Supplemental Security Income

SSA Needs a Uniform Standard for Assessing Childhood Disability Gao ID: HEHS-98-123 May 6, 1998

In 1997, almost 900,000 children received about $5 billion in Supplemental Security Income (SSI) benefits for disabilities. Welfare reform has made eligibility for childhood SSI benefits more restrictive; generally, regulations now require that a child's impairment must result in marked limitations in two areas of functioning or an extreme limitation in one area. Since these changes, GAO has monitored the Social Security Administration's (SSA) adjudication of cases for 288,000 children whose eligibility was subject to review against the new standard, as well as 370,000 new applicants. SSA has made considerable progress in implementing the welfare reform changes, taking important steps to safeguard fairness by identifying children whose benefits may have been terminated inappropriately and establishing remedial action to rereview their cases. But SSA also needs to update its medical listings to ensure that all children are assessed against a uniform severity standard.

GAO noted that: (1) SSA has made considerable progress in implementing the welfare reform changes in eligibility for Supplemental Security Income (SSI) children; (2) it has taken important steps to safeguard fairness by identifying children whose benefits may have been terminated inappropriately and establishing remedial action to rereview their cases; (3) however, because SSA's medical listings reflect multiple levels of severity, SSA also needs to expedite updating and modifying its medical listings to ensure that all children are assessed against a uniform severity standard; (4) the need to revise the listings is a long-standing problem that GAO reported 3 years ago; (5) moreover, SSA needs to take concerted action to follow through on its plan for monitoring and continually improving the quality of decisions regarding children; and (6) consistent with its legislative mandate, GAO will continue to focus its work on SSA's efforts to provide reasonable assurance that it can administer the program consistently and improve the accuracy of childhood disability decisions.

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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