Summary

The Social Security Administration (SSA) is required to conduct periodic examinations, called continuing disability reviews, to determine whether the health of a person receiving disability benefits has improved to the point where the person is no longer considered disabled. Together, the disability insurance and the supplemental security income programs pay about $60 billion annually to 9 million disabled beneficiaries; another 1.6 million nondisabled dependents of beneficiaries also receive benefits. GAO's analysis of persons awaiting such reviews supports SSA's contention that there is little chance that a large proportion of beneficiaries will show enough medical improvement to no longer be considered disabled. As a result, 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 rely less on assessing medical improvement and more on return-to-work programs to better gauge the potential for self-sufficiency. GAO believes that a more cost-effective approach to conducting reviews might involve (1) focusing on beneficiaries with the greatest likelihood of benefit termination because of medical improvement, (2) reviewing a random sample of all other beneficiaries to correct a weakness in SSA's process, and (3) contacting beneficiaries not selected for a review or a financial eligibility redetermination to strengthen program integrity.

GAO found that: (1) about 4.3 million DI and SSI beneficiaries are due or overdue for CDR in fiscal year 1996; (2) SSA selects beneficiaries for CDR on the basis of the likelihood that their benefits will be terminated; (3) SSA plans to improve its CDR selection process by obtaining Medicare and Medicaid data and mailing questionnaires to beneficiaries' physicians; (4) funding for CDR could exceed $4 billion by 2002; (5) SSA must incorporate additional CDR required by legislation into the agency's workload and conduct CDR for beneficiaries whose CDR were previously done at the agency's discretion; (6) SSA should conduct CDR on a random sample of beneficiaries normally excluded from the selection process to improve program integrity; (7) SSA proposal for time-limited benefits may increase the agency's workload when beneficiaries who are terminated from the program reapply for benefits; (8) the formula used by SSA to select beneficiaries for CDR excludes approximately half of those who are due or overdue for CDR; and (9) SSA could utilize CDR to strengthen its return-to-work initiatives.