Summary

During the past decade, the number of persons receiving benefits from Social Security's Disability and Supplemental Security income programs increased 70 percent because of program changes and economic and demographic factors. These programs, which provide assistance to persons with disabilities until they return to work, if that is possible, provided $53 billion in cash benefits to 7.2 million people in 1994. Advances in technology, such as standing wheelchairs and synthetic voice systems, and the medical management of some physical and mental disabilities have allowed some persons to work. Moreover, there has been a greater trend toward inclusion of and participation by people with disabilities in the mainstream of society. Yet both programs have done little to identify recipients who might benefit from rehabilitation and employment assistance and ultimately return to work.

GAO found that: (1) between 1985 and 1994, the combined DI and SSI beneficiary population increased 70 percent and the inflation-adjusted cost of cash benefits grew 66 percent; (2) increases were due to eligibility expansion, program outreach, fewer continuing disability reviews, economic factors, and demographic changes; (3) the beneficiary population is also growing younger and more beneficiaries have longer-term impairments; (4) the development of effective return-to-work strategies for people with severe disabilities is challenging because individuals may require various and changing levels of medical intervention or support, remedial retraining, education, or job coaching; (5) technological and medical advances and economic and social changes have created more potential for some individuals with disabilities to engage in work; (6) the SSI and DI benefit structure, their focus on inabilities rather than abilities, and poor access to rehabilitation services further complicate the difficult process of making disability and work capability determinations; and (7) although the programs offer such work incentives as trial work periods, extended eligibility, earned income exclusion, work expense subsidies, continued health insurance coverage, and reentitlement, they are not appropriately designed or implemented to motivate beneficiaries to return to work.