Academic journal article Social Security Bulletin

Subsequent Program Participation of Former Social Security Disability Insurance Beneficiaries and Supppplemental Security Income Recipients Whose Eligibility Ceased Because of Medical Improvement

Academic journal article Social Security Bulletin

Subsequent Program Participation of Former Social Security Disability Insurance Beneficiaries and Supppplemental Security Income Recipients Whose Eligibility Ceased Because of Medical Improvement

Article excerpt

The Social Security Administration (SSA) periodically reviews the disabilities of Supplemental Security Income (SSI) recipients and Social Security Disability Insurance (DI) beneficiaries to determine if their impairments still meet the requirements for program eligibility. For individuals whose eligibility was ceased after a full medical review from 2003 to 2008, we track subsequent program participation for up to 8 years. We use survival analyses to estimate the time until first return to SSI and DI and explore the differences in returns by various personal and programmatic characteristics such as age, disability type, time on program, and SSA expectations regarding medical improvement. Overall, we estimate that about 30 percent of SSI-only recipients whose eligibility ceases because of medical improvement return to the SSI program within 8 years. For DI-only worker beneficiaries whose eligibility ceases, we estimate that 20 percent will return to the DI program within 8 years.

Selected Abbreviations

CDR continuing disability review

CIF cumulative incidence function

DDS Disability Determination Service

DI Disability Insurance

FMR full medical review

SGA substantial gainful activity

SSA Social Security Administration

SSI Supplemental Security Income

(ProQuest: ... denotes formulae omitted.)

Introduction

Each year, the Social Security Administration (SSA) reviews the status of several hundred thousand Social Security Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) recipients to determine if their medical conditions have improved enough since their last favorable determination of eligibility to allow them to engage in substantial gainful activity (SGA). To be eligible for the SSI disability program, an individual must have limited income and resources and be unable to engage in SGA because of a medically determinable physical or mental impairment that can be expected to result in death or last for at least 12 continuous months.1 To qualify for DI, an individual must have a work history sufficient to attain insured status in addition to meeting the medical requirement.2 At the time of award, or the last favorable review of eligibility, a date is set to revisit the individual's medical eligibility for continued participation. Because reviewing each case helps ensure that only eligible individuals receive payments, it is necessary for maintaining program integrity.

These periodic reviews, required by law, are called continuing disability reviews (CDRs). In order to keep the workload manageable and to limit administrative costs, SSA initiates the CDR process by using statistical models to identify individuals with characteristics indicating potential medical improvement. Based on those model results, SSA conducts a full medical review (FMR) only for cases deemed most likely to involve medical improvement. To individuals with a lower likelihood of medical improvement, SSA sends a "mailer" asking for more information to help determine if a FMR is necessary.

During a FMR, SSA and the state Disability Determination Service (DDS) collect medical information about the participant and determine whether evidence of medical improvement exists. If the individual's condition has improved since the most recent favorable decision such that he or she is able to engage in SGA, program eligibility ceases; if not, the individual continues to receive DI benefits or SSI payments and a date is set for a future review.3 CDRs are estimated to be highly cost effective, saving approximately $9.30 for every dollar spent on them (SSA 2012b).4 For that reason, the 2011 deficit-reduction plan exempted CDR allocations from congressional spending caps, and the Obama administration requested an increase in CDR funding in the 2012 budget.5

The focus on program integrity comes at a time of substantial increases in SSI and DI participation. From 1990 through 2011, the numbers of DI beneficiaries grew from about 3. …

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