Decisions to Appeal, Decisions to Approve: Requalification for SSI by Former DA&A Beneficiaries

When Congress voted to terminate the Supplemental Security Income (SSI) Drug Addiction and Alcoholism (DA&A) program, it sought to disqualify only a relatively small number of DA&A beneficiaries whose impairments would be remediable if they stopped drinking and using other drugs. Alcoholics with advanced liver cirrhosis and heroin addicts with HIV infection, for example, were not targets of retrenchment. Indeed, in a report to Congress, the Congressional Budget Office predicted that 75% of DA&A beneficiaries would remain SSI-eligible due to other qualifying impairments (Congressional Budget Office, 1995). It became the formidable task of the Social Security Administration (SSA) to make careful and procedurally fair decisions about continuing eligibility while ensuring the fewest possible interruptions of benefits.The SSA sent information about the termination of the program and the right to appeal in letters to beneficiaries and to their representative payees.1 To appeal, a request for reconsideration signed by the beneficiary, his or her payee, or another authorized representative had to be submitted to a local SSA office within 60 days of receiving this notification (Social Security Administration, 1996b).2 On appeal, beneficiaries could allege SSI eligibility due to a current impairment or they could request a review of SSA records to determine if the original DA&A determination was the result of administrative error (Social Security Administration, 1996a). In a departure from standard procedure, beneficiaries could opt for a face-to-face hearing with a Disability Determination Service (DDS) hearing examiner at the initial phase of the reconsideration process.3 The SSA was obliged to complete new medical determinations by January 1, 1997, for all beneficiaries who filed a request within 120 days of the enactment of P.L. 104-121 on March 29, 1996. Beneficiaries who did not meet this deadline, but who appealed within 60 days of receiving SSA notification, would continue to receive benefits until the disability determination process was complete, even if it extended beyond January 1, 1997.In this paper we examine factors that affected transition from the DA&A program to continuing SSI benefits based on other qualifying impairments. We treat requalification for SSI as the outcome of a beneficiary's submission of a request for reconsideration and the DDS's efforts to document a qualifying impairment, culminating in a decision to approve or to deny the appeal. We developed two statistical models. The first specifies factors that predict beneficiaries' submission of appeals and the second articulates factors affecting the SSA's disposition. We constructed these models in view of previous research on application for public welfare benefits and the SSA's disability determination process.Factors predicting application for public benefitsPrevious studies have identified three categories of variables that predict application for welfare and disability benefits: individual characteristics, social support and institutional integration, and socio-economic conditions.Individual factorsSalient individual characteristics include physical and mental health status, formal education, relevant knowledge and attitudes, and employability. Even among individuals who believe they have a qualifying, medically determinable impairment, educational and cognitive limitations can discourage application for disability benefits (Menefee et al., 1981). Also, potential applicants may be discouraged by their negative views of program benefits, eligibility criteria, the application process, and unsatisfactory experiences with the public welfare system generally. Since many among the physically and/or mentally impaired have limited coping skills and are intensely averse to stress (Levine et al., 1996), an application process anticipated to be stressful may well be avoided.Financial need is an obviously important consideration in decisions to apply for public benefits. …