Supplemental Security Income: Noncitizen Caseload Continues to Grow
(Testimony, 05/23/96, GAO/T-HEHS-96-149).

GAO discussed the rapid increase in the number of noncitizens receiving
Supplemental Security Income (SSI) benefits. GAO noted that: (1) between
1986 and 1994, the percentage of noncitizen SSI recipients grew from 6
percent to 12 percent; (2) program outreach and eligibility expansion,
limited eligibility review, and limited employment assistance for the
disabled have contributed to the growth of noncitizen and citizen SSI
recipients; (3) immigration provisions that do not require refugees or
asylees to be sponsored or supported by a U.S. resident have also
contributed to the growth of noncitizen SSI recipients; (4) almost 70
percent of noncitizen SSI recipients are at least 65 years old; (5)
disabled noncitizen SSI recipients are the fastest growing recipient
group, averaging 19 percent growth annually between 1986 and 1993; (6)
although an exact number is not known, some non-English-speaking
noncitizen SSI recipients have obtained SSI benefits illegally with the
help of translators; and (7) translator fraud may have contributed to
the growth in the number of disabled noncitizen recipients.

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

 REPORTNUM:  T-HEHS-96-149
     TITLE:  Supplemental Security Income: Noncitizen Caseload Continues 
             to Grow
      DATE:  05/23/96
   SUBJECT:  Income maintenance programs
             Disability benefits
             Elderly persons
             Social security benefits
             Immigrants
             Refugees
             Fraud
             Handicapped persons
IDENTIFIER:  Supplemental Security Income Program
             California
             New York
             Florida
             Old Age Survivors and Disability Insurance Program
             Mexico
             Soviet Union
             Cuba
             Vietnam
             Philippines
             China
             Medicaid Program
             OASDI
             
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Cover
================================================================ COVER


Before the Subcommittee on Human Resources, Committee on Ways and
Means, House of Representatives

For Release on Delivery
Expected at
10:00 a.m.
Thursday,
May 23, 1996

SUPPLEMENTAL
SECURITY INCOME - NONCITIZEN
CASELOAD CONTINUES TO GROW

Statement of Jane L.  Ross, Director
Income Security Issues
Health, Education, and Human Services Division

GAO/T-HEHS-96-149

GAO/HEHS-96-149T


(106810)


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

  SSI - Supplmental Security Income
  SSA - Social Security Administration
  PRUCOL - permanently residing under color of law
  IRCA - Immigration Reform and Control Act of 1986

SUPPLEMENTAL SECURITY INCOME: 
NONCITIZEN CASELOAD CONTINUES TO
GROW
============================================================ Chapter 0

Mr.  Chairman and Members of the Subcommittee: 

Thank you for inviting me to speak about the rapid growth in the
number of noncitizens receiving Supplemental Security Income (SSI)
benefits.  As you are aware, the SSI program provides means-tested
income support payments to eligible aged, blind, or disabled persons. 
In 1995, over 6.5 million SSI recipients received nearly $25 billion
in federal benefits and over $3 billion in state benefits. 

Noncitizens, who include legal immigrants and refugees, accounted for
nearly 25 percent of SSI's caseload growth from 1986 through 1993. 
In December 1995, almost 800,000 noncitizens were receiving SSI
benefits, accounting for about 12 percent of all SSI recipients.  In
1995, federal and state SSI benefits to noncitizens totaled nearly $4
billion. 

Today, I would like to focus on three issues:  the overall growth in
noncitizen SSI caseloads and some of the reasons for it; aged
noncitizen recipients and how financial support from their families
affects their SSI benefits; and disabled noncitizens and the
potential for translator fraud, and actions the Social Security
Administration (SSA) can take to reduce such fraud.  My remarks are
based on two reports we issued last year relating to immigrants and
SSI,\1 and on updated SSA data. 

In summary, we found that noncitizens are one of the fastest growing
groups of SSI recipients.  They represent nearly 33 percent of aged
SSI recipients and about 6 percent of disabled recipients.  While the
growth rate for noncitizen caseloads has slowed somewhat, it is still
higher than that for citizens, and the proportion of noncitizens
relative to other SSI recipients continues to grow.  About two-thirds
of noncitizen SSI recipients, roughly 520,000, live in three
states--California, New York, and Florida.  On the whole, noncitizens
are somewhat more likely to receive SSI than are citizens, but this
may be primarily true for refugees and asylees.  Moreover, the 1980s
saw significant growth in immigration.  Adult children of aged
immigrants and others who say they are willing to financially support
them sometimes do not.  Eventually, some of these aged immigrants
receive SSI.  Also, some translators have assisted noncitizens in
fraudulently obtaining SSI disability benefits. 


--------------------
\1 Supplemental Security Income:  Growth and Changes in Recipient
Population Call for Reexamining Program (GAO/HEHS-95-137, July 7,
1995) and Supplemental Security Income:  Disability Program
Vulnerable to Applicant Fraud When Middlemen Are Used
(GAO/HEHS-95-116, Aug.  31, 1995). 


   BACKGROUND
---------------------------------------------------------- Chapter 0:1

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

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

To be eligible for SSI, individuals must be 65 years old, blind, or
disabled.  To be considered disabled, adults must be unable to engage
in any substantial gainful activity because of a physical or mental
impairment expected to result in death or last at least 12 months. 
Individuals cannot have income greater than the maximum benefit
level, which is about $5,600 per year in 1996, or own resources worth
more than $2,000, subject to certain exclusions, such as a home. 
Individuals must also be U.S.  citizens or immigrants lawfully
admitted for permanent residence or noncitizens "permanently residing
under color of law" (PRUCOL).\2

In 1996, the maximum federal SSI benefit is $470 per month for an
individual and $705 for a couple with both spouses eligible; these
benefit rates are adjusted annually for cost-of-living increases. 
This monthly benefit is reduced on the basis of various factors: 
recipients' incomes; living arrangements, such as living with family;
and other sources of support, including Social Security benefits.  As
a result of these adjustments, the average monthly federal benefit in
1995 was $334. 

In addition to federal SSI benefits, states may provide supplemental
benefits.  In December 1995, nearly 40 percent of SSI recipients
received an average of about $105 per month in state supplemental
benefits at a total cost to the states of about $3.2 billion a year. 

Most SSI recipients are generally eligible for Medicaid and food
stamps, which can cost the government more than SSI benefits
themselves.  For 1994, annual Medicaid benefits averaged about $2,800
for the aged SSI recipients who received them and about $5,300 for
blind and disabled SSI recipients, excluding long-term care costs. 
Including long-term care, Medicaid benefits averaged about $8,300 for
the aged and $7,700 for the disabled.  In September 1994, a
one-person household eligible for both food stamps and SSI, with no
other income, could receive nearly $1,000 per year in food stamp
benefits, depending on the state. 


--------------------
\2 PRUCOL is not an immigration status, such as immigrant or refugee. 
Rather, it is an eligibility status defined in the enabling
legislation for major federal assistance programs, including SSI. 
PRUCOL is more frequently a transitional status for noncitizens who
are becoming permanent residents than for those whose deportation has
been delayed, though it can be either.  Initially, PRUCOL was
interpreted to include primarily refugees and asylees.  Court
decisions have broadened it to include other categories of
noncitizens.  Nearly 75 percent of SSI recipients in the PRUCOL
category are refugees or asylees. 


      SSI PROVISIONS FOR
      NONCITIZENS AND RELATED
      IMMIGRATION POLICY
-------------------------------------------------------- Chapter 0:1.1

Immigrants are those with "lawful permanent resident" status.  They
include those who came here after obtaining an immigrant visa in
their country of origin.  They also include noncitizens already
living here who have changed to this status.  Since SSA data do not
usually reflect changes in immigration status, we describe the status
SSI recipients had when they applied for benefits. 

In addition to immigrants, noncitizens on SSI include refugees and
asylees as well as undocumented aliens legalized by the Immigration
Reform and Control Act of 1986 (IRCA).  Refugees and asylees are
noncitizens who are unable or unwilling to return to their countries
of nationality because of persecution or a well-founded fear of
persecution.  Refugees apply for their status from outside the United
States, while asylees apply from within.  Both are eligible for
permanent resident status after 1 year of continuous presence in the
United States. 

Some legal immigrants are admitted to the country under the financial
sponsorship of a U.S.  resident.  The Immigration and Nationality Act
of 1952, as amended, provides for denying permanent resident status
to noncitizens who are likely to become public charges.  Noncitizens
can demonstrate they will be self-sufficient in several ways,
including having a financial sponsor.  Sponsors sign an affidavit of
support assuring the U.S.  government that the immigrant will not
become a public charge and in which they state they are willing and
able to provide financial assistance to the immigrant for 3 years. 
However, several courts have ruled that these affidavits of support
are not legally binding.  Refugees and asylees do not need to
demonstrate they will be self-sufficient to reside in the United
States. 

SSI's "deeming" provisions, which apply only to immigrants with
financial sponsors, attempt to reinforce immigration policy.  In
determining financial eligibility and benefit levels, SSA deems a
portion of a sponsor's income and resources to be available to the
immigrant.  This provision applies regardless of whether a sponsor is
actually providing financial support.  This provision currently
applies for 5 years from the immigrant's entry into the United
States.\3

On May 2, 1996, the Senate passed an amended version of the
Immigration Control and Financial Responsibility Act of 1996 (H.R. 
2202), which the House of Representatives passed on March 21.  The
bill is still pending conference committee action.  Both the House
and Senate versions of the bill contain provisions to make the
affidavits of support legally enforceable.  They also contain
provisions extending the deeming period.  In addition, the bill makes
some changes to eligibility requirements for noncitizens.  It also
provides that any noncitizen who receives more than 12 months' worth
of federal, state, or local needs-based benefits within 5 years of
becoming a lawful permanent resident (with several exceptions) would
be considered deportable as a "public charge."


--------------------
\3 The Congress temporarily extended SSI's deeming period from 3 to 5
years from January 1994 through September 1996.  However, in the
affidavits of support, sponsors only say they are willing to provide
support for 3 years. 


   OVERVIEW OF NONCITIZEN SSI
   RECIPIENTS
---------------------------------------------------------- Chapter 0:2

From 1986 through 1994, the number of aged or disabled noncitizen SSI
recipients grew an average of 15 percent annually.  In 1986,
noncitizens constituted about 6 percent of all SSI recipients; by
1994, their proportion had grown to nearly 12 percent.  This year,
800,000 noncitizens will receive $3.6 billion in federal SSI
benefits; SSA projects that nearly 1 million noncitizens will receive
almost $5 billion in the year 2000.  From a peak growth rate of 19
percent in 1991, growth in noncitizen cases has slowed substantially,
with a rate of just 6.4 percent last year.  However, this remains
higher than the growth in all SSI cases, which was 3.5 percent last
year.  SSA projects that growth rates will remain in this lower range
at least through the year 2000.  Figure 1 gives past and projected
numbers of noncitizens on SSI. 

   Figure 1:  SSI Noncitizen
   Caseload Growth

   (See figure in printed
   edition.)

Source:  SSA. 

Refugee and asylee cases are growing somewhat faster than immigrant
cases, averaging 18 percent growth annually from 1986 through 1993
compared with 15 percent.  Refugees and asylees constitute a larger
share of SSI's disabled noncitizen population than SSI's aged
population, 23 percent compared with 16 percent. 


      FACTORS CONTRIBUTING TO
      CASELOAD GROWTH
-------------------------------------------------------- Chapter 0:2.1

The number of all SSI recipients has grown dramatically since the
mid-1980s, and some of the factors contributing to this growth apply
to noncitizens and citizens alike.  Such factors include program
outreach, and, in the case of the disabled, eligibility expansion and
limited efforts to review recipients' disability status or help them
return to work.  Still, the number of noncitizens is growing faster
than that of citizens.  From 1986 through 1993, the number of all SSI
recipients grew at an average annual rate of 5 percent, compared with
the 15 percent rate for noncitizens.  In particular, growth among
those aged 65 or over differs dramatically between citizens and
noncitizens.  While the number of aged noncitizens on SSI has grown
dramatically, the number of aged citizens has actually declined. 

Increased immigration has probably contributed to the growth in
noncitizen SSI caseloads.  The number of immigrants rose steadily in
the 1980s, from about 500,000 per year early in the decade to 1.5
million in 1990, then fell to 900,000 in 1993.  Altogether, the
number of immigrants totaled more than 7.3 million in the 1980s. 
Roughly half of these immigrants did not need to demonstrate that
they would be self-sufficient. 

Noncitizens are more likely to receive SSI than citizens:  roughly 3
percent of noncitizens receive SSI compared with 1.8 percent of
citizens.  One reason that may partially explain this is that
noncitizens typically have more limited U.S.  work histories than
life-long residents do and therefore qualify for smaller Social
Security benefits.  This, in turn, may make noncitizens more likely
to qualify for SSI. 

Still, the likelihood of receiving SSI probably varies for different
types of noncitizens.  Refugees and asylees may be more likely than
citizens to receive benefits.  They are not subject to sponsorship
and deeming provisions and may qualify for benefits immediately after
arriving here.  Immigrants admitted through normal procedures may be
no more likely or even less likely than citizens to be on SSI; data
limitations make it difficult to say.\4

About 46 percent of noncitizen recipients applied for SSI within 4
years of entering the United States.  Roughly 5 percent of immigrants
receiving SSI applied within a year of entry compared with 52 percent
of the remaining noncitizens receiving SSI, such as refugees. 


--------------------
\4 Data limitations that prevent drawing firmer conclusions include
the following:  (1) the general population data we examined estimated
the noncitizens' status on the basis of country of origin rather than
on their actual status and (2) SSI data about noncitizens reflect
their status when they applied for benefits, not when they entered
the United States.  See Michael Fix and Jeffrey S.  Passel,
Immigration and Immigrants:  Setting the Record Straight (Washington,
D.C.:  The Urban Institute, 1994), pp.  19-22, 34, and 63-67. 


      NONCITIZEN BENEFICIARY
      PROFILE
-------------------------------------------------------- Chapter 0:2.2

Fifty-one percent of noncitizens on SSI come from six
countries--Mexico, the former Soviet Union, Cuba, Vietnam, the
Philippines, and China.  However, rates of growth vary substantially
by country of origin.  For example, among these six countries, annual
caseload growth from 1986 through 1993 ranged from an average of 11
percent for Cuba to 33 percent for the former Soviet Union. 

About 20 percent of noncitizens on SSI also qualify for Social
Security benefits, compared with 40 percent of all SSI recipients. 
When looking at aged SSI recipients alone, the contrast is even
greater.  About 22 percent of aged noncitizens on SSI qualify for
Social Security compared with over 60 percent of all aged recipients. 
Those noncitizens who do qualify for Social Security tend to get
smaller Social Security benefits and larger SSI benefits compared
with other SSI recipients. 

About two-thirds of noncitizen SSI recipients live in three
states--California, New York, and Florida.  Average annual growth
rates from 1986 through 1993 for the noncitizen caseload varied from
7 percent in Maine to 27 percent in New Mexico. 


   AGED RECIPIENTS AND AFFIDAVITS
   OF SUPPORT
---------------------------------------------------------- Chapter 0:3

Nearly 70 percent of noncitizens on SSI are at least 65 years old. 
Without the growth in noncitizen cases, SSI's aged population would
have decreased 10 percent from 1986 through 1993; instead, it
remained relatively level.  The aged noncitizen caseload grew an
average of 14 percent annually during this period, increasing from 9
percent of aged cases to 23 percent.  In December 1995, noncitizens
were nearly one-third of aged cases.  In 1993, the average federal
SSI monthly benefit was $304 for aged noncitizens compared with $188
for all aged recipients. 

Nearly 60 percent of aged noncitizen SSI recipients have been in the
country fewer than 5 years.  This raises questions about whether
immigration policies have been effective in ensuring that immigrants
will be self-sufficient.  SSI's deeming provisions apply only to
immigrants with financial sponsors.  About 25 percent of immigrants
receiving SSI applied for benefits within a year after the deeming
period expired.  Furthermore, even some affluent sponsors refuse to
support the immigrants they sponsor, especially after the affidavits
of support expire, but we do not know how many. 

In considering changes to financial sponsorship or SSI deeming
policies, it is worth noting that immigrants may respond by changing
their behavior.  For example, restricting benefit eligibility may
prompt more immigrants to become citizens to retain their
eligibility.  Also, immigrants who lose eligibility for federal
welfare programs may turn to state-funded public assistance programs,
thus shifting costs to the states.  For example, the Orange County,
California, Social Services Agency reported a significant cost shift
to its General Relief program as a result of the extension in the SSI
deeming period from 3 to 5 years. 


   DISABLED RECIPIENTS AND
   TRANSLATOR FRAUD
---------------------------------------------------------- Chapter 0:4

While disabled recipients constitute a smaller share of noncitizen
cases than aged recipients, their number is growing faster, averaging
19 percent growth annually from 1986 through 1993.  Noncitizens
increased from 3 percent of disabled cases to 5.5 percent during this
period.  Perhaps the most significant factor contributing to caseload
growth for disabled citizens and noncitizens alike was changes in the
criteria for qualifying as disabled.  New and broader standards for
mental impairments were implemented in the late 1980s.  Since then,
disabled cases with psychiatric diagnoses have accounted for a large
share of the caseload growth.  These changes to the mental impairment
standards may have also contributed to growth in noncitizen caseloads
involving mentally disabled adults; the proportion of cases with a
psychiatric diagnosis is similar for both citizens and noncitizens. 


      TRANSLATOR FRAUD MAY ADD TO
      DISABLED NONCITIZEN CASELOAD
-------------------------------------------------------- Chapter 0:4.1

Translator fraud may contribute to disabled caseload growth and
occurs primarily in noncitizen cases.  Some ineligible
non-English-speaking applicants have obtained SSI benefits illegally
with the help of translators.  The actual number of people who have
done so is unknown.  A translator, also sometimes referred to as a
"middleman," is a person or organization that provides translation
and/or other services for a fee to help individuals apply for SSI. 

For example, a Washington State translator arrested for fraud had
helped at least 240 immigrants obtain $7 million in SSI benefits by
coaching them on which medical symptoms to claim and by providing
false information on their medical conditions and family histories. 
In California, at least 6,000 potentially fraudulent applications
have been identified since July 1992.  Of these 6,000 applications,
about 30 percent represented SSI claims that were being paid.\5
Mistakes in accurately determining disability are costly.  Given that
the average time on disability is 11 years before recipients reach
age 65, we estimated that a single ineligible SSI recipient can
receive a total of about $113,000 from SSI, Medicaid, and the Food
Stamp program.\6

A combination of factors has contributed to SSI's vulnerability to
fraud involving translators.  First, SSA's management practices and
shortage of bilingual staff have allowed applicants to use
translators that they select.  For example, applicants have been able
to apply for benefits at the field office of their choice--SSA has
not restricted applicants to offices in which SSA has staff who speak
their language.  In addition, applicants' medical histories often
have lacked documentation.  And finally, SSA has had limited
monitoring of translators, limited funds for investigations, and a
lack of coordination with state Medicaid agencies. 

The Congress, SSA, and several states have begun efforts to prevent
or detect fraudulent SSI claims involving translators.  Federal
legislation has made SSI fraud a felony and has given SSA access to
information from the Immigration and Naturalization Service and the
Centers for Disease Control and Prevention.  SSA established a task
force in April 1993 on translators that has suggested initiatives
such as developing and managing a translator database.  Also as a
result of this task force, SSA's San Francisco regional office is
periodically reviewing the disability status of possibly fraudulent
cases involving translators. 

In addition to these efforts, we have recommended that SSA implement
a more comprehensive, programwide strategy for keeping ineligible
applicants from ever being accepted on the SSI rolls.\7

SSA could require that its own bilingual staff or contractors conduct
interviews with non-English-speaking applicants and explore the use
of videoconferencing technology to maximize the use of SSA bilingual
staff.  SSA should also share among its field offices information it
has already gathered about translators until its planned database is
established.  Furthermore, SSA should institute a mechanism to obtain
regular access to investigative results from states with Medicaid
fraud control units to help identify fraudulent claims associated
with illegal translator activity. 


--------------------
\5 About 1,800 of the 6,000 applications represented cases that could
have been subject to periodic reviews of a recipient's disability
status.  SSA had completed about 400 of these reviews as of June
1995. 

\6 The actual total amount of $112,805 represents $50,688 from SSI,
$55,396 from Medicaid, and $6,721 from food stamps.  Some applicants
ineligible for SSI could still be eligible for Medicaid, food stamps,
or both. 

\7 GAO/HEHS-95-116, Aug.  31, 1995. 


   OBSERVATIONS
---------------------------------------------------------- Chapter 0:5

Noncitizens are one of the fastest growing groups of SSI recipients;
their number grew an average of 15 percent annually from 1986 through
1993.  To some extent, this parallels the rapid growth in immigration
in the 1980s as well as in SSI caseloads overall.  Caseload growth
for noncitizens has slowed substantially to just over 6 percent last
year, and SSA projects that growth rates will remain in this more
moderate range.  Still, according to SSA, noncitizen SSI recipients
are projected to number nearly 1 million and receive nearly $5
billion in federal benefit payments in the year 2000 compared with
about 800,000 and $3.6 billion this year. 

As a percentage of aged SSI recipients, noncitizens increased from 9
percent to nearly 33 percent from 1986 through 1995.  Adult children
of some aged immigrants say they are willing to financially support
their relatives but sometimes do not.  Eventually, some of these aged
immigrants receive SSI.  About 25 percent of immigrants receiving SSI
applied for benefits within a year of the deeming period's
expiration. 

Regarding translator fraud, our work suggests that it occurs
primarily in noncitizen cases.  Although we do not know how often
such fraud occurs, we believe it can be reduced with a more
comprehensive, programwide strategy for keeping ineligible applicants
from ever receiving benefits. 


-------------------------------------------------------- Chapter 0:5.1

This concludes my testimony.  I would be happy to answer any
questions. 


   CONTRIBUTORS
---------------------------------------------------------- Chapter 0:6

For more information on this testimony, please call Jane Ross,
Director, at (202) 512-7215.  Other major contributors include
Assistant Directors Chris Crissman and Cindy Fagnoni and Evaluators
Ken Stockbridge and Ann Lee. 


*** End of document. ***