Supplemental Security Income:

Progress Made in Implementing Welfare Reform Changes; More Action Needed

HEHS-99-103: Published: Jun 28, 1999. Publicly Released: Jun 28, 1999.

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Pursuant to a legislative requirement, GAO reviewed the impact of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 on the Supplemental Security Income (SSI) Program, focusing on the Social Security Administration's (SSA) progress in: (1) redetermining the eligibility of children already receiving benefits against the law's new eligibility criteria; (2) implementing the law's requirements for ongoing continuing disability reviews (CDR) and the related treatment provision; and (3) revising the interim final regulations to implement the law's eligibility criteria and the medical listings for childhood impairments, which are used to determine whether a child is disabled.

GAO noted that: (1) SSA has completed 98 percent of the one-time eligibility redeterminations required for 288,000 children already receiving benefits when welfare reform was enacted; (2) by November 1998, these redeterminations had found about 115,300 children to be ineligible for SSI; (3) however, the actual number of children who ultimately will lose benefits is not yet known, because about half of the 115,300 children found ineligible have appealed the results of their redeterminations; (4) SSA estimates that about 100,000 children will be found ineligible for SSI after all required redeterminations and appeals are completed; (5) in fiscal year (FY) 1997, SSA conducted CDRs, when required, on two of the three groups of children targeted by the new law: (a) low-birth-weight babies (7,100); and (b) 18-year-olds (48,800); (6) however, SSA did not conduct CDRs in 1997 for the largest of the three groups--all other children under 18 whose impairments are likely to improve; (7) existing backlogs and competing workloads have impeded SSA's ability to perform CDRs on this group; (8) when FY 1998 began, SSA had 371,000 CDRs to complete for these children; (9) SSA plans to ensure that all required childhood CDRs will be completed or underway by 2000; (10) the delay in conducting most CDRs also delayed application of the law's new requirement that the child's representative payee provide evidence, at the time of each CDR, that the child is and has been receiving medically necessary and available treatment for his or her impairment; (11) SSA has not yet decided whether any revisions are necessary to the interim final regulations that were issued to implement the law's new definition of disability for children; (12) SSA has taken initial steps to update its medical listing of impairments, which are used to determine whether a child qualifies for benefits; (13) however, it has not revised its medical listings to ensure that all children are assessed against a uniform severity standard; (14) while SSA says it has made updating the listings a priority and that it plans to eliminate inconsistencies among the listings as it proceeds, it has not set a timetable for achieving this; and (15) until SSA completes this initiative, its medical listings for childhood impairments will continue to reflect multiple levels of severity and therefore will not ensure equity among children receiving SSI disability benefits.

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