Supplemental Security Income

Although benefits paid to elderly persons receiving supplemental security income must be reduced when they enter nursing homes covered by Medicaid, the Social Security Administration (SSA) is not always notified of the change and full benefits continue to be paid. Such overpayments, totaling an estimated $100 million annually, could be reduced by electronically obtaining nursing home admissions data. SSA could then use an automated interface to automatically adjust the benefits of supplemental security income recipients admitted to nursing homes.

GAO noted that: (1) SSA estimates that overpayments to individuals in nursing homes may exceed $100 million annually; however, the exact extent is unknown; (2) despite SSA procedures to prevent overpayments, and recent legislation designed to further help prevent these overpayments to SSI recipients in nursing homes, GAO determined, based on SSA data, that it had detected overpayments totaling $24 million to about 31,000 recipients in fiscal year 1995; (3) in two states GAO visited, New York and Texas, GAO determined that SSA may not have been aware of an additional 1,699 SSI recipients recently admitted to nursing homes during a 1-month period and potentially overpaid these individuals $515,714 in benefits during the subsequent month alone; (4) SSA efforts to prevent these overpayments or detect them in a timely manner have had little success; (5) in many cases, recipients or their representative payees did not report the change in living arrangements in a timely manner; (6) in addition, because of other work priorities, SSA field representatives have not routinely contacted the over 23,000 U.S. nursing homes to solicit their cooperation in notifying SSA of admissions of SSI recipients, as SSA policies require; (7) furthermore, GAO's analysis of SSA data shows that overpayments to SSI recipients residing in nursing homes have increased by nearly 13 percent since the October 1995 effective date of the legislation that was designed to reduce overpayments; (8) SSA could more quickly detect overpayments by electronically obtaining nursing home admissions data directly from states to help identify recent changes in recipients' living arrangements; (9) SSA could then use an automated interface to automatically adjust the benefits of SSI recipients admitted to nursing homes who are ineligible for continuation of benefits due to temporary institutionalization and prevent the occurrence of overpayments for the ensuing months; (10) in the states GAO visited, GAO found that the state Medicaid agencies can make these data available to SSA; (11) SSA could use an existing data exchange system with states to obtain the needed data electronically; (12) in the interim period, while some states prepare their automated systems to make the electronic exchange of data with SSA, states could provide SSA with tapes or paper listings of this information for SSA's use in detecting overpayments; and (13) to identify the program improvements such an automated interface could produce, GAO conducted a joint effort with SSA and Tennessee that identified over $31,000 in overpayments.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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