United States General Accounting Office

GAO Report to the Chairman, Committee on

Finance, U.S. Senate, and the Chairman,

Committee on Ways and Means, House

of Representatives

July 1995 SUPPLEMENTAL

SECURITY INCOME

Growth and Changes in

Recipient Population

Call for Reexamining

Program

GAO/HEHS-95-137

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-260598 

July 7, 1995

The Honorable Bob Packwood

Chairman, Committee on Finance

United States Senate

The Honorable Bill Archer

Chairman, Committee on Ways and Means

House of Representatives

The Supplemental Security Income (SSI) program is the largest cash

assistance program for the poor and one of the fastest growing entitlement

programs; program costs have grown 20 percent annually in the last 4

years. SSI provides means-tested income support payments to eligible aged,

blind, or disabled persons. Last year, over 6 million SSI recipients received

nearly $22 billion in federal benefits and over $3 billion in state benefits.

In the past year, the Congress has focused much attention on SSI’s growth.

Last year it enacted provisions limiting drug addicts’ benefits, and this year

it is considering further restrictions for these recipients as well as for

children and noncitizens. Since January, we have reported several times

on SSI and related issues.1

 We initiated this report to provide an overview

of the SSI program and its recent history. Specifically, the report examines

factors contributing to caseload growth and changes in the characteristics

of SSI recipients.

We developed the information for this report by reviewing the literature as

well as interviewing officials and analyzing data from the Social Security

Administration (SSA), which has overall responsibility for administering the

SSI program. To examine state caseloads and different recipient

populations, we analyzed 10-percent sample data files for each December

from 1986 to 1993, the only years these files were available. These files are

random samples of all cases in a given month on the Supplemental

Security Record (SSR), which is the master administrative database on SSI

recipients.

Results in Brief Since the mid-1980s, a variety of changes in the SSI program have made

benefits available to a broader population. Both congressional actions and

court decisions have allowed a wider range of impairments to qualify as

disabilities, notably for mentally impaired adults and for children. Also, the

1

See list of related GAO products inside the back cover.

Page 1 GAO/HEHS-95-137 SSI Caseload Growth
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Congress has mandated increased outreach and publicity efforts to help

overcome barriers to getting SSI. Meanwhile, some disabled recipients may

stay on SSI longer and receive larger benefits than they would otherwise

because the program has devoted little effort to checking that recipients

continue to be disabled and helping them return to work.

Since these program changes began, the SSI recipient population has

changed dramatically; disabled recipients now account for nearly

80 percent of federal SSI payments.2

 Before the mid-1980s, the number of

SSI recipients was relatively stable, and the number of aged recipients was

decreasing. Since then, the number of disabled SSI recipients has increased

an average of over 8 percent annually; the number of aged recipients has

remained almost level. (See fig. 1.)

2

Unless otherwise specified, we use the word “disabled” only for those recipients under age 65 and

“aged” for all recipients aged 65 and over. When disabled recipients turn 65, SSI program data typically

continue to count them among the disabled. Disabled recipients aged 65 and over accounted for

10 percent of all SSI recipients in 1993, and their number increased an average of 2.4 percent annually

from 1986 through 1993.

Page 2 GAO/HEHS-95-137 SSI Caseload Growth
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Figure 1: Number of SSI Recipients by

Eligibility Group 6


5


4


3


2


1


0

SSI Recipients (Millions)

Disabled


Blind


Aged

1974 1978 1982 1986

Year

1990 1994

Page 3 GAO/HEHS-95-137 SSI Caseload Growth
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Source: Annual Statistical Supplement to the Social Security Bulletin, 1976-1993, and SSA data.

Three groups have accounted for nearly 90 percent of SSI’s growth since

1991—adults with mental impairments, children, and noncitizens. SSI

recipients now tend to be younger, stay on SSI longer, receive larger

benefits, and depend more on SSI as a primary source of income.

These changes in the SSI program and its recipients call for reexamining

how best to serve this needy population while reassuring the public of the

program’s integrity. Moreover, medical, technological, and social changes

are challenging the historic presumption that the disabilities that SSI covers

are total and long term. Therefore, the program should emphasize helping

SSI recipients achieve their productive capacity and thereby help decrease

their dependence on SSI. As the administration and the Congress explore

how to help these recipients return to work, SSA can take steps now to

strengthen program integrity. For example, increasing the number of

reviews of recipients’ disability status beyond the minimal number

currently required would help ensure that those who are no longer

disabled do not receive benefits.

Background The Congress established SSI in 1972 to replace federal grants to similar

state-administered programs, which varied substantially in benefit levels

and eligibility requirements. The Congress intended SSI as a supplement to

the Social Security Old Age, Survivors, and Disability Insurance (OASDI)

program for those who had little or no Social Security coverage.

Federal SSI benefits are funded by general revenues and based on need,

unlike Social Security benefits, which are funded by payroll taxes and, in

effect, based on the contributions of individuals and their employers.

To be eligible for SSI, individuals must be either at least 65 years old, blind,

or disabled. Individuals cannot have income greater than the maximum

benefit level or own resources worth more than $2,000 ($3,000 for a

couple), subject to certain exclusions, such as a home. This financial

eligibility test also factors in the income and resources of spouses living in

the same household or parents, in the case of children. Individuals must

Page 4 GAO/HEHS-95-137 SSI Caseload Growth
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also be U.S. citizens or immigrants lawfully admitted for permanent

residence or aliens “permanently residing under color of law” (PRUCOL).3

To be considered disabled, adults must be unable to engage in any

substantial gainful activity4

 because of a physical or mental impairment

expected to result in death or last at least 12 months. For children, the

impairment must be “of comparable severity” to one that qualifies an adult

as disabled. SSI and the Social Security Disability Insurance (DI) program

use the same standards and procedures for determining disability. An

applicant whose disability claim has been rejected can appeal at four

levels. Exhausting all appeals can take more than 2 years. Applicants

whose appeals succeed are awarded SSI payments retroactive to the date

of their application.

In 1995, the maximum federal SSI monthly benefit is $458 per month for an

individual and $687 for a couple if both spouses are eligible; these benefit

rates are adjusted annually for cost-of-living increases. This monthly

benefit level is intended as a guaranteed minimum income and therefore is

reduced depending upon recipients’ incomes, living arrangements, and

other sources of support, including Social Security benefits and the

income of spouses living in the same household or parents, in the case of

children. Still, because SSI is an individual entitlement, no cap exists on the

benefits a household may receive. Because of the various benefit

adjustments, the average federal monthly benefit in 1993 was $324 for the

disabled and $195 for the aged.

Since SSI provides income support as a last resort, SSI recipients must file

for any other benefits for which they may be eligible, such as Social

Security or workers’ compensation. In 1993, 40 percent of SSI recipients

also received Social Security benefits, down from 49 percent in 1986.

Under DI, someone must be disabled continuously for 5 months before

benefits begin, which is not true under SSI. Therefore, many receive SSI

benefits only until they become eligible for DI, if their DI benefit is then

large enough to make them ineligible for SSI. About 75 percent of disabled

3

PRUCOL is not an immigration status, such as immigrant or refugee. Rather, it is an eligibility status

defined in the enabling legislation for major federal assistance programs, including SSI. PRUCOL is

more frequently a transitional status for aliens who are becoming permanent residents than for those

whose deportation has been delayed, though it can be either. Initially, PRUCOL was interpreted to

include primarily refugees and asylees. Court decisions have broadened it to include other categories

of aliens. Nearly 75 percent of SSI recipients in this PRUCOL category are refugees or asylees.

4

“Substantial gainful activity” is defined as earning more than $500 per month.

Page 5 GAO/HEHS-95-137 SSI Caseload Growth
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adult SSI recipients who also qualify for DI benefits stop getting SSI within 1

year, compared with about 29 percent of other disabled adults.5

In addition to federal SSI benefits, states may provide supplemental

benefits.6

 The District of Columbia and all but seven states provide these

supplements.7

 These supplements vary, reflecting differences in regional

living costs as well as in living arrangements. In December 1994, nearly

3 million SSI recipients, or roughly half, received an average of about $110

per month in state supplemental benefits at a total cost to the states of

about $3.5 billion.

Most SSI recipients are automatically eligible for Medicaid and Food

Stamps. In 1993, Medicaid benefits averaged about $2,600 for aged SSI

recipients who received Medicaid benefits and about $5,000 for blind and

disabled SSI recipients, excluding nursing home and institutional care.8

 In

September 1994, a one-person household eligible for both Food Stamps

and SSI, with no other income, could receive up to $83 per month, or nearly

$1,000 per year, in Food Stamp benefits, depending on the state.9

 (Income,

including SSI benefits, reduces Food Stamp benefits.) Thus, the cost of

Medicaid and Food Stamps for SSI recipients may exceed the cost of SSI

benefits, which averages more than $4,000 per year, though many SSI

recipients might qualify for these programs even if they were not on SSI.

Some families receiving Aid to Families With Dependent Children (AFDC)

have one or more family members who receive SSI, though no recipient

may receive both SSI and AFDC benefits. In determining a family’s AFDC

benefit, the program does not consider an SSI recipient part of the family.

In 1992, the average AFDC monthly payment per family was $374. By having

one child qualified as disabled under SSI, an AFDC family can increase its

income by as much as $458 per month, which would more than double the

average AFDC benefit.

5

Kalman Rupp and Charles G. Scott, “Length of Stay on the Supplemental Security Income Disability

Program,” Social Security Bulletin, Vol. 58, No. 1 (1995), pp. 29-47.

6

Also, states must supplement benefits for those covered by the state assistance programs that SSI

replaced in 1974 if the previous benefit was higher than the federal benefit level.

7

These seven states are Arkansas, Georgia, Kansas, Mississippi, Tennessee, Texas, and West Virginia.

North Dakota leaves the supplements up to the counties but pays 50 percent of the benefit costs. Also,

the Northern Mariana Islands do not provide supplemental benefits. The Northern Mariana Islands are

the only U.S. territory whose residents are eligible for SSI.

8

In this instance, disabled recipients aged 65 and over are counted with the disabled, not the aged.

9

In Hawaii, because of higher food costs, the maximum Food Stamp benefit for SSI recipients was $187

per month. California provides increased cash aid instead of Food Stamps.

Page 6 GAO/HEHS-95-137 SSI Caseload Growth
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In addition to providing cash benefits, both SSI and the DI program include

return-to-work components. Both programs include work incentive

provisions and screen and refer disabled and blind recipients to state

vocational rehabilitation agencies. Refusing rehabilitation services is

cause for benefits termination. SSI’s work incentives include

• disregarding the first $65 to $85 of earned income and half of the

remaining earned income in determining benefit levels;

• disregarding income used for impairment-related work expenses for the

disabled and any work expenses for the blind;

• disregarding income or resources set aside to achieve a work goal, such as

education or starting a business;

• continuing benefits even if earnings exceed the “substantial gainful

activity” amount, though earnings still reduce benefits as described above;

• continuing eligibility for Medicaid even though earnings may reduce SSI

cash benefits to nothing; and

• allowing recipients to be reinstated if their work attempts fail or their

ability to work is erratic.

Factors Contributing

to SSI’s Growth

A variety of factors has contributed to the rapid growth in the SSI caseload,

although the relative effects of these factors on growth are not fully

understood. Program factors, such as expanded disability criteria and

major outreach efforts, have brought more individuals onto the rolls at

younger ages. Widely publicized reports of fraud and abuse suggest

another potential source of new recipients, and such reports can also

significantly erode public confidence in the program’s integrity.

Meanwhile, some disabled recipients may stay on SSI longer and receive

more in benefits than they would otherwise because SSA has devoted little

effort to (1) checking that recipients continue to be disabled and

(2) helping recipients return to work.

In addition, various other factors have contributed to growth; some of

these are external to SSI, such as increased immigration and economic

conditions. We summarize these factors in table 1 and discuss them

below.10

10See also Social Security: Federal Disability Programs Face Major Issues (GAO/T-HEHS-95-97, Mar. 2,

1995).

Page 7 GAO/HEHS-95-137 SSI Caseload Growth
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Table 1: Factors Contributing to SSI’s

Growth

Program factors

More persons brought into the program Eligibility expansion: Legislative and

regulatory changes have increased

access to disability benefits.

Program outreach: The Congress

mandated that SSA seek eligible persons

to apply for SSI through outreach

campaigns.

Fraud and abuse: Allegations have been

made that certain SSI recipients, such as

some children and immigrants, have

received benefits though ineligible.

Some recipients on SSI longer Continuing disability reviews (CDR): Until

1994, the law did not require SSA to

perform CDRs for SSI cases, and SSA

spent little effort on CDRs.

Return to work efforts: Helping people with

disabilities return to work is a low priority of

the SSI program.

Additional factors

Immigration Growing numbers of noncitizens have

been admitted to the United States, and

noncitizens are more likely to receive SSI

than citizens.

Economic conditions Recession may increase applications and

affect eligibility and benefit levels.

Medical breakthroughs Disabled individuals now have better

chances to live longer through medical

and technological advances.

Transfers from state programs Some states help public assistance

recipients enroll in SSI.

Health insurance Individuals may be applying for SSI or

staying on the rolls longer to have

Medicaid coverage.

Eligibility Expansion A congressional oversight committee in the early 1980s found that federal

courts, psychiatric and vocational counseling professionals, and we had

raised serious questions about the adequacy of SSA’s standards for

assessing mental impairment for both DI and SSI. Addressing these

concerns, the Congress passed the Disability Benefits Reform Act (DBRA)

in 1984, effectively expanding the definition of disability for both adults

and children. In particular, the act required new standards for mental

Page 8 GAO/HEHS-95-137 SSI Caseload Growth
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impairments that incorporated a person’s ability to compete in the job

market. It also required SSA to consider the combined effects of multiple

impairments if no single impairment were sufficiently disabling to allow

someone to qualify for benefits and required increased attention to pain’s

effect on the ability to work. Further, the act allowed SSA to consider

nonmedical evidence offered, for example, by an applicant’s family and

friends. Finally, the act required increased emphasis on opinions of

physicians treating the individuals and on evaluating their functional

limitations.

In addition to DBRA, a 1990 Supreme Court decision, Sullivan v. Zebley,

493 U.S. 521, ruled that SSA’s disability determination process for children

“does not account for all impairments ‘of comparable severity’ [to

adults]...” and thus violated the law because it held children to a more

restrictive standard. For those children who do not qualify by meeting

SSA’s strict listings of impairments, the Court required SSA to add an

individualized functional assessment (IFA) of how their impairment limits

their ability to act and behave in age-appropriate ways. Also in 1990, SSA

issued regulations revising and expanding its standards for assessing

mental impairments, specifically in children. These standards incorporated

functional criteria, added impairments that qualified as disabilities, such as

attention deficit hyperactivity disorder, and added more weight to

nonmedical evidence from parents, teachers, social workers, and others.

Program Outreach At the direction of the Congress and on its own initiative, SSA has

increased its outreach efforts to better inform potential recipients of their

SSI eligibility. These efforts have attempted to reduce barriers for potential

applicants, such as a lack of information about the program, perceived

stigma from accepting benefits, and the complexity of the application

process. Along the same lines, state and local agencies and nonprofit

groups serving the poor have focused more attention on encouraging

eligible persons to enroll, not just for cash payments but to establish

eligibility for Medicaid and Food Stamps as well.

In 1983, the Congress passed legislation requiring SSA to identify all Social

Security Old Age recipients whose benefits fell below the SSI benefit level

and to notify them of the availability of SSI benefits. In addition to this

one-time effort, the law required ongoing notices to Social Security

recipients who reach age 65 and to certain disabled recipients.

Page 9 GAO/HEHS-95-137 SSI Caseload Growth
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Beginning in 1989, SSA made SSI outreach an ongoing agency priority; it

conducted demonstration programs, increased coordination with other

agencies serving the poor, and encouraged field office outreach initiatives.

The Omnibus Budget Reconciliation Act of 1989 established a permanent

outreach program for disabled and blind children. Also, as part of a

settlement related to the Zebley decision, SSA launched a national media

campaign and conducted outreach in schools and welfare offices to enroll

more children.

In 1990, we reported on SSA district managers’ views on SSI outreach.11

They acknowledged the need for outreach and believed they were doing

enough. They were implementing a wide range of outreach activities, but it

was not clear which were most effective. About 40 percent believed

outreach was needed for non-English-speaking people.

Also, in 1990, the Congress mandated that SSA expand the scope of its

outreach efforts and provided funds for SSA to complete a series of

outreach demonstration projects. Since then, SSA has provided $33 million

for 136 cooperative agreements targeting diverse populations such as

African Americans, Native Americans, the homeless, the mentally ill, and

persons who have tested positive for the human immunodeficiency virus.

Fraud and Abuse A portion of SSI’s growth may be attributable to increased incidence of

fraud and abuse in the past decade. A lack of empirical evidence makes it

difficult to estimate the extent of the problem. Nevertheless, news reports

have provided accounts of foreign-born SSI applicants coached by

middlemen or translators to feign mental illness and children coached by

parents to fake mental impairments by misbehaving or doing poorly in

school to qualify for SSI benefits. Regardless of the actual extent of such

abuse, reports like these can significantly erode public confidence in the

program’s integrity.

Limited Numbers of CDRs The purpose of CDRs is to verify that disabled recipients still have an

impairment that prevents them from working. In 1993 and 1994, we

reported12 that while SSA has had authority to perform such reviews for SSI

11Social Security: District Managers’ Views on Outreach for Supplemental Security Income Program

(GAO/HRD-91-19FS, Oct. 30, 1990).

12Social Security: Continuing Disability Review Process Improved, But More Targeted Reviews Needed

(GAO/T-HEHS-94-121, Mar. 10, 1994); Social Security Disability: SSA Needs to Improve Continuing

Disability Review Program (GAO/HRD-93-109, July 8, 1993).

Page 10 GAO/HEHS-95-137 SSI Caseload Growth
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recipients, it has done relatively few. In 1994, the Congress directed SSA to

perform a minimum number of disability reviews for SSI recipients.

Accordingly, SSA plans to conduct reviews on 100,000 SSI adults and on

one-third of SSI children turning age 18 for each of the 3 fiscal years

beginning in 1996.

In contrast, before 1994, the law already required SSA to conduct reviews at

least once every 3 years for Social Security DI recipients in cases in which

medical improvement is possible or expected, and regulations required

that a review be scheduled every 7 years in cases in which medical

improvement is not expected. About 500,000 DI cases come due for a

review each year. However, while SSA has improved the review process, it

has a current backlog of 1.8 million DI reviews. Given available resources,

it has planned for only 234,000 CDRs in fiscal year 1996. Since DI benefit

rates are larger than SSI’s, the cost-effectiveness of DI reviews may be

higher. Still, since 1 in 6 DI recipients also receives concurrent SSI benefits,

the backlog has also reduced to some degree the number of SSI

terminations.

Limited Return to Work

Efforts

Helping people with disabilities return to work has been a low priority of

SSA and the Congress for both the SSI and DI programs, and, in fact, SSI and

DI return virtually no one to work. This low priority is especially evident in

vocational rehabilitation (VR), to which relatively few resources are

allocated. For example, for every $100 SSA spends on cash benefits, it

spends little more than $.10 on VR, and few recipients are referred for VR

services. As we reported in 1993, VR beneficiaries receive, on average, only

modest services and show limited long-term improvement.13 In 1993,

compared with $52 billion in combined SSI and DI benefit payments,

$63 million was spent for VR. Of over 7 million SSI and DI disabled

recipients, only 300,000 were referred for VR, and 6,000 were successfully

rehabilitated.

Recipients may also perceive that the risk of losing benefits upon

returning to work is too high. The SSI program has work incentive

provisions to encourage recipients to try returning to work, without

jeopardizing their cash and medical benefits should they fail, as well as

ease the transition to work. However, many recipients are not familiar

with these provisions or do not understand them. As a result, a significant

13Vocational Rehabilitation: Evidence for Federal Program’s Effectiveness Is Mixed (GAO/PEMD-93-19,

Aug. 27, 1993).

Page 11 GAO/HEHS-95-137 SSI Caseload Growth
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unrealized potential may exist for returning recipients to work or reducing

their dependence on SSI.

Growth in Immigration The number of immigrants steadily increased in the 1980s, from about

500,000 per year early in the decade to 900,000 in 1993. Altogether,

immigrants in the 1980s totaled more than 7.3 million. Over 30 percent of

U.S. population growth in the 1980s can be attributed to immigration.

For this report, we use “immigrants” to refer to those with “lawful

permanent resident” status. Foreign-born people seeking to immigrate to

the United States can obtain this status with an immigrant visa issued

overseas by the U.S. State Department. However, those already residing in

the United States can also obtain this status. For example, refugees and

asylees are not considered immigrants upon arrival here but are eligible

for lawful permanent resident status after 1 year of continuous residence

in the United States. Also, under the Immigration Reform and Control Act

of 1986, certain undocumented aliens can change to permanent status.

Because noncitizens other than immigrants may receive SSI benefits and

because some immigrants eventually become citizens and then receive

benefits, we use “noncitizens” to refer to all foreign-born residents who

have not yet become citizens.

Since the 1980s, noncitizens have been one of the fastest growing groups

of both aged and disabled SSI recipients. Also, noncitizens are more likely

to receive SSI than citizens; roughly 3 percent of noncitizens receive SSI

compared with 1.8 percent of citizens. Among other reasons that may

explain this, noncitizens typically have more limited histories of working

in the United States than life-long residents and therefore qualify for

smaller Social Security benefits; in turn, they are more likely to qualify for

SSI. Still, the likelihood of receiving SSI probably varies for different types

of noncitizens. Refugees and asylees may be more likely than citizens to

receive benefits while immigrants admitted through normal procedures

may be no more likely or even less likely than citizens to be on SSI; data

limitations make it difficult to say.14

14Data limitations that prevent drawing firmer conclusions include the following: (1) the general

population data we examined estimated the noncitizens’ status on the basis of country of origin rather

than their actual status and (2) SSI data about noncitizens reflect their status at the time of application

and not upon entering the United States. See Michael Fix and Jeffrey S. Passel, Immigration and

Immigrants: Setting the Record Straight, The Urban Institute (Washington, D.C.: 1994), pp. 19-22, 34,

and 63-67.

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Roughly half of those granted immigrant status in the 1980s were not

subject to immigration policies that attempt to exclude people who are

likely to become public charges. Included are about 1 million refugees and

asylees who obtained full permanent resident status. Also, the Congress

passed the Immigration Reform and Control Act in 1986, which legalized

over 2.5 million previously illegal aliens.

Other Factors Contribute

to Caseload Growth

In addition to changes in the SSI program and the general population

increases, a variety of other factors has contributed to caseload growth.

Economic factors—such as the 1990-91 recession—may account for some

of the increase. In times of high unemployment, aged or disabled persons

may lose their jobs and turn to SSI for support. Losing even part of their

income may allow them to meet SSI’s financial eligibility requirements.

Also, the prevalence of some disabilities may have increased. For example,

those who 10 years ago would not have been expected to survive certain

health conditions, such as kidney disease, are now being kept alive by

medical and therapeutic advances. Further, young adults who would not

have been expected to survive spinal cord injuries now have a much better

chance of survival and more opportunity to regain many functions. Finally,

infants born with congenital defects or low birth weight have a better

chance of survival today than in the past, although they may sustain

disabilities.

Many state and local governments have enrolled recipients of other

welfare programs in SSI. When such recipients are eligible for SSI, state and

local governments can reduce their own spending as well as increase

benefit levels for their beneficiaries. From discussions with 10 state

welfare administrators, we estimate that at least half of all states fund

programs that actively assist disabled welfare recipients through the SSI

application process. For example, five states reported using such

programs to generate gross savings of about $90 million in a given year by

helping enroll in SSI nearly 26,000 individuals receiving state benefits. Most

of these gains came from one state, which reportedly saved over

$60 million by helping nearly 15,400 public assistance recipients enroll in

SSI instead of state general assistance in fiscal year 1994.

Finally, the recent increase in the number of people without affordable

health insurance may have affected the size of SSI. The uninsured

population under age 65 in the United States grew by 5 million between

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1988 and 1992. Coupled with this growth, limitations in employer-based

health care coverage for chronic conditions may have prompted some

individuals to apply for SSI to obtain Medicaid.

Characteristics of

Current SSI

Recipients

Overall SSI caseload growth has been concentrated almost exclusively in

the disabled population, which grew an average of over 8 percent annually

from 1986 through 1993 and now accounts for nearly 80 percent of federal

SSI payments. During this period, the aged SSI population stayed almost

level but would have decreased by 10 percent without the growth in

noncitizen cases.15 The aged SSI population has decreased from 47 to

35 percent of all SSI recipients. Even among the disabled SSI population, the

proportion of older recipients has decreased; those aged 50 and older have

decreased from 36 to 28 percent of disabled recipients. Blind recipients

have been a constant and small share of the total. (See app. I for more

detail on age demographics.)

Three subpopulations have accounted for nearly 90 percent of the growth

since 1991—adults with mental impairments, children, and noncitizens.16

These groups typically have not contributed much in Social Security taxes.

Accordingly, they receive smaller concurrent Social Security benefits than

other SSI recipients, or none at all, and therefore receive higher SSI benefits.

(See table 2.) Among the aged, recipients who did not qualify for any

Social Security benefit increased from 12 to 36 percent of cases between

1986 and 1993. Among the disabled, such recipients increased from 69 to

73 percent of cases over the same period. (See app. I for more detail on

concurrent benefit and SSI benefit levels.)

15This and many of the other statistics cited in this report are estimates based on our analysis of a

10-percent random sample of SSI recipients. Therefore, these estimates are subject to sampling error.

However, because of the extremely large sample sizes (roughly 500,000 cases per year), the sampling

errors for national estimates are very small, generally less than plus or minus 1 percentage point at a

95-percent confidence level.

16See also Supplemental Security Income: Recent Growth in the Rolls Raises Fundamental Program

Concerns (GAO/T-HEHS-95-67, Jan. 27, 1995).

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Table 2: Summary of SSI Caseload

Growth Patterns

Number of

cases

(1993)a

Percentage

of all

cases

(1993)a

Percentage

average

annual

growth

rate

(1986-93)

Average

monthly

benefit

(1993)

By selected subpopulations

Mentally disabled adults 1,751,000 29.3% 11.0% $325

Blind or disabled children 770,501 12.9 16.4 397

Aged or disabled noncitizens 674,150 11.3 15.5 316

All other recipients 2,900,000 48.0 <2.0

By eligibility group

Aged 2,091,651 35.0 0.7 195

Disabled 3,807,223 63.6 8.2 324

All SSI recipients 5,984,330 100.0 4.9 $278

aSubgroups may not add up to the total because of overlaps in the populations listed. Blind

recipients accounted for 1.4 percent of all cases in 1993, down from 2 percent in 1986.

Because many children and mentally disabled adults would not have

qualified previously, much of the growth reflects a one-time addition of

such recipients. Because of this, it is not clear that such dramatic growth

will continue indefinitely; in fact, rates of caseload growth in the past 2

years have declined somewhat, though they are still high.

Caseload growth varies dramatically by state. For example, growth in the

disabled SSI population ranged from 4 to 17 percent on average annually

from 1986 through 1993. Moreover, states experienced concentrations of

growth in different recipient subpopulations. (See app. I for state-level

detail.) For noncitizen cases, seven states accounted for 84 percent of the

growth—California, New York, Florida, Texas, Illinois, New Jersey, and

Massachusetts, in descending order; these states receive the largest shares

of immigrants. Across all states, the rates of growth in noncitizen cases

varied considerably, from 7 to more than 25 percent annually on average.

Mental Impairments

Predominate Among

Disabled Adults

Among disabled adults on SSI, mental impairments predominate,

accounting for 56 percent of such cases in 1993. Moreover, they accounted

for 64 percent of the growth from 1986 through 1993 in cases for which

diagnoses were available. Mental retardation cases grew an average of

9 percent annually but constituted a fairly level 25 percent of the disabled

adult caseload. However, growth in other mental impairment cases was

Page 15 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

more dramatic, averaging 13 percent annually and increasing from 26 to

33 percent of cases over this period.

Mentally disabled adult recipients are younger on average than other

disabled adults; 82 percent are under age 50 compared with 57 percent for

other impairments. As a result, these recipients are likely to contribute to

sustained growth in the caseload and benefit costs since they enroll in SSI

at a younger age and typically stay on longer. Also, because these

recipients are younger, whatever contributions they may have made to

Social Security may be based on lower average wages than those disabled

at later ages. As a result, any Social Security benefits they receive may be

smaller than those of older recipients, and so their SSI benefits may be

larger. (See app. I for more detail on the age and benefit levels of the

mentally disabled.)

Included in the category of “mental impairment other than retardation” are

those recipients designated as drug addicts and alcoholics (DA&A), who

numbered over 100,000 in February 1995. From 1988 through 1994, these

cases grew an average of 41 percent annually, multiplying eightfold.

Addicts required to participate in the DA&A program are those who would

not qualify for disability if their addiction ended. Thus, the DA&A

designation does not apply to all addicts on SSI. In May 1994, we reported

on the DA&A program and found that 150,000 addicts receive SSI benefits; of

these, more than half would qualify as disabled without their addiction.17

By law, these designated DA&A recipients must have a representative

payee, or third party, manage their benefits, and they must participate in

treatment when it is available. In our May 1994 report, we noted that

finding qualified payees for addicts has been a long-standing problem for

SSA. Payees are generally unpaid volunteers; the vast majority are relatives

or friends. An SSA study found payee controls to be lax in many cases,

particularly when addicts’ friends were the payees. The study also showed

that organizational payees tended to provide the most control because

they can more effectively deal with abusive or threatening addicts.

Further, while substance abuse treatment is required, SSA is not permitted

to pay for treatment nor can the addict be required to pay for it. Exactly

who pays for what types of treatment for SSI DA&A recipients is not known.

Some services are covered by state Medicaid programs, but states vary

greatly in the type, amount, duration, and scope of services provided. In

17Social Security: Major Changes Needed for Disability Benefits for Addicts (GAO/HEHS-94-128,

May 13, 1994).

Page 16 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

our May 1994 report, we noted that only about 9 percent of DA&A recipients

were in treatment; the remainder were either not in treatment (7 percent)

or their treatment status was not known (84 percent). SSA was then taking

steps to correct shortcomings in its monitoring efforts.

The alarming growth in DA&A cases and allegations of program abuse

prompted the Congress to strengthen controls of payments to addicts in

the Social Security Independence and Program Improvements Act of 1994

(SSIPIA). The act generally requires that SSI benefit payments to DA&A

recipients end after 3 years. It also expands the DA&A program

requirements to cover DI recipients; gives preference to organizations as

representative payees; and mandates an SSA study of the feasibility, cost,

and equity of requiring representative payees for all DI and SSI addicts, even

if they would be disabled without the addiction.

Number of Children on

SSI, Especially With Mental

Impairments, Is Growing

Fast

Before 1990, the growth in the number of disabled children receiving SSI

was moderate, averaging 3 percent annually since 1984. Then, from the

beginning of 1990 through 1994, the growth averaged 25 percent annually,

and the number tripled to nearly 900,000. Their share of the disabled SSI

population grew from about 12 percent before 1990 to 22 percent in 1994.

Also, SSA researchers project that, from age of first eligibility to age 65,

children on SSI will receive benefits for more than 25 years on average

compared with about 15 years for those aged 18 to 34 and less than 10

years for those aged 35 and above.18 So children recipients especially

contribute to sustaining higher caseloads.

Mental impairments predominate among children, accounting for over half

of all cases. Mental retardation, one of two broad categories of mental

impairments, has consistently accounted for 37 percent of children

receiving SSI, both before and after 1990. However, other mental

impairments have increased from 5 to nearly 18 percent of children’s

cases, increasing from 17,000 cases in 1989 to 136,000 cases in 1993. In

1994, we reported that the portion of mental disability awards to children

with behavior problems, such as attention deficit disorder, is just

22 percent but growing.19

As required by the Zebley ruling, SSA began to use IFAs to make disability

determinations for children whose impairments do not meet SSA’s strict

18Rupp and Scott, pp. 29-47.

19Social Security: Rapid Rise in Children on SSI Disability Rolls Follows New Regulations

(GAO/HEHS-94-225, Sept. 9, 1994).

Page 17 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

listings of impairments. The new IFA process, which added 219,000

children to the benefit rolls through September 1994, permits the award of

benefits to children with less severe impairments than those in SSA’s

medical listings of impairments. In our recent report on the IFA, we noted

that about 84 percent of children qualifying based on IFAs have mental

impairments.20 Also, about one-half of the awards for behavioral disorders,

including attention deficit disorder, are based on the IFA criteria.

The news media have widely reported allegations that parents coach their

children to fake mental impairments by misbehaving or doing poorly in

school so they can qualify for SSI benefits. Our recent report in part

attempted to assess the IFA’s vulnerability to such coaching. However, we

found that substantiating and measuring the extent of such coaching are

extremely difficult. Studies we reviewed found little evidence of

widespread coaching but could not rule it out.

Nevertheless, our report documented the many subjective judgments built

into each step of the IFA process, which make it difficult to administer

consistently and leave it susceptible to manipulation. We concluded that

the likelihood of significantly reducing the judgment involved in evaluating

age-appropriate functioning was remote and that more consistent

decisions could be reached if children were evaluated on the basis of the

functional criteria in SSA’s medical listings. Given our findings, we

suggested that the Congress could consider eliminating the IFA, which

would reduce the growth in awards and target disability benefits to

children with more severe impairments.

Some households have more than one child on SSI. SSI benefits are adjusted

only for the income of parents, not of other children, so benefits for each

additional child may be as high as for the first child. According to a recent

SSA study,21 8.5 percent of SSI recipients live in households receiving two or

more checks, excluding group living situations and couples with no other

SSI recipients in the household. Nearly three-quarters of these recipients

live in households with only two recipients. About 0.6 percent of SSI

recipients live in households with more than three recipients. About

24 percent of those in multirecipient households are children under age 18

while another 35 percent are adults living with their parents.

20Social Security: New Functional Assessments for Children Raise Eligibility Questions

(GAO/HEHS-95-66, Mar. 10, 1995).

21Alfreda Brooks, Lenna Kennedy, and Charles Scott, SSI Recipients in Multirecipient Households,

Social Security Administration, unpublished, March 1994.

Page 18 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

Number of Noncitizens

Growing Fast Among Both

Aged and Disabled

Recipients

From 1986 through 1993, the number of aged or disabled noncitizen

recipients grew an average of 15 percent annually, reaching nearly 700,000

in 1993. In 1982, noncitizens constituted 3 percent of all SSI recipients, and,

in 1986, they constituted 6 percent; by 1993, they constituted nearly

12 percent. Of these, 69 percent were at least 65 years old, and 31 percent

were disabled.

Had it not been for the growth in noncitizens, the aged SSI population

would have decreased 10 percent from 1986 through 1993. The noncitizen

caseload grew from 9 percent of aged cases to 23 percent in this period.

Although disabled recipients constitute a smaller share of noncitizen

cases, their number is growing faster, averaging 19 percent annually

compared with 14 percent for aged cases from 1986 through 1993. They

have increased from 3 percent of disabled cases to 5.5 percent.

Recent media reports and congressional hearings have focused attention

on allegations that translators and other intermediaries help

non-English-speaking noncitizens fraudulently qualify for SSI disability

benefits. In some parts of the United States, the noncitizen populations

speak so many different languages and dialects that SSA is unlikely to have

staff proficient in each of them. While the full extent of such activities is

unknown, translators are known to have coached claimants to fake mental

impairments, such as delayed stress syndrome or depression. They have

controlled disability determination interviews by answering all questions

asked of the claimants. They have prepared applications for numerous

claimants using identical wording to describe the same mental

impairment. They have also established relationships with unscrupulous

doctors who have submitted false medical evidence.

More generally, noncitizens on SSI have come to this country under a

variety of circumstances, as discussed earlier. For example, some have

come through normal immigration channels, and others have come as

refugees or asylees. Different provisions in both immigration law and SSI

policy apply to these groups. Patterns of caseload growth also vary among

groups of noncitizens. However, SSI data only permit analysis of recipients’

immigration status when they applied. Some refugees may have converted

to normal immigrant status by the time they apply, and some immigrants

may have become citizens.

Some legal immigrants are admitted to the country under the financial

sponsorship of a U.S. resident. The Immigration and Nationality Act of

Page 19 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

1952, as amended, provides for excluding aliens who are likely to become

public charges. Aliens can show they will be self-sufficient, among several

other ways, by getting a financial sponsor. Sponsors sign an affidavit of

support, in which they agree to provide financial assistance to the

immigrant for 3 years. However, several courts have ruled that these

affidavits of support are not legally binding. Refugees and asylees,

moreover, do not need a sponsor to reside in the United States; in 1993,

18 percent of SSI’s noncitizen recipients were refugees or asylees when

they applied. In addition, the undocumented aliens legalized by the

Immigration Reform and Control Act of 1986 were not admitted to the

United States under these sponsorship provisions; in 1993, roughly

3 percent of SSI’s noncitizen recipients were identified as part of this group

when they applied.

SSI’s “deeming” provisions attempt to reinforce this immigration policy by

factoring a portion of sponsors’ resources into financial eligibility

decisions and benefit calculations for the immigrants they sponsor.22 In

1993, as many as 75 percent of SSI’s noncitizen recipients could have been

subject to these provisions when they applied, but many of these may not

have come to the United States under financial sponsorship. Before 1994,

this deeming applied for 3 years from the immigration date. About

25 percent of immigrants receiving SSI applied for benefits within a year of

their 3-year sponsorship period’s expiring. The Congress temporarily

extended the deeming period from 3 to 5 years starting in January 1994

and continuing through September 1996.

Refugee and asylee cases are growing somewhat faster than immigrant

cases, averaging 18 percent annually from 1986 through 1993 compared

with 15 percent. Still, they constitute just 18 percent of all noncitizens on

SSI compared with 74 percent for immigrants. Refugees and asylees

constitute a larger share of SSI’s disabled noncitizen population than SSI’s

aged population, 23 percent compared with 16 percent.

About 46 percent of noncitizen recipients applied for SSI within 4 years of

entering the United States. Only 5 percent of SSI immigrants applied within

a year of entry compared with 52 percent of the remaining SSI noncitizens,

as might be expected from the sponsorship provisions for immigrants.

About 44 percent of disabled SSI noncitizens have been in the United States

22These deeming provisions do not apply if an immigrant becomes blind or disabled after admission to

the United States as a permanent resident.

Page 20 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

less than 5 years as of 1993, compared with 57 percent of aged

noncitizens.23

Of noncitizens on SSI, 51 percent come from six countries—Mexico, the

former Soviet Union, Cuba, Vietnam, the Philippines, and China, in

descending order of caseloads. However, rates of growth vary

substantially by country of origin, from an average of 11 percent annually

for Cuba to 33 percent for the former Soviet Union, among these six

countries. Except for Cuba, these are the countries with the largest shares

of immigrants to the United States overall.

Concluding

Observations

As SSI caseloads have grown rapidly, they have become increasingly

dominated by younger, mentally disabled recipients, who stay in the

program longer. Disabled recipients now account for nearly 80 percent of

federal SSI payments. Rapid growth in noncitizen cases further contributes

to changes in the program’s character. Both these younger and noncitizen

recipients tend to depend more on SSI as their primary source of income.

Over the long term, these trends provide compelling reasons to reexamine

the program’s assumptions and priorities, which will require thoughtful

attention. They raise issues not only of which populations the program

should serve but also whether the program should provide cash benefits

only or work with recipients more actively to help them increase their

self-sufficiency.

More specifically, technology and medical treatment to help the disabled

adapt are constantly improving, and society’s perceptions of disability are

changing. These trends, combined with the increased number of younger

recipients, especially children, challenge the program’s historic

presumption that the disabilities it covers are total and long term. In cases

of physical disabilities among older workers, who previously

predominated in the SSI program, rehabilitation and returning to work

were perhaps reasonably not emphasized. The program has thus had little

experience in supporting rehabilitative efforts, which may hold more

promise for younger recipients.

Therefore, finding effective ways to help disabled recipients achieve their

productive capacity and work as much as possible should have a higher

priority. This applies at least as much to children as adults; disability has a

23In these percentages, disabled recipients aged 65 and over (who constituted 8 percent of all

noncitizens) are counted with the disabled, not the aged.

Page 21 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

very different meaning for them. Children who cannot function at an

age-appropriate level may be able to develop so that they can work by the

time they reach adulthood. Also, finding effective approaches for

recipients with mental impairments, particularly those with limited work

histories, may require special attention. More emphasis on returning to

work should signal to recipients that work, where feasible, is a program

expectation. Such efforts should help decrease their dependence on SSI,

help them achieve their productive capacity, and improve program

integrity as well.

The growth in noncitizen cases raises issues about immigration policy in

addition to issues about SSI policy. The immigration law’s provisions on

sponsorship and the SSI provisions about deeming sponsors’ income and

resources may not adequately exclude immigrants from the United States

who are likely to become public charges.

Over the short term, however, SSA can do a variety of things to bolster

program integrity. For example, we have previously recommended

conducting more CDRs, which would help reassure the public that benefits

are not available to those who are no longer disabled; although the

Congress last year required a minimal number of these, more could be

done. Also, as we have previously recommended, increased monitoring of

drug addicts and alcoholics would help ensure that they are getting

treatment; also, finding organizations instead of family and friends to serve

as their representative payees would help ensure that their cash benefits

are spent for food, clothing, and shelter, not drugs and alcohol. In the case

of applicants who do not speak English, increased monitoring of

translators and finding ways to use agency-selected translators would help

minimize the opportunities for fraud and abuse.

The Congress could also consider a variety of program changes. For

example, we have already noted that the Congress could consider

eliminating the IFA used in making some disability determinations for

children. This would improve the consistency of the process and make it

less susceptible to manipulation. It would also reduce the growth in

awards and target disability benefits to children with more severe

impairments.

Agency Comments We shared a draft of this report with SSA program officials for a technical

review. They found our report and our analysis of SSA data to be generally

Page 22 GAO/HEHS-95-137 SSI Caseload Growth
B-260598 

accurate. They had some technical comments, which we have

incorporated where appropriate.

SSA officials objected that we cited fraud, waste, and abuse as causes of

program growth even though determining the extent of such problems is

difficult. However, we state only that these are possible causes of growth

and clearly acknowledge the lack of information about their extent.

SSA officials also noted that, with regard to the drug addict and alcoholic

population, SSA is well on the way to implementing the stringent

requirements of SSIPIA, which address both monitoring treatment and using

institutional payees. They also noted that SSA has taken strong measures to

combat interpreter fraud. Assessing such activities is beyond the scope of

this report.

Please contact me on (202) 512-7215 if you have any questions about this

report. Other GAO contacts and staff acknowledgments are listed in

appendix II.

Jane L. Ross

Director, Income Security Issues

Page 23 GAO/HEHS-95-137 SSI Caseload Growth
Contents

Letter 1

Appendix I 

Additional

Information on SSI

Caseload Growth

26

Recipient Population Is Getting Younger 26

Recipients Are Getting Fewer and Smaller Social Security

Benefits

30

Recipients Are Getting Larger SSI Benefits 32

State Experiences Vary Widely 33

Appendix II 

GAO Contacts and

Acknowledgments

37

Related GAO Products 40

Tables Table 1: Factors Contributing to SSI’s Growth 8

Table 2: Summary of SSI Caseload Growth Patterns 15

Figures Figure 1: Number of SSI Recipients by Eligibility Group 3

Figure I.1: Younger Recipients Are Growing Share of SSI Cases 27

Figure I.2: Change in Age Distribution in U.S. Population 28

Figure I.3: Change in SSI Recipiency Rates by Age Group 29

Figure I.4: Mentally Disabled Recipients Tend to Be Younger

Than Other Disabled Recipients

30

Figure I.5: SSI Recipients Receiving Social Security Benefits, by

Amount of Social Security Benefit

31

Figure I.6: SSI Recipients Receiving Social Security

Benefits—Three Fast-Growing Subpopulations, by Benefit

Amount

32

Figure I.7: More SSI Recipients Are Getting Larger Benefits 33

Figure I.8: State Data on SSI Caseload Growth, by Eligibility

Group

34

Figure I.9: State Data on SSI Caseload Growth, by Selected

Subpopulations

35

Page 24 GAO/HEHS-95-137 SSI Caseload Growth
Contents

Abbreviations

AFDC Aid to Families With Dependent Children

CDR continuing disability review

DA&A drug addicts and alcoholics

DBRA Disability Benefits Reform Act of 1984

DI Social Security Disability Insurance

IFA individualized functional assessment

OASDI Social Security Old Age, Survivors, and Disability Insurance

PRUCOL permanently residing under color of law

SSA Social Security Administration

SSI Supplemental Security Income

SSIPIA Social Security Independence and Program Improvements

Act of 1994

SSR Supplemental Security Record

VR vocational rehabilitation

Page 25 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Since 1986, more SSI recipients are younger and receive smaller concurrent

Social Security benefits and larger SSI benefits. Three groups of recipients

have accounted for the vast majority SSI’s caseload growth—adults with

mental impairments, children, and noncitizens. The first two groups tend

to be younger than other recipients. All three groups are less likely to

qualify for concurrent Social Security benefits at all, and those recipients

who do qualify tend to get smaller Social Security benefits. In turn, all

three groups tend to get larger SSI benefits. At the state level, patterns of

caseload growth among these three groups vary considerably.

Recipient Population

Is Getting Younger

Younger SSI recipients are increasing as a share of all recipients. (See fig.

I.1.) From 1986 through 1993, every age group under 60 except one has

increased as a share of SSI recipients, although those aged 60 and over

have decreased substantially.24 The 50 to 59 age group increased its share

slightly but only because of the dramatic decline in the 65 and over age

group’s share; as a share of disabled cases alone, the 50 to 59 age group

decreased from 21 to 18 percent (not shown in graph). The most dramatic

increase was in the under-18 age group, from 5 to 12 percent of all cases.

24All of the analysis in this appendix excludes blind recipients, who accounted for 1.4 percent of all

cases in 1993, down from 2 percent in 1986.

Page 26 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.1: Younger Recipients Are

Growing Share of SSI Cases

(1986-1993)

Percentage of Aged or Disabled SSI Cases

0

10

20

30

40

Under

18

18-29 30-39 40-49 50-59 60-64 65 &

Over

Age Group

5

12 12 11

9

12

8

11 11 12

7 6

48

36

1986

1993

Comparing these results with U.S. population trends puts them in

perspective and reveals a notable increase in recipiency rates. The small

drop in the 18 to 29 age group as a share of cases corresponds with a

larger drop as a share of the U.S. population, which reflects the aging of

the baby boom generation. (See fig. I.2.) Dividing the SSI population by the

U.S. population for each age group gives us a recipiency rate. Recipiency

rates increased for every age group under age 65; again, the most dramatic

increase proportionally was in the under-18 age group. (See fig. I.3.)

Overall, SSI’s recipiency rate increased from 1.7 to 2.3 percent from 1986

through 1993.

Page 27 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.2: Change in Age Distribution

in U.S. Population (1986-1993) Percentage of U.S. Population

0

5

10

15

20

25

Under

18

18-29 30-39 40-49 50-59 60-64 65 &

Over

Age Group

26 27

21

17

16 17

11

14

9 9

5 4

12 12

1986

1993

Page 28 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.3: Change in SSI Recipiency

Rates by Age Group (1986-1993) Percentage of U.S. Population Receiving SSI

0

1

2

3

4

5

6

7

Under

18

18-29 30-39 40-49 50-59 60-64 65 &

Over

Age Group

0.4

1.0 0.9

1.4

0.9

1.6

1.2

1.8

2.1

2.9 2.8

3.8

6.8 6.7

1986

1993

Page 29 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Mentally disabled recipients tend to be younger than those with physical

disabilities. Nearly 65 percent of all mentally disabled recipients are under

age 40 compared with about 41 percent of the physically disabled. (See fig.

I.4.) Conversely, nearly 70 percent of disabled recipients under age 40 have

mental disabilities compared with less than 50 percent of those aged 40

and over.

Figure I.4: Mentally Disabled

Recipients Tend to Be Younger Than

Other Disabled Recipients (1993)

Age Group as Percentage of Diagnosis Group

0

10

20

Under

18

18-29 30-39 40-49 50-59 60-64

Age Group

21

16

21

11

22

14

18

16

13

25

5

17

Mentally Disabled

Physically Disabled

Recipients Are

Getting Fewer and

Smaller Social

Security Benefits

Since 1986, the share of SSI recipients who do not qualify for any

concurrent Social Security benefit has increased from 51 to 60 percent.

(See fig. I.5.) Meanwhile, the share of all recipients who receive

concurrent benefits decreased in the highest categories of Social Security

benefit amounts.

Page 30 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.5: SSI Recipients Receiving

Social Security Benefits, by Amount of

Social Security Benefit (1986 Versus

1993)

Percentage of Aged or Disabled SSI Recipients

0

20

40

60

SSI Only Less Than $200 $200-$299 $300 & Over

Social Security Monthly Benefit Amount in 1993 Dollars

51

60

5 5

15

10

29

25

1986

1993

Each of the three fast-growing groups that we highlight—adults with

mental impairments, children, and noncitizens—have proportionally fewer

recipients who also qualify for Social Security benefits than the SSI

population as a whole. (See fig. I.6.) Of those group members who do

qualify for Social Security, a smaller share get larger benefits compared

with other SSI recipients.25

25About 8 percent of children on SSI received Social Security benefits in 1993. Children can receive

Social Security benefits as dependents or survivors of workers that qualify for Social Security.

Page 31 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.6: SSI Recipients Receiving

Social Security Benefits—Three

Fast-Growing Subpopulations, by

Benefit Amount (1993)

Percentage of Recipients in Subpopulation

0

20

40

60

80

SSI Only Less Than $200 $200-$299 $300 & Over

Social Security Monthly Benefit Amount

60

74

92

79

5 5 5 4

10

6

1

5

25

16

1

12

All SSI Recipients

All Mentally Disabled

All Children

All Noncitizens

Note: These numbers exclude blind recipients.

Recipients Are

Getting Larger SSI

Benefits

More SSI recipients got larger SSI benefits in 1993 than in 1986, even after

adjusting for inflation. (See fig. I.7.) The share of SSI recipients in each

benefit amount category under $300 per month declined while the share in

the highest benefit categories increased. In fact, the average SSI benefit

increased 16 percent in constant, that is, inflation-adjusted dollars. The

declining share of SSI recipients who also qualify for Social Security

contributes to this trend, but some of the trend could result from

decreases in other sources of income and financial support. The increasing

share of SSI recipients who are disabled also contributes to this trend

because the disabled have higher average benefits.

Page 32 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.7: More SSI Recipients Are

Getting Larger Benefits (1986 Versus

1993)

Percentage of Aged or Disabled SSI Recipients

0

10

20

30

40

Less than $99 $100 to $199 $200 to $299 $300 to $399 $400+

SSI Monthly Benefit Amount in 1993 Dollars

31

25

14

12

16

8

5

12

35

43

1986

1993

State Experiences

Vary Widely

Figures I.8 and I.9 summarize by state patterns of SSI caseload growth

overall and for the three fast-growing populations we highlight.26 Rates of

SSI caseload growth varied considerably by state and for different

subpopulations within states. For 1986 through 1993, average annual

growth rates for all SSI recipients ranged from 3 to 12 percent.27

26Unless otherwise specified, we use the word “disabled” only for those recipients under age 65 and

“aged” for those aged 65 and over. When disabled recipients turn 65, SSI program data typically

continue to count them among the disabled.

27All of the state-level statistics cited in this appendix, except for recipiency rates, are estimates based

on our analysis of a 10-percent random sample of SSI recipients nationwide. Sampling errors do not

exceed plus or minus 4.1 percentage points at a 95-percent confidence level. Given these sampling

errors, readers should be cautious when making their own comparisons between these state-level

estimates because the difference between estimates may not be statistically significant.

Page 33 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.8: State Data on SSI Caseload Growth, by Eligibility Group

State

All SSI recipients Aged Disabled

Average annual State caseload as Recipiency Average annual Group as percent Average annual Group as percent

growth rate percent of U.S. total rate growth rate of state total growth rate of state total

(1986-1993) (1993) (1993) (1986-1993) (1993) (1986-1993) (1993)

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut 

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho 

Illinois 

Indiana 

Iowa

Kansas

Kentucky 

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota 

Mississippi

Missouri 

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina 

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

United States total

3% 2.6% 3.6% -3% 39% 8% 61%

8 0.1 1.0 2 26 10 74 

9 1.1 1.5 3 30 12 70 

3 1.5 3.7 -4 37 10 63 

5 16.3 3.1 3 46 7 54 

8 0.9 1.4 2 28 10 72 

5 0.7 1.2 4 29 6 71 

4 0.2 1.3 2 29 6 71 

3 0.3 3.2 0 34 4 66 

7 5.0 2.1 3 44 11 56 

3 3.1 2.7 -2 39 7 61 

6 0.3 1.4 6 50 6 50 

7 0.2 1.3 1 23 10 77 

8 4.1 2.0 2 23 10 77 

7 1.4 1.4 0 19 10 81 

5 0.7 1.4 -2 26 8 74 

6 0.5 1.3 -1 23 9 77 

6 2.5 3.7 -1 30 10 70 

4 2.9 3.8 -2 33 9 67 

3 0.5 2.2 -1 34 6 66 

5 1.2 1.4 2 34 7 66 

4 2.4 2.4 -1 35 8 65 

6 3.2 1.9 -0 22 9 78 

7 0.9 1.2 1 28 10 72 

3 2.3 5.0 -3 40 9 60 

4 1.8 2.0 -3 28 8 72 

7 0.2 1.4 2 24 10 76 

5 0.3 1.2 -0 27 7 73 

9 0.3 1.1 3 30 14 70 

6 0.2 0.8 2 22 8 78 

6 2.3 1.7 3 36 7 64 

6 0.7 2.4 2 37 9 63 

6 9.1 2.9 4 38 7 62 

3 2.9 2.5 -1 40 7 60 

3 0.1 1.3 -2 33 7 67 

7 3.6 1.8 0 19 10 81 

3 1.2 2.1 -3 37 8 63 

7 0.7 1.4 2 26 9 74 

5 3.9 1.9 1 29 7 71 

4 0.3 2.1 -0 34 7 66 

3 1.7 2.8 -2 39 6 61 

6 0.2 1.7 -1 29 10 71 

4 2.8 3.2 -2 35 8 65 

5 6.2 2.0 2 44 9 56 

11 0.3 0.9 3 18 13 82 

4 0.2 2.1 -3 28 7 72 

5 2.0 1.8 0 36 8 64 

7 1.4 1.5 2 25 9 75 

5 1.0 3.2 -0 26 7 74 

5 1.7 2.0 -2 26 8 74 

12 0.1 1.0 2 22 17 78 

5% 100.0% 2.3% 1% 36% 8% 64%

Source: Data on recipiency rates from Committee on Ways and Means, U.S. House of

Representatives, Overview of Entitlement Programs: 1994 Greenbook. Other data from GAO

analysis of SSA’s 10-percent sample of the Supplemental Security Record file.

Page 34 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

Figure I.9: State Data on SSI Caseload Growth, by Selected Subpopulations

State

All mentally disabled Children Noncitizens

Average annual Group as percent Average annual Group as percent Average annual Group as percent

growth rate of state total growth rate of state total growth rate of state total

(1991-1993) (1993) (1986-1993) (1993) (1986-1993) (1993)

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut 

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho 

Illinois 

Indiana 

Iowa

Kansas

Kentucky 

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota 

Mississippi

Missouri 

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina 

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

United States total

20% 37% 18% 15% 8% 0%

11 41 11 9 a 10 

20 37 17 13 19 10 

20 33 22 18 a 0 

9 31 14 6 17 30 

13 39 16 12 20 8 

9 42 12 9 15 10 

14 41 12 17 a 3 

9 35 13 9 14 5 

19 31 22 14 12 22 

14 36 16 12 20 2 

9 31 9 5 10 25 

21 46 16 21 a 2 

22 50 21 15 15 9 

18 49 19 19 12 1 

13 47 16 15 13 3 

22 49 20 18 15 4 

18 42 17 11 a 0 

24 39 19 20 8 2 

12 38 9 7 7 2 

13 37 17 11 17 11 

16 38 14 7 15 14 

21 51 23 15 13 4 

17 48 20 12 17 10 

18 34 18 16 a 0 

16 44 20 16 15 1 

13 38 12 12 a 1 

13 42 15 17 a 2 

23 37 20 11 17 13 

12 48 11 14 a 3 

15 37 15 12 14 17 

16 30 17 13 27 6 

15 35 17 11 14 19 

13 34 19 12 22 1 

11 40 12 10 a 1 

20 53 20 17 16 2 

15 35 20 14 15 2 

17 43 17 12 17 8 

14 43 16 13 15 4 

17 40 11 10 13 14 

14 35 16 13 13 1 

10 37 17 17 a 1 

18 41 17 11 16 1 

17 27 15 12 16 13 

20 52 20 19 17 6 

14 44 11 9 a 1 

16 37 20 13 16 6 

15 43 17 10 18 14 

17 43 13 10 a 0 

15 49 20 16 18 4 

19 46 a 16 a 1 

16% 38% 18% 12% 15% 12%

Page 35 GAO/HEHS-95-137 SSI Caseload Growth
Appendix I 

Additional Information on SSI Caseload

Growth

aWe omitted these estimates because the number of cases in these categories in these states

was very small, especially in 1986.

The states with the most SSI recipients, in order of caseloads, are

California, with 16.3 percent of all cases; New York, with 9.1 percent;

Texas, with 6.2 percent; and Florida, with 5.0 percent. To put each state’s

share in perspective, recipiency rates also vary widely by state, from

0.8 percent in New Hampshire to 5 percent in Mississippi for 1993; the U.S.

rate was 2.3 percent. These percentages are calculated as the average

number of monthly SSI recipients over the state’s July population. For the

four largest states, the recipiency rates were as follows: California,

3.1 percent; New York, 2.9 percent; Texas, 2.0 percent; and Florida,

2.1 percent.

Of the four largest states, none had both growth rates and shares of cases

consistently higher or lower than the national average for all three

highlighted populations. California had a faster growth rate and a larger

share of cases than average only for noncitizens. New York and Texas

generally mirrored the national experience, but New York had a

substantially larger share of noncitizens, and Texas had a substantially

smaller share of mentally disabled recipients than the national average.

Florida had a slower rate of growth for noncitizens but a larger share of

them.

For the mentally disabled, average annual growth rates varied from

9 percent in three states, including California, to 24 percent in Louisiana.

This group as a share of state cases ranged from 30 percent in New Mexico

to 53 percent in Ohio.

For children, average annual growth rates varied from 9 percent in Hawaii

and Maine to 23 percent in Michigan. This group as a share of state cases

ranged from 5 percent in Hawaii to 21 percent in Idaho.

For noncitizens, average annual growth rates varied from 7 percent in

Maine to 27 percent in New Mexico. This group as a share of state cases

ranged from virtually 0 percent in five states to 30 percent in California.

Page 36 GAO/HEHS-95-137 SSI Caseload Growth
Appendix II 

GAO Contacts and Acknowledgments

Contacts Donald C. Snyder, Assistant Director, (202) 512-7204

Kenneth C. Stockbridge, Evaluator-in-Charge, (202) 512-7264

Acknowledgments In addition to those named above, the following individuals made major

contributions to this report: Cynthia A. Bascetta, Assistant Director, and

Vanessa R. Taylor, Senior Evaluator (computer science).

Page 37 GAO/HEHS-95-137 SSI Caseload Growth
Appendix II 

GAO Contacts and Acknowledgments

Page 38 GAO/HEHS-95-137 SSI Caseload Growth
Appendix II 

GAO Contacts and Acknowledgments

Page 39 GAO/HEHS-95-137 SSI Caseload Growth
Related GAO Products

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Social Security Disability: SSA Needs to Improve Continuing Disability

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Social Security: District Managers’ Views on Outreach for Supplemental

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(105681) Page 40 GAO/HEHS-95-137 SSI Caseload Growth
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