Cutting Off SSI Disability Benefits At Age 18 Leads To Adverse Life Outcomes

    From The Impact Of Losing Childhood Supplemental Security Income Benefits On Long-Term Education and Health Outcomes by Priyanka Anand and Hansoo Ko, a study for the Center for Retirement Research at Boston College:

Many youth with disabilities rely on Supplemental Security Income (SSI) as an important source of income for their families, but they must go through a redetermination process at age 18 if they are to continue receiving those benefits into adulthood. Our project uses data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine the long-term impact of losing child SSI upon turning 18, due to the 1996 welfare reform, on education and health outcomes. We compare the long-term outcomes of those who turned 18 just after August 1996 with those who turned 18 just before, given that the reform increased the strictness of medical reviews for 18-year-old beneficiaries. Because the respondents are in their 30s and 40s in the later waves of the survey, we also examine the health outcomes of their children.

The paper found that:

• Those who were likely to lose SSI at age 18 have fewer years of education and are less likely to attend college than those who were less likely to lose their benefits.
• There is suggestive evidence of worse health outcomes for the children of those who were likely to lose their SSI benefits at age 18.

The policy implications of the findings are:

• Discontinuing benefits at age 18 has a negative impact on the human capital attainment of child SSI beneficiaries, which may explain their lower long-term earnings relative to other disadvantaged populations.
• The negative impacts of discontinuing child SSI benefits may continue into the next generation.
• Moderate amounts of cash transfers to children of vulnerable families may lead to lasting positive impacts. ...
  

    Wouldn't it be possible to do these age 18 redeterminations in a less harsh way, even without a legislative change? Give at least a little weight to the prior finding of disability? Where the claimant was approved based upon a child Listing and that child Listing is almost identical to the adult Listing, create a presumption that the disability hasn't ended? The current process seems to me to be designed to be as harsh as possible. Can't Social Security do better?

EM On Musculoskeletal Disorders

     The Social Security Administration has issued an Emergency Message titled Additional Guidance for Evaluating Evidence in Cases Involving the Musculoskeletal Disorders Listings. It's designed to convey the news of the Temporary Final Rule on "close proximity of time" published recently in the Federal Register but it also addresses the need for assistive devices, such as a cane or walker or motorized wheelchair.

Senators Seek Answers On SSI Overpayments

     From a press release:

U.S. Senators Ron Wyden, D-Ore.[Chairman of the Senate Finance Committee, which has jurisdiction over Social Security], Sherrod Brown, D-Ohio [Chairman of the Finance Committee's Social Security Subcommittee], and Bob Casey, D-Pa., urged the Social Security Administration (SSA) to provide additional information on the scope and magnitude of Supplemental Security Income (SSI) beneficiaries who had their benefits suspended and were assessed an overpayment due to receiving Economic Impact Payments (EIPs)[a pandemic program]. ...

Between April 2020 and July 2021, these payments were disregarded as countable resources for 12 months for purposes of SSI eligibility. In August 2021, SSA announced that  EIPs would not be counted toward eligibility and payment amount for SSI purposes indefinitely. However, SSA suspended benefits and assessed overpayments to individuals receiving SSI benefits because of the stimulus payments.

Senator Wyden previously raised this concern with SSA in two separate hearings in 2021, and the agency responded stating they had updated its policy guidance for SSA staff.  However, recent reporting has shown that SSI beneficiaries continue to receive overpayment notices because of the EIPs. 

To understand the scope and magnitude of beneficiaries affected, and the actions SSA has taken to resolve such suspensions and overpayments, the senators asked the SSA Acting Commissioner to provide the following information:

1. The number of individuals who had their benefits reduced or suspended because of the EIPs during the following periods: 

a. March 2020 to July 2021; 

b. August 2021 to December 2022; and 

c. January 2023 to September 2023.

2. Of those individuals identified in Question 1:

a. The number of individuals whose benefits were reinstated without an appeals hearing.

b. The number of individuals whose benefits were reinstated due to an appeals hearing.

c. The number of individuals whose appeals are pending.

d. The number of individuals who appeals were denied.

3. A list of the agency’s past and ongoing actions to address people who received overpayment notices resulting from EIPs?

4. The number of claimants who were denied SSI benefits because of the EIPs.

5. Whether SSA has required each beneficiary impacted to file an appeal.

Borderline Disorder And Social Security Disability

     From Course And Predictors Of Social Security Disability Insurance In Patients With Borderline Personality Disorder Over 24 years Of Prospective Follow-up by Kramer, U., Temes, C.M., Frankenburg, F.R. et al:

Methods:

A total of 290 inpatients with BPD [Borderline Personality Disorder] were interviewed at baseline and 12 consecutive follow-up waves, each separated by two years, after index hospitalization. Included were also 72 inpatients with other personality disorders. Surviving patients were reinterviewed. A series of interviews and self-report measures were used to assess psychosocial functioning and treatment history, axis I and II disorders, and childhood/adult adversity. 

Results:

Results show that rates of SSDI [Social Security Disability Insurance] utilization were relatively stable over 24 years of follow-up (on average, 47.2% of the patients with BPD were on SSDI). Patients with BPD were three times more likely to be on SSDI than patients with other PDs. Patients with BPD displayed flexibility in their usage of SSDI. By 24 years, 46% of patients remitted, out of which 85% experienced recurrence and 50% of the patients had a new onset over time. In multivariate analyses, four variables were found to predict SSDI status in patients with BPD over time. These variables were: age 26 or older, lower IQ, severity of non-sexual childhood abuse, and presence of PTSD. ...

    There is one thing about this study that make me wonder. Hospitalization is uncommon for Borderline Disorder itself yet this study tracked patients who had been hospitalized. That would suggest that these patients either had unusually bad cases of Borderline Disorder or had other psychiatric diagnoses in addition to Borderline Disorder. I will say that sometimes those with Borderline Disorder are hospitalized by mistake because the behaviors of the patients involved suggested some other disorder such as Bipolar Disorder. There's certainly the intensity of symptoms with Borderline Disorder, just not that much risk of suicide or homicide, which, in general, is what gets you hospitalized for a psychiatric disorder these days.

    The fact that patients with Borderline Disorder were much more likely to be on Social Security disability benefits than those with other personality disorders is not surprising. To begin with, Social Security approves almost no one based upon a personality disorder alone. However, Borderline is one of the worst personality disorders you can have. If anyone is going to be approved on a personality disorder, it's likely to be someone with Borderline Disorder. Also, those with other really severe personality, disorders such as Antisocial Personality Disorder, are likely to spend a lot of time in prison. That's not the case with Borderline Disorder.

    Clients with Borderline Disorder are difficult for me to deal with but it's not just their relationships with lawyers. People with Borderline Disorder can't maintain relationships with anyone, including employers. That's the problem. The fact that less than 50% of those with Borderline Disorder are on Social Security disability benefits is proof of how hard it is to be approved for Social Security disability benefits. Very few of those with a Borderline Disorder diagnosis work more than intermittently. That's just a fact. If you have a disorder that prevents you from working on a regular basis, shouldn't you be approved for Social Security disability benefits?

User Fee Up To $117 In 2024

     The user fee, which amounts to a tax, on attorneys who represent Social Security claimants will be $117 per case for 2024.

Social Security Subcommittee Schedules New Hearing

      The House Social Security Subcommittee has scheduled a hearing on “One Million Claims and Growing: Improving Social Security’s Disability Adjudication Process” for October 26.

Yesterday's House Social Security Subcommittee Hearing

     Here's a media account of yesterday's House Social Security Subcommittee hearing on overpayments. As I expected, GOP members beat up on the Acting Commissioner, whose name they seemed unable to pronounce, probably because they'd never seen her before. When there's a problem, it's far easier to blame someone than to examine the root causes of the problem. Democratic members, of course, defended Kijakazi and expressed outrage over the agency's funding, among other things.

Nice Idea, But ...

     From an article by Jack Smalligan and Chantel Boyens of the Urban Institute in The Hill concerning Social Security overpayments and how to reduce them:

... [W]e proposed that the Social Security Administration adopt a prospective eligibility and certification process. Under this approach, the agency would review a beneficiary’s eligibility and benefit level periodically and certify the beneficiary’s benefit level for a fixed period of time. If a beneficiary’s income changed, their benefits would be revised when they were due for recertification — but the agency would not be able to claw back past payments. ...

This is not a radical proposal: It is how other safety net programs, such as SNAP, already work. This approach also aligns with the Social Security Administration’s own practice for redetermining benefits for disability beneficiaries when they experience a medical improvement that might decrease their need for benefits. ...

    I suppose this would be nice but I don't know where the manpower for doing all those Title II redeterminations would come from. Well-meaning people such the authors of this piece cannot grasp the depth of the staffing crisis at Social Security.

House Hearing On Overpayments Today

     The Social Security Subcommittee of the House Ways and Means Committee will hold a hearing at 2:00 this afternoon on Protecting Beneficiaries from the Harm of Improper Payments. Here's the witness list:

• Dr. Kilolo Kijakazi, Ph.D.
  Acting Commissioner, Social Security Administration (SSA)
• Ms. Tonya Eickman
  Program Audit Division Director, Social Security Administration Office of the Inspector General (OIG)
• Ms. Elizabeth Curda
  Director, Education, Workforce, and Income Security, U.S. Government Accountability Office (GAO)

     If your focus is on protecting beneficiaries, wouldn't you want to hear from an affected beneficiary? Instead they're calling in witnesses from Social Security's Office of Inspector General and the Government Accountability Office, agencies which have inaccurately conflated overpayments with fraud and which have favored unremitting efforts to recover overpayments. No, it looks like the focus will be on beating up on Kijakazi. I'm not sure that in general there's that much to beat up Kijakzi on anyway but blaming her for the overpayment issues is wrong. This mess has been brewing for decades.

How Do You Provide Services In This Kind Of Environment?

     The Senate Special Committee on Aging held a hearing yesterday on Securing Social Security: Accessing Payments and Preserving the Program for Future Generations. The hearing was held in Phoenixville, PA. Here's an excerpt from the testimony of Jessica LaPointe, President of American Federation of Government Employees, AFL-CIO (AFGE) Council 220, the labor union that represents most Social Security employees. This chart shows employee attrition rates at selected Social Security field office in Pennsylvania:

     Remember, these field office positions require lots of training and experience.