Supplemental Security Income

The Social Security Administration (SSA) has made significant progress in implementing welfare reform's requirements for assessing children's continuing eligibility for benefits. It has finished almost all of the one-time redeterminations required for children who had been receiving benefits when welfare reform was enacted, and it has done continuing disability reviews when required on low-birth-weight babies and 18-year-olds. It also has a plan to ensure that all required continuing disability reviews for children under 18 whose conditions are likely to improve will be completely underway by 2000. However, 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, and it has made little progress in updating its medical listings for childhood impairments. Although it has taken steps to accomplish the update, such as recruiting staff, it has not set a timetable to accomplish the update. Until SSA completes this initiative, its medical listings for childhood impairments will continue to reflect multiple levels of severity. Because the listings are the only basis on which children qualify for benefits, the lack of a uniform severity level in the listings raises equity concerns.

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.