Supplemental Security Income: An Overview of Program Integrity and Management Challenges
Published: 2015-06-03T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The SSI program, administered by SSA, provides cash assistance to eligible aged, blind, and disabled individuals with limited financial means. In fiscal year 2014, the program paid nearly $56 billion in federally funded benefits to about 8.2 million individuals. The program has grown substantially in recent years, and is expected to grow more in the near future. SSA has a stewardship responsibility to guard against improper payments and to address program integrity issues that if left unchecked could increase the potential for waste, fraud, and abuse. SSA estimated that it made $5.1 billion in improper payments in fiscal year 2014. In addition, SSA's management concerns are wide ranging and include ensuring its workforce is able to meet service delivery needs.
In this statement, GAO describes SSA's challenges with 1) ensuring SSI program integrity and 2) managing the program. This testimony is primarily based on GAO products issued from 2002 to 2015, which used multiple methodologies, including analyses of SSI administrative data from fiscal years 2000 to 2011; reviews of relevant federal laws, regulations, and guidance; and interviews of SSA officials. In May 2015, GAO obtained current data on improper payments and updates from SSA reports and guidance on actions taken to address GAO's past recommendations.
section_title: What GAO Found
paragraphs: The Social Security Administration (SSA) faces challenges with ensuring the integrity of the Supplemental Security Income (SSI) program's processes for preventing, detecting, and recovering overpayments. For example, SSA is required in certain circumstances to periodically review SSI recipients' medical and financial eligibility, yet the lack of timely reviews and difficulty getting complete financial information hinder SSA's ability to prevent and detect overpayments to recipients. SSA estimated that $4.2 billion of the payments it administered to SSI recipients in fiscal year 2013 were overpayments. In June 2012, GAO found that SSA had accumulated a substantial backlog of recipients' medical eligibility reviews, including for over 23,000 children with mental impairments who were deemed likely to medically improve when initially determined eligible for benefits. GAO recommended that SSA eliminate its backlog for these children and conduct timely reviews going forward, estimating based on fiscal year 2011 data that these actions could save more than $3.1 billion over 5 years by preventing related overpayments. SSA recently reported that it has increased the number of medical eligibility reviews conducted for SSI children in each year since 2012, completing nearly 90,000 reviews in fiscal year 2014—in contrast to the 25,000 reviews completed in fiscal year 2011—and plans to continue these efforts. In December 2012, GAO also reported that a lack of comprehensive, timely information on SSI recipients' financial accounts and wages led to overpayments. GAO noted that SSA had recently developed electronic tools to address these issues, and SSA reported that the agency is gaining experience using them. However, despite these efforts, in May 2015, the SSA Office of the Inspector General found that overpayments associated with financial account information have increased in recent years and recommended SSA continue researching initiatives that will help to reduce improper payments in the SSI program. SSA agreed to this recommendation.
SSA faces several management challenges in administering SSI related to workload, service delivery, and program complexity. In 2013, GAO reported that as a result of an ongoing retirement wave, SSA faced a loss of institutional knowledge and expertise, which may result in increased review backlogs and improper payments. GAO recommended that SSA update its succession plan, in line with federal internal controls guidance that states that management should plan for succession and ensure continuity of needed skills and abilities. In response, SSA published a human capital document detailing its succession plans. Federal internal controls guidance also states that agencies should comprehensively identify and manage risks, and GAO also recommended SSA develop a long-term service delivery plan to determine, among other things, how SSA will address both program integrity and other workloads. In response, SSA published an April 2015 description of its vision for future service delivery and indicated it plans to develop a strategy for achieving this vision moving forward. SSA also noted the importance of simplifying its policies and procedures to meet its service delivery goals and SSA has plans to do so. Program complexity is a long-standing challenge that contributes to administrative expenses and potential overpayments. GAO is beginning work for this subcommittee related to how benefit amounts are calculated for multiple SSI recipient households, an area that SSA has considered for program simplification.
section_title: What GAO Recommends
paragraphs: GAO has previously made recommendations to help SSA strengthen its program oversight and address management challenges. In response, the agency has taken some steps and plans to do more.

section_title: Letter
paragraphs: I am pleased to be here today to discuss our work on the Supplemental  Security Income (SSI) program, including issues affecting program  integrity—which left unchecked, increase the potential for waste, fraud,  and abuse. As you know, the Social Security Administration’s (SSA) SSI  program provides cash assistance for eligible aged, blind, and disabled  individuals with limited financial means. In fiscal year 2014, the SSI  program paid almost $56 billion in federally funded benefits to about 8.2  million individuals. The program has grown substantially in recent years,  and is expected to grow more in the near future, in part because of  population growth. SSA’s strategic goals and objectives for fiscal year  2015 reflect a wide range of management concerns, ranging from  ensuring that SSA has a workforce with the competence and agility to  address service demands to creating new opportunities for individuals  with disabilities to return to work. SSA also has a stewardship  responsibility to guard against improper payments. Given the size of the  SSI program, even small errors in benefit payments can result in a  significant loss of taxpayer dollars.
My testimony—based primarily on reports we issued from 2002 to  2015—describes SSA’s challenges with (1) ensuring SSI program  integrity and (2) managing the program. We used multiple methodologies  to conduct the work for these reports. For example, we reviewed and  analyzed SSI administrative data from fiscal years 2000 to 2011;  reviewed relevant federal laws, regulations, and guidance; reviewed key  agency documents, such as SSA’s strategic plan, human capital plan,  strategic leadership succession plan, and annual SSI stewardship  reports; and interviewed management and staff from SSA headquarters,  selected regions, and field offices. We assessed the data we received  and concluded that the data were sufficiently reliable for the purposes of  our reports. More information on the scope and methodology of our work  is contained within our published reports.
We conducted the work on which this statement is based in accordance  with generally accepted government auditing standards. Those standards  require that we plan and perform the audit to obtain sufficient, appropriate  evidence to provide a reasonable basis for our findings and conclusions  based on our audit objectives. We believe that the evidence obtained  provides a reasonable basis for our findings and conclusions based on  our audit objectives.
subsections: section_title: Background
paragraphs: The SSI program was established in 1972 under Title XVI of the Social  Security Act and provides payments to low-income aged, blind, and  disabled persons—both adults and children—who meet the financial  eligibility requirements. A disability is defined for adults as the inability to  engage in any substantial gainful activity because of any medically  determinable physical or mental impairment(s) that can be expected to  result in death, or has lasted or can be expected to last for a continuous  period of not less than 12 months.
To meet financial eligibility requirements, in fiscal year 2014, an  individual’s or married couple’s monthly countable income had to be less  than the monthly federal SSI benefit rate of $721 per month for an  individual and $1,082 per month for a married couple. Further, countable  resources (such as financial institution accounts) had to be $2,000 or less  for individuals and $3,000 or less for married couples. Recipients are to  report changes in their income and financial resources to SSA as soon as  they occur and a penalty may be deducted from the recipient’s benefit if  the report is not made within 10 days after the close of the month in which  they change. In addition, to determine an individual’s ongoing financial  eligibility for SSI program payments, SSA conducts periodic  “redeterminations.” During a redetermination, field office staff perform a  variety of activities to verify recipients’ income, resources, living  arrangements, and other factors to determine their continued SSI  program eligibility. These activities may include querying internal and  external databases, checking with employers and banks, and performing  interviews with recipients to obtain current information.
To ensure that only recipients who remain disabled continue to receive  benefits, SSA is required to conduct periodic continuing disability reviews  (CDR) in certain circumstances. These reviews assess whether  recipients are still eligible for benefits based on several criteria, including  their current medical condition. During the CDR process, SSA applies a  medical improvement standard. Under this standard, SSA may  discontinue benefits for an individual if it finds substantial evidence  demonstrating both that a beneficiary’s medical condition has improved  and that the individual is able to engage in substantial gainful activity. If  SSA determines that these conditions have not been met in the course of  conducting a CDR, the recipient may continue to receive benefits until the  individual receives a subsequent CDR (which potentially could result in a  discontinuation of benefits), dies, or transitions to Social Security  retirement benefits.
Multiple entities are involved in determining recipients’ initial and  continued eligibility. After an SSA field office determines that an SSI  applicant meets the program’s financial requirements, a state Disability  Determination Services agency reviews the applicant’s medical eligibility.  Similarly, SSA field offices conduct redeterminations of recipients’  financial eligibility, and state Disability Determination Services agencies  assess continued medical eligibility.
Complex eligibility rules and many layers of review with multiple handoffs  from one person to another make the SSI program complicated and also  costly to administer. During fiscal year 2014, SSA estimated that it made  $5.1 billion in improper payments in the program. As our prior work has  shown, improper payments, including overpayments, may result, in part,  because eligibility reviews are not conducted when scheduled,  information provided to SSA is incomplete or outdated, or errors are  made in applying complex program rules.
section_title: SSA Faces Program Integrity Challenges in Preventing, Detecting, and Recovering Overpayments
subsections: section_title: SSA Could Prevent Billions of Dollars in Overpayments by Conducting More Disability Reviews and Could Ensure Review Consistency by Improving Guidance
paragraphs: Because CDRs are a key mechanism for ensuring continued medical  eligibility, when SSA does not conduct them as scheduled, program  integrity is affected and the potential for overpayments increases as some  recipients may receive benefits for which they are no longer eligible. SSA  reported in January 2014 that it is behind schedule in assessing the  continued medical eligibility of its disability program recipients and has  accumulated a backlog of 1.3 million CDRs. In recent years, SSA has  cited resource limitations and a greater emphasis on processing other  workloads as reasons for the decrease in the number of reviews  conducted. From fiscal years 2000 to 2011, the number of adult and  childhood CDRs fell approximately 70 percent, according to our analysis  of SSA data. More specifically, CDRs for children under age 18 with  mental impairments—a group that comprises a growing majority of all  child SSI recipients—declined by 80 percent.
Children make up about 15 percent of all SSI recipients, and we reported  in 2012 that CDRs for 435,000 child recipients with mental impairments  were overdue, according to our analysis of SSA data. Of these, nearly  half had exceeded their scheduled CDR date by 3 years, and 6 percent  exceeded their scheduled date by 6 years. Of the 24,000 childhood  CDRs pending 6 years or more, we found that about 70 percent were for  children who, at initial determination, SSA classified as likely to medically  improve within 3 years of their initial determination. Twenty-five percent— over 6,000—of these pending CDRs were for children medically expected  to improve within 6 to 18 months of their initial determination. Reviews  of children who are expected to medically improve are more productive  than reviews of children who are not expected to improve because they  have a greater likelihood of benefit cessation and thus yield higher cost  savings over time. SSA officials report that the agency has placed a  higher priority on conducting CDRs for populations other than SSI  children that they believe will result in greater savings over time.  However, our analysis of SSA’s data showed that SSI child claims that  received a CDR in fiscal year 2011 were ceased at a higher rate than  other claims.
In our June 2012 report, we recommended that SSA eliminate the  existing CDR backlog of cases for children with impairments who are  likely to improve and, on an ongoing basis, conduct CDRs at least every 3  years for these children. If this recommendation were implemented, SSA  could potentially save $3.1 billion over 5 years by preventing  overpayments to children with mental impairments, according to our  analysis of fiscal year 2011 data.
SSA generally agreed that it should complete more CDRs for SSI children  but emphasized that it is constrained by limited funding and competing  workloads. Moving forward, one of the goals in SSA’s Fiscal Year 2014- 2018 Strategic Plan is to strengthen the integrity of the agency’s  programs. In line with this goal, SSA requested additional program  integrity funding for fiscal year 2015 to enable the agency to conduct  more CDRs, and Congress made these funds available. SSA recently  reported that in each year since 2012, it has increased the number of  reviews conducted for SSI children, completing nearly 90,000 reviews in  fiscal year 2014, in contrast to the 25,000 reviews it completed in fiscal  year 2011, the year prior to GAO’s audit. The agency stated it will  continue to work toward eliminating its CDR backlog for SSI children if it  receives sustained and predictable funding. While additional funding may  help address the backlog, we continue to have concerns about the  agency’s ability to manage its resources in a manner that adequately  balances its service delivery priorities with its stewardship responsibility.  Because SSA has noted that it considers SSI childhood CDRs to be a  lower priority than other CDRs, it is unclear whether the agency will  continue to use new increases in funding to review children most likely to  medically improve—reviews that could yield a high return on investment.
As a result of CDRs, disability recipients that SSA determines have  improved medically may cease receiving benefits; however, several  factors may hinder SSA’s ability to make this determination. In prior  work, our analysis of SSA data showed that 1.4 percent of all people  who left the agency’s disability programs between fiscal years 1999 and  2005 did so because SSA found that they had improved medically;  however, recipients more commonly left for other reasons, including  conversion to Social Security retirement benefits or death. At that time,  we identified a number of factors that challenged SSA’s ability to assess  disability program recipients using the medical improvement standard,  including (1) limitations in SSA guidance for applying the standard; (2)  inadequate documentation of prior disability determinations; (3) failure to  abide with the requirement that CDR decisions be made on a neutral  basis—without a presumption that the recipient remained disabled; and  (4) the judgmental nature of the process for assessing medical  improvement. For example, we noted that—based on a review of the  same evidence—one examiner may determine that a recipient has  improved medically and discontinue benefits, while another examiner may  determine that medical improvement has not been shown and will  continue the individual’s benefits. Furthermore, we concluded that the  amount of judgment involved in the decision-making process increases  for certain types of impairments, such as psychological impairments,  which are more difficult to assess than others, such as physical  impairments.
These issues have implications for the consistency and fairness of SSA’s  medical improvement decision-making process, as well as program  integrity, and in 2006, we recommended that SSA clarify several aspects  of its policies for assessing medical improvement. Since then, SSA has  taken some steps that may help address the issues we raised but has not  fully implemented our recommendation. For example, SSA began  implementing an electronic claims analysis tool for use during initial  disability determinations to (a) document a disability adjudicator’s detailed  analysis and rationale for either allowing or denying a claim, and (b)  ensure that all relevant SSA policies are considered during the disability  adjudication process. In addition, SSA reported in its fiscal year 2016  annual performance plan that it will continue to expand the use and  functionality of this analysis tool to help hearing offices standardize and  better document the hearing decision process and outcomes. However,  SSA’s guidance for assessing medical improvement may continue to  present challenges when applying the standard. As of May 2015, the  guidance does not provide any specific measures for what constitutes a  “minor” change in medical improvement, and it instructs examiners to  exercise judgment in deciding how much of a change justifies an increase  in the ability to work. We continue to believe that SSA should fully  implement the actions we previously recommended to improve guidance  in this area.
In light of the questions that have been raised about SSA’s ability to  conduct and manage timely, high-quality CDRs for its disability programs,  we are currently undertaking a study of SSA’s CDR policies and  procedures for this Subcommittee. More specifically, we are examining  how SSA prioritizes CDRs, the extent to which SSA reviews the quality of  CDR decisions, and how SSA calculates cost savings from CDRs. We  look forward to sharing our findings once our audit work is complete.
section_title: A Lack of Comprehensive and Timely Financial Information Contributes to Overpayments
paragraphs: In addition to overpayments that result when CDRs are not conducted as  scheduled, overpayments may result when financial information provided  to SSA is incomplete or outdated. In December 2012, we reported that  SSA lacks comprehensive, timely information on SSI recipients’ financial  institution accounts and wages. For fiscal year 2011, the unreported  value of recipients’ financial institution accounts, such as checking and  savings accounts, and unreported wages were the major factors  associated with causes of overpayments, and were associated with about  $1.7 billion (37 percent) of all SSI overpayments. Specifically,  overpayments occurred because recipients did not report either the  existence of financial institution accounts, increases in account balances,  or monthly wages.
SSA has developed tools in recent years to obtain more comprehensive  and timely financial information for SSI recipients, but these tools have  limitations:
The Access to Financial Institutions initiative, which SSA implemented  in all states in June 2011, involves electronic searches of about 96  percent of the financial institutions where SSI recipients have a direct  deposit account. This initiative therefore provides SSA with  independent data on a recipient’s financial institution accounts for use  in periodically redetermining their eligibility for payments. However, in  our December 2012 report, we found that this initiative does not  capture all relevant financial institutions, and SSA staff were generally  not required to conduct these searches for recipients who, for  example, report a lesser amount of liquid resources or do not report  any financial accounts.
The Telephone Wage Reporting system, implemented in fiscal year  2008, allows recipients to call into an automated telephone system to  report their monthly wages. Agency officials reported that this system  should ease the burden of reporting wages for some recipients and  save time for SSA staff since wage data is input directly into SSA’s  computer system. At the same time, the accuracy and completeness  of information obtained through this system is limited because it relies  on self-reported data and the system is unable to process wage  information for individuals who work for more than one employer.
SSA recently reported that it is continuing to gain experience using these  tools and is studying the effects of recent expansions to the Access to  Financial Institutions initiative. In May 2015, the SSA Office of the  Inspector General (OIG) noted that despite SSA’s implementation of the  Access to Financial Institutions initiative, the dollar amount of  overpayments associated with financial account information has  increased over the last few fiscal years. The OIG recommended that SSA  continue (1) monitoring Access to Financial Institutions to ensure a  positive return on investment and (2) researching other initiatives that will  help to reduce improper payments in the SSI program. SSA agreed with  the OIG’s recommendations and noted that it is studying the effects of  recent expansions of the initiative, including an increase in the number of  undisclosed bank account searches performed and inclusion of more  recipients with lower levels of liquid resources.
Over the years, we have also identified issues with inaccurate wage  reporting by employers that have contributed to improper payments. We  and the SSA OIG have previously identified patterns of errors and  irregularities in wage reporting, such as employers using one Social  Security number for more than one worker in multiple tax years.  Inaccurate wage information can lead SSA to make either overpayments  or underpayments to SSI recipients. In July 2014, we identified indications  of possible Social Security number misuse in wage data used by SSA for  the SSI program. In one case, an individual in California had wages  reported from 11 different employers in seven other states during the  same quarter of calendar year 2010, suggesting that multiple individuals  may have been using the SSI recipient’s Social Security number and  name for work. According to SSA, Social Security number misuse can  cause errors in wage reporting when earnings for one individual are  incorrectly reported to the record of another person having a similar  surname. However, we found that the prevalence of such Social  Security number misuse in SSA’s wage data was unclear.
section_title: SSA’s Oversight and Documentation of Overpayment Waivers Is Limited
paragraphs: When an SSI overpayment is identified, recipients are generally required  to repay the overpaid amount, although they can request a waiver of  repayment under certain circumstances. We reported in December 2012  that SSA increased its recovery of SSI overpayment debt by 36 percent  from $860 million to $1.2 billion from fiscal year 2002 to fiscal year 2011.  However, SSA grants most overpayment waiver requests, and waiver  documentation and oversight was limited. Specifically, in fiscal year  2011, SSA approved about 76 percent of all SSI overpayment waivers  requested by recipients. Claims representatives, who are located in  SSA’s approximately 1,230 field offices, have the authority to approve  such waivers, and SSA does not require supervisory review or approval  for overpayment waivers of $2,000 or less. According to the standards for  internal control in the federal government, agencies must have controls in  place to ensure that no individual can control all key aspects of a  transaction or event. We recommended that SSA review the agency’s  policy concerning the supervisory review and approval of overpayment  waiver decisions of $2,000 or less. SSA agreed with this recommendation  and subsequently convened a workgroup to evaluate this policy and  review the payment accuracy of a random sample of waiver decisions.  SSA found that the dollar accuracy rate of the randomly selected waiver  transactions it reviewed in the SSI program was nearly 99 percent.  However, in a more recent review of 5,484 SSI waiver decisions of less  than $2,000, SSA found that 50 percent of decisions were processed  incorrectly. In light of this finding, we continue to believe that additional  supervisory review may improve program integrity. However, as a result  of its earlier study findings, SSA decided to continue its current policy for  waiver decisions of $2,000 or less.
Beyond SSA’s field offices, we also found limited oversight of the waiver  process on a national basis. In our December 2012 report, we concluded  that management oversight of the SSI overpayment waiver decision  process is limited. Specifically, SSA did not analyze trends in the type,  number, and dollar value of waivers granted, including those waivers  below the $2,000 approval threshold that SSA staff can unilaterally  approve, or determine whether there were waiver patterns specific to SSA  offices, regions, or individual staff. Without such oversight and controls in  place, SSA is unaware of trends in the waiver process that may  jeopardize the agency’s ability to maximize its overpayment recovery  efforts and safeguard taxpayer dollars. We recommended that SSA  explore ways to strengthen its oversight of the overpayment waiver  process. While the agency agreed with the intent of this recommendation,  it cited resource constraints to creating and analyzing data at the level of  detail specified in our recommendation. However, we continue to believe  that, short of additional steps to better compile and track additional data  on waiver patterns specific to SSA offices and individuals, SSA will be  constrained in its efforts to recover identified overpayments.
section_title: SSA Faces Several Management Challenges in Administering SSI
subsections: section_title: SSA Is Taking Some Steps to Address Ongoing Workload and Service Delivery Challenges
paragraphs: SSA faces management challenges that may constrain its ability to  ensure program integrity. As mentioned above, SSA has cited challenges  with balancing the demands of competing workloads, including CDRs,  within its existing resources. In February 2015, we reported that SSA has  taken a number of steps toward managing its workload and improving the  efficiency of its operations, but capacity challenges persist, and delays in  some key initiatives have the potential to counteract efficiency gains.
SSA is also facing succession planning challenges in the coming years  that could affect program integrity. In 2013, we reported that SSA projects  that it could lose nearly 22,500 employees, or nearly one-third of its  workforce, due to retirement—its primary source of attrition—between  2011 and 2020. An estimated 43 percent of SSA’s non-supervisory  employees and 60 percent of its supervisors will be eligible to retire by  2020. During this same time, workloads and service delivery demands  are expected to increase. The high percentage of supervisors who are  eligible to retire could result in a gap in certain skills or institutional  knowledge. For example, regional and district managers told us they had  lost staff experienced in handling the most complex disability cases and  providing guidance on policy compliance. SSA officials and Disability  Determination Services managers also told us that it typically takes 2 to 3  years for new employees to become fully proficient and that new hires  benefit from mentoring by more experienced employees. SSA’s  Commissioner also noted that as a result of attrition, some offices could  become understaffed, and that without a sufficient number of skilled  employees, backlogs and wait times could significantly increase and  improper payments could grow. Federal internal controls guidance states  that management should consider how best to retain valuable employees,  plan for their eventual succession, and ensure continuity of needed skills  and abilities. Thus, we recommended that SSA update its succession  plan to mitigate the potential loss of institutional knowledge and expertise  and help ensure leadership continuity. In response to our  recommendation, SSA published a human capital operating plan,  detailing specific workforce management and succession planning steps  SSA will take across the organization. We believe this is an important  step in addressing the upcoming workload and workforce challenges.
In our 2013 report, we also concluded that SSA’s long-term strategic  planning efforts did not adequately address the agency’s wide-ranging  challenges. For example, in the absence of a long-term strategy for  service delivery, the agency would be poorly positioned to make  decisions about its critical functions. Such decisions include how the  agency will address disability claims backlogs while ensuring program  integrity, how many and what type of employees SSA will need for its  future workforce, and how the agency will more strategically use its  information technology and physical infrastructure to best deliver  services. Federal internal controls guidance states that federal agencies  should comprehensively identify risks, analyze and decide how to  manage these risks, and establish mechanisms to deal with continual  changes in governmental, economic, industry, regulatory, and operating  conditions. We recommended that SSA develop a long-term strategy for  service delivery. We also noted that without a dedicated entity to provide  sustained leadership, SSA’s planning efforts would likely remain  decentralized and short-term. We recommended that SSA consider  having an entity or individual dedicated to ensuring that SSA’s strategic  planning activities are coordinated agency-wide.
In response to these recommendations, SSA appointed a chief strategic  officer responsible for coordinating agency-wide planning efforts. SSA  has also recently taken a key step toward developing a long-range  strategic plan to address wide-ranging management challenges. In April  2015, SSA published Vision 2025, which incorporates input from  employees, advocates, members of Congress, and other stakeholders  and articulates a vision of how SSA will serve its customers in the future.  As a next step, SSA has indicated that it will create working groups  representing a cross-section of SSA staff. Under the leadership of SSA’s  Chief Strategic Officer, they will be charged with developing a strategic  roadmap for the next 10 years that will define actions SSA will need to  take and resources required to achieve SSA’s vision for 2025. Moving  forward, SSA will need to implement the steps outlined in its long-term  strategic plan—as well as those in its human capital plan—to ensure it  has the capacity and resources needed to manage future workloads while  making quality decisions.
section_title: SSI Program Complexity Is a Long-Standing Challenge
paragraphs: As stated in Vision 2025, SSA plans to realize its service delivery vision in  part by simplifying and streamlining its policies and procedures, and in  2013, SSA formed an SSI Simplification Workgroup that is tasked with  identifying promising proposals that could simplify the SSI program and  reduce improper payments. Program complexity has been a long- standing challenge for SSI that contributes to administrative expenses  and the potential for overpayments. In addition to collecting  documentation of income and resources to determine SSI benefit  amounts, SSA staff must also apply a complex set of policies to  document an individual’s living arrangements and financial support being  received. These policies depend heavily on recipients to accurately  report a variety of information, such as whether they live alone or with  others; the extent to which household expenses are shared; and exactly  what portion of those expenses an individual pays. Over the life of the  program, these policies have become increasingly complex. The  complexity of SSI program rules pertaining to these areas of benefit  determination is reflected in the program’s administrative costs. In fiscal  year 2014, SSI benefit payments represented about 6 percent of benefits  paid under all SSA-administered programs, but the SSI program  accounted for 33 percent of the agency’s administrative expenditures. In  our prior work, we noted that staff and managers we interviewed cited  program complexity as a problem leading to payment errors, program  abuse, and excessive administrative burdens. In December 2012, we  also reported that the calculation of financial support received was a  primary factor associated with SSI overpayments from fiscal year 2007  through fiscal year 2011. The SSI Simplification Workgroup is  considering options for simplifying benefit determination policies as well  as adding a sliding scale for multiple SSI recipients in the same family.
In light of these long-standing issues, we have begun work for this  Subcommittee that will provide information about SSI recipients who are  often subject to complex benefit determination policies. Generally, if two  members of a household receive SSI benefits, both members are eligible  for the maximum amount of benefits, unless they are married. However,  this benefit structure does not directly reflect savings that may result from  multiple individuals sharing household expenses, and the policies SSA  currently applies to address this issue are highly complex and  burdensome. Over the last two decades, various groups have proposed  applying a payment limit to the benefits received by more multiple- recipient households, which could be used in place of the more complex  calculations SSA currently performs. Our new study is examining such  households and the potential administrative or other barriers to  implementing a change in the amount of benefits received by households  with multiple recipients.
section_title: Promoting Employment and Self-Sufficiency Among Recipients Is a Long-Standing Challenge
paragraphs: Another long-standing challenge for the SSI program is that once on  benefits, few individuals leave the disability rolls, despite the fact that  some may be able to do so through increased earnings and employment.  Our prior work has noted that if even a small percentage of disability  program recipients engaged in work, SSA’s programs would realize  substantial savings that could offset program costs. To this end, the  Ticket to Work and Work Incentives Improvement Act of 1999 provided  for the establishment of the Ticket to Work and Self-Sufficiency Program  (Ticket program) which provides eligible disability program recipients with  employment services, vocational rehabilitation services, or other support  services to help them obtain and retain employment and reduce their  dependency on benefits. In May 2011, we reported that the Ticket  program continued to experience low participation rates, despite revisions  to program regulations that were designed to attract more disability  program recipients and service providers. Further, although participants  have a variety of differing needs, the largest service providers in the  program focused on those who were already working or ready to work.  One service provider told us that certain disability program recipients are  often screened out because they lack the education, work experience, or  transportation needed to obtain employment. We made several  recommendations for improving program oversight in our May 2011  report, which the agency has since implemented. However, the number  of individuals using the Ticket program who left the disability rolls  because of employment remains low—under 11,000 in fiscal year 2014.
Individuals who start receiving SSI as children often collect benefits for  the long term, potentially because they do not receive interventions that  could help them become self-sufficient. Approximately two-thirds of child  recipients remain on SSI after their age 18 redeterminations. Research  has found that children who remain on SSI benefits into early adulthood  have higher school dropout rates, lower employment rates, and lower  postsecondary enrollment rates in comparison to the general young adult  population. Additionally, these youth participate in vocational services at a  low rate. In light of this, concerns have been raised that SSA is not doing  enough to inform youth on SSI who are approaching age 18 about  available employment programs. At the request of this Subcommittee, we  will soon begin work to examine SSA’s efforts to promote employment  and self-sufficiency among youth on SSI.
Chairman Boustany, Ranking Member Doggett, and Members of the  Subcommittee, this completes my prepared statement. I would be  pleased to respond to any questions that you may have at this time.
section_title: GAO Contacts and Staff Acknowledgments
paragraphs: If you or your staff have any questions about this statement, please  contact me at (202) 512-7215 or bertonid@gao.gov. Contact points for  our Offices of Congressional Relations and Public Affairs may be found  on the last page of this statement. GAO staff who made key contributions  to this statement include Rachel Frisk, Alexander Galuten, Isabella  Johnson, Kristen Jones, Phil Reiff, and Walter Vance.
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