Social Security Disability: Alternatives Would Boost Cost-Effectiveness
of Continuing Disability Reviews (Letter Report, 10/16/96,
GAO/HEHS-97-2).

Pursuant to a congressional request, GAO reviewed the Disability
Insurance (DI) and Supplemental Security Income (SSI) programs, focusing
on: (1) the backlog of DI and SSI cases due for continuing disability
reviews (CDR); (2) the number and characteristics of individuals who are
due for CDR; (3) whether adequate resources are available for conducting
CDR; and (4) ways to improve the CDR process.

GAO found that: (1) almost half of all DI and SSI beneficiaries are due
or overdue for CDR in fiscal year 1996; (2) the typical beneficiary
awaiting CDR is under age 59, has been receiving benefits for an average
of 8 years, is unlikely to medically improve, and has been overdue for
CDR for 3 years; (3) SSA uses either a full medical examination or a
mail-in form to conduct CDR, depending on the likelihood that it will
find reason to terminate a recipient's benefits; (4) it is too soon to
tell if authorized funding will be adequate to conduct all required CDR
through 2002; (5) the SSA plan to conduct over 8 million CDR over 7
years is ambitious; and (6) SSA could improve the CDR process by
reviewing beneficiaries most likely to medically improve, conducting CDR
on a random sample from all other beneficiaries, and using CDR contact
to determine beneficiaries' rehabilitation needs.

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

 REPORTNUM:  HEHS-97-2
     TITLE:  Social Security Disability: Alternatives Would Boost 
             Cost-Effectiveness of Continuing Disability Reviews
      DATE:  10/16/96
   SUBJECT:  Persons with disabilities
             Disability benefits
             Social security benefits
             Aid for the disabled
             Medical examinations
             Federal social security programs
             Vocational rehabilitation
             Eligibility determinations
             Evaluation methods
IDENTIFIER:  Supplemental Security Income Program
             SSA Master Beneficiary Record
             Social Security Disability Insurance Program
             
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Cover
================================================================ COVER


Report to the Chairman, Subcommittee on Social Security, Committee on
Ways and Means, House of Representatives

October 1996

SOCIAL SECURITY DISABILITY -
ALTERNATIVES WOULD BOOST
COST-EFFECTIVENESS OF CONTINUING
DISABILITY REVIEWS

GAO/HEHS-97-2

Continuing Disability Reviews

(106808)


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-270339

October 16, 1996

The Honorable Jim Bunning
Chairman, Subcommittee on Social Security
Committee on Ways and Means
House of Representatives

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

You asked us to provide information about the backlog of cases due
for CDRs under the DI program.  We were also asked by the Chairman,
Senate Special Committee on Aging, to provide information on the CDR
process and how to improve it.  As agreed with your office, we are
providing the same information to you and the Chairman, Senate
Special Committee on Aging, 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 our forthcoming report on SSA's review of SSI
recipients' disability status, we will 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:  Improvements Needed to Continuing
Disability Review Process (GAO/HEHS-97-1, 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. ***