting costs of Not $3,100
additional food stamps applicable
Net savings per beneficiary $90,000 $23,395
dropped from the program
Total estimated savings to the federal government
----------------------------------------------------------
Net program savings (number $1,293,570,00 $262,304,740
of beneficiaries dropped 0
multiplied by net savings
per beneficiary)
Less: cost of sending $50,608,725 $28,029,975
scannable mailer (number of
beneficiaries contacted at
$25)
Total estimated net savings $1,242,961,27 $234,274,765
from proposed initiative 5
(combined total =
$1,477,236,040)
----------------------------------------------------------
--------------------
\23 In order to minimize the burden placed on beneficiaries to
provide SSA with information, those who would be receiving financial
eligibility redeterminations are excluded from the proposed mail
contact. Currently, SSA does not have a system for coordinating the
collection of CDR and financial eligibility redetermination
information. If a system for providing coordination was developed,
SSA might want to consider collecting the CDR-related information
contained in the proposed mail contact at the same time that it
collects information for financial eligibility redeterminations. SSA
is currently exploring the potential for better coordinating CDRs and
redeterminations. Our forthcoming report on SSA's review of SSI
recipients' disability status contains a discussion of SSA's efforts
to coordinate CDRs and financial eligibility determinations.
HOW SSA CONDUCTS CONTINUING
DISABILITY REVIEWS
========================================================== Appendix II
This appendix provides details on SSA's procedures for conducting
CDRs. More specifically, we (1) outline the process for conducting
full medical CDRs and (2) discuss SSA's use of mailer CDRs.
FULL MEDICAL REVIEWS
-------------------------------------------------------- Appendix II:1
Generally, a full medical CDR is used to determine with certainty
whether a beneficiary has medically improved to the point that the
person is no longer disabled and should be removed from the
disability rolls. The full medical CDR process is labor-intensive
and generally involves (1) one of 1,300 SSA field offices to
determine whether the beneficiary is engaged in any substantial
gainful activity (SGA), and (2) one of 54 state DDS agencies to
determine whether the beneficiary continues to be disabled, a step
that frequently involves examination of the beneficiary by at least
one medical doctor. A full medical CDR generally follows an
eight-step evaluation process (see fig. II.1).
Figure II.1: Eight-Step
Evaluation Process for a Full
Medical CDR
(See figure in printed
edition.)
\a If an exception to MI applies in which the initial determination
was fraudulently obtained or the beneficiary does not cooperate with
SSA, benefits are terminated.
Source: SSA program operations manual system.
At step one, the SSA field office determines whether the beneficiary
is engaged in SGA. Field office staff contact the beneficiary, often
through a face-to-face meeting, and obtain information on the
person's condition, medical treating sources, and the effect of the
impairment on the beneficiary's ability to perform SGA. This
information describes any changes that have occurred since the
initial application or most recent CDR and includes types of
treatment received, medicines received, specialized tests or
examinations, vocational rehabilitation services received, and any
schools or training classes attended since the last medical
determination. The SSA field office also obtains information on any
work activities since the person became disabled, whether the
condition continues to interfere with the ability to work, and
whether the beneficiary has been released for work by the treating
physician. Benefits are terminated for beneficiaries engaged in SGA,
regardless of medical condition. A beneficiary found to be not
working or working but earning less than SGA has his or her case
forwarded to the state DDS office.
At step two, the DDS compares the beneficiary's condition with the
Listing of Impairments developed by SSA. The listings contain over
150 categories of medical conditions that, according to SSA, are
severe enough ordinarily to prevent a person from engaging in SGA.
The DDS obtains medical evidence from the sources who treated the
beneficiary during the 12 months prior to the CDR. If the medical
evidence provided is insufficient for a disability decision, the DDS
will arrange for a consultative examination by an independent doctor.
A beneficiary whose impairment is cited in the listings or whose
impairment is at least as severe as those impairments in the
listings, and who is not engaged in SGA, is found to be still
disabled.
At step three, a beneficiary whose impairment is not cited in the
listings or whose impairment is less severe than those cited in the
listings is evaluated further to determine whether there has been
medical improvement (MI). MI is defined as any decrease in medical
severity of the impairment(s) present at the time of the most recent
medical determination. In deciding whether MI has occurred, the DDS
considers changes in symptoms, signs, and/or laboratory findings and
determines whether these changes reflect decreased medical severity
of the impairment(s). If MI has not occurred, the DDS skips step
four and proceeds to step five to consider whether any exceptions to
MI apply.
At step four, for beneficiaries for whom MI has occurred, the DDS
determines whether MI is related to the ability to work. MI relates
to the ability to work when there is an increase in a person's
residual functional capacity (RFC) to do basic work activities
compared with the person's RFC at the last medical determination.
When MI does not relate to the ability to work, the DDS proceeds to
step five. If MI relates to the ability to work, the DDS goes to
step six.
At step five, the DDS determines whether exceptions to MI apply.
Exceptions provide a way for SSA to find a beneficiary no longer
disabled in certain limited situations even though there is no
decrease in the severity of the impairment. There are two exceptions
to MI. The first exception applies to certain situations in which
the person can engage in SGA--for example,when substantial evidence
shows that advances in medical or vocational therapy or technology
have favorably affected the severity of a beneficiary's impairment or
RFC to do basic work activities. The second exception can apply
without regard to the person's ability to engage in SGA--for example,
in situations in which the prior determination was fraudulently
obtained or in which the beneficiary fails to cooperate with SSA in
providing information or in having an examination. At any point in
the eight-step evaluation process, if the second exception applies,
benefits are terminated. If no exceptions apply, disability benefits
are continued.
At step six, when either the first exception applies or MI is
determined to be related to the ability to work, the DDS determines
whether the beneficiary's current impairment is severe. According to
SSA standards, a severe impairment is one that significantly limits a
person's ability to do basic work activities, such as standing,
walking, speaking, understanding and carrying out simple
instructions, using judgment, responding appropriately to
supervision, and dealing with change. If the DDS determines that the
impairment is not severe, benefits are terminated.
At step seven, for beneficiaries with severe impairments, the DDS
determines whether the beneficiary can still perform work he or she
has done in the past. This determination is based on an assessment
of the beneficiary's current RFC. If the person is found to be able
to do past work, benefits are terminated.
At step eight, for beneficiaries found unable to perform work done in
the past, the DDS determines whether the beneficiary can do other
work that exists in the national economy. Using SSA guidelines, the
DDS considers the person's age, education, vocational skills, and RFC
to determine what other work, if any, the beneficiary can perform.
Unless the DDS concludes that the person can perform work that exists
in the national economy, benefits are continued.
MAILER CDRS
-------------------------------------------------------- Appendix II:2
Mailer CDRs enable SSA to conduct more CDRs without performing
labor-intensive full medical reviews. The mailer CDR is a
questionnaire through which a beneficiary provides information about
health, medical care, work history, and training (see fig. II.2 for
the questionnaire currently used).\24 Currently, SSA sends mailer
CDRs to a portion of beneficiaries with the lowest estimated
likelihood of benefit termination.
In conjunction with data on the beneficiaries' impairment, age, and
other characteristics, SSA uses responses to mailer CDRs to help
identify those beneficiaries most likely to have medically improved
who thus should receive full medical reviews. For example, if the
beneficiary indicates that his or her health is better, SSA will
generally conduct a full medical CDR. In mental impairment cases,
SSA may decide that a full medical CDR is unwarranted even if the
beneficiary reports MI. If, however, the beneficiary indicates that
his or her health is the same or worse, SSA then reviews the
beneficiary's response to the next question on whether, within the
last 2 years, a doctor has indicated that the person can return to
work. On the basis of the beneficiary's responses to the CDR mailer
and characteristics, SSA assesses the potential effects of any
hospitalizations or surgeries on the beneficiary's health status and
the importance of ongoing medical treatment or its absence to the
beneficiary's health condition. If necessary, SSA will contact the
beneficiary for additional information or clarification. If SSA's
analysis indicates possible MI, the beneficiary is referred for a
full medical CDR. Otherwise, the beneficiary is rescheduled for a
future CDR.
Figure II.2: SSA's Disability
Update Report
(See figure in printed
edition.)
(See figure in printed
edition.)
--------------------
\24 In fiscal year 1996, SSA started using a scannable,
machine-readable questionnaire form.
SUPPLEMENTARY DATA ON CDRS
========================================================= Appendix III
Table III.1
Full Medical and Mailer CDRs Completed,
FY 1988-95
Mailer
CDRs
completed
without
For the full
Fiscal For the DI SSI medical
year program program reviews Total
---------- ---------- ---------- ---------- ----------
1987 195,991 14,339 210,330
1988 321,246 32,573 353,819
1989 280,452 86,364 366,816
1990 155,586 39,500 195,086
1991 54,638 18,830 73,468
1992 58,430 14,715 73,145
1993 27,413 8,517 34,581 70,511
1994 72,852 10,743 31,007 114,602
1995 127,895 34,664 76,122 238,681
----------------------------------------------------------
Note: DI program figures include CDRs completed on beneficiaries
concurrently enrolled in both DI and SSI programs. SSA began
counting mailer cases as CDRs in 1993. During the years shown, SSA
conducted mailer CDRs only on beneficiaries in the DI program.
Sources: State agency operating reports for fiscal years 1987 to
1995 and SSA's OD reports on mailer CDRs for fiscal years 1993 to
1995.
Table III.2
Amount Spent by SSA on Full Medical and
Mailer CDRs, FY 1992-95
(Dollars in thousands)
Fiscal year Amount spent
------------------------------------------ --------------
1992 $30,027
1993 24,983
1994 39,409
1995 68,769
----------------------------------------------------------
Source: SSA's Office of Budget.
Table III.3
DI and SSI CDRs Due in FY 1996, by
Medical Improvement Classification
Not
Program/beneficiary type MIE MIP MINE specified Total
----------------------------- ---------- ---------- ---------- ---------- ----------
Disability Insurance program
-----------------------------------------------------------------------------------------
Disabled workers 162,525 1,286,525 542,479 0 1,991,529
Disabled widows and widowers \a \a \a 69,105 69,105
of disabled workers
Disabled adult children of \a \a \a 292,715 292,715
disabled workers
Subtotal 162,525 1,286,525 542,479 361,820 2,353,349
Supplemental Security Income program\b
-----------------------------------------------------------------------------------------
Disabled adults 186,727 785,383 421,580 0 1,393,693
Disabled children 114,231 348,156 53,354 0 515,739
Subtotal 300,958 1,133,539 474,934 0 1,909,432
Total, DI and SSI programs 463,483 2,420,064 1,017,413 361,820 4,262,781
-----------------------------------------------------------------------------------------
\a Not available.
\b Estimates based on a 15-percent sample. Because of rounding
during the estimation process, row entries may not sum to row totals.
Sources: GAO analysis of MBR and SSIRD extracts, records supplied by
SSA's OD, and data supplied by SSA's Office of Systems Requirements.
Table III.4
Distribution of DI and SSI Beneficiaries
Due for CDRs Included in and Excluded
From SSA's Selection Process for
Estimating the Likelihood of Benefit
Termination
DI SSI\a Total
---------------------- ---------- ---------- ----------
Total beneficiaries 2,353,349 1,909,432 4,262,781
Beneficiaries included in selection process
----------------------------------------------------------
MIEs under 60 years 145,201 174,194
old
MIPs under 60 years 1,000,713 688,570
old
Subtotal 1,145,914 862,764 2,008,678
Percentage of column 48.7% 45.2% 47.1%
total
Beneficiaries excluded from selection process
----------------------------------------------------------
MIEs 60 years and over 17,324 12,533
MIPs 60 years and over 285,812 96,814
MINEs 542,479 421,580
DI disabled widows and 69,105
widowers
DI adult disabled 292,715
children
SSI children 515,739
Subtotal 1,207,435 1,046,666 2,254,101
Percentage of column 51.3% 54.8% 52.9%
total
----------------------------------------------------------
Note: The DI category includes concurrent beneficiaries who receive
both DI and SSI.
\a Estimates based on a 15-percent sample.
Sources: GAO analysis of MBR and SSIRD extracts, and records
supplied by SSA's OD.
Table III.5
Estimated Likelihood of Benefit
Termination for DI and SSI Beneficiaries
Included in SSA's Estimation Process for
CDR Selection
Likelihood of benefit
termination DI SSI\a
---------------------------- ------------- -------------
Under 5% 78.2 74.9
5-24% 19.7 21.8
25-49% 1.6 2.9
50-74% 0.4 0.3
Over 74% 0.1 0.0
==========================================================
Total 100.0 100.0
----------------------------------------------------------
Note: SSA estimates the likelihood of benefit termination only for
DI MIE and MIP workers under age 60 and for SSI adult MIEs and MIPs
under age 60.
\a Column does not total 100% because of rounding.
Sources: GAO analysis of MBR and SSIRD extracts, and records
supplied by SSA's OD.
Table III.6
CDRs SSA Plans to Conduct in FY 1996-
2002
Full medical
Fiscal year Mailer CDRs CDRs Total CDRs
------------- ------------- ------------- -------------
1996 270,000 248,000
1997 280,000 346,000
1998 744,000 428,500
1999 880,000 593,400
2000 890,000 779,800
2001 820,000 777,600
2002 840,000 678,000
==========================================================
Total 4,724,000 3,851,300 8,575,300\a
----------------------------------------------------------
\a The total number of CDRs exceeds the total number of beneficiaries
receiving CDRs because 393,000 beneficiaries are estimated to receive
both a mailer CDR and a full medical CDR.
Source: SSA's Office of Budget as of July 31, 1996.
TABLES ON CDR POPULATION
CHARACTERISTICS
========================================================== Appendix IV
Table IV.1
Characteristics of DI Workers Awaiting
CDRs in FY 1996, by Program and Medical
Improvement Classification
MIE MIP\a MINE Total MIE MIP\a MINE Total MIE MIP\a MINE Total
------------------ -------- -------- -------- -------- ---------- --------- --------- --------- --------- --------- --------- -----------
Total CDR 131,312 1,056,91 449,214 1,637,43 31,213 229,612 93,265 354,090 162,525 1,286,525 542,479 1,991,529
population 3 9
Age in years
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 30 4,808 14,825 3,770 23,403 3,968 16,713 2,935 23,616 8,776 31,538 6,705 47,019
30-39 23,959 117,142 43,989 185,090 9,154 61,571 20,759 91,484 33,113 178,713 64,748 276,574
40-49 46,171 301,577 111,232 458,980 10,193 67,447 24,946 102,586 56,364 369,024 136,178 561,566
50-59 41,744 376,546 136,325 554,615 6,099 55,102 21,990 83,191 47,843 431,648 158,315 637,806
60 and over 14,630 246,823 153,898 415,351 1,799 28,779 22,635 53,213 16,429 275,602 176,533 468,564
Average age (mean) 48 52 53 52 43 46 49 46 47 51 53 51
Average age 48 53 56 53 42 25 49 46 4 52 55 52
(median)
Diagnostic group
-----------------------------------------------------------------------------------------------------------------------------------------------------
Infectious and 519 9,032 5,274 14,825 130 2,538 984 3,652 649 11,570 6,258 18,477
parasitic
diseases
Neoplasms 3,300 17,938 3,874 25,112 321 1,835 449 2,605 3,621 19,773 4,323 27,717
Endocrine, 7,071 64,186 10,219 81,476 1,824 16,437 2,304 20,565 8,895 80,623 12,523 102,041
nutritional, and
metabolic
diseases
Disorders of blood 337 2,143 500 2,980 48 653 172 873 385 2,796 672 3,853
and blood-
forming organs
Mental disorders, 58,584 349,273 82,225 490,082 18,989 110,381 19,688 149,058 77,573 459,654 101,913 639,140
excluding mental
retardation
Mental retardation 2,331 37,334 34,729 74,394 1,891 24,880 22,219 48,990 4,222 62,214 56,948 123,384
Neurological and 8,141 66,188 83,221 157,550 1,470 9,961 13,631 25,062 9,611 76,149 96,852 182,612
sensory disorders
Circulatory 7,689 108,010 65,372 181,071 1,008 12,404 6,378 19,790 8,697 120,414 71,750 200,861
disorders
Respiratory 1,352 26,011 12,512 39,875 314 4,466 2,107 6,887 1,666 30,477 14,619 46,762
disorders
Digestive 1,727 12,392 3,049 17,168 212 1,789 410 2,411 1,939 14,181 3,459 19,579
disorders
Genitourinary 1,132 4,169 8,954 14,255 138 719 1,643 2,500 1,270 4,888 10,597 16,755
disorders
Skin and 322 3,197 560 4,079 52 514 83 649 374 3,711 643 4,728
subcutaneous
tissue disorders
Musculoskeletal 26,194 264,520 47,600 338,314 3,090 30,161 5,272 38,523 29,284 294,681 52,872 376,837
disorders
Congenital 139 2,729 1,442 4,310 22 487 366 875 161 3,216 1,808 5,185
anomalies
Injuries 9,693 48,056 28,863 86,612 1,295 6,525 4,231 12,051 10,988 54,581 33,094 98,663
Other 264 2,309 2,088 4,661 36 342 373 751 300 2,651 2,461 5,412
Not identified 2,517 39,426 58,732 100,675 373 5,520 12,955 18,848 2,890 44,946 71,687 119,523
Estimated likelihood of benefit termination
-----------------------------------------------------------------------------------------------------------------------------------------------------
Subpopulation with 115,893 801,034 916,927 29,308 199,679 228,987 145,201 1,000,713 1,145,914
likelihood
estimated\b
Under 5% 81,190 631,794 712,984 21,277 161,961 183,238 102,467 793,755 896,222
5-24% 30,143 153,976 184,119 7,136 34,503 41,639 37,279 188,479 225,758
25-49% 3,467 10,745 14,212 795 2,756 3,551 4,262 13,501 17,763
50-74% 875 3,143 4,018 91 348 439 966 3,491 4,457
75% and over 218 1,376 1,594 9 111 120 227 1,487 1,714
Average likelihood 6 4 4 5 4 4 6 4 4
(mean)
Average likelihood 3 2 2 3 2 2 3 2 2
(median)
Number of years receiving benefits
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 45,143 69,445 4,274 118,862 10,483 16,614 829 27,926 55,626 86,059 5,103 146,788
4-5 36,073 267,188 13,152 316,413 9,260 64,375 2,896 76,531 45,333 331,563 16,048 392,944
6-7 27,051 247,751 36,457 311,259 6,582 52,617 6,237 65,436 33,633 300,368 42,694 376,695
8-9 11,197 161,876 58,287 231,360 2,390 33,143 11,386 46,919 13,587 195,019 69,673 278,279
10 or over 11,848 310,653 337,044 659,545 2,498 62,863 71,917 137,278 14,346 373,516 408,961 796,823
Average years 6 9 15 10 6 8 15 10 6 9 15 10
(mean)
Average years 5 7 14 9 5 7 13 8 5 7 14 9
(median)
CDR maturity
-----------------------------------------------------------------------------------------------------------------------------------------------------
Maturing in FY 29,588 250,529 86,972 367,089 6,122 58,312 11,899 76,333 35,710 308,841 98,871 443,422
1996
Matured 1 year ago 26,972 171,807 75,736 274,515 6,339 40,931 15,528 62,798 33,311 212,738 91,264 337,313
Matured 2 years 19,761 167,043 53,946 240,750 5,254 34,245 11,890 51,389 25,015 201,288 65,836 292,139
ago
Matured 3 years 16,234 129,197 33,212 178,643 4,191 27,190 9,022 40,403 20,425 156,387 42,234 219,046
ago
Matured 4 years 14,721 112,659 41,388 168,768 3,690 25,227 7,865 36,782 18,411 137,886 49,253 205,550
ago
Matured 5-10 years 21,651 168,196 124,085 313,932 5,008 32,465 13,580 51,053 26,659 200,661 137,665 364,985
ago
Matured over 10 1,376 30,784 338 32,498 297 3,585 23,397 27,279 1,673 34,369 23,735 59,777
years ago
Not identified 1,009 26,698 33,537 61,244 312 7,657 84 8,053 1,321 34,355 33,621 69,297
Average years 3 3 3 3 3 3 3 3 3 3 3 3
(mean)
Average years 2 2 2 2 3 2 3 2 2 2 2 2
(median)
Gender
-----------------------------------------------------------------------------------------------------------------------------------------------------
Female 52,362 387,329 143,205 582,896 16,931 121,270 40,532 178,733 69,293 508,599 183,737 761,629
Male 78,907 669,275 305,865 1,054,04 14,280 108,320 52,722 175,322 93,187 777,595 358,587 1,229,369
7
Not identified 43 309 144 496 2 22 11 35 45 331 155 531
Race
-----------------------------------------------------------------------------------------------------------------------------------------------------
Black 20,542 180,617 76,872 278,031 7,364 58,438 25,754 91,556 27,906 239,055 102,626 369,587
White 102,617 836,377 357,118 1,296,11 21,281 157,559 63,178 242,018 123,898 993,936 420,296 1,538,130
2
Other 6,188 25,563 9,997 41,748 2,001 9,375 3,113 14,489 8,189 34,938 13,110 56,237
Not identified 1,965 14,356 5,227 21,548 567 4,240 1,220 6,027 2,532 18,596 6,447 27,575
-----------------------------------------------------------------------------------------------------------------------------------------------------
\a We classified 583 of the records for worker beneficiaries under
the age of 60 as MIP because a MIE or MIP classification was not
specified.
\b SSA does not estimate the likelihood of benefit termination for
MIE and MIP workers aged 60 and over or for MINE workers. Therefore,
the total number with an estimated likelihood of benefit termination
is less than the total for the column.
Source: GAO analysis of MBR records and files supplied by OD.
Table IV.2
Characteristics of DI Workers Awaiting
CDRs in FY 1996, by Program and Medical
Improvement Classification, in
Percentages
MIE\ MIP\a MINE Total MIE MIP\a MINE Total MIE MIP\a MINE Total
------------------ -------- -------- -------- -------- ---------- --------- --------- --------- --------- --------- --------- -----------
Total CDR 131,312 1,056,91 449,214 1,637,43 31,213 229,612 93,265 354,090 162,525 1,286,525 542,479 1,991,529
population 3 9
Age in years
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 30 4 1 1 1 13 7 3 7 5 2 1 2
30-39 18 11 10 11 29 27 22 26 20 14 12 14
40-49 35 29 25 28 33 29 27 29 35 29 25 28
50-59 32 36 30 34 20 24 24 23 29 34 29 32
60 and over 11 23 34 25 6 13 24 15 10 21 33 24
Average age (mean) 48 52 53 52 43 46 49 46 47 51 53 51
Average age 48 53 56 53 42 25 49 46 47 52 55 52
(median)
Diagnostic group
-----------------------------------------------------------------------------------------------------------------------------------------------------
Infectious and 0 1 1 1 0 1 1 1 0 1 1 1
parasitic
diseases
Neoplasms 3 2 1 2 1 1 0 1 2 2 1 1
Endocrine, 5 6 2 5 6 7 2 6 5 6 2 5
nutritional, and
metabolic
diseases
Disorders of blood 0 0 0 0 0 0 0 0 0 0 0 0
and blood-
forming organs
Mental disorders, 45 33 18 30 61 48 21 42 48 36 19 32
excluding mental
retardation
Mental retardation 2 4 8 5 6 11 24 14 3 5 10 6
Neurological and 6 6 19 10 5 4 15 7 6 6 18 9
sensory disorders
Circulatory 6 10 15 11 3 5 7 6 5 9 13 10
disorders
Respiratory 1 2 3 2 1 2 2 2 1 2 3 2
disorders
Digestive 1 1 1 1 1 1 0 1 1 1 1 1
disorders
Genitourinary 1 0 2 1 0 0 2 1 1 0 2 1
disorders
Skin and 0 0 0 0 0 0 0 0 0 0 0 0
subcutaneous
tissue disorders
Musculoskeletal 20 25 11 21 10 13 6 11 18 23 10 19
disorders
Congenital 0 0 0 0 0 0 0 0 0 0 0 0
anomalies
Injuries 7 5 6 5 4 3 5 3 7 4 6 5
Other 0 0 0 0 0 0 0 0 0 0 0 0
Not identified 2 4 13 6 1 2 14 5 2 3 13 6
Estimated likelihood of benefit termination
-----------------------------------------------------------------------------------------------------------------------------------------------------
Subpopulation with 115,893 801,034 916,927 29,308 199,679 228,987 145,201 1,000,713 1,145,914
likelihood
estimated\b
Under 5% 70 79 78 73 81 80 71 79 78
5-24% 26 19 20 24 17 18 26 19 20
25-49% 3 1 2 3 1 2 3 1 2
50-74% 1 0 0 0 0 0 1 0 0
75% and over 0 0 0 0 0 0 0 0 0
Average likelihood 6 4 4 5 4 4 6 4 4
(mean)
Average likelihood 3 2 2 3 2 2 3 2 2
(median)
Number of years receiving benefits
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 34 7 1 7 34 7 1 8 34 7 1 7
4-5 27 25 3 19 30 28 3 22 28 26 3 20
6-7 21 23 8 19 21 23 7 18 21 23 8 19
8-9 9 15 13 14 8 14 12 13 8 15 13 14
10 and over 9 29 75 40 8 27 77 39 9 29 75 40
Average years 6 9 15 10 6 8 15 10 6 9 15 10
(mean)
Average years 5 7 14 9 5 7 13 8 5 7 14 9
(median)
CDR maturity
-----------------------------------------------------------------------------------------------------------------------------------------------------
Maturing in FY 23 24 19 22 20 25 13 22 22 24 18 22
1996
Matured 1 year ago 21 16 17 17 20 18 17 18 20 17 17 17
Matured 2 years 15 16 12 15 17 15 13 15 15 16 12 15
ago
Matured 3 years 12 12 7 11 13 12 10 11 13 12 8 11
ago
Matured 4 years 11 11 9 10 12 11 8 10 11 11 9 10
ago
Matured 5-10 years 16 16 28 19 16 14 15 14 16 16 25 18
ago
Matured over 10 1 3 0 2 1 2 25 8 1 3 4 3
years ago
Not identified 1 3 7 4 1 3 0 2 1 3 6 3
Average years 3 3 3 3 3 3 3 3 3 3 3 3
(mean)
Average years 2 2 2 2 3 2 3 2 2 2 2 2
(median)
Gender
-----------------------------------------------------------------------------------------------------------------------------------------------------
Female 40 37 32 36 54 53 43 50 43 40 34 38
Male 60 63 68 64 46 47 57 50 57 60 66 62
Not identified 0 0 0 0 0 0 0 0 0 0 0 0
Race
-----------------------------------------------------------------------------------------------------------------------------------------------------
Black 16 17 17 17 24 25 28 26 17 19 19 19
White 78 79 79 79 68 69 68 68 76 77 77 77
Other 5 2 2 3 6 4 3 4 5 3 2 3
Not identified 1 1 1 1 2 2 1 2 2 1 1 1
-----------------------------------------------------------------------------------------------------------------------------------------------------
\a We classified 583 of the records for worker beneficiaries under
the age of 60 as MIP because a MIE or MIP classification was not
specified.
\b SSA does not estimate the likelihood of benefit termination for
MIE and MIP workers aged 60 and over or for MINE workers. Therefore,
the total number with an estimated likelihood of benefit termination
is less than the total for the column.
Source: GAO analysis of MBR records and files supplied by OD.
Table IV.3
Characteristics of DI Workers Awaiting
CDRs in FY 1996, by Program, Age, and
Medical Improvement Classification
Tota MIP\ Tota
MIE MIP\a MINE Total MIE MIP MINE l MIE a MINE l MIE MIP MINE Total MIE MIP\a MINE Total MIE MIP MINE Total
------------ ---- ----- ----- ----- ---- ----- ----- ---- ---- ---- ---- ---- ----- ----- ----- ----- ------ ------ ------ ------- ----- ----- ------ ------
Total CDR 115, 801,0 290,0 1,206 15,4 255,8 159,1 430, 29,3 199, 69,8 298, 1,905 29,93 23,40 55,24 145,20 1,000, 359,92 1,505,8 17,32 285,8 182,55 485,69
population 893 34 66 ,993 19 79 48 446 08 679 56 843 3 9 7 1 713 2 36 4 12 7 3
Age in years
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Under 30 4,80 14,82 3,770 23,40 3,96 16,7 2,93 23,6 8,776 31,537 6,704 47,017
8 4 2 8 13 4 15
30-39 23,9 117,1 43,98 185,0 9,15 61,5 20,7 91,4 33,112 178,71 64,748 276,573
58 42 9 89 4 71 59 84 3
40-49 46,1 301,5 111,2 458,9 10,1 67,4 24,9 102, 56,364 369,02 136,17 561,560
71 74 31 76 93 46 45 584 0 6
50-59 40,9 367,4 131,0 539,5 5,99 53,9 21,2 81,1 46,949 421,44 152,29 620,686
56 94 76 26 3 49 18 60 3 4
60 and over 15,4 255,8 159,1 430, 1,905 29,93 23,40 55,24 17,32 285,8 182,55 485,69
19 79 48 446 3 9 7 4 12 7 3
Average age 46 48 48 48 62 63 63 63 41 43 45 43 62 63 63 63 45 47 48 47 62 63 63 63
(mean)
Average age 47 49 49 49 62 63 63 63 41 43 44 43 62 63 63 63 46 48 48 48 62 63 63 63
(median)
Diagnostic group
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Infectious 443 7,357 3,727 11,52 76 1,675 1,547 3,29 119 2,32 787 3,23 11 214 197 422 562 9,681 4,514 14,757 87 1,889 1,744 3,720
and 7 8 4 0
parasitic
diseases
Neoplasms 2,54 9,808 2,510 14,86 757 8,130 1,364 10,2 268 1,20 314 1,79 53 626 135 814 2,811 11,017 2,824 16,652 810 8,756 1,499 11,065
3 1 51 9 1
Endocrine, 6,16 49,02 5,520 60,71 903 15,16 4,699 20,7 1,64 13,7 1,22 16,5 175 2,728 1,080 3,983 7,817 62,731 6,744 77,292 1,078 17,89 5,779 24,749
nutritional, 8 2 0 4 66 9 09 4 82 2
and
metabolic
diseases
Disorders of 299 1,751 359 2,409 38 392 141 571 44 610 153 807 4 43 19 66 343 2,361 512 3,216 42 435 160 637
blood and
blood-
forming
organs
Mental 54,6 315,6 54,66 424,9 3,94 33,65 27,55 65,1 18,2 105, 14,7 138, 691 5,368 4,957 11,01 72,935 420,63 69,397 562,966 4,638 39,02 32,516 76,174
disorders, 37 21 6 24 7 2 9 58 98 013 31 042 6 4 0
excluding
mental
retardation
Mental 2,21 34,31 28,95 65,48 114 3,022 5,777 8,91 1,84 23,6 18,8 44,3 44 1,232 3,350 4,626 4,064 57,960 47,821 109,845 158 4,254 9,127 13,539
retardation 7 2 2 1 3 7 48 69 64
Neurological 7,21 52,61 62,94 122,7 923 13,57 20,27 34,7 1,35 8,70 11,3 21,4 112 1,254 2,238 3,604 8,576 61,321 74,337 144,234 1,035 14,82 22,515 38,378
and sensory 8 4 4 76 4 7 74 8 7 93 58 8
disorders
Circulatory 6,11 61,35 29,20 96,67 1,57 46,65 36,17 84,3 868 8,14 3,34 12,3 140 4,256 3,032 7,428 6,986 69,504 32,547 109,037 1,711 50,91 39,203 91,824
disorders 8 6 1 5 1 4 1 96 8 6 62 0
Respiratory 1,08 14,88 4,584 20,55 264 11,12 7,928 19,3 280 3,09 948 4,32 34 1,370 1,159 2,563 1,368 17,980 5,532 24,880 298 12,49 9,087 21,882
disorders 8 4 6 7 19 6 4 7
Digestive 1,33 8,898 1,795 12,03 388 3,494 1,254 5,13 189 1,39 273 1,85 23 399 137 559 1,528 10,288 2,068 13,884 411 3,893 1,391 5,695
disorders 9 2 6 0 2
Genitourinar 979 3,096 7,340 11,41 153 1,073 1,614 2,84 120 588 1,46 2,17 18 131 180 329 1,099 3,684 8,803 13,586 171 1,204 1,794 3,169
y disorders 5 0 3 1
Skin and 254 2,451 258 2,963 68 746 302 1,11 45 407 42 494 7 107 41 155 299 2,858 300 3,457 75 853 343 1,271
subcutaneous 6
tissue
disorders
Musculoskele 22,4 178,7 20,21 221,3 3,75 85,80 27,38 116, 2,73 21,5 2,39 26,6 353 8,600 2,878 11,83 25,174 200,27 22,606 248,052 4,110 94,40 30,266 128,78
tal 37 11 2 60 7 9 8 954 7 61 4 92 1 2 9 5
disorders
Congenital 116 2,037 1,036 3,189 23 692 406 1,12 21 422 304 747 1 65 62 128 137 2,459 1,340 3,936 24 757 468 1,249
anomalies 1
Injuries 8,20 35,86 22,43 66,50 1,48 12,19 6,432 20,1 1,19 5,30 3,64 10,1 105 1,225 582 1,912 9,399 41,165 26,080 76,644 1,589 13,41 7,014 22,019
9 5 1 5 4 1 07 0 0 9 39 6
Other 211 1,761 1,696 3,668 53 548 392 993 29 292 317 638 7 50 56 113 240 2,053 2,013 4,306 60 598 448 1,106
Not 1,61 21,49 42,83 65,94 900 17,93 15,89 34,7 246 3,25 9,64 13,1 127 2,265 3,306 5,698 1,863 24,745 52,484 79,092 1,027 20,20 19,203 40,431
identified 7 0 5 2 6 7 33 5 9 50 1
Estimated likelihood of benefit termination
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Subpopulatio 115, 801,0 916,9 29,3 199, 228, 145,20 1,000, 1,145,9
n with 893 34 27 08 679 987 1 713 14
likelihood
estimated\b
Under 5% 81,1 631,7 712,9 21,2 161, 183, 102,46 793,75 896,222
90 94 84 77 961 238 7 5
5-24% 30,1 153,9 184,1 7,13 34,5 41,6 37,279 188,47 225,758
43 76 19 6 03 39 9
25-49% 3,46 10,74 14,21 795 2,75 3,55 4,262 13,501 17,763
7 5 2 6 1
50-74% 875 3,143 4,018 91 348 439 966 3,491 4,457
75% and over 218 1,376 1,594 9 111 120 227 1,487 1,714
Average 6 4 4 5 4 4 6 4 4
likelihood
(mean)
Average 3 2 2 3 2 2 3 2 2
likelihood
(median)
Number of years receiving benefits
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 42,5 61,44 3,945 107,9 2,55 8,001 329 10,8 10,2 15,8 803 26,8 242 772 26 1,040 52,832 77,286 4,748 134,866 2,794 8,773 355 11,922
91 4 80 2 82 41 42 86
4-5 32,8 213,6 12,60 259,1 3,20 53,51 549 57,2 8,85 58,7 2,82 70,3 403 5,669 72 6,144 41,722 272,37 15,427 329,527 3,611 59,18 621 63,417
65 72 3 40 8 6 73 7 06 4 87 8 5
6-7 22,6 172,2 28,99 223,8 4,37 75,52 7,466 87,3 6,03 43,7 5,63 55,4 549 8,850 607 10,00 28,711 215,99 34,621 279,324 4,922 84,37 8,073 97,371
78 25 1 94 3 6 65 3 67 0 30 6 2 6
8-9 9,02 110,7 39,12 158,8 2,17 51,12 19,16 72,4 2,10 27,0 9,35 38,4 290 6,143 2,035 8,468 11,121 137,75 48,476 197,348 2,466 57,26 21,197 80,931
1 51 5 97 6 5 2 63 0 00 1 51 1 8
10 and over 8,73 242,9 205,4 457,0 3,11 67,71 131,6 202, 2,07 54,3 51,2 107, 421 8,499 20,66 29,58 10,815 297,30 256,65 564,771 3,531 76,21 152,31 232,05
8 42 02 82 0 1 42 463 7 64 48 689 9 9 6 0 0 1 2
Average 6 9 14 10 8 9 16 12 6 8 14 9 8 10 17 13 6 9 14 10 8 9 16 12
years
(mean)
Average 5 7 13 8 7 8 14 10 5 7 13 8 7 8 15 10 5 7 13 8 7 8 14 10
years
(median)
CDR maturity
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Maturing in 28,2 229,5 46,42 304,1 1,35 21,00 40,54 62,9 6,00 56,3 6,65 69,0 121 1,928 5,245 7,294 34,233 285,90 53,080 373,217 1,477 22,93 45,791 70,205
FY 1996 32 20 6 78 6 9 6 11 1 84 4 39 4 7
Matured 1 25,4 144,3 36,60 206,4 1,53 27,41 39,12 68,0 6,18 37,9 10,2 54,3 150 2,950 5,304 8,404 31,628 182,37 46,833 260,836 1,683 30,36 44,431 76,477
year ago 39 94 9 42 3 3 7 73 9 81 24 94 5 3
Matured 2 18,0 109,4 29,16 156,6 1,68 57,63 24,78 84,0 5,06 28,0 8,75 41,8 191 6,180 3,133 9,504 23,143 137,47 37,918 198,538 1,872 63,81 27,918 93,601
years ago 80 12 1 53 1 1 5 97 3 65 7 85 7 1
Matured 3 14,1 86,22 23,12 123,5 2,08 42,97 10,08 55,1 3,93 21,9 7,47 33,3 260 5,247 1,549 7,056 18,083 108,16 30,602 156,850 2,342 48,22 11,632 62,196
years ago 52 2 9 03 2 5 3 40 1 43 3 47 5 2
Matured 4 11,8 79,17 30,40 121,4 2,84 33,48 10,98 47,3 3,33 20,7 6,18 30,2 351 4,455 1,683 6,489 15,215 99,949 36,586 151,750 3,196 37,93 12,667 53,800
years ago 76 7 4 57 5 2 4 11 9 72 2 93 7
Matured 5- 16,2 109,4 90,69 216,4 5,38 58,71 33,39 97,4 4,27 24,8 7,10 36,2 734 7,571 6,475 14,78 20,545 134,37 97,799 252,723 6,114 66,28 39,866 112,26
10 years 71 85 4 50 0 1 1 82 4 94 5 73 0 9 2 2
ago
Matured over 872 16,38 250 17,50 504 14,40 88 14,9 202 1,99 23,3 25,5 95 1,592 11 1,698 1,074 18,374 23,636 43,084 599 15,99 99 16,693
10 years 1 3 3 95 3 86 81 5
ago
Not 971 26,44 33,39 60,80 38 255 144 437 309 7,64 75 8,03 3 10 9 22 1,280 34,090 33,468 68,838 41 265 153 459
identified 3 3 7 7 1
Average 3 3 3 3 4 4 3 4 3 2 3 3 5 4 3 4 3 3 3 3 4 4 3 4
years
(mean)
Average 2 2 3 2 4 3 2 3 2 2 3 2 5 4 2 3 2 2 3 2 4 3 2 3
years
(median)
Gender
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Female 46,1 293,4 89,89 429,5 6,17 93,84 53,30 153, 15,6 101, 27,5 144, 1,324 20,10 12,94 34,37 61,798 394,65 117,48 573,935 7,495 113,9 66,254 187,69
91 84 9 74 1 5 6 322 07 170 84 361 0 8 2 4 3 45 4
Male 69,6 507,2 200,0 776,9 9,24 162,0 105,8 277, 13,6 98,4 42,2 154, 581 9,833 10,46 20,87 83,358 605,72 242,28 931,372 9,829 171,8 116,30 297,99
59 41 25 25 8 34 40 122 99 87 61 447 1 5 8 6 67 1 7
Not 43 309 142 494 0 0 2 2 2 22 11 35 0 0 0 0 45 331 153 529 0 0 2 2
identified
Race
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Black 18,4 142,2 51,99 212,7 2,05 38,37 24,87 65,3 6,92 49,9 18,3 75,2 442 8,440 7,381 16,26 25,410 192,24 70,370 288,020 2,496 46,81 32,256 81,567
88 42 7 27 4 5 5 04 2 98 73 93 3 0 5
White 89,7 624,2 226,0 940,0 12,8 212,0 131,0 356, 19,9 137, 47,8 205, 1,326 19,90 15,29 36,52 109,69 761,94 273,92 1,145,5 14,20 231,9 146,37 392,56
41 88 42 71 76 89 76 041 55 657 79 491 2 9 7 6 5 1 62 2 91 5 8
Other 5,76 21,13 7,294 34,19 421 4,433 2,703 7,55 1,87 7,97 2,48 12,3 126 1,405 624 2,155 7,642 29,100 9,783 46,525 547 5,838 3,327 9,712
7 0 1 7 5 0 9 34
Not 1,89 13,37 4,733 20,00 68 982 494 1,54 556 4,05 1,11 5,72 11 186 105 302 2,453 17,428 5,848 25,729 79 1,168 599 1,846
identified 7 4 4 4 4 5 5
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\a We classified 583 of the records for worker beneficiaries under
the age of 60 as MIP because a MIE or MIP classification was not
specified.
\b SSA does not estimate the likelihood of benefit termination for
MIE and MIP workers aged 60 and over or for MINE workers. Therefore,
the total number with an estimated likelihood of benefit termination
is less than the total for the column.
Source: GAO analysis of MBR records and files supplied by OD.
Table IV.4
Characteristics of DI Workers Awaiting
CDRs in FY 1996, by Program, Age, and
Medical Improvement Classification, in
Percentages
Tota MIP\ Tota
MIE MIP\a MINE Total MIE MIP MINE l MIE a MINE l MIE MIP MINE Total MIE MIP\a MINE Total MIE MIP MINE Total
------------ ---- ----- ----- ----- ---- ----- ----- ---- ---- ---- ---- ---- ----- ----- ----- ----- ------ ------ ------ ------- ----- ----- ------ ------
Total CDR 115, 801,0 290,0 1,206 15,4 255,8 159,1 430, 29,3 199, 69,8 298, 1,905 29,93 23,40 55,24 145,20 1,000, 359,92 1,505,8 17,32 285,8 182,55 485,69
population 893 34 66 ,993 19 79 48 446 08 679 56 843 3 9 7 1 713 2 36 4 12 7 3
Age in years
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Under 30 4 2 1 2 14 8 4 8 6 3 2 3
30-39 21 15 15 15 31 31 30 31 23 18 18 18
40-49 40 38 38 38 35 34 36 34 39 37 38 37
50-59 35 46 45 45 20 27 30 27 32 42 42 41
60 and over 100 100 100 100 100 100 100 100 100 100 100 100
Average age 46 48 48 48 62 63 63 63 41 43 45 43 62 63 63 63 45 47 48 47 62 63 63 63
(mean)
Average age 47 49 49 49 62 63 63 63 41 43 44 43 62 63 63 63 46 48 48 48 62 63 63 63
(median)
Diagnostic group
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Infectious 0 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1
and
parasitic
diseases
Neoplasms 2 1 1 1 5 3 1 2 1 1 0 1 3 2 1 1 2 1 1 1 5 3 1 2
Endocrine, 5 6 2 5 6 6 3 5 6 7 2 6 9 9 5 7 5 6 2 5 6 6 3 5
nutritional,
and
metabolic
diseases
Disorders of 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
blood and
blood-
forming
organs
Mental 47 39 19 35 26 13 17 15 62 53 21 46 36 18 21 20 50 42 19 37 27 14 18 16
disorders,
excluding
mental
retardation
Mental 2 4 10 5 1 1 4 2 6 12 27 15 2 4 14 8 3 6 13 7 1 1 5 3
retardation
Neurological 6 7 22 10 6 5 13 8 5 4 16 7 6 4 10 7 6 6 21 10 6 5 12 8
and sensory
disorders
Circulatory 5 8 10 8 10 18 23 20 3 4 5 4 7 14 13 13 5 7 9 7 10 18 21 19
disorders
Respiratory 1 2 2 2 2 4 5 4 1 2 1 1 2 5 5 5 1 2 2 2 2 4 5 5
disorders
Digestive 1 1 1 1 3 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 2 1 1 1
disorders
Genitourinar 1 0 3 1 1 0 1 1 0 0 2 1 1 0 1 1 1 0 2 1 1 0 1 1
y disorders
Skin and 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
subcutaneous
tissue
disorders
Musculoskele 19 22 7 18 24 34 17 27 9 11 3 9 19 29 12 21 17 20 6 16 24 33 17 27
tal
disorders
Congenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
anomalies
Injuries 7 4 8 6 10 5 4 5 4 3 5 3 6 4 2 3 6 4 7 5 9 5 4 5
Other 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0
Not 1 3 15 5 6 7 10 8 1 2 14 4 7 8 14 10 1 2 15 5 6 7 11 8
identified
Estimated likelihood of benefit termination
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Subpopulatio 115, 801,0 916,9 29,3 199, 228, 145,20 1,000, 1,145,9
n with 893 34 27 08 679 987 1 713 14
likelihood
estimated\b
Under 5% 70 79 78 73 81 80 71 79 78
5-24% 26 20 20 24 17 18 26 19 20
25-49% 3 1 2 3 1 2 3 1 2
50-74% 1 0 0 0 0 0 1 0 0
75% and over 0 0 0 0 0 0 0 0 0
Average 6 4 4 5 4 4 6 4 4
likelihood
(mean)
Average 3 2 2 3 2 2 3 2 2
likelihood
(median)
Number of years receiving benefits
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 37 8 1 9 17 3 0 3 35 8 1 9 13 3 0 2 36 8 1 9 16 3 0 2
4-5 28 27 4 21 21 21 0 13 30 29 4 24 21 19 0 11 29 27 4 22 21 21 0 13
6-7 20 22 10 19 28 30 5 20 21 22 8 19 29 30 3 18 20 22 10 19 28 30 4 20
8-9 8 14 13 13 14 20 12 17 7 14 13 13 15 21 9 15 8 14 13 13 14 20 12 17
10 and over 8 30 71 38 20 26 83 47 7 27 73 36 22 28 88 54 7 30 71 38 20 27 83 48
Average 6 9 14 10 8 9 16 12 6 8 14 9 8 10 17 13 6 9 14 10 8 9 16 12
years
(mean)
Average 5 7 13 8 7 8 14 10 5 7 13 8 7 8 15 10 5 7 13 8 7 8 14 10
years
(median)
CDR maturity
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Maturing in 24 29 16 25 9 8 25 15 20 28 10 23 6 6 22 13 24 29 15 25 9 8 25 14
FY 1996
Matured 1 22 18 13 17 10 11 25 16 21 19 15 18 8 10 23 15 22 18 13 17 10 11 24 16
year ago
Matured 2 16 14 10 13 11 23 16 20 17 14 13 14 10 21 13 17 16 14 11 13 11 22 15 19
years ago
Matured 3 12 11 8 10 14 17 6 13 13 11 11 11 14 18 7 13 12 11 9 10 14 17 6 13
years ago
Matured 4 10 10 10 10 18 13 7 11 11 10 9 10 18 15 7 12 10 10 10 10 18 13 7 11
years ago
Matured 5- 14 14 31 18 35 23 21 23 15 12 10 12 39 25 28 27 14 13 27 17 35 23 22 23
10 years
ago
Matured over 1 2 0 1 3 6 0 3 1 1 33 9 5 5 0 3 1 2 7 3 3 6 0 3
10 years
ago
Not 1 3 12 5 0 0 0 0 1 4 0 3 0 0 0 0 1 3 9 5 0 0 0 0
identified
Average 3 3 3 3 4 4 3 4 3 2 3 3 5 4 3 4 3 3 3 3 4 4 3 4
years
(mean)
Average 2 2 3 2 4 3 2 3 2 2 3 2 5 4 2 3 2 2 3 2 4 3 2 3
years
(median)
Gender
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Female 40 37 31 36 40 37 33 36 53 51 39 48 70 67 55 62 43 39 33 38 43 40 36 39
Male 60 63 69 64 60 63 67 64 47 49 60 52 30 33 45 38 57 61 67 62 57 60 64 61
Not 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
identified
Race
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Black 16 18 18 18 13 15 16 15 24 25 26 25 23 28 32 29 17 19 20 19 14 16 18 17
White 77 78 78 78 84 83 82 83 68 69 69 69 70 66 65 66 76 76 76 76 82 81 80 81
Other 5 3 3 3 3 2 2 2 6 4 4 4 7 5 3 4 5 3 3 3 3 2 2 2
Not 2 2 2 2 0 0 0 0 2 2 2 2 1 1 0 1 2 2 2 2 0 0 0 0
identified
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\a We classified 583 of the records for worker beneficiaries under
the age of 60 as MIP because a MIE or MIP classification was not
specified.
\b SSA does not estimate the likelihood of benefit termination for
MIE and MIP workers aged 60 and over or for MINE workers. Therefore,
the total number with an estimated likelihood of benefit termination
is less than the total for the column.
Source: GAO analysis of MBR records and files supplied by OD.
Table IV.5
Characteristics of Selected DI Workers
Awaiting CDRs in FY 1996, by Program and
Estimated Likelihood of Benefit
Termination
75% 75% 75%
Under 25- 50- and Under 25- 50- and Under 25- 50- and
5% 5-24% 49% 74% over Total 5% 5-24% 49% 74% over Total 5% 5-24% 49% 74% over Total
---------- ------ ------ ------ ------ ------ ------ ----- ------ ----- ----- ------ ------ ------ ------ ----- ----- ----- -------
Total CDR 712,98 184,11 14,212 4,018 1,594 916,92 183,2 41,639 3,551 439 120 228,98 896,22 225,75 17,76 4,457 1,714 1,145,9
population 4 9 7 38 7 2 8 3 14
Age in years
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 30 7,454 8,422 2,838 807 111 19,632 13,93 4,854 1,662 231 4 20,681 21,384 13,276 4,500 1,038 115 40,313
0
30-39 83,842 49,140 6,001 1,712 405 141,10 53,47 15,667 1,383 154 48 70,725 137,31 64,807 7,384 1,866 453 211,825
0 3 5
40-49 253,99 87,794 4,061 1,185 709 347,74 60,08 17,033 432 38 50 77,639 314,08 104,82 4,493 1,223 759 425,384
6 5 6 2 7
50-59 367,69 38,763 1,312 314 369 408,45 55,74 4,085 74 16 18 59,942 423,44 42,848 1,386 330 387 468,392
0 0 9 1
Average 49 44 38 38 44 48 44 40 32 32 42 43 48 43 37 37 43 47
age
(mean)
Average 50 44 37 37 44 49 44 40 30 30 42 43 49 43 35 36 44 48
age
(median)
Diagnostic group
-----------------------------------------------------------------------------------------------------------------------------------------------------
Infectious 5,573 1,969 224 30 4 7,800 1,821 568 51 3 0 2,443 7,394 2,537 275 33 4 10,243
and
parasitic
diseases
Neoplasms 2,236 7,640 1,884 572 19 12,351 295 874 269 38 1 1,477 2,531 8,514 2,153 610 20 13,828
Endocrine, 40,717 12,921 932 452 168 55,190 12,08 2,757 391 109 20 15,358 52,798 15,678 1,323 561 188 70,548
nutrition 1
al, and
metabolic
diseases
Disorders 1,053 574 347 75 1 2,050 290 186 148 30 0 654 1,343 760 495 105 1 2,704
of blood
and
blood-
forming
organs
Mental 309,75 57,793 2,545 133 34 370,25 103,2 18,694 1,313 59 1 123,31 412,99 76,487 3,858 192 35 493,569
disorders, 3 8 44 1 7
excluding
mental
retardati
on
Mental 31,802 4,673 44 2 8 36,529 24,27 1,179 29 5 6 25,495 56,078 5,852 73 7 14 62,024
retardati 6
on
Neurologic 49,530 10,224 63 9 6 59,832 7,706 2,337 19 2 1 10,065 57,236 12,561 82 11 7 69,897
al and
sensory
disorders
Circulator 61,967 5,330 172 2 3 67,474 7,951 1,057 7 0 1 9,016 69,918 6,387 179 2 4 76,490
y
disorders
Respirator 12,225 3,697 49 1 0 15,972 2,523 846 7 0 0 3,376 14,748 4,543 56 1 0 19,348
y
disorders
Digestive 5,454 4,230 507 45 1 10,237 791 735 51 1 1 1,579 6,245 4,965 558 46 2 11,816
disorders
Genitourin 1,469 1,758 658 184 6 4,075 361 275 67 5 0 708 1,830 2,033 725 189 6 4,783
ary
disorders
Skin and 1,479 1,030 159 33 4 2,705 222 173 51 6 0 452 1,701 1,203 210 39 4 3,157
subcutane
ous
tissue
disorders
Musculoske 160,55 38,406 1,835 323 34 201,14 17,58 6,515 181 16 0 24,298 178,13 44,921 2,016 339 34 225,446
letal 0 8 6 6
disorders
Congenital 1,473 580 92 8 0 2,153 256 153 31 3 0 443 1,729 733 123 11 0 2,596
anomalies
Injuries 21,047 17,754 3,349 1,701 223 44,074 2,959 2,928 529 74 0 6,490 24,006 20,682 3,878 1,775 223 50,564
Other 1,038 775 91 47 21 1,972 147 137 29 5 3 321 1,185 912 120 52 24 2,293
Not 5,618 14,765 1,261 401 1,062 23,107 729 2,225 378 83 86 3,501 6,347 16,990 1,639 484 1,148 26,608
identified
Medical improvement classification
-----------------------------------------------------------------------------------------------------------------------------------------------------
MIE 81,190 30,143 3,467 875 218 115,89 21,27 7,136 795 91 9 29,308 102,46 37,279 4,262 966 227 145,201
3 7 7
MIP\a 631,79 153,97 10,745 3,143 1,376 801,03 161,9 34,503 2,756 348 111 199,67 793,75 188,47 13,50 3,491 1,487 1,000,7
4 6 4 61 9 5 9 1 13
Number of years receiving benefits
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 73,606 27,288 3,015 119 7 104,03 19,27 5,826 951 29 0 26,083 92,883 33,114 3,966 148 7 130,118
5 7
4-5 184,11 56,437 4,560 1,317 111 246,53 51,78 14,326 1,290 155 3 67,563 235,90 70,763 5,850 1,472 114 314,100
2 7 9 1
6-7 153,72 37,126 2,722 1,153 177 194,90 39,92 9,225 549 102 4 49,800 193,64 46,351 3,271 1,255 181 244,703
5 3 0 5
8-9 95,327 22,324 1,385 593 143 119,77 23,91 4,872 247 55 8 29,100 119,24 27,196 1,632 648 151 148,872
2 8 5
10 and 206,21 40,944 2,530 836 1,156 251,68 48,33 7,390 514 98 105 56,441 254,54 48,334 3,044 934 1,261 308,121
over 4 0 4 8
Average 9 8 7 8 15 9 8 7 7 8 15 8 9 8 7 8 15 8
years
(mean)
Average 7 6 6 7 15 7 7 6 5 6 15 7 7 6 6 7 15 7
years
(median)
CDR maturity
-----------------------------------------------------------------------------------------------------------------------------------------------------
Maturing 177,75 71,236 6,708 1,478 573 257,75 45,05 15,273 1,858 151 47 62,385 222,81 86,509 8,566 1,629 620 320,137
in FY 7 2 6 3
1996
Matured 1 128,56 36,706 3,000 1,146 421 169,83 35,13 8,423 490 98 24 44,170 163,69 45,129 3,490 1,244 445 214,003
year ago 0 3 5 5
Matured 2 104,79 20,502 1,410 540 244 127,49 27,67 5,075 286 67 26 33,128 132,47 25,577 1,696 607 270 160,620
years ago 6 2 4 0
Matured 3 85,918 13,350 727 270 109 100,37 22,19 3,489 170 18 6 25,874 108,10 16,839 897 288 115 126,248
years ago 4 1 9
Matured 4 79,316 11,065 454 169 49 91,053 21,10 2,879 96 24 3 24,111 100,42 13,944 550 193 52 115,164
years ago 9 5
Matured 5- 107,89 17,032 573 173 88 125,75 25,49 3,534 117 18 1 29,168 133,38 20,566 690 191 89 154,924
10 years 0 6 8 8
ago
Matured 14,193 2,932 87 20 21 17,253 1,880 292 12 9 2 2,195 16,073 3,224 99 29 23 19,448
over 10
years ago
Not 14,554 11,296 1,253 222 89 27,414 4,695 2,674 522 54 11 7,956 19,249 13,970 1,775 276 100 35,370
identified
Average 3 2 1 2 2 3 3 2 1 2 1 3 3 2 1 2 2 3
years
(mean)
Average 2 1 1 1 1 2 2 1 0 1 1 2 2 1 1 1 1 3
years
(median)
Gender
-----------------------------------------------------------------------------------------------------------------------------------------------------
Female 265,35 67,835 4,839 1,144 498 339,67 95,89 19,278 1,400 161 44 116,77 361,25 87,113 6,239 1,305 542 456,452
9 5 4 7 3
Male 447,30 116,26 9,368 2,874 1,096 576,90 87,32 22,361 2,151 278 76 112,18 534,62 138,62 11,51 3,152 1,172 689,086
1 1 0 0 6 1 2 9
Not 324 23 5 0 0 352 24 0 0 0 0 24 348 23 5 0 0 376
identified
Race
-----------------------------------------------------------------------------------------------------------------------------------------------------
Black 126,31 30,891 2,650 633 240 160,73 45,74 10,157 884 111 23 56,920 172,06 41,048 3,534 744 263 217,650
6 0 5 1
White 555,90 142,99 10,696 3,157 1,278 714,02 126,2 28,544 2,422 291 88 157,61 682,17 171,53 13,11 3,448 1,366 871,641
8 0 9 67 2 5 4 8
Other 19,723 6,479 516 130 49 26,897 7,601 2,058 152 26 8 9,845 27,324 8,537 668 156 57 36,742
Not 11,037 3,759 350 98 27 15,271 3,625 880 93 11 1 4,610 14,662 4,639 443 109 28 19,881
identified
-----------------------------------------------------------------------------------------------------------------------------------------------------
Note: SSA does not estimate the likelihood of benefit termination
for MIE and MIP workers aged 60 and over or for MINE workers.
\a We classified 583 of the records for worker beneficiaries under
the age of 60 as MIP because a MIE or MIP classification was not
specified.
Source: GAO analysis of MBR records and files supplied by OD.
Table IV.6
Characteristics of Selected DI Workers
Awaiting CDRs in FY 1996, by Program and
Estimated Likelihood of Benefit
Termination, in Percentages
75% 75%
Under 25- 50- and Under 25- 50- 75% and Under 25- 50- and
5 % 5-24% 49% 74% over Total 5% 5-24% 49% 74% over Total 5% 5-24% 49% 74% over Total
---------- ------ ------ ------ ------ ------ ------ ----- ------ ----- ----- ------- ------ ------ ------ ----- ----- ----- ------
Total CDR 712,98 184,11 14,212 4,018 1,594 916,92 183,2 41,639 3,551 439 120 228,98 896,22 225,75 17,76 4,457 1,714 1,145,
population 4 9 7 38 7 2 8 3 914
Age in years
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 30 1 5 20 20 7 2 8 12 47 53 3 9 2 6 25 23 7 4
30-39 12 27 42 43 25 15 29 38 39 35 40 31 15 29 42 42 26 18
40-49 36 48 29 29 44 38 33 41 12 9 42 34 35 46 25 27 44 37
50-59 52 21 9 8 23 45 30 10 2 4 15 26 47 19 8 7 23 41
60 and 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
over
Average 49 44 38 38 44 48 44 40 32 32 42 43 48 43 37 37 43 47
age
(mean)
Average 50 44 37 37 44 49 44 40 30 30 42 43 49 43 35 36 44 48
age
(median)
Diagnostic group
-----------------------------------------------------------------------------------------------------------------------------------------------------
Infectious 1 1 2 1 0 1 1 1 1 1 0 1 1 1 2 1 0 1
and
parasitic
diseases
Neoplasms 0 4 13 14 1 1 0 2 8 9 1 1 0 4 12 14 1 1
Endocrine, 6 7 7 11 11 6 7 7 11 25 17 7 6 7 7 13 11 6
nutrition
al, and
metabolic
diseases
Disorders 0 0 2 2 0 0 0 0 4 7 0 0 0 0 3 2 0 0
of blood
and
blood-
forming
organs
Mental 43 31 18 3 2 40 56 45 37 13 1 54 46 34 22 4 2 43
disorders,
excluding
mental
retardati
on
Mental 4 3 0 0 1 4 13 3 1 1 5 11 6 3 0 0 1 5
retardati
on
Neurologic 7 6 0 0 0 7 4 6 1 0 1 4 6 6 0 0 0 6
al and
sensory
disorders
Circulator 9 3 1 0 0 7 4 3 0 0 1 4 8 3 1 0 0 7
y
disorders
Respirator 2 2 0 0 0 2 1 2 0 0 0 1 2 2 0 0 0 2
y
disorders
Digestive 1 2 4 1 0 1 0 2 1 0 1 1 1 2 3 1 0 1
disorders
Genitourin 0 1 5 5 0 0 0 1 2 1 0 0 0 1 4 4 0 0
ary
disorders
Skin and 0 1 1 1 0 0 0 0 1 1 0 0 0 1 1 1 0 0
subcutane
ous
tissue
disorders
Musculoske 23 21 13 8 2 22 10 16 5 4 0 11 20 20 11 8 2 20
letal
disorders
Congenital 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0
anomalies
Injuries 3 10 24 42 14 5 2 7 15 17 0 3 3 9 22 40 13 4
Other 0 0 1 1 1 0 0 0 1 1 3 0 0 0 1 1 1 0
Not 1 8 9 10 67 3 0 5 11 19 72 2 1 8 9 11 67 2
identified
Medical improvement classification
-----------------------------------------------------------------------------------------------------------------------------------------------------
MIE 11 16 24 22 14 13 12 17 22 21 8 13 11 17 24 22 13 13
MIP\a 89 84 76 78 86 87 88 83 78 79 92 87 89 83 76 78 87 87
Number of years receiving benefits
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 10 15 21 3 0 11 11 14 27 7 0 11 10 15 22 3 0 11
4-5 26 31 32 33 7 27 28 34 36 35 3 30 26 31 33 33 7 27
6-7 22 20 19 29 11 21 22 22 15 23 3 22 22 21 18 28 11 21
8-9 13 12 10 15 9 13 13 12 7 13 7 13 13 12 9 15 9 13
10 and 29 22 18 21 73 27 26 18 14 22 88 25 28 21 17 21 74 27
over
Average 9 8 7 8 15 9 8 7 7 8 15 8 9 8 7 8 15 8
years
(mean)
Average 7 6 6 7 15 7 7 6 5 6 15 7 7 6 6 7 15 7
years
(median)
CDR maturity
-----------------------------------------------------------------------------------------------------------------------------------------------------
Maturing 25 39 47 37 36 28 25 37 52 34 39 27 25 38 48 37 36 28
in FY
1996
Matured 1 18 20 21 29 26 19 19 20 14 22 20 19 18 20 20 28 26 19
year ago
Matured 2 15 11 10 13 15 14 15 12 8 15 22 14 15 11 10 14 16 14
years ago
Matured 3 12 7 5 7 7 11 12 8 5 4 5 11 12 7 5 6 7 11
years ago
Matured 4 11 6 3 4 3 10 12 7 3 5 3 11 11 6 3 4 3 10
years ago
Matured 5- 15 9 4 4 6 14 14 8 3 4 1 13 15 9 4 4 5 14
10 years
ago
Matured 2 2 1 0 1 2 1 1 0 2 2 1 2 1 1 1 1 2
over 10
years ago
Not 2 6 9 6 6 3 3 6 15 12 9 3 2 6 10 6 6 3
identified
Average 3 2 1 2 2 3 3 2 1 2 1 3 3 2 1 2 2 3
years
(mean)
Average 2 1 1 1 1 2 2 1 0 1 1 2 2 1 1 1 1 3
years
(median)
Gender
-----------------------------------------------------------------------------------------------------------------------------------------------------
Female 37 37 34 28 31 37 52 46 39 37 37 51 40 39 35 29 32 40
Male 63 63 66 72 69 63 48 54 61 63 63 49 60 61 65 71 68 60
Not 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
identified
Race
-----------------------------------------------------------------------------------------------------------------------------------------------------
Black 18 17 19 16 15 18 25 24 25 25 19 25 19 18 20 17 15 19
White 78 78 75 79 80 78 69 69 68 66 73 69 76 76 74 77 80 76
Other 3 4 4 3 3 3 4 5 4 6 7 4 3 4 4 4 3 3
Not 2 2 2 2 2 2 2 2 3 3 1 2 2 2 2 2 2 2
identified
-----------------------------------------------------------------------------------------------------------------------------------------------------
Note: SSA does not estimate the likelihood of benefit termination
for MIE and MIP workers aged 60 and over or for MINE workers.
\a We classified 583 of the records for worker beneficiaries under
the age of 60 as MIP because a MIE or MIP classification was not
specified.
Source: GAO analysis of MBR records and files supplied by OD.
Table IV.7
Characteristics of Adult and Child SSI
Recipients Awaiting CDRs in FY 1996, by
Medical Improvement Classification
MIE MIP\a MINE Total MIE MIP MINE Total MIE MIP MINE Total
------------------ -------- -------- -------- -------- --------- --------- --------- ---------- --------- --------- --------- -----------
Total estimated 186,727 785,383 421,580 1,393,69 114,231 348,156 53,354 515,739 300,958 1,133,539 474,934 1,909,432
CDR population 3
Age in years
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 5 32,053 11,994 1,460 45,508 32,053 11,994 1,460 45,507
5-9 33,426 108,452 10,780 152,657 33,426 108,449 10,780 152,655
10-14 33,106 153,767 25,327 212,199 33,106 153,763 25,327 212,196
15-17 6,140 30,401 6,013 42,554 6,140 30,401 6,013 42,554
18-21 10,207 40,654 12,087 62,947 9,506 43,535 9,760 62,802 19,713 84,188 21,847 125,748
22-29 27,453 105,454 108,435 241,342 27,453 105,455 108,435 241,343
30-39 46,280 164,034 120,282 330,596 46,280 164,036 120,282 330,598
40-49 53,187 197,821 72,595 323,603 53,186 197,823 72,594 323,604
50-59 37,067 180,501 69,194 286,763 37,066 180,503 69,194 286,764
60 and over 12,533 96,814 38,987 148,335 12,533 96,815 38,987 148,335
Not identified 0 107 0 107 0 113 13 127
Average age (mean) 42 44 40 42 9 12 13 11 29 34 37 34
Average age 42 44 37 42 9 12 13 12 30 35 34 34
(median)
Diagnostic group
-----------------------------------------------------------------------------------------------------------------------------------------------------
Infectious and 913 9,600 2,653 13,167 153 1,053 213 1,420 1,067 10,654 2,867 14,587
parasitic
diseases
Neoplasms 2,680 8,780 1,467 12,927 5,453 3,020 747 9,220 8,133 11,800 2,213 22,147
Endocrine, 11,067 53,700 5,660 70,427 11,180 25,394 2,027 38,601 22,247 79,095 7,687 109,028
nutritional, and
metabolic
diseases
Disorders of blood 553 3,833 773 5,160 1,220 6,820 640 8,680 1,773 10,654 1,413 13,840
and blood-
forming organs
Mental disorders, 99,960 323,121 46,987 470,071 22,133 69,070 4,507 95,709 122,093 392,193 51,494 565,781
excluding mental
retardation
Mental retardation 22,760 132,627 104,895 260,282 22,873 143,427 14,367 180,664 45,633 276,051 119,262 440,946
Neurological and 9,340 30,313 36,627 76,281 10,213 44,895 12,307 67,415 19,553 75,208 48,934 143,695
sensory disorders
Circulatory 3,593 33,860 13,420 50,874 1,600 2,507 473 4,580 5,193 36,367 13,894 55,454
disorders
Respiratory 2,467 12,867 5,547 20,880 6,193 8,754 953 15,900 8,660 21,620 6,500 36,780
disorders
Digestive 1,860 6,387 847 9,093 833 1,127 220 2,180 2,693 7,513 1,067 11,273
disorders
Genitourinary 800 2,973 4,113 7,887 527 1,053 153 1,733 1,327 4,027 4,267 9,620
disorders
Skin and 507 1,340 207 2,053 180 333 60 573 687 1,673 267 2,627
subcutaneous
tissue disorders
Musculoskeletal 9,753 57,247 6,947 73,947 2,093 4,034 540 6,667 11,847 61,281 7,487 80,614
disorders
Congenital 380 2,747 2,613 5,740 5,993 14,461 4,080 24,534 6,373 17,207 6,693 30,274
anomalies
Injuries 8,347 15,400 7,153 30,900 987 1,880 420 3,287 9,333 17,280 7,573 34,187
Other 720 2,260 840 3,820 21,893 17,681 3,373 42,948 22,613 19,940 4,213 46,767
Not identified 11,027 88,327 180,830 280,183 707 2,647 8,273 11,627 11,733 90,975 189,103 291,811
Estimated likelihood of benefit termination
-----------------------------------------------------------------------------------------------------------------------------------------------------
Subpopulation with 174,194 688,570 862,764
likelihood
estimated\b
Under 5% 121,301 525,322 646,623
5-24% 45,760 142,307 188,067
25-49% 6,507 18,813 25,320
50-74% 500 1,927 2,427
75% and over 127 200 327
Average likelihood 5 4 5
(mean)
Average likelihood 2 2 2
(median)
Number of years receiving benefits
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 43,020 79,400 9,127 131,548 58,952 79,684 2,653 141,290 101,973 159,083 11,780 272,837
4-5 38,087 260,368 28,494 326,950 25,513 155,767 9,573 190,851 63,600 416,134 38,067 517,800
6-7 29,967 182,847 44,834 257,649 10,660 60,876 9,840 81,375 40,626 243,724 54,674 339,024
8-9 28,247 106,847 67,068 202,162 9,660 24,421 9,667 43,748 37,906 131,269 76,734 245,910
10 and over 47,407 155,821 272,058 475,284 9,446 27,408 21,620 58,475 56,853 183,230 293,678 533,760
Not identified 0 100 0 100 0 0 0 0 0 100 0 100
Average years 7 7 13 9 5 6 9 6 6 7 12 8
(mean)
Average years 7 6 12 8 4 5 9 5 5 6 11 6
(median)
CDR maturity
-----------------------------------------------------------------------------------------------------------------------------------------------------
Due in FY 1996 18,153 157,761 64,161 240,075 24,086 127,566 6,660 158,311 42,240 285,325 70,821 398,385
Due 1 year ago 26,767 153,301 55,321 235,389 29,326 95,738 6,867 131,930 56,093 249,038 62,188 367,318
Due 2 years ago 38,214 123,534 54,108 215,855 20,393 50,889 6,760 78,042 58,606 174,423 60,868 293,897
Due 3 years ago 16,927 97,854 52,314 167,095 9,853 25,955 5,607 41,414 26,780 123,809 57,921 208,509
Due 4 years ago 15,167 87,994 51,247 154,408 6,707 18,754 5,273 30,734 21,873 106,748 56,521 185,142
Due 5-10 years ago 53,920 135,367 122,475 311,763 16,806 22,374 16,793 55,975 70,726 157,743 139,269 367,738
Due over 10 years 9,327 14,207 12,247 35,780 1,940 2,087 3,100 7,127 11,267 16,294 15,347 42,907
ago
Not identified 8,253 15,367 9,707 33,327 5,120 4,794 2,293 12,207 13,373 20,160 12,000 45,534
Average years 4 3 4 3 3 2 4 2 3 3 4 3
(mean)
Average years 3 2 4 3 2 1 4 2 4 2 4 2
(median)
Gender
-----------------------------------------------------------------------------------------------------------------------------------------------------
Female 103,000 448,095 226,637 777,734 43,486 125,412 21,733 190,631 146,486 573,510 248,370 968,366
Male 83,720 337,135 194,943 615,799 70,738 222,697 31,613 325,048 154,459 559,830 226,557 940,846
Not identified 7 153 0 160 7 47 7 60 13 200 7 220
Race
-----------------------------------------------------------------------------------------------------------------------------------------------------
Black 50,307 231,928 103,868 386,103 32,453 129,706 14,313 176,471 82,759 361,633 118,182 562,574
White 87,520 353,742 219,037 660,299 37,739 122,879 24,880 185,498 125,259 476,622 243,917 845,798
Other 24,367 88,740 39,734 152,841 12,646 42,429 7,520 62,595 37,013 131,169 47,254 215,436
Not identified 24,533 110,974 58,941 194,448 31,393 53,142 6,640 91,176 55,926 164,116 65,581 285,624
-----------------------------------------------------------------------------------------------------------------------------------------------------
Note: Estimates are based on a 15-percent sample. The largest
percentage sampling error in the column at the 95-percent confidence
level is provided in the corresponding column in table IV.8. Because
of rounding during the estimation process, row entries may not sum to
row totals.
\a We classified 236 sample records for adult beneficiaries as MIPs
because a MIE or MIP classification was not specified.
\b SSA does not estimate the likelihood of benefit termination for
MIEs and MIPs aged 60 and over. Therefore, the total number with an
estimated likelihood of benefit termination is less than the total
number for the column. Furthermore, SSA does not estimate the
likelihood of benefit termination for children or MINEs.
Source: GAO analysis of SSIRD records and files supplied by OD.
Table IV.8
Characteristics of Adult and Child SSI
Recipients Awaiting CDRs in FY 1996, by
Medical Improvement Classification, in
Percentages
MIE MIP\a MINE Total MIE MIP MINE Total MIE MIP MINE Total
------------------ -------- -------- -------- -------- ---------- --------- --------- --------- --------- --------- --------- -----------
Total estimated 186,727 785,383 421,580 1,393,69 114,231 348,156 53,354 515,739 300,958 1,133,539 474,934 1,909,432
CDR population 3
Largest sampling 0.6 0.3 0.4 0.2 0.7 0.4 1.1 0.3 0.5 0.2 0.4 0.2
error in column
at the 95-
percent
confidence level
Age in years
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 5 28 3 3 9 11 1 0 2
5-9 29 31 20 30 11 10 2 8
10-14 29 44 47 41 11 14 5 11
15-17 5 9 11 8 2 3 1 2
18-21 5 5 3 5 8 13 18 12 7 7 5 7
22-29 15 13 26 17 9 9 23 13
30-39 25 21 29 24 15 14 25 17
40-49 28 25 17 23 18 17 15 17
50-59 20 23 16 21 12 16 15 15
60 and over 7 12 9 11 4 9 8 8
Average age (mean) 42 44 40 42 9 12 13 11 29 34 37 34
Average age 42 44 37 42 9 12 13 11 30 35 34 34
(median)
Diagnostic group
-----------------------------------------------------------------------------------------------------------------------------------------------------
Infectious and 0 1 1 1 0 0 0 0 0 1 1 1
parasitic
diseases
Neoplasms 1 1 0 1 5 1 1 2 3 1 0 1
Endocrine, 6 7 1 5 10 7 4 7 7 7 2 6
nutritional, and
metabolic
diseases
Disorders of blood 0 0 0 0 1 2 1 2 1 1 0 1
and blood-
forming organs
Mental disorders, 54 41 11 34 19 20 8 19 41 35 11 30
excluding mental
retardation
Mental retardation 12 17 25 19 20 41 27 35 15 24 25 23
Neurological and 5 4 9 5 9 13 23 13 6 7 10 8
sensory disorders
Circulatory 2 4 3 4 1 1 1 1 2 3 3 3
disorders
Respiratory 1 2 1 1 5 3 2 3 3 2 1 2
disorders
Digestive 1 1 0 1 1 0 0 0 1 1 0 1
disorders
Genitourinary 0 0 1 1 0 0 0 0 0 0 1 1
disorders
Skin and 0 0 0 0 0 0 0 0 0 0 0 0
subcutaneous
tissue disorders
Musculoskeletal 5 7 2 5 2 1 1 1 4 5 2 4
disorders
Congenital 0 0 1 0 5 4 8 5 2 2 1 2
anomalies
Injuries 4 2 2 2 1 1 1 1 3 2 2 2
Other 0 0 0 0 19 5 6 8 8 2 1 2
Not identified 6 11 43 20 1 1 16 2 4 8 40 15
Estimated likelihood of benefit termination
-----------------------------------------------------------------------------------------------------------------------------------------------------
Subpopulation with 174,194 688,570 862,764
likelihood
estimated\b
Under 5% 70 76 75
5-24% 26 21 22
25-49% 4 3 3
50-74% 0 0 0
75% and over 0 0 0
Average likelihood 5 4 5
(mean)
Average likelihood 2 2 2
(median)
Number of years receiving benefits
-----------------------------------------------------------------------------------------------------------------------------------------------------
Under 4 23 10 2 9 52 23 5 27 34 14 2 14
4-5 20 33 7 23 22 45 18 37 21 37 8 27
6-7 16 23 11 18 9 17 18 16 13 22 12 18
8-9 15 14 16 15 8 7 18 8 13 12 16 13
10 and over 25 20 65 34 8 8 41 11 19 16 62 28
Average years 7 7 13 9 5 6 9 6 6 7 12 8
(mean)
Average years 7 6 12 8 4 5 9 5 5 6 11 6
(median)
CDR maturity
-----------------------------------------------------------------------------------------------------------------------------------------------------
Due in FY 1996 10 20 15 17 21 37 12 31 14 25 15 21
Due 1 year ago 14 20 13 17 26 27 13 26 19 22 13 19
Due 2 years ago 20 16 13 15 18 15 13 15 19 15 13 15
Due 3 years ago 9 12 12 12 9 7 11 8 9 11 12 11
Due 4 years ago 8 11 12 11 6 5 10 6 7 9 12 10
Due 5-10 years ago 29 17 29 22 15 6 31 11 24 14 29 19
Due over 10 years 5 2 3 3 2 1 6 1 4 1 3 2
ago
Not identified 4 2 2 2 4 1 4 2 4 2 3 2
Average years 4 3 4 3 3 2 4 2 3 3 4 3
(mean)
Average years 3 2 4 3 2 1 4 2 4 2 4 2
(median)
Gender
-----------------------------------------------------------------------------------------------------------------------------------------------------
Female 55 57 54 56 38 36 41 37 49 51 52 51
Male 45 43 46 44 62 64 59 63 51 49 48 49
Race
-----------------------------------------------------------------------------------------------------------------------------------------------------
Black 27 30 25 28 28 37 27 34 27 32 25 29
White 47 45 52 47 33 35 47 36 42 42 51 44
Other 13 11 9 11 11 12 14 12 12 12 10 11
Not identified 13 14 14 14 27 15 12 18 19 14 14 15
-----------------------------------------------------------------------------------------------------------------------------------------------------
Note: Estimates are based on a 15-percent sample. The largest
percentage sampling error at the 95-percent confidence level is near
the top of each column. Because of rounding during the estimation
process, row entries may not sum to row totals.
\b We classified 236 of the sample records for adult beneficiaries as
MIPs because a MIE or MIP classification was not specified.
\c SSA does not estimate the likelihood of benefit termination for
MIEs and MIPs aged 60 and over. Therefore, the total with an
estimated likelihood of benefit termination is less than the total
number for the column. Furthermore, SSA does not estimate the
likelihood of benefit termination for children or MINEs.
Source: GAO analysis of SSIRD records and files supplied by OD.
Table IV.9
Characteristics of SSI Recipients
Awaiting CDRs in FY 1996, by Age and
Medical Improvement Classification
MIE MIP\a MINE MIE MIP MINE
---------------- ----- ----- ----- ----- ----- -----
Total estimated 174,1 688,5 382,5 12,53 96,81 38,98
CDR population 94 70 93 3 4 7
Age in years
----------------------------------------------------------
18-21 10,20 40,65 12,08
7 4 7
22-29 27,45 105,4 108,4
3 54 35
30-39 46,28 164,0 120,2
0 34 82
40-49 53,18 197,8 72,59
7 21 5
50-59 37,06 180,5 69,19
7 01 4
60 and over 12,53 96,81 38,98
3 4 7
Average age 40 41 37 62 63 62
(mean)
Average age 41 42 35 62 63 62
(median)
Diagnostic group
----------------------------------------------------------
Infectious and 847 8,653 2,460 67 947 193
parasitic
diseases
Neoplasms 2,453 7,107 1,313 227 1,673 153
Endocrine, 9,833 45,14 4,640 1,233 8,560 1,020
nutritional, 0
and metabolic
diseases
Disorders of 553 3,733 753 0 100 20
blood and
blood-forming
organs
Mental 94,64 301,4 42,41 5,313 21,63 4,573
disorders, 7 88 4 3
excluding
mental
retardation
Mental 22,24 128,1 101,1 513 4,493 3,767
retardation 7 34 28
Neurological and 8,540 26,90 34,35 800 3,413 2,273
sensory 0 4
disorders
Circulatory 2,993 20,07 9,000 600 13,78 4,420
disorders 3 7
Respiratory 2,067 8,353 3,440 400 4,513 2,107
disorders
Digestive 1,740 5,433 707 120 953 140
disorders
Genitourinary 753 2,653 3,807 47 320 307
disorders
Skin and 460 1,187 173 47 153 33
subcutaneous
tissue
disorders
Musculoskeletal 8,453 37,79 4,727 1,300 19,45 2,220
disorders 3 3
Congenital 373 2,607 2,593 7 140 20
anomalies
Injuries 7,793 12,55 6,627 553 2,847 527
3
Other 633 1,993 773 87 267 67
Not identified 9,807 74,76 163,6 1,220 13,56 17,14
7 83 0 7
Estimated likelihood of benefit termination
----------------------------------------------------------
Subpopulation 174,1 688,5
with likelihood 94 70
estimated\b
Under 5% 121,3 525,3
01 22
5-24% 45,76 142,3
0 07
25-49% 6,507 18,81
3
50-74% 500 1,927
75% and over 127 200
Average 5 4
likelihood
(mean)
Average 2 2
likelihood
(median)
Number of years receiving benefits
----------------------------------------------------------
Under 4 42,03 75,71 7,560 987 3,687 1,567
4 4
4-5 36,36 234,5 24,28 1,727 25,78 4,207
0 88 7 0
6-7 27,39 154,1 39,04 2,573 28,71 5,793
3 34 1 3
8-9 25,56 89,00 59,72 2,687 17,84 7,347
0 0 1 7
10 and over 42,84 135,0 251,9 4,560 20,78 20,07
7 34 84 7 4
Not identified 0 100 0 0 0 0
Average years 7 7 13 9 8 11
(mean)
Average years 7 6 12 9 7 10
(median)
CDR maturity
----------------------------------------------------------
Due in FY 1996 17,60 148,0 57,86 553 9,713 6,293
0 47 8
Due 1 year ago 26,02 139,9 49,14 740 13,37 6,173
7 27 7 3
Due 2 years ago 35,57 105,0 48,74 2,640 18,49 5,360
3 40 7 3
Due 3 years ago 15,95 82,58 47,46 973 15,26 4,847
3 7 7 7
Due 4 years ago 14,06 74,47 47,58 1,100 13,52 3,667
7 4 1 0
Due 5-10 years 49,01 111,9 111,9 4,907 23,39 10,54
ago 4 74 35 3 0
Due over 10 8,400 11,91 11,16 927 2,293 1,080
years ago 3 7
Not identified 7,560 14,60 8,680 693 760 1,027
7
Average years 4 3 4 5 4 4
(mean)
Average years 3 2 4 5 3 3
(median)
Gender
----------------------------------------------------------
Female 94,64 381,8 202,0 8,360 66,25 24,57
0 42 63 4 4
Male 79,54 306,5 180,5 4,173 30,54 14,41
7 88 30 7 4
Not identified 7 140 0 0 13 0
Race
----------------------------------------------------------
Black 47,75 206,9 95,71 2,553 24,93 8,153
4 94 5 3
White 81,78 312,4 201,2 5,740 41,26 17,74
0 75 90 7 7
Other 22,50 75,40 34,64 1,867 13,34 5,087
0 0 7 0
Not identified 22,16 93,70 50,94 2,373 17,27 8,000
0 0 1 3
----------------------------------------------------------
Note: Estimates are based on a 15-percent sample. The largest
percentage sampling error in the column at the 95-percent confidence
level is provided in the corresponding column in table IV.10.
Because of rounding during the estimation process, row entries may
not sum to row totals.
\a We classified 236 sample records for adult beneficiaries as MIPs
because a MIE or MIP classification was not specified.
\b SSA does not estimate the likelihood of benefit termination for
MIEs and MIPs aged 60 and over or for MINEs. Therefore, the total
number with an estimated likelihood of benefit termination is less
than the total number for the column.
Source: GAO analysis of SSIRD records and files supplied by OD.
Table IV.10
Characteristics of SSI Recipients
Awaiting CDRs in FY 1996, by Age and
Medical Improvement Classification, in
Percentages
MIE MIP\a MINE MIE MIP MINE
---------------- ----- ----- ----- ----- ----- -----
Total estimated 174,1 688,5 382,5 12,53 96,81 38,98
CDR population 94 70 93 3 4 7
Largest sampling 0.6 0.3 0.4 2.3 0.8 1.3
error in column
at the 95-
percent
confidence
level
Age in years
----------------------------------------------------------
18-21 6 6 3
22-29 16 15 28
30-39 27 24 31
40-49 31 29 19
50-59 21 26 18
60 and over 100 100 100
Average age 40 41 37 62 63 63
(mean)
Average age 41 42 35 62 63 63
(median)
Diagnostic group
----------------------------------------------------------
Infectious and 0 1 1 1 1 0
parasitic
diseases
Neoplasms 1 1 0 2 2 0
Endocrine, 6 7 1 10 9 3
nutritional,
and metabolic
diseases
Disorders of 0 1 0 0 0 0
blood and
blood-forming
organs
Mental 54 44 11 42 22 12
disorders,
excluding
mental
retardation
Mental 13 19 26 4 5 10
retardation
Neurological and 5 4 9 6 4 6
sensory
disorders
Circulatory 2 3 2 5 14 11
disorders
Respiratory 1 1 1 3 5 5
disorders
Digestive 1 1 0 1 1 0
disorders
Genitourinary 0 0 1 0 0 1
disorders
Skin and 0 0 0 0 0 0
subcutaneous
tissue
disorders
Musculoskeletal 5 5 1 10 20 6
disorders
Congenital 0 0 1 0 0 0
anomalies
Injuries 4 2 2 4 3 1
Other 0 0 0 1 0 0
Not identified 6 11 43 10 14 44
Estimated likelihood of benefit termination
----------------------------------------------------------
Subpopulation 174,1 688,5
with likelihood 94 70
estimated\b
Under 5% 70 76
5-24% 26 21
25-49% 4 3
50-74% 0 0
75% and over 0 0
Average 5 4
likelihood
(mean)
Average 2 2
likelihood
(median)
Number of years receiving benefits
----------------------------------------------------------
Under 4 24 11 2 8 4 4
4-5 21 34 6 14 27 11
6-7 16 22 10 21 30 15
8-9 15 13 16 21 18 19
10 and over 25 20 66 36 21 51
Not identified 0 0 0 0 0 0
Average years 7 7 13 9 8 11
(mean)
Average years 7 6 12 9 7 10
(median)
CDR maturity
----------------------------------------------------------
Due in FY 1996 10 22 15 4 10 16
Due 1 year ago 15 20 13 6 14 16
Due 2 years ago 20 15 13 21 19 14
Due 3 years ago 9 12 12 8 16 12
Due 4 years ago 8 11 12 9 14 9
Due 5-10 years 28 16 29 39 24 27
ago
Due over 10 5 2 3 7 2 3
years ago
Not identified 4 2 2 6 1 3
Average years 4 3 4 5 4 4
(mean)
Average years 3 2 4 5 3 3
(median)
Gender
----------------------------------------------------------
Female 54 55 53 67 68 63
Male 46 45 47 33 32 37
Not identified 0 0 0 0 0 0
Race
----------------------------------------------------------
Black 27 30 25 20 26 21
White 47 45 53 46 43 46
Other 13 11 9 15 14 13
Not identified 13 14 13 19 18 21
----------------------------------------------------------
Note: Estimates are based on a 15-percent sample. The largest
percentage sampling error at the 95-percent confidence level is
provided near the top of each column. Because of rounding during the
estimation process, row entries may not sum to row totals.
\a We classified 236 sample records for adult beneficiaries as MIPs
because a MIE or MIP classification was not specified.
\b SSA does not estimate the likelihood of benefit termination for
MIEs and MIPs aged 60 and over or for MINEs. Therefore, the total
number with an estimated likelihood of benefit termination is less
than the total number for the column.
Source: GAO analysis of SSIRD records and files supplied by OD.
Table IV.11
Characteristics of Selected SSI Adults
Awaiting CDRs in FY 1996, by Estimated
Likelihood of Benefit Termination
Under 25- 50- Over
5% 5-24% 49% 74% 74% Total
------------ ------ ------ ------ ---- ------ ------
Total 646,62 188,06 25,320 2,42 327 862,76
estimated 3 7 7 4
CDR
population\
a
Age in years
----------------------------------------------------------
18-21 49,287 580 820 160 13 50,860
22-29 96,360 21,933 13,033 1,51 67 132,90
3 7
30-39 126,46 74,167 8,920 613 153 210,31
1 4
40-49 170,50 77,974 2,327 140 67 251,00
1 8
50-59 203,91 13,407 220 0 27 217,56
4 8
Not 100 7 0 0 0 107
identified
Average age 42 39 30 29 36 41
(mean)
Average age 43 40 29 28 33 41
(median)
Diagnostic group
----------------------------------------------------------
Infectious 5,873 2,973 593 53 7 9,500
and
parasitic
diseases
Neoplasms 3,240 4,967 1,240 107 7 9,560
Endocrine, 43,034 10,360 1,393 187 0 54,974
nutritional,
and
metabolic
diseases
Disorders of 1,833 1,253 920 280 0 4,287
blood and
blood-
forming
organs
Mental 316,80 71,020 7,987 253 73 396,13
disorders, 1 5
excluding
mental
retardation
Mental 146,58 2,913 680 187 13 150,38
retardation 7 1
Neurological 23,220 11,993 187 40 0 35,440
and sensory
disorders
Circulatory 19,687 3,273 93 7 7 23,067
disorders
Respiratory 6,987 3,227 207 0 0 10,420
disorders
Digestive 2,060 4,853 253 7 0 7,173
disorders
Genitourinar 1,480 1,553 300 67 7 3,407
y disorders
Skin and 493 753 313 87 0 1,647
subcutaneous
tissue
disorders
Musculoskele 27,867 16,860 1,440 60 20 46,247
tal
disorders
Congenital 1,667 813 360 127 13 2,980
anomalies
Injuries 7,813 10,373 2,120 40 0 20,347
Other 1,367 927 300 13 20 2,627
Not 36,613 39,954 6,933 913 160 84,574
identified
Medical improvement classification
----------------------------------------------------------
MIE 121,30 45,760 6,507 500 127 174,19
1 4
MIP\b 525,32 142,30 18,813 1,92 200 688,57
2 7 7 0
Number of years receiving benefits
----------------------------------------------------------
Under 4 78,180 34,267 4,980 307 13 117,74
7
4-5 198,72 64,007 7,520 687 7 270,94
8 8
6-7 138,50 37,880 4,660 473 7 181,52
7 7
8-9 86,547 22,960 4,320 667 67 114,56
1
10 and over 144,56 28,953 3,840 293 233 177,88
1 1
Not 100 0 0 0 0 0
identified
Average 8 7 7 7 13 7
years
(mean)
Average 7 6 6 7 12 6
years
(median)
CDR maturity
----------------------------------------------------------
Due in FY 121,38 38,627 5,073 533 27 165,64
1996 7 7
Due 1 year 120,92 39,220 5,393 400 20 165,95
ago 1 4
Due 2 years 105,49 30,847 3,880 340 53 140,61
ago 4 4
Due 3 years 74,967 20,933 2,367 253 20 98,540
ago
Due 4 years 70,800 15,620 1,947 153 20 88,540
ago
Due 5-10 123,94 31,280 5,040 567 160 160,98
years ago 1 7
Due over 10 15,887 3,860 507 40 20 20,313
years ago
Not 13,227 7,680 1,113 140 7 22,167
identified
Average 3 3 3 3 5 3
years
(mean)
Average 3 2 2 2 6 2
years
(median)
Gender
----------------------------------------------------------
Female 362,28 100,56 12,280 1,16 193 476,48
2 0 7 2
Male 284,20 87,500 13,033 1,26 133 386,13
8 0 5
Not 133 7 7 0 0 147
identified
Race
----------------------------------------------------------
Black 191,20 55,607 7,173 667 93 254,74
8 8
White 293,02 86,387 13,333 1,34 173 394,25
1 0 5
Other 72,307 22,340 2,940 300 13 97,900
Not 90,087 23,733 1,873 120 47 115,86
identified 1
----------------------------------------------------------
Note: Estimates are based on a 15-percent sample. The largest
percentage sampling error in the column at the 95-percent confidence
level is provided in the corresponding column in table IV.12.
Because of rounding during the estimation process, row entries may
not sum to row totals.
\a SSA does not estimate the likelihood of benefit termination for
MIEs and MIPs aged 60 and over or for MINEs.
\b We classified 236 sample records for adult beneficiaries as MIPs
because a MIE or MIP classification was not specified.
Source: GAO analysis of SSIRD records and files supplied by OD.
Table IV.12
Characteristics of Selected SSI Adults
Awaiting CDRs in FY 1996, by Estimated
Likelihood of Benefit Termination, in
Percentages
Under 25- 50- Over
5% 5-24% 49% 74% 74% Total
------------ ------ ------ ------ ---- ------ ------
Total 646,62 188,06 25,320 2,42 327 862,76
estimated 3 7 7 4
CDR
population\
a
Largest 0.3 0.6 1.6 5.1 14.0 0.3
sampling
error in
column at
the 95-
percent
confidence
level
Age in years
----------------------------------------------------------
18-21 8 0 3 7 4 6
22-29 15 12 51 62 20 15
30-39 20 39 35 25 47 24
40-49 26 41 9 6 20 29
50-59 32 7 1 0 8 25
Not 0 0 0 0 0 0
identified
Average age 42 39 30 29 36 41
(mean)
Average age 43 40 29 28 33 41
(median)
Diagnostic group
----------------------------------------------------------
Infectious 1 2 2 2 2 1
and
parasitic
diseases
Neoplasms 1 3 5 4 2 1
Endocrine, 7 6 6 8 0 6
nutritional,
and
metabolic
diseases
Disorders of 0 1 4 12 0 0
blood and
blood-
forming
organs
Mental 49 38 32 10 22 46
disorders,
excluding
mental
retardation
Mental 23 2 3 8 4 17
retardation
Neurological 4 6 1 2 0 4
and sensory
disorders
Circulatory 3 2 0 0 2 3
disorders
Respiratory 1 2 1 0 0 1
disorders
Digestive 0 3 1 0 0 1
disorders
Genitourinar 0 1 1 3 2 0
y disorders
Skin and 0 0 1 4 0 0
subcutaneous
tissue
disorders
Musculoskele 4 9 6 2 6 5
tal
disorders
Congenital 0 0 1 5 4 0
anomalies
Injuries 1 6 8 2 0 2
Other 0 0 1 1 6 0
Not 6 21 27 38 49 10
identified
Medical improvement classification
----------------------------------------------------------
MIE 19 24 26 21 39 20
MIP\b 81 76 74 79 61 80
Number of years receiving benefits
----------------------------------------------------------
Under 4 12 18 20 13 4 14
4-5 31 34 30 28 2 31
6-7 21 20 18 20 2 21
8-9 13 12 17 27 20 13
10 and over 22 15 15 12 71 21
Not 0 0 0 0 0 0
identified
Average 8 7 7 7 13 7
years
(mean)
Average 7 6 6 7 12 6
years
(median)
CDR maturity
----------------------------------------------------------
Due in FY 19 21 20 22 8 19
1996
Due 1 year 19 21 21 16 6 19
ago
Due 2 years 16 16 15 14 16 16
ago
Due 3 years 12 11 9 10 6 11
ago
Due 4 years 11 8 8 6 6 10
ago
Due 5-10 19 17 20 23 49 19
years ago
Due over 10 2 2 2 2 6 2
years ago
Not 2 4 4 6 2 3
identified
Average 3 3 3 3 5 3
years
(mean)
Average 3 2 2 2 6 2
years
(median)
Gender
----------------------------------------------------------
Female 56 53 49 48 59 55
Male 44 47 51 52 41 45
Not 0 0 0 0 0 0
identified
Race
----------------------------------------------------------
Black 30 30 28 27 29 30
White 45 46 53 55 53 46
Other 11 12 12 12 4 11
Not 14 13 7 5 14 13
identified
----------------------------------------------------------
Note: Estimates are based on a 15-percent sample. The largest
percentage sampling error at the 95-percent confidence level is
provided near the top of each column. Because of rounding during the
estimation process, row entries may not sum to row totals.
\a SSA does not estimate the likelihood of benefit termination for
MIEs and MIPs aged 60 and over or for MINEs.
\b We classified 236 sample records for adult beneficiaries as MIPs
because a MIE or MIP classification was not specified.
Source: GAO analysis of SSIRD records and files supplied by OD.
(See figure in printed edition.)Appendix V
COMMENTS FROM THE SOCIAL SECURITY
ADMINISTRATION
========================================================== Appendix IV
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
The following are GAO's comments on the Social Security
Administration's letter dated September 23, 1996.
GAO COMMENTS
-------------------------------------------------------- Appendix IV:1
1. When SSA considers legislative changes that would make the CDR
process more cost-effective, we believe that it must reassess the
requirements of the existing schedule for conducting CDRs. According
to SSA officials, if an initial CDR finds that a beneficiary is still
disabled, subsequent CDRs are likely to result in the same
conclusion. We question whether additional CDRs for that beneficiary
are appropriate or cost-effective. Similarly, predictive formulas
for DI worker beneficiaries allow SSA to determine those workers most
likely to medically improve. Other groups not now included in the
selection process may yield additional groups that are cost-effective
to review.
2. While we recognize that the use of the formulas established the
cases that fall into the "middle group," SSA officials told us that
SSA does not know which type of CDR--full medical or mailer--is more
appropriate for those beneficiaries. SSA has at least two efforts
under way to improve its ability to determine which type of CDR would
be the more cost-effective.
3. We agree that SSA is currently testing the feasibility of
expanding the use of formulas to the MINEs, and the report states
that such an effort is under way.
4. While cost-effectiveness is an important aspect of the CDR
process, we also believe that to ensure program integrity, all
beneficiaries should have some likelihood of selection for a CDR.
Such a program weakness is particularly troubling given that SSA has
been unable to conduct all required CDRs for almost a decade and it
estimates that the backlog will not be eliminated for another 7
years.
5. Our recommendation provides a comprehensive approach to program
management that focuses on cost-effectiveness, program integrity, and
increased contact with beneficiaries. Increased beneficiary contact
is valuable to remind beneficiaries that their disability status is
being monitored and that they are responsible for reporting medical
improvement. We believe that such a contact also offers an
additional opportunity for SSA to further its program improvement
efforts. For example, it could be used to identify medical treating
sources that should receive the medical treating source mailer
currently under development.
6. We believe that ongoing periodic contact with beneficiaries is
essential to a well managed program and should be done even if such
an activity is considered a program operating cost. However, in
estimating the costs of increased contact with beneficiaries, we
considered a number of factors, including administrative and other
costs. Because SSA could not provide us with estimates for these
costs, we used the cost of the CDR mailer process to approximate the
costs. The cost of the mailer reflects a more expensive manual
process; thus we believe that it overstates the true cost of a
scannable mail contact. In addition, because of the significant cost
savings likely to result from the termination of benefits for
individuals who do not respond--a net federal savings of over $1.4
billion--we believe that there is sufficient latitude to cover the
cost of such an initiative.
7. Given the challenges that SSA faces, we continue to believe that
its ability to eliminate the backlog of all required CDRs is
uncertain. It may be possible for SSA to conduct the number of CDRs
in its plan. However, the plan excludes about 848,000 required CDRs
that are currently due or overdue. In addition, it does not include
new CDRs and disability eligibility redeterminations required by the
1996 amendments to the Social Security Act, which take precedence
over other required CDRs. Additional challenges are cited in our
report.
8. We are pleased that SSA agrees with our recommendation to
integrate return-to-work initiatives and the CDR process and that SSA
has efforts under way to elicit the assistance of federal and private
sector partners in the development of a return-to-work strategy. In
our report, we acknowledge that field office employees play a limited
role in providing information on VR opportunities to beneficiaries
when they apply, but we also note that these staff take VR-related
actions during a full medical CDR, and that state VR agencies have a
role in limiting candidates for rehabilitation.
GAO CONTACTS AND STAFF
ACKNOWLEDGMENTS
========================================================== Appendix VI
GAO CONTACTS
Robert L. MacLafferty, Assistant Director, (415) 904-2000
Kerry Gail Dunn, Evaluator-in-Charge, (415) 904-2000
Ann Lee, Evaluator-in-Charge, (415) 904-2000
STAFF ACKNOWLEDGMENTS
In addition to those named above, the following persons made
important contributions to this report: Susan E. Arnold, Senior
Evaluator; Christopher C. Crissman, Assistant Director; Julian M.
Fogle, Senior Evaluator; Elizabeth A. Olivarez, Evaluator; Susan K.
Riggio, Evaluator; Vanessa R. Taylor, Senior Evaluator (Computer
Science); and Ann T. Walker, Evaluator (Database Manager).
RELATED GAO PRODUCTS
=========================================================== Appendix 0
Supplemental Security Income: Some Recipients Transfer Valuable
Resources to Qualify for Benefits (GAO/HEHS-96-79, Apr. 30, 1996).
SSA Disability: Program Redesign Necessary to Encourage Return to
Work (GAO/HEHS-96-62, Apr. 24, 1996).
PASS Program: SSA Work Incentives for Disabled Beneficiaries Poorly
Managed (GAO/HEHS-96-51, Feb. 28, 1996).
SSA's Rehabilitation Programs (GAO/HEHS-95-253R, Sept. 7, 1995).
Supplemental Security Income: Disability Program Vulnerable to
Applicant Fraud When Middlemen Are Used (GAO/HEHS-95-116, Aug. 31,
1995).
Social Security Disability: Management Action and Program Redesign
Needed to Address Long-Standing Problems (GAO/T-HEHS-95-233, Aug. 3,
1995).
Supplemental Security Income: Growth and Changes in Recipient
Population Call for Reexamining Program (GAO/HEHS-95-137, July 7,
1995).
Disability Insurance: Broader Management Focus Needed to Better
Control Caseload (GAO/T-HEHS-95-164, May 23, 1995).
Supplemental Security Income: Recipient Population Has Changed as
Caseloads Have Burgeoned (GAO/T-HEHS-95-120, Mar. 27, 1995).
Social Security: Federal Disability Programs Face Major Issues
(GAO/T-HEHS-95-97, Mar. 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).
Social Security: New Continuing Disability Review Process Could Be
Enhanced (GAO/HEHS-94-118, June 27, 1994).
Disability Benefits for Addicts (GAO/HEHS-94-178R, June 8, 1994).
*** End of document. ***