CDR

1

Felix Vaks

Actuary, Office of the Chief Actuary

Social Security Administration

November 9, 2017
Disclaimer

2

• The views presented here are mine and do not represent 

the Social Security Administration or the Office of the Chief 

Actuary within SSA.
CDR

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Continuing Disability Review

A Continuing Disability Review (CDR) is a routine medical 

review done by the Social Security Administration (SSA). 

CDRs are done to make sure that people receiving Social 

Security (OASDI) and Supplemental Security Income (SSI) 

disability benefits are still disabled and entitled to those 

benefits.

CDR is part of SSA’s Program Integrity
CDR Cost and Program Savings

4

• We estimate that the CDRs will save a present value of more than ten times 

that amount in Federal benefits over the next 40 years.

• In 2018 SSA will spend around $900 Million to conduct nearly 900 thousand 

CDRs.
SSA Administered Programs

5

• OASI: Old-Age and Survivors Insurance

• DI: Disability Insurance

• SSI: Supplemental Security Income

Supplemental Security Income (SSI) is a government program 

that is run by SSA that provides stipends to low-income and low 

assets people who are either aged 65 or older, blind, or disabled.
SSI and DI Disability

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Both SSI and DI determine disability the same way:

• Disability for an adult is defined as the inability to engage in any SGA (Substantial Gainful 

Activity) by reason of any medically determinable physical or mental impairment that can 

be expected to result in death or that has lasted or can be expected to last for a continuous 

period of at least 12 months.

SGA – Substantial Gainful Activity 

• a level of work activity and earnings for people 

receiving disability benefits. 

• In 2017 SGA is generally $1,170 a month
Continuing Disability Review

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By law SSA is required to review each case to determine 

if the individual is still eligible for benefits.

Person received benefits for several years. Is the individual still disabled?

Determine if there was any significant improvement in the disability.
CDR Projection Models

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1) How Many

2) How Much

- CDRs are processed in each year

- Is the Savings from Cessations due to a CDR

2 Questions

How Many CDRs

• Budget

• DDS

How Much Savings

• Cost vs Savings

• Appropriate Funds

Office of Chief Actuary – uses several models for:

• OMB Budget

• CDR Report
CDR

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1) SSI Only

My area of expertise is:

2) Medical CDR

What I am going to present will 

primarily deal with SSI Medical CDR.
CDR Process

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In 2017 there are over 6 million SSI recipients under 65 years old.

How often to do a CDR?

The frequency of review depends on the likelihood of medical improvement.

DDS determines a diary (category) of when the next CDR is due.
CDR Diaries

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DIARY

MIE

MIP

MINE

Definition

- Medical Improvement Expected

- Medical Improvement Possible

- Medical Improvement Not Expected

Next Due Date

- In 1 Year

- In 3 Years

- In 7 Years

| MIE – 1 Year | MIP – 3 Years | MINE – 7 Years | 
Processed vs. Not Processed

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• Even those due for a CDR in a certain year cannot always be 

processed in that year.

• Those CDRs that are not processed that year are delayed 

to the following year.

• BACKLOG
Categories of SSI Reviews

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LBW Children Adults Age 18 

Redetermination

1) Low Birth Weights (LBW) - Children that are born prematurely 

or with low birth weight

2) Other Children - Children that are not low birth weight

3) Adults - Recipients that are over 18 years of age
Age 18 Redetermination

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Definition of Disability

Adult: physical or mental impairment that results in the inability 

to do any substantial gainful activity (SGA) (at least 12 months) 

Child: physical or mental impairment that results in marked and 

severe functional limitation (at least 12 months)
Age 18 Illustration

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Child Adult

Age 18 

Redetermination
Determining How Many CDRs Are There in 

Any Given Year

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We are going to go through the CDR process by each category and see how 

it flows.
LBW

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Did not Process 

CDR in that Year

Processed CDR 

in that Year

Postpone to 

Following Year

Backlog
LBW

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Processed CDR 

in that Year

MIE MIP MINE CDR in 

2017

Next CDR 

Due in 2018

Next CDR 

Due in 2020

Next CDR Due in 2024

Continuance Cessation

Done*

Rediary
KIDS

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Did not Process 

CDR in that Year

Processed CDR 

in that Year
KIDS-Not Processed

20

Current Age 

Less than 17

Current 

Age is 17

Backlog AGE 18 

Redetermination

Following Year
KIDS

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Processed CDR 

in that Year Continuance Cessation

Done*

Rediary
KIDS

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KIDS 

CDR

Rediary

2nd CDR

NO YES

AGE 18 

Redet.

Turning Age 18 Before 

Diary is Due?

1st CDR
KIDS-Scenario 1

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CDR in 2017 MIE MIP MINE

Next CDR Due in 2018

Next CDR Due in 2020

Next CDR Due in 2024

Rediary

2017 9

YEAR 

of CDR

2018 10

2020 12

2024 16

AGE at 

CDR

Not going to turn Age 18 

before any Diary is due.
KIDS-Scenario 2

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CDR in 2017 MIE MIP MINE

Next CDR Due in 2018

Next CDR Due in 2020

Next CDR Due in 2024

Rediary

2017 13

YEAR 

of CDR

2018 14

2020 16

2024 20

AGE at 

CDR

MINE diary would be due in 2022, 

two years earlier than its due date.
ADULT CDR

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• Over 1 Million Adults CDRs are processed 

every year.

• Total cost for Adults CDR would then be $1.7 Billion. 

• Adult Cessation rate is around 5%

• 1.6 Million Adult CDR would not get a cessation

• $1.6 Billion of spending would not result in a cessation

• Each full CDR costs around $1,000 to process.

• In 2016 there were 1.7 Million Adults CDR 

processed.
ADULT Mailers

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• In mid 1990’s SSA started a mailer system.

• Adults that have a high chance of medical 

improvement get a FMR (Full Medical Review).

• Adults that have a low chance of medical 

improvement get a mailer.

• Purpose was to save on administrative cost 

without losing efficiency in the program.

• Goal is to do a CDR on only the most likely cases of cessation.
Mailers Process

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• A mailer is sent out to be filled out by the recipient.

• Mailer contains 6 questions about the disability of the person.

• Based on the answers SSA determines if the individual needs a full 

medical review or defer individual’s diary until next CDR.

• If the person needs a full medical review after a mailer is 

processed he is referred by SSA as a “Do-CDR” 
Mailer’s Profile Model

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• Based on different inputs the model determines if the individual has 

a “High”, “Medium”, and “Low” chance of cessation.

• Model has many inputs including age, how long they have been on 

SSI, whether they previously had a CDR and many more.

• The model is tested every year by having 60,000 individuals sampled 

from the DI and SSI population that is due for a CDR. Those individuals 

get a mailer and a FMR (regardless of profile scores) and results are 

compared to the model.

• To determine who gets a mailer, SSA developed a profile model.

• The inputs of every individual is updated and the profile is 

rescored at the beginning of every year.
Profile Score for Mailer

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• Profile score alone will not determine who gets a mailer.

• “High” chance of cessation is all relative.

• Not all “High” will be Full Medical Review (FMR) and not all 

“Low” will be Mailers.

• SSA uses a mixture of Profile score and Diary to determine 

who gets a Mailer or a FMR.
Mailers Administrative Savings

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• 1.7 Million Adults CDR were processed in 2016.

• Each full CDR costs around $1,000 to process

• Each mailer costs around $20 to process

Using Mailers

1.2 Million Mailers x $20 = $24 Million

• Out of those 1.7 million, 1.2 million were mailers.

Mailers process saved over $1 Billion.

Without Using Mailers

1.2 Million FMR x $1,000 = $1.2 Billion
ADULT CDR PROCESS

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Full Medical 

Review (FMR)

Mailers Do-CDR

Adult in the CDR process can be in any of the three groups:

Immediately 

get a FMR

Immediately 

get a Mailer

Get a FMR 

after Mailer is 

returned and 

processed
Adult CDR

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FMR Mailers

Do-CDR

Continuance Cessation

Rediary

Deferral

Continuance Cessation Rediary

Rediary
Rediary Transitions

LBW

KIDS

KIDS Age 18 

Redet.

FMR

Mailer

FMR

Mailer

Do-CDR

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Kids Rediary

MIE MIE MIP MINE

1st CDR 2nd CDR

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Kids Rediary

MIE MIE MIP MINE

1st CDR 2nd CDR

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MIP MIE MIP MINE
Kids Rediary

MIP MIE MIP MINE

1st CDR 2nd CDR

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MINE MIE MIP MINE

MIE MIE MIP MINE
Kids Rediary

MIE MIE MIP MINE

MIP MIE MIP MINE

MINE MIE MIP MINE

MIE

MIP

MINE

MIE MIP MINE

1 3 x 3 Matrix st CDR 2nd CDR

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Adults Rediary

High 

MIE

MIE MIP MINE

1st CDR

High

MIE MIP MINE MIE MIP MINE

Medium Low

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Adults Rediary

High 

MIE

MIE MIP MINE

1st CDR

High

MIE MIP MINE MIE MIP MINE

Medium Low

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High 

MIP

MIE MIP MINE MIE MIP MINE MIE MIP MINE
Adults Rediary

MIE MIP MINE

High

MIE MIP MINE MIE MIP MINE

Medium Low

MIE

MIP

MINE

MIE

MIP

MINE

MIE

MIP

MINE

High

Medium

Low

9 x 9 Matrix

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How many CDRs will be processed in 2021?

Year

2017

2018

2019

2020

2021

MIE

MIE

MIE

MIE

Variation 1

MIE

MIP

Variation 2

MIE

MIP

Variation 3

Rediaries

Backlog

CDRs 

Coming Due

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Other Factors in the Model

1) Attrition (due to death, too much income or resource etc.)

2) Cessations from CDR (by category)

3) Aging Out of CDR process

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AGE

Age is an important factor in the CDR model.

• Children to Adult transition

• Aging Out Adults

• Assumptions

Assumptions

• Setting assumptions by age

• Applying the assumptions by age

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Assumptions with Age - Diaries

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0 10 20 30 40 50 60

PERCENT OF TOTAL

AGE AS OF OCTOBER 2017

DIARIES AS PERCENT OF TOTAL IN EACH SINGLE YEAR OF AGE

MIE

MIP

MINE
Assumptions with Age - Profiles

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18 23 28 33 38 43 48 53 58 63

PERCENT OF TOTAL

AGE AS OF OCTOBER 2017

PROFILES AS PERCENT OF TOTAL IN EACH SINGLE YEAR OF AGE

HI

MED

LOW
How Much - CDR Program Savings

Cessations

• How many cessations

• When are they final

Cessation

Done*

Appeal

Claimant has 60 days to appeal his/her denial of benefits.

46
CDR Appeals Process

There are four level of appeals

• Reconsideration

• Hearing by an administrative law judge

• Review by the Appeals Council; and

• Federal Court review

Recon ALJ Appeals 

Council

Federal 

Court

Initial 

Decision

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Ultimate Cessations and Timing of Cessation

Recon ALJ Appeals 

Council

Initial 

Decision

January 

2017

May 

2017

January 

2018

January 

2019

1,000 

Cessations

800 

Cessations

720 

Cessations

700 

Cessations

People in 

Cessation

Timing of 

Cessation

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Estimating the Savings

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• Present Value of Future Benefits

• Determine how much benefit the individual would have 

been paid in each year

• Take into account attrition and recidivism

Attrition – person would die or lose eligibility for benefits even

without cessation

Recidivism – person would reapply and receive benefits after cessation

• Savings accumulate over each year
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Monthly Number of Individuals Off the SSI Payment Rolls Attributable to Medical CDRs

Without Appeals Process (Initial Cessations)

Fiscal Year 

of Initial 

Decision

Fiscal Year of Federal Savings Totals

2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2017 - 27

2017 1000 900 810 729 656 590 531 478 430 387 349 6,862 

2018 1000 900 810 729 656 590 531 478 430 387 6,513 

2019 1000 900 810 729 656 590 531 478 430 6,126 

2020 1000 900 810 729 656 590 531 478 5,695 

2021 1000 900 810 729 656 590 531 5,217 

2022 1000 900 810 729 656 590 4,686 

2023 1000 900 810 729 656 4,095 

2024 1000 900 810 729 3,439 

2025 1000 900 810 2,710 

2026 1000 900 1,900 

2027 1000 1,000 

Totals

2017 - 27 1,000 1,900 2,710 3,439 4,095 4,686 5,217 5,695 6,126 6,513 6,862 48,243 

11,000 -> 48,000
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Monthly Number of Individuals Off the SSI Payment Rolls Attributable to Medical CDRs

With Appeals Process (Ultimate Cessations)

Fiscal Year 

of Initial 

Decision

Fiscal Year of Federal Savings Totals

2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2017 - 27

2017 333 600 840 756 680 612 551 496 446 402 362 6,079 

2018 333 600 840 756 680 612 551 496 446 402 5,717 

2019 333 600 840 756 680 612 551 496 446 5,316 

2020 333 600 840 756 680 612 551 496 4,869 

2021 333 600 840 756 680 612 551 4,373 

2022 333 600 840 756 680 612 3,822 

2023 333 600 840 756 680 3,210 

2024 333 600 840 756 2,529 

2025 333 600 840 1,773 

2026 333 600 933 

2027 333 333 

Totals

2017 - 27 333 933 1,773 2,529 3,210 3,822 4,373 4,869 5,316 5,717 6,079 38,956

11,000 -> 39,000
Sum It All Up

How Many How Much

CDR Program 

Savings

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Links

(2014) CDR Report - https://www.ssa.gov/legislation/other.html

(2017) SSI Report - https://www.ssa.gov/OACT/ssir/index.html

Thank you for listening

Questions?

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