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.

OHO Operating Data

     A recently released report on operations at Social Security's Office of Hearings Operations (OHO):

Click on image to view full size

 

    Note that in Fiscal Year (FY) 2022 OHO had 283,134.40 overtime hours. In the recently concluded FY 2023 OHO had 458,437.69 overtime hours, an increase of 62%. That's extraordinary when you consider the needs of other part of the Social Security Administration. OHO is so much more visible to Congress than boring parts of Social Security such as the teleservice centers and payment centers.

CCD Comments On SSI iClaims

     The Coalition For Constituents With Disablities (CCD), the major umbrella organization of non-profits who help the disabled, has sent comments to the Social Security Administration on its plan to allow electronically filed claims for Supplemental Security Income. Here are a few excerpts:

.. We would like to express our general support for SSA’s efforts. For too long, there has been an unnecessary divide between SSI and SSDI claimants. SSDI claimants could complete their applications for benefits completely online, while SSI claimants were subjected to long wait times at Field Offices, or over the phone, to complete an application for benefits.

The process for applying for SSI is labyrinthine and confusing. Our members seeking SSI report often being met by well-meaning, but overworked employees prone to misunderstandings and mistakes. Further, SSI recipients are among the most at-risk members of society, and SSI benefits are often their families’ only source of cash available to pay for shelter and other necessities.  ...

The proposed request indicates that third-party assisters may use iClaim to apply for an applicant. It also indicates that after a third-party assister completes the application, the applicant will be required to either physically sign the application, or verbally attest to its contents telephonically. However, if a claimant is using the online system to provide this information, it seems unnecessary to require either a wet signature or verbal attestation by an employee. In our experience, claimants are still having difficulty receiving mail, particularly in poorer areas. Further, requiring SSA employees to call claimants also adds an extra, unnecessary burden on employees. SSA should explore allowing claimants to sign their application at a later time and complete an e-signature. ...

The proposed request notes that “iClaim uses dynamic pathing, which ensures claimants are only asked to complete the questions that are relevant to them.” In principle, this seems to be a positive development. We commend SSA’s goal of ensuring the application process is streamlined as much as possible. That said, SSA should make public how the dynamic pathing process will work. ...

Other People Have A Dream; He Had A Fake Bomb

      From WRDW in Augusta, GA:

The Richmond County Sheriff’s Office bomb squad and other officers were called to [the local Social Security field office]..

Once on scene, deputies were given a description of a man with a red jacket carrying a book bag.

The sheriff’s office identified Keyon Dickens, 38, of Blake Drive, as the suspect.

Deputies saw Dickens walking along the side of the building and ordered him to drop the book bag, the report states.

Officials say Dickens dropped the bag, was detained and walked over to the patrol vehicle.

According to the report from the sheriff’s office, deputies found a white paper towel on Dickens, that had “I have a bomb” written on it.

While the bomb squad responded, deputies say Dickens “requested if he was going to be on the news and that we should loosen his handcuffs so that he looks good for the news.” …

Social Security Subcommittee Schedules Hearing On Overpayments

      The House Social Security Subcommittee has scheduled a hearing for October 18 on “examining how the Social Security Administration can better identify improper payments before they occur and provide beneficiaries with adequate notice when they occur.”

This Year's COLA Is 3.2%

    As expected, this year's Cost Of Living Adjustment (COLA) is 3.2%.

Suspect In Custody After Suspicious Package Found At Georgia Field Office

     From WRDW/WAGT:

A suspect was taken into custody after a suspicious package was found at the Social Security Administration office [in Augusta, GA] on Tuesday, according to the Richmond County Sheriff’s Office. ...

 By 1 p.m., the bomb squad had cleared a suspicious package and a suspect had been taken into custody, according to authorities. ...

What’s Going On With Social Security’s Appropriations?

      Have you wondered about Social Security’s Fiscal Year 2024 appropriations situation? Wanted nonpartisan information?  The Library of Congress’s Congressional Information has you covered in its recently released report Social Security Administration (SSA): FY2024 Annual Limitation on Administrative Expenses (LAE) Appropriation: In Brief. They explain why it’s technically not an appropriation but an LAE. What the report doesn’t say is that the situation for Social Security and almost all other federal agencies is a mess because the Republican majority in the House of Representatives is in complete disarray.

Disability Insurance Income Saves Lives

     From Disability Insurance Income Saves Lives by Alexander Gelber, Timothy Moore, Zhuan Pei and Alexander Strand:

We show that higher payments from US Social Security Disability Insurance (DI) reduce mortality. Using administrative data on new DI beneficiaries, we exploit discontinuities in the benefit formula through a regression kink design. We estimate that $1,000 more in annual DI payments decreases the annual mortality rate of lower-income beneficiaries by approximately 0.18 to 0.35 percentage points, implying an elasticity of mortality with respect to DI income of around -0.6 to -1.0. We find no robust evidence of an effect of DI income on the mortality of higher-income beneficiaries. The mortality effects imply large welfare benefits of disability insurance.

Press Release On Overpayments

     A press release from the Acting Commissioner of Social Security:

The Social Security Administration has provided people with income security for over 80 years.  The agency takes seriously its responsibilities to ensure eligible individuals receive the benefits to which they are entitled and to safeguard the integrity of benefit programs to better serve its customers.  Agency employees work hard to pay the right person the right amount at the right time, and payment accuracy rates remain high.

Social Security pays $1.4 trillion in benefits to more than 71 million people each year.  While payment accuracy rates are high, overpayments do happen given the number of people the agency serves, the number of changes in their circumstances, and the complexity of the programs.

Only around 0.5 percent of Social Security payments are overpayments. For the Supplemental Security Income (SSI) program, overpayments also represent a small percentage of payments—about 8 percent—but are higher due to the complexity in administering statutory income and resource limits and asset evaluations.

“Despite our high accuracy rates, I am putting together a team to review our overpayment policies and procedures to further improve how we serve our customers,” said Kilolo Kijakazi, Acting Commissioner of Social Security. “I have designated a senior official to work out of the Office of the Commissioner to lead the team and report directly to me.”

There is misinformation in the media claiming that the Social Security Administration is attempting to collect $21 billion.  This figure was derived from the total amount of overpayments that have occurred over the history of the programs.  Each person’s situation is unique, and the agency handles overpayments on a case-by-case basis. In particular, if a person doesn’t agree that they’ve been overpaid, or believes the amount is incorrect, they can appeal.  If they believe they shouldn’t have to pay the money back, they can request that the agency waive collection of the overpayment.  There’s no time limit for filing a waiver.

The agency is continually improving how it serves the millions of people who depend on its programs, including by preventing overpayments and making it easier to navigate the recovery and waiver processes.

For instance, the agency just released its streamlined waiver request form that is easier to understand and less burdensome for people to request a debt recovery waiver.  It is also developing a new electronic payroll data exchange program that will automatically use wage information to adjust payment amounts when appropriate to prevent overpayments.  Additionally, the agency intends to publish a proposed rule to streamline processes and reduce burden so eligible individuals can more easily seek debt relief.

When overpayments do happen, the agency is required by law to adjust benefits or recover debts.  The law allows Social Security to waive recovery in some cases, which must be balanced with the agency’s stewardship responsibility to safeguard the integrity of benefit programs and the trust funds.

Social Security is committed to working with people if they seek to appeal or to explore potential repayment options and waivers when allowed by law.

For more information about the overpayment process, please see Overpayments Fact Sheet

.

Acting Commissioner Orders Reviews Of Overpayments

     From KFF Health News:

The federal agency that oversees Social Security announced Wednesday that it will review the way it handles “overpayments” — money it sends beneficiaries that it later determines they weren’t entitled to receive. 

The Social Security Administration made the announcement weeks after KFF Health News and Cox Media Group reported that the agency has been trying to reclaim billions of dollars from beneficiaries, including many poor, retired, and disabled people who have spent the money and are unable to repay it. 

“Despite our high accuracy rates, I am putting together a team to review our overpayment policies and procedures to further improve how we serve our customers,” Kilolo Kijakazi, acting commissioner of Social Security, said in a news release.

Kijakazi said she had chosen a “senior official” to lead the team and report directly to her.   …

     This issue will certainly come up when there’s a confirmation hearing for Martin O’Malley’s nomination for Commissioner.   I hope that’s coming up soon. 

Initial Processing Backlogs

     Social Security has released numbers showing the backlogs at the initial level on disability claims. This is from more than six months ago but I don't think there's been significant improvement since. The situation may be worse. The processing time is expressed in days. You can click on the images to view them full size.